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PubMed1986

Serving two masters: a dilemma in general practice.

General practitioners are the custodians of large quantities of confidential information, and they are often asked to use this to furnish reports for third parties. The implications of consenting to the disclosure of information for such purposes are frequently ill understood by patients. If there is a possibility that such disclosure may disadvantage the patient, the doctor should discuss the matter personally with the patient before releasing any information.

Adult↗
PubMed1996

Fracture management in general practice.

General practitioners are often confronted with patients who have sustained fractures. A clear understanding of the principles governing fracture management is essential particularly for those GPs who do not have easy access to orthopaedic surgeons. Inappropriately treated fractures can lead to chronic pain and deformity as well as the obvious medico-legal complications. If in doubt over the management of any fracture, obtain a second opinion. This article will aim to cover the important principles of fracture management, using a 'cook's tour' of the body to highlight these principles.

Casts, Surgical↗
PubMed2006

The management of bipolar disorder in general practice.

General practitioners have a key role in managing patients with bipolar disorder, a condition which affects at least one in 200 Australians each year and is the sixth leading cause of disability in the population. Although diagnosis and treatment of the illness is complex, effective treatment can lead to good outcomes for many patients. GPs can contribute significantly to early recognition of bipolar disorder, avoiding the long delays in accurate diagnosis that have been reported. As in other complex recurrent or persistent illnesses, GPs are well placed to coordinate multidisciplinary "shared care" with specialists and other health care professionals. GPs also provide continuing general medical care for patients with bipolar disorder, and are in a unique position to understand patients' life circumstances and to monitor their progress over time. The last decade has seen many advances in medication for bipolar disorder, including the introduction of new therapies and the refinement of treatment protocols using older medications. There has also been increasing recognition of the contribution of psychological therapies to symptom relief, relapse prevention, optimal function, and quality of life.

Antidepressive Agents↗
PubMed1996

The quality of prescribing in general practice.

General practitioner prescribing is a subject of legitimate interest to all those concerned with the quality of patient care. The analysis of prescribing and cost data can reveal much about this quality. Suggests that both general practitioners and those who administer and advise on family practitioner services will need to understand the issues involved. Warns that, taken in isolation, prescribing data can be misleading, and it must be compared with other aspects of patient care. Simple calculations can suggest areas of possible under-prescribing and over-prescribing, and in turn lead to consideration of the criteria for diagnosis of common chronic diseases such as asthma and diabetes, as well as their subsequent management. Suggests that the prescribing of both new drugs and those of dubious merit is a subject for particular scrutiny, and those who prescribe these drugs must accept the duty of extra vigilance this imposes on them.

Drug Prescriptions↗
PubMed2004

Qualitative study investigating the process of giving anti-smoking advice in general practice.

General practitioners' (GPs') anti-smoking advice promotes patients' smoking cessation but little is known about how GPs use their short consultations to give advice. We used semi-structured interviews with 27 UK GPs to investigate how GPs believe they should advise smokers to stop and the reasons underpinning these beliefs. GPs reported a limited repertoire of techniques for dealing with smokers who were not motivated to stop. They also reported using confrontational advice-giving styles with patients who continued to smoke despite suffering from smoking-related illnesses. GPs might find it easier and more rewarding to discuss smoking with patients if they possessed a greater range of skills for dealing with non-motivated smokers.

Attitude of Health Personnel↗
PubMed1988

Efficacy of ofloxacin in the treatment of lower respiratory tract infections in general practice.

General practitioners assessed the efficacy and safety of ofloxacin in the treatment of lower respiratory tract infections in 100 patients. Treatment consisted of ofloxacin 200 mg twice daily for seven days. Evaluation of therapy was based on clinical and bacteriological parameters. Two patients were withdrawn from the study because of gastro-intestinal symptoms of nausea and vomiting. There were no significant drug-related alterations in haematological or biochemical parameters following treatment. Pathogens present in pre-treatment sputum specimens were eradicated from 63 of 66 patients. The overall assessment of response to treatment in the 98 evaluable patients was recorded as cured (45), much improved (47), slightly better (3), same (2) and slightly worse (1). It was concluded from these results that ofloxacin was both safe and effective in the treatment of lower respiratory tract infections.

