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PubMedDate not supplied

Telephone versus face to face interviewing as a means of collecting data relevant to the management of diabetes among general practitioners in France: a randomized design.

Successful patient education requires planed programs with specific target populations. As general practitioners see 85% of noninsulin-dependent diabetics in France, this study was designed to test the feasibility of the telephone as a method for data collection within the context of a random sample of general practitioners in the Paris region. In addition, data were collected assessing physician's perceptions of various barriers and facilitators to the management of this illness. The study demonstrated the feasibility of phone interviews among general practitioners, as no significant differences were found in response rates or for any single variable collected on the telephone versus "face-to-face". Treatment patterns were described and results indicated that 77% of general practitioners agreed to participate in a subsequent study and, of these 93% agreed to the participation of their noninsulin-dependent patients.

Data Collection↗

PubMed1994

Bereavement care: relationships between the intensive care unit and the general practitioner.

This study examines relationships between an intensive care unit and the general practitioners within a local health authority in respect of bereavement care. A questionnaire to all 113 local general practitioners generated a response from 67 (59.3%). While about two-fifths of respondents reported at least one of their patients dying on the intensive care unit, half said that they were often first informed by relatives. Although four-fifths of inner city general practitioners offered some form of bereavement service, it ranked lowest in terms of priority on time, and a further one-seventh provided no service at all. Half the respondents thought that hospital staff could do more to help. The implications for practice are discussed.

Bereavement↗

PubMed1980

How safe is general practitioner obstetrics?

The high perinatal mortality among infants of women transferred from general practitioner to consultant care is well known, the implication being that if these women had been booked for consultant care several of the deaths might not have occurred. The findings of this study indicate that booking into a consultant unit did not reduce perinatal mortality and suggest that, where liaison between hospital and general practitioners is good and transfer easy, booking into a general practitioner maternity unit can be as safe for low-risk women as booking into a consultant unit.

England↗

PubMed1985

Referral of musculoskeletal disease patients by family and general practitioners.

We surveyed general and family practitioners to evaluate their patterns of referring musculoskeletal disease patients to rheumatologists and orthopedists. Patients who had rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis were most often referred to rheumatologists, whereas patients with osteoarthritis, persistent low back pain, and post-traumatic knee pain were most often referred to orthopedists. As conditions worsened in severity, referrals were more frequent. Patients with conditions that were difficult to diagnose, such as possible shoulder tendinitis that was unresponsive to initial nonsteroidal therapy, undiagnosed polyarthritis, and intermittent knee swelling with pain, were most often treated without referral and, when referred, were most often sent to orthopedists. Belief in the effectiveness of rheumatologists or orthopedists correlated strongly with reported referral behavior, yet most respondents considered themselves capable of managing the majority of patients with musculoskeletal diseases. Neither practice arrangement, board certification, nor educational background affected referral behavior. However, younger physicians were more likely (P = 0.002) to refer patients to rheumatologists. Multivariate analysis showed that the significant predictors of global referral behavior were belief in the effectiveness of subspecialists and a small number of musculoskeletal problems seen by the generalist. The predictors of referral to rheumatologists were belief in rheumatologist efficacy and young physician age.

Adult↗

PubMed1998

Does the French general practitioner correctly investigate and treat osteoporosis? Groupe Rhumatologique d'Etudes Cliniques de Midi-Pyrénées.

In our region, more than half the patients with osteoporosis are investigated and treated by general practitioners. We carried out two surveys to discover whether the diagnosis and treatment of osteoporosis were correctly carried out by general practitioners in the Midi-Pyrénées region. The first survey concerned 85 patients who had been diagnosed with osteoporosis by their general practitioner. These patients were being seen for the first time in a hospital or private practice setting by a rheumatologist who completed a questionnaire based solely on the history taken from the patient and the records in the patient's possession. For the second survey, 200 general practitioners who had referred patients to the rheumatology department were sent a questionnaire on their management of osteoporosis. Fifty-two physicians completed and returned the questionnaire. More than half the general practitioners started treatment of osteoporosis without fractures on the basis of standard spinal X-rays where the radiologist suggested bone mineral loss. The initial biological investigation was correctly carried out by only 6% of physicians. Treatment was correctly prescribed in only 34% of cases of osteoporosis with fractures, 50% of osteoporosis without fractures and 50% of senile cortical osteoporosis.

