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PubMed1996

Clinical incidents in general practice. Communication between casualty departments and general practitioners.

The incident Monitoring in General Practice Project began as an initiative of the Professional Indemnity Review. Anonymous data from general practitioners about unintended, and possibly adverse events were collected in order to develop preventive strategies that might ultimately increase patient safety and therefore reduce litigation. Feedback and sharing of experiences and ideas about these events, possible management strategies or the project as a whole are invited from readers.

Australia↗
PubMed1994

What happens to patients following open access gastroscopy? An outcome study from general practice.

BACKGROUND: Open access gastroscopy allows general practitioners to request a gastroscopy without prior referral to a specialist. The effect of open access gastroscopy upon patient management is poorly explored. Most studies have been hospital based and have focused on diagnostic yields and on means of tightening requests to reduce inefficient use. A user evaluation can only be made by measuring outcomes in primary care. AIM: A study was undertaken to determine the impact of open access gastroscopy in general practice and in particular, the value of a normal result. METHOD: All general practices in South Tees District Health Authority were asked to participate. Any of their patients who had had open access gastroscopy in the year prior to July 1990 were identified from the hospital computer and their general practitioner notes examined. Patient management during the year prior to the open access gastroscopy was compared with the year after. The main outcome measures were: detection rate and grade of lesion, change in graded score of prescribed drugs, consultation rate for dyspepsia and non-dyspepsia problems, and further hospital referral and investigations. Outcomes among those with normal and abnormal gastroscopy results were compared. RESULTS: The study sample comprised 715 patients, 36% of whom had a normal gastroscopy result, 34% a major abnormality and 26% a minor abnormality (4% of patients had miscellaneous diagnoses). It was found that 39% of all patients, and 60% of those with normal findings on open access gastroscopy had their drug treatment stopped or reduced in grade after the investigation. Of those with a major endoscopic abnormality 58% increased their treatment score. Consultations for dyspepsia in the year before and after gastroscopy fell by 57% overall among those with a normal gastroscopy result, by 37% among those with a minor finding and by 33% in those with a major finding. There was a 21% fall in consultations for all reasons among those with a normal gastroscopy result but those with a minor abnormality had a 23% increase in non-dyspepsia consultations. Of all patients 19% were referred to hospital subsequently. CONCLUSION: Open access gastroscopy has a major effect upon patient management in general practice, and a normal endoscopy result has an important an impact as an abnormal one. Open access gastroscopy is associated with a rationalization of drug therapy, reduced consultations and a low hospital referral rate.

Dyspepsia↗
PubMed2005

[The practice guideline 'TIA' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

A transient ischaemic attack (TIA) can be seen as an attack of angina of the brain. In the first weeks following a TIA there is a sizeable risk of subsequent stroke. After this period, this increased risk tapers off and an elevated risk of cardiovascular disorders remains, with the emphasis on its cardiac component. The management of a patient with a TIA in general practice focuses on these two risk periods. The long-term cardiovascular risk can easily be reduced by prescribing aspirin, an established procedure in general practice. The immediate threat of obstruction of the carotid artery may, as was only recently firmly established, be averted by a timely referral for additional diagnostics and, when needed, carotid desobstruction. This part of TIA management in general practice, however, is hampered by the current waiting periods for these procedures.

Female↗
PubMed1991

Patient education about cough: effect on the consulting behaviour of general practice patients.

The aim of this general practice study was to examine how the consulting behaviour of patients with a cough was affected when the tasks and responsibilities of patients, practice nurses and general practitioners were reorganized. In four 'average' single-handed general practices the effects on the consulting behaviour of patients of a rational practice policy on cough and the provision of systematic patient education on cough were compared with patient behaviour in four matched control practices. Changes of behaviour were measured in 548 patients who consulted for cough at least twice, in two successive autumn-winter periods. Significantly more patients in the experimental practice changed their behaviour to follow the practice guidelines than did patients in the control practices (56% versus 30%, P less than 0.001). The proportion of patients who continued to consult in the approved manner was greater among patients receiving intervention (66% versus 29%, P less than 0.001). This was equally true for patients who had suffered less than four episodes of cough or more than four episodes. The more often the patients received the education, the more effective it was. All patients who consulted the general practitioner for cough during the first autumn-winter period filled in a cough diary during the second period. From this it appeared that the intervention did not result in patients delaying consultation when they had a cough lasting longer than three weeks or one with 'serious' symptoms. It would appear that a rational practice policy and the provision of patient education can stimulate patients to modify their consulting behaviour. This could result in a reduction in the costs of health care.

Adolescent↗
PubMed1999

Headache in children in Dutch general practice.