Adult↗
PubMed1987

Be your own coroner: an audit of 500 consecutive deaths in a general practice.

General practitioners' medical records of a geographically defined population of about 1600-1800 have been retained since 1964. Details of care by general practitioners and hospital correspondence were available for 500 deaths (277 men, 223 women) from 1964 to 1985, including deaths at home, at work, in the street, in short term and long term institutional care, and within six months of release from institutional care. The periods 1964-73 and 1974-85 were compared. The proportion of men aged greater than or equal to 80 who died increased from 20 (14%) in 1964-73 to 22 (16%) in 1974-85, but the proportion of women aged greater than or equal to 80 who died increased from 21 (23%) to 50 (39%). Of all deaths, 223 (45%) were thought to have had avoidable causal factors, of which 132 (59%) were attributed to patients, 45 (20%) to the general practitioner, 9 (4%) to hospitals, and 37 (17%) to others. The number of deaths related to smoking decreased from 31 (43%) in men aged less than 70 to 19 (30%) but in women aged less than 70 increased from 4 (10%) to 11 (26%). The proportion of deaths in women who were already dependent six months before death increased from 55 (58%) to 81 (63%) but in men remained constant at 64 (46%) in the first period and 62 (46%) in the second. Nearly two thirds of all deaths occurred at home in both periods--about twice the proportion for England and Wales--but the proportion of men dying at home decreased from 87 (62%) to 76 (56%). A critical analysis of deaths in whole populations by primary care teams can identify changes that are needed both in the work and organisation of the team and in the behaviour of the population itself.

Adult↗
PubMed1987

Antimicrobial prophylaxis of infective endocarditis: effect of BSAC recommendations on compliance in general practice.

General dental practitioners in the South West Region of the U.K. were surveyed to assess compliance with the recently published recommendations of the British Society for Antimicrobial Chemotherapy on the antimicrobial prophylaxis of infective endocarditis. For the majority of dental patients, the level of prophylaxis had improved compared with previous reports: 75% of practitioners organized the prophylaxis themselves, 80% gave oral amoxycillin to penicillin non-allergic patients, and 86% gave erythromycin to penicillin-allergic patients. Some 51% complied to an acceptable level with recommended amoxycillin schedules but only 2% complied with erythromycin schedules. The BSAC recommended prophylactic regimens have certainly improved compliance although they are not yet universally accepted.

Anti-Infective Agents↗
PubMed1995

A critical incident study of general practice trainees in their basic general practice term.

OBJECTIVE: To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. DESIGN: Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. SUBJECTS: Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. RESULTS: Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. CONCLUSION: The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

Adult↗
PubMed2001

A national general practice census: characteristics of rural general practices.

OBJECTIVES: The aim of the present study was to describe, using a national census, the characteristics of rural general practices and compare these with city and town general practices. METHODS: A previously piloted, anonymous but linked, questionnaire was issued to all GPs in Ireland. A liaison network covering the country was developed to increase the response rate. Respondents were asked to designate the location of their main surgery as being city (>20 000 population), town (>5000) or rural (<5000). Each responding practice was asked to nominate one partner to complete a specific section on practice information. RESULTS: Completed individual questionnaires were returned from 2093 GPs (86% response rate). Information on 1429 practice centres was provided; 488 (34%) of these were designated as city, 405 (28%) as town and 536 (38%) as rural. Rural practices reported fewer private patients (P < 0.001) and more socio-economically deprived patients (P < 0.001) than those in towns or cities. The mean number (SD) of total scheduled hours per average week per GP was 77.95 (37.0) for city practices, 80.6 (35.9) for town and 103.6 (39.0) for rural (P < 0.001). Rural practices are more likely, in comparison with those in cities and towns, to have attached staff working from purpose-built premises which are publicly owned. Rural practices also have more contacts with members of the primary care team such as Public Health Nurses, and the quality of these contacts is described more positively. The range of available services is broadly similar, with emergency medical equipment being available more frequently in rural practices. CONCLUSION: This study suggests that rural practitioners and their practices differ from their urban counterparts in many important aspects. Consideration should be given to the development of formal under- and postgraduate rural general practice programmes to prepare new, and continue to enthuse present, rural GPs.