Adult↗

PubMed2001

The use of primary, secondary, community and social care by families who frequently consult their general practitioner.

There have been very few studies that have examined either the use of other health and social services by patients who frequently consult their general practitioner, or the patterns of service use of frequently attending families. This study has three aims: to quantify the number of contacts to primary, secondary, community and social services of families who frequently attend their general practitioner; to examine the temporal patterns of these contacts and the patterns of use within families; and to determine the nature of these contacts and how they were valued by patients and health professionals. Thirty-five individuals in seven families completed diaries of health service use for 8 weeks; records from primary and community care records were analysed; health professionals and patients provided satisfaction scores for their contacts. The data were compared to standard datasets. The subjects made far more consultations with all health services than predicted, and less than half of these were with the general practitioner. Thirty-two per cent of the contacts with staff based within the health centre were not reported on the diary sheets. Temporal patterns of consulting were apparent within the families. The "index frequent attenders" within each family had most contacts. The differences between professional groups for the nature of the contact were marked, with over two-thirds of general practitioner contacts being for "specific symptoms or problems", and over two-thirds of health visitor contacts being for "weight problems". These findings show that patients who make high use of general practitioners' services also have a large number of contacts for health reasons with a range of other health and social services. These need to be considered as an outcome measure for trials of intervention for frequent attendance. More work is needed to explore why some individuals and their families make high use of health services.

Community Health Services↗

PubMed1992

Factors which influence the decision whether or not to prescribe: the dilemma facing general practitioners.

In this study of the influences affecting general practitioners' decisions whether or not to prescribe, 69 principals and five trainees in general practice were asked about the factors that made these decisions difficult for them and the circumstances in which the decision caused them to feel uncomfortable. Discomfort was reported most frequently in prescribing for respiratory disease, psychiatric conditions and skin problems, though the range of problems mentioned was wide. The range of drugs for which the decision of whether or not to prescribe was difficult was also wide but psychotropic drugs, antibiotics, drugs acting on the cardiovascular system and non-steroidal anti-inflammatory drugs were most often mentioned. Patient factors said to be important included age, ethnicity, social class and education, the doctor's prior knowledge of the patient, the doctor's feeling towards the patient, communication problems, and the doctor's desire to try to preserve the doctor-patient relationship. Doctor specific factors included concerns about drugs, factors relating to doctors' role perception and expectations of themselves, uncertainty, peer influences, logistic factors, and the experience of medical or therapeutic misadventures. The results of this study support earlier work on the influence of social factors on prescribing decisions and show that this influence affects the entire range of clinical problems. The results also reveal the importance of logistic factors. The overriding concern of doctors to preserve the doctor-patient relationship and the range of attitudes, perceptions and experiences of doctors that have a bearing on the decision to prescribe begin to explain the apparent irrationality of some general practitioner prescribing.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗

PubMed1994

Education in palliative care: a qualitative evaluation of the present state and the needs of general practitioners and community nurses.

