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PubMed2004

[Sexual contact between general practitioner and patient in the Netherlands: prevalence and risk factors].

OBJECTIVE: To obtain data on sexual contact between general practitioners (GPs) and their patients and to determine the relationship between sexual abuse and GP characteristics. DESIGN: Cross-sectional. METHOD: In February-May 2002, anonymous questionnaires were mailed to a randomized sample of 1250 general practitioners in the Netherlands. RESULTS: A total of 977 general practitioners responded (response: 80%). This number included relatively large numbers of women and GPs aged > or = 50. Out of the 977 GPs, 32 had had sexual contact with a patient at some time: 30/695 (4.3%) of the male GPs and 2/247 (0.8%) of the female GPs Coitus was reported by 24 (75%) of them. Of the 32 perpetrators 11 (34%) had had sexual contact with 2 or more patients. Of the 30 male GPs who engaged in sexual contact with patients, 20 (67%) afterwards felt positive about the sexual encounter for himself and 22 (73%) for the patient. Sexual contact with a patient occurred more often among men who at the time of the survey were aged < or = 50 [corrected]. The incidence was not related to the degree of urbanisation of the practice area or to the size of the practice partnership. CONCLUSION: Sexual contacts between general practitioners and their patients are not just incidents. It is not enough to be conscious of one's own sexual feelings towards patients. Implementation of a clear policy is needed.

Adult↗

PubMed1997

Incentives for general practitioners to provide brief interventions for alcohol problems.

AIMS: To assess current practices and attitudes of general practitioners towards prevention and intervention with problem drinkers. METHODS: GPs randomly selected in the Central and Southern Health Regions answered a 134 item questionnaire on their involvement with patients with alcohol related problems. RESULTS: In all, 136 general practitioners responded representing 85% of those approached. When asked how often they provided interventions with alcohol problems, 86% reported managing under 13 patients per year, indicating an intervention rate of less than 1% of the mean practice size. In terms of disease prevention, 86% rated 'drinking moderately' as important but this endorsement ranked fifth behind other lifestyle behaviours such as 'not smoking' at 99%. When asked about their perceived role, they indicated higher role legitimacy but lower work satisfaction with alcohol problems. In terms of training, three-quarters stated they had received less than eleven hours of postgraduate alcohol education. They also rated their current effectiveness with alcohol problems as substantially less than potential effectiveness. They indicated the main obstacles to be: government funding policies, lack of adequate training and a need for improved resources and support services. CONCLUSIONS: With research having established the effectiveness of interventions for harmful alcohol consumption, attention has shifted to ways of engaging general practitioners in providing interventions. This study highlighted how changes to government health policy and improved competency and skilled based training could lead to a greater acceptance by general practitioners of the role they could play in reducing alcohol related problems.

Alcoholic Intoxication↗

PubMed1992

General practitioners' attendance at courses accredited for the postgraduate education allowance.

An analysis was undertaken in the northern half of the South Western Regional Health Authority of general practitioners' attendance at courses accredited for the postgraduate educational allowance over one year. A total of 358 courses provided 2341 hours of accredited education and produced a total general practitioner attendance of 50,389 hours. The mean attendance per principal in the area was 49.2 hours although the region may be a net importer of attenders from outside the area. Of the 50,389 total hours of attendance, 28.3% were in health promotion, 48.2% in disease management and 23.5% in service management. Course provision and attendance varied considerably over the year. September, October and November accounted for 42.7% of the total hours of attendance, compared with 6.8% in June, July and August. Courses of two to four days or of one week duration accounted for 48.3% of total attendance hours; 10.1% of total attendance hours were at commercially organized courses and 5.6% at courses organized by practices. A total of 66.1% of attendance hours were in postgraduate centres and 6.8% in the practice. Courses with more than 30 participants accounted for 15.9% of courses attended. A total of 174 general practitioners and others organized courses, 21 of them influencing 33,521 hours of general practitioner education. The study shows that in this area, there was an encouraging provision, range and uptake of continuing education courses for general practitioners. The concentration of educational activities in postgraduate centres underlines the need for increased provision for developing educational skills for clinical tutors.

Education, Medical, Continuing↗

PubMed1998

The role of the general practitioner in postnatal care: a survey from Australian general practice.