Censuses↗
PubMed1996

Insomnia in general practice. Results from NSW General Practice Survey 1991-1992.

OBJECTIVE: To assess whether an educational visit to GPs providing information about the non-drug and drug management of anxiety and insomnia can reduce subsequent rates of benzodiazepine prescription. METHOD: A randomised controlled trial of 286 NSW general practitioners conducted during 1991 and 1992. RESULTS: The educational visit was statistically significant in reducing the number of new prescriptions recorded by general practitioners for new diagnoses of insomnia. However, the majority of benzodiazepine prescriptions were for patients continuing treatment for insomnia or anxiety/depression. Overall, benzodiazepines were the sole management of insomnia recorded by the surveyed GPs in most cases (93.5%). In comparison, non-drug management for anxiety and depression was offered to more than a third of patients with anxiety and depression. (Benzodiazepines were the only management of anxiety and depression in just over 50% of cases.) DISCUSSION: This study shows general practitioners can change their management of insomnia and that change is most likely to occur when the problem is new, rather than old. The decreased emphasis on drug treatment in the general practice management of anxiety and depression may reflect the change in psychiatric teaching for these conditions. Further, most of the publicity about benzodiazepines has been in relation to their use for anxiety disorders. Doctors were interested in learning about advances in the understanding of sleep disorders and their non-drug management.

Australia↗
PubMed1999

[Prospective follow-up of 3,228 patients suffering from clinical benign prostatic hyperplasia (BPH) treated for 3 years wi alfuzosin in general practice. BPH Group in General Practice].

OBJECTIVE: To determine (a) the amplitude and duration of reduction of the symptom score and improvement of the HRQL score (including sexual function), (b) the adverse effects and (c) the incidence of acute urinary retention and prostatic surgery during the 3 years of alfuzosin treatment. MATERIAL AND METHODS: 3,228 patients suffering from BPH were included by 812 centers in a 3-year open prospective study and were treated with alfuzosin (immediate release) at the recommended dosage. A symptom score (modified Boyarsky) and a specific HRQL score, comprising 20 items including 3 questions on sexuality (Urolifetm BPH Qol20) were self-administered on inclusion and after 3, 6, 12, 18, 24, 30 and 36 months. RESULTS: 2,579 patients (79.9%) completed the 3 years of the study. The symptom score was significantly decreased by 54% at 3 months and this reduction was maintained until 36 months (-48.4%); the HRQL score was significantly improved by 45.4% at 12 months and this improvement was maintained until 36 months (+43.4%). Alfuzosin was well tolerated: the qualitative and quantitative distribution of adverse effects was identical to that previously observed in placebo-controlled trials (vertigo-dizziness: 2.1%). Adverse effects were responsible for 4.2% of drop-outs from the trial. 120 patients (3.7%) were operated for BPH and 9 patients (0.3%) developed acute urinary retention. CONCLUSION: This prospective study confirms the long-term safety of use of alfuzosin under routine general practice conditions and emphasizes the need to measure HRQL in the context of the patient's opinion.

Adrenergic alpha-Antagonists↗
PubMed1976

General practice observed. Child abuse and general practice.

In a general practice of 9250 patients with 1841 children under 10 there were 12 cases of actual abuse during 1973-6. In March 1976 30 children were at risk. A preventive scheme was set up and the short-term outcome was good. There were no cases of serious abuse among the children at risk.

Child Abuse↗
PubMed1997

Identifying the active general practice workforce in one division of general practice: the utility of public domain databases.