A questionnaire survey was carried out of all general practitioners, community hospital nurses and community nurses working in Worcester Health District in the west of England, to assess the present state and future needs of their education in palliative care. The overall response rate of the survey was 72%. The respondents were an experienced group of doctors and nurses. They felt that their undergraduate or basic training did not prepare them to care for dying patients in the community. Educational needs were identified: control of symptoms other than pain and bereavement care were priorities for doctors. Community hospital nurses rated pain control education as a major need. Alternative medicine and caring for dying children were additional areas for further education for the general practitioner and community nurses. Ninety per cent of general practitioners, 84% of community hospital nurses and 95% of community nurses felt that multi-disciplinary teaching sessions would be helpful. Analysis of their responses revealed that these would be most likely to succeed it they were arranged in the middle of the day during lunch or in the evenings. The doctors felt that they lacked protected learning time. Nurses also felt this, but in addition, identified lack of finance as a limiting factor in their post-basic education. There was evidence that existing educational resources in the district are under-utilized.

Community Health Nursing↗

PubMed1994

General practitioner distribution and population dynamics: Munich, 1950-1990.

The problem of variable geographic distribution of physicians appears to be universal and intransigent. There is growing evidence from several developed countries of primary physicians avoiding areas in large cities increasingly populated by poor and ethnic minorities. This paper extends the research to Germany. Here, the changing population structure of Munich from 1950 through 1990, characterized by a large influx of foreign guestworkers, is illustrated. Selected changes in the medical care system and the role of the general practitioner pertinent to the question of supply and distribution are also discussed. Within this context, the geographic distribution of general practitioners' offices is examined for possible response to the concentration of foreigners in Districts within the City. In the aggregate, the distribution of general practitioners follows the geographic trends of the general population during the study period. However, geographic distribution of general practitioners varies widely on a District by District assessment. Though the exception, in several Districts there are indications that general practitioners may be avoiding locating offices in areas characterized by high density of foreign populations. This paper also draws attention to the importance of investigative scale to conclusions relating general practitioner distribution to spatial-temporal population trends.

Avoidance Learning↗

PubMed2000

Cross sectional study of reporting of epileptic seizures to general practitioners.

OBJECTIVE: Comparison of reporting of recent epileptic seizures by patients to a doctor and anonymously. DESIGN: Cross sectional study of patients with epilepsy by comparison of paired questionnaires. SETTING: Rural and urban general practices in Norfolk. PARTICIPANTS: 122 patients aged over 16 years and able to self complete a questionnaire who were recruited by 31 general practitioners when attending for review of their epilepsy. MAIN OUTCOME MEASURE: The difference in reported occurrence of seizure to general practitioners and in a linked anonymous questionnaire. RESULTS: 18 patients failed to report a seizure in the past year to their general practitioner (uncontrolled epilepsy). 40% (24/60) of people with epilepsy who anonymously reported a seizure in the past year held a driving licence, but only six revealed this to their general practitioner. The unemployment rate was 34%, substantially higher than the 9% in the general population. Measures of anxiety, depression, and stigmatization were higher in patients with uncontrolled epilepsy. CONCLUSIONS: A significant proportion of patients with epilepsy under-report their seizures. Recognition of underreporting is important if patients are to benefit from adequate and appropriate treatment. General practitioners' ability to treat epilepsy is hampered by their role in regulating the rights of epileptic patients to hold a driving licence or access certain occupations.

Adolescent↗

PubMed1995

General practitioners' background knowledge of their patients.

The aim of the study was to describe the background knowledge of their patients used by general practitioners in decision making in the consultation. Tape-recorded interviews with 22 general practitioners randomly selected from one FHSA, concerning 198 consultations, were used. General practitioners were asked to describe their background knowledge of the first ten patients seen that day, and to describe how their management decisions were influenced by this information. The interviews were analysed from transcripts. All except one doctor appeared to identify patients as 'copers' or 'non-copers'. Decisions which appeared to be linked with coping were: (1) expecting them to have a physical illness; (2) offering reassurance, expecting that to be effective; (3) deciding that there was no need to take action; (4) allowing the patient to decide on some aspect of management. Decisions linked with not coping were: (1) to look for a psychological diagnosis; (2) to offer reassurance, but expecting that not to be effective; (3) to examine or refer because of the doctor's perception of the patient's expectations. General practitioners also appeared to make decisions based on their perception of their patients' social support. If there was thought to be adequate support, or no social stress, the doctors decided (1) to look for a physical diagnosis; (2) to leave some decisions to the patient; (3) not to involve outside agencies in management; and (4) to ignore those areas of the patient's life which were thought not to be a problem. If doctors believed that there were problems with support, they seemed to try to give more of their time, and to refer or investigate more.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗

PubMed1996

Effectiveness of telephone prompts when surveying general practitioners: a randomised trial.