BACKGROUND: Despite the practice of routine postnatal check-ups, many women experience problems in the months after childbirth. General practitioners (GPs) are involved in routine postnatal care, yet little research has been undertaken to explore this role. AIM: To report the views of Australian GPs as to what physical examination and discussion should take place at the routine six week postnatal check-up and to determine the influence of gender on the approach to the check-up. METHOD: Postal survey of 1104 Australian GPs, yielding an eligible sample of 1022. RESULTS: A total of 715/1022 (70%) usable surveys returned. Over 65% of GPs recommend routine examination of the abdomen, blood pressure, perineum, vagina, pelvic floor, and breasts at the six week check-up. Fewer than a half the sample believed that physical problems (urine and bowel symptoms, back problems), sexual issues, relationship and parenting issues should be routinely discussed. After controlling for age, practice location, obstetric practice, and qualifications, the sex of the GP remains an important factor influencing the GP's approach to postnatal care. Female GPs are three times more likely to believe that maternal feelings should be discussed routinely and about twice as likely to believe that infant sleeping/behaviour, maternal sleeping/diet/tiredness, coping with other children, relationship with partner, and household work should form part of the routine discussion with all recent mothers. CONCLUSIONS: Sex of practitioner and older age (60 years or more) are the two most important influences on a GP's approach to postnatal care. This study indicates a need for GPs to shift their focus from routine examination to indicated examination to allow more time to discuss common postnatal problems.

Adult↗

PubMed1999

Nursing's contribution to general practice: general practitioners' and practice nurses' views.

This study was instigated by the paucity of knowledge relating to the work of nurses employed by general practitioners in Australia and the phenomenal development of the practice nurse role in the United Kingdom. A mailed survey of general practitioners and practice nurses within one Division of General Practice in South-East Queensland, sought, among other things, their views about the current and potential contribution of nursing to general practice. Eighty-four out of 164 (51%) general practitioners and 37 out of 67 (55%) practice nurses responded to the survey. Results indicated that both general practitioners and practice nurses appreciated the value of nursing services in general practice and would sanction the employment of more nurses especially for the purpose of preventive care. The majority of nurses were agreeable to the notion that the nurse's role could, and should, be expanded to include autonomous functioning while most of the doctors were amenable to some extension of nursing practice but reticent or opposed to any independent interventions.

Attitude of Health Personnel↗

PubMed1990

The general practitioner's use and expectations of an accident and emergency department.

In an attempt to establish what the general practitioner expects from an accident and emergency department, and how closely the service provided correlates with that view, a 12-point questionnaire was sent to the general practitioners in the Glasgow Royal Infirmary catchment area. Out of the 61.2% of general practitioners who replied, the majority wish to have responsibility for their own patients for conditions which are neither accidents nor emergencies. There is less agreement as to how much should be done within an accident and emergency department and on the appropriate modes of referral and communication between the general practitioner and the hospital service. Further consultation and cooperation are necessary to interpret and resolve these differences.

Attitude of Health Personnel↗

PubMed1992

Assessment of the otoscopic skills of general practitioners and medical students: is there room for improvement?

Ear, nose and throat problems are common in general practice, yet undergraduate and postgraduate teaching in the subject is variable and often sparse. The assumption that direct experience in otoscopy in practice will compensate for inadequate previous tuition was tested by assessing a group of 53 general practitioners and 59 medical students. Confidence in otoscopy was assessed using a visual analogue scale and skill was assessed by clinical examination of four ears. Otoscopy was divided into identifying the tympanic membrane, distinguishing a normal from an abnormal membrane and identifying specific features of the membrane. The medical students and general practitioners were comparable in both confidence and skill for all parameters except skill in identification of specific features of the tympanic membrane, in which the students' ability was greater (Student's t-test, P < 0.01). In both groups the percentage of false negative observations was reassuringly low--for students the mean was 3.0%; and for general practitioners 4.3%. There is room for improvement in general practitioner's training in otoscopy. Supervised tuition is essential and cannot be compensated for by unsupervised experience. More involvement with ear, nose and throat problems in vocational training or attendance at continuing education courses is suggested.

Clinical Competence↗

PubMed1983

Referrals from general practitioners to a social services department.

One year's referrals from general practitioners to a social services department were studied. There was a low referral rate and a bias towards women, the elderly and the less affluent. The referrals were predominantly made for practical help with problems of ill health. A high proportion of clients were allocated to non-social work staff, and the social service intervention, generally of short duration, showed a sympathetic response to the practical requests of general practitioners. The limited use of social workers by doctors is considered to be the result of ignorance or scepticism about psychodynamic social work skills. Closer liaison between general practitioners and social workers, and a clearer presentation by social workers of their professional skills, are suggested solutions to this problem.

Adolescent↗

PubMed2002

[Comparable case finding percentages of osteoporosis despite diverging reasons for ordering bone densitometry by general practitioners and specialists].