OBJECTIVE: To identify the non-specialist medical practitioner workforce engaged in active general practice in the region served by the Division of General Practice-Northern Tasmania and to determine the usefulness of public domain databases for enumeration of individual non-specialists providing general practice services. METHODS: A masterlist of the active general practice workforce was compiled by obtaining the names and addresses/postcodes of all non-specialist medical practitioners who were listed in at least one of nine public domain databases and who were confirmed by selected local medical practitioners to be in active general practice in the three months prior to 30 June 1994. This masterlist was used in calculating the sensitivity and positive predictive value (PPV) of each of the nine databases for enumerating non-specialist practitioners in active general practice. RESULTS: Combining the databases resulted in a list of 475 practitioners, which was refined to 139 practitioners who, by our criteria, were in active general practice. Databases had a range of sensitivities and PPVs, but those with high sensitivity tended to have low PPVs, and vice versa. The most useful database for enumerating these practitioners was the mailing list for Australian Family Physician (sensitivity, 94%; PPV, 0.79). CONCLUSIONS: When used alone, no single database had both high sensitivity and high positive predictive value for identifying the active general practice workforce. Combining multiple databases may improve precision. Developing methods to identify recent departures from local active practice has the potential to improve the PPV of existing highly sensitive databases.

Australia↗
PubMed1990

[Cholesterol measurement in general practice--Norwegian general practitioners' attitudes and estimation of their own practice].

In 1988 a group of Norwegian experts published a programme for treatment of patients with increased cholesterol. The programme recommended dietary counselling when plasma cholesterol exceeded 5 mmol/l. In the autumn 1988 the Norwegian National Health Association started a campaign on cholesterol for health personnel. In order to find out to what extent general practitioners adhered to the recommendations of the programme, a random sample of 100 general practitioners were sent a questionnaire before and after the campaign. The results showed no significant differences in the doctors' attitudes towards diagnosis and treatment of patients with increased plasma cholesterol. Both before and after the campaign the plasma cholesterol levels at which they would initiate follow-up, dietary counselling or drug therapy were 1-2 mmol/l above the levels recommended by the expert group. The attitude of the general practitioners was more conservative than the recommendations of the programme. The interval between the information meeting and the post study was only six months. It is a complicated process to change attitudes and practice routines, and the time required may be longer than six months. Furthermore, the recommendations of the programme were questioned by other doctors, which reduced its impact.

Adult↗
PubMed2001

Non-steroidal anti-inflammatory and cytoprotective drug co-prescription in general practice. A general practitioner-based survey in France.

BACKGROUND AND AIM: Non-steroidal anti-inflammatory drugs (NSAIDs) represent one of the most frequently prescribed drugs. Gastrointestinal damage, the most common side effect of NSAIDs. can be limited by the prescription of cytoprotective agents. In order to assess determinants of NSAID-associated cytoprotective agent prescriptions in primary care practice, we performed a general practitioner (GP)-based study. METHODS: After a 2-month intensive information campaign, the participation of all GPs of the Côte d'Or (France) administrative area was requested. During a 2-month period, GPs had to return a mailed questionnaire on NSAID prescription for up to ten consecutive patients aged over 18 years who required NSAIDs. This 30-item questionnaire included questions about the patient, the type of NSAID and the GP. RESULTS: GP participation rate was 24%, and 791 prescriptions were provided. GPs who participated in the study were representative of GPs of the area in terms of sex, time elapsed since graduation and GP practice area. Around 80% of the patients included in the study were under the age of 65 years. The proportion of prescriptions combining NSAIDs and gastroprotective agents was 29.5%. Omeprazole accounted for 58% of the coprescriptions and misoprostol for 29%. Independent determinants associated with the co-prescription of a cytoprotective agent were age [odds ratio (OR) 4.1; confidence interval (CI) 95% 2.3 7.4], previous history of poor NSAID tolerance (OR 10.4; CI 95% 5.8-18.6), previous history of moderate to severe digestive disorders (OR 13.4; CI 95% 5.1 35.4) and indication for chronic illness (OR 1.8, CI 95% 1.1-3.1). Prescriptions of cytoprotective drugs were in conformity with official guidelines for 78.3% of the patients. Although around 60% of the patients with risk factors for poor tolerance received a gastroprotective drug, 50% of the patients over 65 years did not receive it. Conversely, nearly 12% of the patients with no risk factors were prescribed cytoprotective agents. Patient history was the main reason put forward by GPs for prescribing cytoprotective drugs. CONCLUSION: Although a large majority of GP prescriptions were in accordance with official recommendations, inadequate NSAID prescription practices remain relatively frequent especially with regard to the elderly.

Adult↗