AIM: To describe the occurrence of headache in general practice, the diagnoses made in general practice, and the management. METHOD: Data from the Dutch national survey of morbidity and interventions in general practice were used. The practice population (103 practices) comprised 63,753 children aged 0-14 years. RESULTS: In 634 episodes, headache was a reason for encounter. The incidence of headache presented to the general practitioner was 40.2 per 1000 person years. More than half of the episodes were related to an infectious disease, among which upper respiratory tract infections predominated. The incidence rate of the diagnosis idiopathic headache was 7.3 episodes per 1000 person years. The incidence increased with age and was higher in girls than in boys. In only 12% of cases of idiopathic headache were special investigations carried out, mostly blood examinations. Medication was prescribed in 27% of all episodes of idiopathic headache. In the absence of an infectious disease, many headache episodes were associated with psychosocial problems. Family problems and school problems were mentioned most often. CONCLUSION: Headache in children as reason for encounter is a common problem in general practice, often associated with an infectious disease. When confronted with a child with idiopathic headache, the general practitioner should be aware of a possible psychosocial component.

Adolescent↗
PubMed2003

First year of practice visits for the Rural Depression Anxiety Research and Treatment General Practice program.

OBJECTIVE: To describe the first 12 months activities of a key component of a General Practice Psychiatry program - the GP practice visit. DESIGN: Questionnaire to evaluate effects on participating general practitioners practice. SETTING: Rural group general practices. SUBJECTS: Thirty-two general practitioners in the Loddon Campaspe Southern Mallee region in Victoria. INTERVENTIONS: Practice visits involved a combination of each of three key activities: primary consultation, secondary consultation and/or case discussion and formal teaching. RESULTS: General practitioners reported a variety of changes in their practice as a result of the visits. CONCLUSION: Practice visits appear to be a useful means of influencing GP's practice. Further work is required to determine whether such changes are accompanied by demonstrable benefits in patient outcome. WHAT IS ALREADY KNOWN: Several models to assist GPs effectively manage mental health problems have been described. These models require regular contact and so have had limited utility in rural settings. WHAT THIS STUDY ADDS: This study suggests that infrequent contact or input, based on well established models, can alter GP's clinical behaviour.

Anxiety↗
PubMed2000

Relative activity and referral patterns for diabetes and non-diabetes in general practice.

AIMS: To describe and compare general practice (GP) activity for patients with and without diabetes using a survey of general practices representing over 10% of the Welsh population. METHODS: The Welsh GP Morbidity Database Project (GPMDP) collected data including demographic and lifestyle information and consultation data such as diagnosis, referral and surgical procedures. These data were analysed to establish the annual period prevalence of diabetes and compare the relative number of consultations and referrals. RESULTS: A total of 4,182 diabetic patients were recorded (prevalence 1.41%) and accounted for 77,371 (4.4%) consultations. Patients with diabetes were four-times more likely to be referred to community services (relative risk (RR) 4.1, 95% CI 3.7-4.7), in particular district nursing (RR 3.8, 1.9-7.7), optician services (RR 8.9, 5.0-15.7), chiropody (RR 8.2 6.4-10.5) and dietician services (RR 21.2, 17.6-25.5). Patients with diabetes were also more likely to be followed-up in general practice (RR 6.7, 6.2-7.2) both within 1 month (RR 6.7, 6.2-7.2) and 1 month to 1 year (RR 9.7, 8.9-10.7). Emergency admissions were also more likely for patients with diabetes (RR 6.8, 6.2-7.5) as were elective admissions to general medicine (RR 5.6, 4.6-6.7), surgery (RR 1.8, 1.5-2.0) and opthalmology (4.2, 3.4-5.2). CONCLUSION: The increased utilization of health services apparent in secondary care was confirmed in primary care. Further research is required to determine levels of community activity after initial referral.

Adolescent↗
PubMed1982

The preregistration houseman in general practice.

During 1979-80 an experimental preregistration house physician post in general practice was conducted at Aldermoor Health Centre in Southampton in rotation with medical posts at Southampton General Hospital. Ten house physicians took part in the experiment that lasted for 19 months and each doctor spent two months in general practice. The house physicians settled quickly into general practice and found the experience both enjoyable and worth while. The hospital consultants, general practitioners, and the house physicians themselves thought that this was a valuable extension to preregistration education. The experiment raised several questions, some of which were specific to the type of rotation organised and others that were more fundamental to the whole concept of the preregistration house physician in general practice. If the experiment is to be repeated a longer period in general practice is strongly recommended. A full year rotation is suggested with four months each of surgery, medicine, and general practice.

Attitude of Health Personnel↗
PubMed2000

Evaluation of a pilot project to use computers in a rural general practice term.

In 1998, the Department of General Practice (Faculty of Medicine and Dentistry, University of Western Australia) ran a pilot project to use computers in a sixth year rural general practice term. Students were provided with a laptop computer to take into rural and remote areas throughout Western Australia during their 4-week clinical attachment. An email mailing list was set up for course participants to share experiences and complete set learning activities specifically related to rural general practice. An evaluation of this pilot project found that students felt less isolated on rural attachments, course outcomes were improved and rural preceptors were more involved in the programme. The development of a teaching and learning programme that involves the use of computers in rural general practice for undergraduate students has the potential to improve the quality of their medical education.

Education, Distance↗