OBJECTIVE: To assess the use of bone densitometry in practice. DESIGN: Retrospective. METHOD: General practitioners who had ordered bone densitometry for their patients were asked to fill in a questionnaire on the reasons for the request and the subsequent treatment they prescribed. For a similar number of patients from the outpatient clinics of general internal medicine and endocrinology, the medical records were examined to obtain the same information. RESULTS: In 9 months, general practitioners requested 150 bone density measurements; for 117 of these the data were complete. In one year, 150 measurements were requested by the outpatient clinics. Marked differences in the reasons for the request were seen in loss of body height, back pain and requests from the patient (indications for general practitioners) and in osteoporotic fractures and the use of corticosteroids (indications for specialists). The average result of the measurements, however, was the same, with mean T-scores in the lumbar spine of -2.26 and -2.19, respectively and case-finding percentages of osteoporosis of 21% on the basis of the lumbar spine and 40% on the basis of the spine or hip. Bone densitometry carried out after an osteoporotic fracture was associated with the lowest mean bone mineral density, followed by measurement on the basis of abnormal X-rays. Bone densitometry at the patient's request was associated with the highest bone density. The percentage of patients found to have osteoporosis turned out to be dependent on the site of measurement, the used reference ranges, and the method of reporting, especially for patients older than 70 years. When the bone density corresponded to a diagnosis of osteoporosis, nearly all patients were treated, mainly with a bisphosphonate. Treatment was also frequently started when the bone density was reduced, i.e. in case of osteopenia. Some patients with normal bone density were treated as well. The reason for such treatment was not always clear. CONCLUSION: General practitioners and specialists used different risk factors in deciding whether bone densitometry was indicated. However, the two groups used this diagnostic tool with equal efficiency, since both the percentages of osteoporosis detected and the average bone densities were the same.

Absorptiometry, Photon↗

PubMed1993

Guidelines for good practice in the diagnosis and treatment of non-insulin-dependent diabetes mellitus. Report of a joint working party of the British Diabetic Association, the Research Unit of the Royal College of Physicians, and the Royal college of General Practitioners.

The guidelines were prepared by a working party of physicians, general practitioners, specialist nurses, public health physicians, an economist, and a patient. They should be of value in establishing locally agreed guidelines. Non-insulin-dependent diabetes (NIDDM) affects more than 1% of the population, and 70-80% of all people with diabetes have this form of disorder. Care of these patients by general practitioners is rapidly increasing and perhaps the majority will, at least in the early stages, be treated in primary care. The working party encourages the formation of district diabetes committees involving both general practitioners and hospital specialists to support and maintain the best standards of diabetes care.

Diabetes Mellitus, Type 2↗

PubMed1999

Learning effects of a workshop in palliative cancer care for general practitioners.

BACKGROUND: Cancer patients may unnecessarily suffer from pain and other symptoms due to insufficient knowledge on the part of their doctors. In The Netherlands, the general practitioner is considered to be the key provider of palliative care for the cancer patient. Therefore, the authors developed and conducted workshops to teach symptom control to general practitioners. These workshops contained learning objectives from which they selected 18 items to form a questionnaire with five-point response scales. The goal of this study was to investigate changes in the knowledge and attitude scores of the participating general practitioners. METHODS: The participants were asked to complete the questionnaire at the start of the workshop and also four months later. RESULTS: Responses were obtained from 120 general practitioners for the pre-workshop and 96 for the post-workshop questionnaires. The majority of the scores increased toward the desired effect, and some items' scores improved by almost two points. CONCLUSION: The results suggest improvements in general practitioners' knowledge and attitude scores with regard to cancer pain and symptom management. Future studies should try to link these improvements with quality-of-life parameters of terminal cancer patients and their families.

Curriculum↗

PubMed1996

[The competence of family physicians in caring for dementia patients. A survey of general practitioners in Quebec].

OBJECTIVE: To assess the knowledge and skills of general practitioners in Quebec with respect to persons with dementia. DESIGN: A questionnaire containing 47 multiple-choice questions on aptitude and nine questions on practice profiles and demographics. SETTING: Province of Quebec. PARTICIPANTS: Twelve hundred general practitioners selected randomly. MAIN OUTCOME MEASURES: Performance with respect to the questionnaire's four objectives: to rate background knowledge, to evaluate physicians' knowledge of the assessment and treatment of dementia, to assess follow-up, and to assess interpersonal skills. RESULTS: Average performance on the questionnaire was 64.7%, with a standard deviation of 11.79%. Performance did not differ markedly from one objective to the next. Most respondents were male (61.6%), working in urban settings (61.7%). Most (72.5%) were between 25 and 44 years, and 44.7% had between 6 and 15 years' experience. About half (44.7%) belonged to group practices, 43.8% worked in acute care hospitals, and 20.6% worked in extended care hospitals. CONCLUSIONS: Quebec general practitioners have average ability to care for patients with dementia. Continuing education should focus on increasing physicians' knowledge of dementia, especially for those with the lowest scores; physicians 55 years and older, those practising alone, and those who spend less than 60% of their practice time with elderly patients.

Adult↗

PubMed1990

Belgian general practitioners on their vocational training: a postal inquiry.