BACKGROUND: Response rates to recent surveys of general practitioners have ranged from 44-95%. The effectiveness of a telephone prompt by a non-medical research assistant in advance of survey mail-out was unknown at the time of this study. OBJECTIVE: To determine the effectiveness of a telephone prompt by a non-medical research assistant to enhance response rates to a lengthy survey. SUBJECTS: 364 randomly selected general practitioners randomised into intervention and control groups. OUTCOME VARIABLE: Cumulative response rate at Day 18 and Day 60. DESIGN: Intervention group received a telephone call in advance of the survey. The control group received conventional mail-outs. Non-responders in both groups were telephoned at Day 28 and sent a reminder letter and questionnaire. RESULTS: 77% of the intervention group responded to the survey compared to 64% of the control group. Intention-to-treat analysis demonstrated a significantly earlier response by Day 18 (continuity corrected chi 2 = 18.15; df = 1; p < 0.001) and a significantly higher overall response by Day 60 (continuity corrected chi 2 = 5.41, df = 1, p < 0.009) from the intervention group. CONCLUSION: A telephone prompt by a non-medical research assistant will accelerate and enhance response rates to a survey of general practitioners although the differential effectiveness of a non-medical researcher compared to a medical practitioner conducting such prompts remains unstudied.

Australia↗

PubMed1997

Helicobacter pylori serology and the management of young dyspeptics: a UK survey of gastroenterologists and general practitioners with an interest in gastroenterology.

AIM: To survey the current use of Helicobacter pylori serology for pre-endoscopy screening and management of young dyspeptics amongst gastroenterologists and general practitioners with an interest in gastroenterology in the United Kingdom. METHODS: A postal questionnaire was sent to 536 members of the British Society of Gastroenterology and 164 members of the Primary Care Society in Gastroenterology. RESULTS: Of those who responded (66%), 25% of general practitioners and 17% of gastroenterologists were using H. pylori serology as a screening test for young dyspeptics. General practitioners and gastroenterologists differed in their use of serology to guide management strategies (P < 0.0003): general practitioners eradicate infection from sero-positive patients prior to endoscopy (92%), whilst the majority of gastroenterologists endoscope sero-positive patients before treatment (55%). More gastroenterologists (89%) would re-test all or selected patients to assess eradication compared to general practitioners (45%). 106 different drug regimes were being used as first line treatment. CONCLUSIONS: H. pylori serology as a pre-endoscopy screening test for young dyspeptic patients was used by only a fifth of respondents. There were wide variations in attitudes and practice in the way H. pylori serology was used in the management of young dyspeptics. Trials comparing clinical outcome and cost-effectiveness of different serology-based strategies are needed.

Adult↗

PubMed1987

Notifying general practitioners about deaths in hospital: an audit.

Information from hospital doctors about the death of a patient in hospital is important to general practitioners. Six general practices in the Dundee district recorded the date and place of death for all 272 practice patients dying over a 14-month period. In the 193 cases (71%) for which the hospital was responsible for informing the practice of the death the method by which the practice first learned of the death and the time interval between death and the writing of the official hospital letter was also recorded. An immediate telephone call, the established method of informing practices of deaths occurring in hospital took place in only 58% of cases and the letter from hospital was sent within one week in only 49% of cases. These proportions were unaltered by the issue of a unit medical circular to hospital staff informing them of the problem and requesting more prompt notification.The ability of general practitioners to help bereaved relatives is compromised by the present inadequacies in communication between hospitals and general practice. The unit medical circular - the standard method of resolving interprofessional problems - would appear to be ineffective.

Bereavement↗

PubMed2004

General practitioners' perceptions of sharing workload in group practices: qualitative study.

OBJECTIVE: To explore general practitioners' beliefs and experiences of distribution of workload and teamwork between doctors in general practice. DESIGN: Qualitative semistructured interview study. SETTING: South London. PARTICIPANTS: 18 general practitioners from 11 practices. MAIN OUTCOME MEASURES: Perceptions and experiences of distribution of workload and teamwork between doctors. RESULTS: Equitable distribution of workload was a common concern among general practitioners in group practices. Several ways of addressing the problem were identified, including relying on trust, creating systems of working based on explicit rules such as points' systems, and improving communication. Improvement of communication was hampered by the taboo nature of the problem. CONCLUSION: Resentment about perceived inequalities in workload places a further burden on general practices. The issue of working together warrants further support.

Attitude of Health Personnel↗

PubMed2001

Smoking cessation counseling practices of general practitioners in Montreal.

BACKGROUND: Despite the cost-effectiveness of physician smoking cessation counseling, many physicians do not adhere to current clinical practice guidelines. METHODS: A cross-sectional mail survey was conducted in a random sample of general practitioners in Montreal to document cessation-counseling practices and identify correlates of these activities. RESULTS: Of 440 eligible general practitioners, 337 (77%) completed the questionnaire. Despite favorable beliefs/attitudes about cessation counseling, only 10.5% of general practitioners provided "thorough" counseling. While high proportions of general practitioners ascertained smoking status and encouraged patients to quit, relatively few offered adjunct support (i.e., for patients preparing to quit, 49.8% offered follow-up visits; 42.5% offered educational material; 20% referred patients to community resources). Correlates of counseling completeness included high self-efficacy to provide counseling (odds ratio (OR) = 2.0, 95% confidence interval (1.1-3.6)) and favorable beliefs/attitudes about counseling (OR = 3.6 (2.0-6.4)). Correlates of ascertaining smoking status included female gender (OR = 2.3 (1.5-3.5)), high self-efficacy (OR = 3.5 (2.0-5.9)), and favorable beliefs/attitudes (OR = 2.7 (1.6-4.5)). Correlates of offering adjunct support included female gender (OR = 1.9 (1.1-3.2)), awareness of stages of change (OR = 2.4 (1.3-4.4)), and knowledge of community resources to help patients quit (OR = 2.3 (1.3-3.9)). CONCLUSION: Support, training, and intervention programs to overcome lack of awareness and knowledge, unfavorable beliefs/attitudes, and low self-efficacy could increase and enhance cessation counseling practices among general practitioners.

Adult↗

PubMed1987

Study of written communication between general practitioners and departments of child psychiatry.

Previous studies have pointed to the general dissatisfaction with written communication between general practitioners and medical specialists, in terms of quality and usefulness to both groups. This study examined the letters of referral from general practitioners to two child psychiatry departments and the replies of the psychiatric staff, and looked at the information exchanged in the light of the needs of both groups. It was concluded that the requirements of both psychiatric staff and general practitioners were being met to a limited extent, but that there was room for improvementon both sides.

Child Psychiatry↗

PubMed1988

Survey of patients' satisfaction with access to general practitioners.

The north west England faculty patients' liaison group, supported by community health councils and family practitioner committees, surveyed patients' perceptions of accessibility to general practitioners in seven districts in 1985 and 1986. Findings on appointment systems, telephone access and out-of-hours calls are compared with those from other surveys. The results show that patients' satisfaction with appointment systems is related to the efficiency of their own general practitioner's system. The results also show higher levels of dissatisfaction with waiting times for outof- hours visits than in studies 10 years ago and that a large proportion of patients would like direct telephone access to their general practitioner.

Consumer Behavior↗