Vocational training of general practitioners in Belgium consists--among others--of 34 seminars to be followed in small groups during a period of two years. The purpose of this study was to develop an instrument for continuing evaluation of this system, and to gather evaluative data. 58% of 177 young general practitioners responded to our postal inquiry, in which ten open-ended questions were put, and 50 statements were to be rated on a six-point-scale. The inquiry revealed that the Belgian vocational training has a large influence on the evolution from inexperienced young doctor to self-confident general practitioner. Factor analysis on the scores of the 50 statements uncovered three dimensions: (1) working climate, (2) learning results, and (3) identification. The reliability of the scales, constructed for each of these factors, was between 0.80 and .86 (Cronbach's alpha). Mean scores on these scales were all high. The Belgian vocational training seems to be accepted and appreciated by the young GPs, but improvements might be suggested.

Attitude of Health Personnel↗

PubMed1981

Child health care in the United States: a comparison of pediatricians and general practitioners.

We compared the care delivered to children by pediatricians and general practitioners, using data from the National Ambulatory Medical Care Survey (NAMCS). These two types of physicians provide almost three fourths of all office-based care for children under 15 years old. Pediatricians saw more very young children and fewer adolescents than did general practitioners. They provided more constant care over time and more routine preventive care in all age groups, and they made more diagnoses in children seen for this latter type of care. The distribution of other reasons for visits was the same for both types of physicians. For most of the common presenting problems, pediatricians ordered more laboratory tests but prescribed fewer drugs. The data suggest that general practitioners were more immediately accessible than pediatricians. Although the implications of these findings require further exploration, these differences in the constancy and accessibility of care, frequency of diagnoses made, and costs of commonly ordered laboratory tests may affect the quality, effectiveness, and efficiency of children's health care.

Adolescent↗

PubMed1988

Views of general practitioners in the Oxford region on microcomputing and collaboration with health authorities and family practitioner committees.

A postal questionnaire was sent to the senior partners of all 353 general practices in the Oxford region to investigate their interest in microcomputing and in pooling data with other general practitioners, health authorities and family practitioner committees. The response rate was 58%. Twenty per cent of responders already used a microcomputer and a further 59% intended to purchase a microcomputer for the practice. Nearly all the practices with an interest in microcomputing wanted to use it to produce age-sex registers, to establish recall groups and for repeat prescribing. Approximately 90% of interested practices reported that they would be prepared to link their data with family practitioner committees or health authorities, while 76% were interested in collaborating with other general practitioners for research. The results show that general practitioners will require support in utilizing the data that they produce.

Attitude of Health Personnel↗

PubMed1988

Relationship between general practitioners' attitudes and methods of dealing with psychosocial problems.

The relationship between general practitioners' attitudes and the methods they use when dealing with psychosocial problems was investigated using a questionnaire that was answered by a group of 30 general practitioners. The results showed that: (1) the doctor's desire to help is in general associated with the need to be appreciated; (2) when treating sexual problems, the giving of information is associated with a desire to change the patient; (3) when dealing with problems associated with chronic illness, the giving of encouragement to the patient is accompanied by a desire to give advice. The findings suggest that the way in which a general practitioner treats psychosocial problems depends partly on the type of problem and partly on his own attitude.

Adult↗

PubMed1996

The role of general practitioners in mental health care: a survey of needs and problems.

OBJECTIVE: To assess the attitudes of general practitioners to central Auckland mental health service provision, and their perceived role and educational needs for clinical management of patients with mental disorders. METHOD: A postal questionnaire survey of all general practitioners within the Auckland Healthcare (Central Auckland CHE) area. RESULTS: 140 (49%) valid responses were returned from 287 sampled. 94% supported a shared care role with mental health services; 57% considered their role as main case manager to be important. 79% of the general practitioners considered they had insufficient time to manage patients with mental disorders. 69% of respondents reported difficulties receiving information about changes to treatment; 65% were unsure whether patients had a case manager, and 64% reported general difficulties with liaison with the mental health services. Education about a range of mental health issues was sought by three quarters of the group. CONCLUSION: This survey suggested that liaison between general practice and specialist mental health services in central Auckland is poor, but that general practitioners are eager to seek ways to improve the care of people suffering mental disorders.

Adult↗

PubMed1991

Old persons' contact with general practitioners in relation to health: a Danish population study.

The study describes health, social situation, and contact with general practitioners in a random sample of non-institutionalized persons 70-95 years old in Denmark. There was a strong correlation between health and contact with general practitioners. A small group, 3% of the respondents, had no health problems, but had been in contact with a general practitioner within the previous month. This group was characterized by a strong social network and a high degree of life satisfaction. Another small group, including 3% of the respondents, had extensive health problems, but had nevertheless not been in contact with a general practitioner within the previous year. This group was characterized by a weak social network and a low degree of life satisfaction.

Age Factors↗