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PubMed2006

Evaluation of an interpractice visit peer review program for rural Australian general practice registrars.

Changes to the Australian General Practice Training Program occurred in 2001 allowing registrars in small rural communities to undertake all of their training in one practice. A disadvantage of this change was that there was limited exposure for registrars to different types of general practice. An interpractice visit program utilising peer review between registrars was developed to provide this exposure. This article describes rural Australian general practice registrars' views and experiences of a pilot interpractice visit peer review program.

Australia↗
PubMed2000

Developing a 'consultation quality index' (CQI) for use in general practice.

BACKGROUND: The core values of general practice include holism and patient-centredness. None of the measures of quality of care in general practice presently capture the expression of these values at routine consultations. OBJECTIVES: The aim of the present study was to construct a 'consultation quality index' (CQI) which reflects the core values of general practice, using as proxies 'consultation length' and how well patients 'know the doctor' as process measures and 'patient enablement' as an outcome measure. METHODS: The CQI was constructed from data collected from 23 799 adult English-speaking patients consulting 221 doctors in four demographically contrasting areas of the UK during 2 weeks of March/April 1998. A total of 171 doctors who entered 50 qualifying consultations were allocated scores for the three component variables, and a total CQI was calculated. RESULTS: CQI scores were in the range 4-18. Validity was examined by looking at high and low scorers in greater detail and by searching for correlates with case mix, patient age and gender, and the deprivation scores of the practices concerned. Particular attention was paid to how registrars and doctors new to their practices scored. The scores of different doctors in the same practice were also noted. The results had strong face validity and were independent of case mix and deprivation. Reliability was gauged by examining similar work from a previous study which had collected information on consultation length and enablement over three time periods. High CQI scores were associated with smaller overall practice list sizes. CONCLUSIONS: We have outlined possible uses for the CQI as part of the packages assessing quality of care by doctors and practices. The measure may also have a part to play in recognizing poorly performing doctors. We suggest how CQI scores could contribute to an incentive scheme to reward good consulting practice. Further work is in hand to compare doctors' CQI scores with scores based on performance indicators constructed from routine NHS data on prescribing and preventive medicine.

Family Practice↗
PubMed1998

The development of general practice standards in Australia. Royal Australian College of General Practitioners.

The Royal Australian College of General Practitioners has spent 4 years developing a set of entry standards which define the minimum features of general practices expected for the mid-1990s. The project design followed a slow, iterative process, with several opportunities for wide consultation with professional, consumer and Government groups. The draft standards were piloted in 25 volunteer practices, modified and then field-tested in 200 randomly selected practices representing urban and rural practices. Results of this field testing showed that the standards had content validity and that reliable measures were possible using triangulation from several data sources. The current version of the standards has been distributed widely for voluntary application in Australian general practices from early 1997.

Australia↗
PubMed1981

Depressive illness in general practice.

A review of published literature concerning psychological illness in General Practice shows that the spectrum of illness seen differs considerably from that met with in hospital practice. The incidence of depressive illness in General Practice is described and the relationship of life events, physical disease and social factors to depression are noted. The difficulties experienced in the diagnosis of depression in the General Practice setting are described and evidence is given of the high use of drug therapy in the General Practice management of depression. The need for education in psychological illness that is more appropriate to the understanding and management of depression in General Practice is stressed.

Depression↗
PubMed1990

Need for and provision of general practice in London.

This study examines the spatial distribution of general practice in London, taking into account both practice and population characteristics. While need for general practice is higher in inner London, some areas of outer London experience high levels of need. Inner London tends to have a greater quantity but lower quality of general practice. However, as in the case of the needs indices, this situation cannot be described as a simple inner city/outer city dichotomy. It is concluded that not all inner London areas suffer from high need and poor general practice and not all outer London areas have low need and good general practice.

Catchment Area, Health↗
PubMed1991

Violence in general practice: a survey of general practitioners' views.

OBJECTIVE: To survey the extent of abuse and violence directed towards general practitioners during the course of their professional duties and to categorize the characteristics of such aggression. DESIGN: Retrospective survey of the views of a large sample of general practitioners by using a piloted postal questionnaire. SETTING: All medical practices in the west midlands. SUBJECTS: A total of 1093 general practitioners (40.6% of the total sample) who responded to the questionnaire. MAIN OUTCOME MEASURE: Number of incidents of aggression experienced by the general practitioners during a period of 12 months and the incidence of various precipitating factors. RESULTS: Although the response was low at 40.6%, this study is the largest published database on aggression towards family doctors. In all, 687 (62.9%) of the responders had experienced abuse or violence during the previous 12 months, and 191 (17.5%) had experienced some sort of abuse at least once a month and 11 (1%) had experienced verbal abuse every day. Even assuming that all of the non-responders did not experience any violence, then aggression in patients affects 25.5% of general practitioners in the west midlands. For those practitioners who had experienced aggression in patients the annual incidence of an event per general practitioner was 2.42. In all, 96 (14%) of these general practitioners thought that aggression was increasing. A total of 1520 (91.3%) of all incidents comprised verbal abuse or threats with no direct physical act. The surgery was the commonest location for aggression, with 942 (56.6%) incidents; however, 90 (62.5%) of the incidents involving assault or injury occurred during domiciliary visits and 22 (66%) of the injuries were received during night calls. Relatives were the aggressors in 668 (37.6%) cases, anxiety was a precipitant in 435 (25.7%) cases, and a long wait in 183 (10.8%). CONCLUSIONS: Violence towards general practitioners is common and may be increasing. Some of the precipitants of aggression are potentially avoidable and practices should make strenuous attempts to identify such factors and remedy them. Staff training in interpersonal skills and recognising anxious or intoxicated patients is essential and should be supplemented by consideration of surgery layout and repair. Doctors should avoid delays for patients by rearranging booking policies or surgery times and lengths. Victims of aggression must be followed up. A prospective study or centralised recording of incidents should be funded.

Adolescent↗
PubMedDate not supplied

Developments in British general practice.

The essential characteristics of British general practice--a defined list of patients for each practitioner, the pivotal role of general practice in controlling access to specialist services, and the primary care team--all are likely to be preserved for the foreseeable future. New government legislation will attempt to increase the accountability of general practitioners, to reward "good practice", and to encourage greater emphasis on preventive activities. This article provides an overview of general practice in the United Kingdom, including administrative issues, reimbursement structures, research directions, and government policies.

Adult↗
PubMed2001

A quasi-randomised controlled trial of water as a quick softening agent of persistent earwax in general practice.

BACKGROUND: Earwax is a common problem in general practice. The incidence of complaints owing to earwax in general practice in the Netherlands is 39.3 per 1000 patients. AIM: To determine the feasibility of a strategy using water as a quick dispersant for persistent earwax, compared with the usual strategy using oil as a dispersant for three days in a general practice setting. DESIGN OF STUDY: Practice based, prospective controlled intervention study. SETTING: Forty-two patients (59 ears) in four general practices in the Netherlands. METHOD: Patients with persistent earwax were randomised into an intervention group and a control group. For patients in the intervention group, water drops at body temperature were dropped into the impacted ear and the auditory meatus was blocked with a wet wad of cotton. After the patient had waited for 15 minutes in the waiting room a series of attempts at syringing was completed. Patients in the control group received the usual strategy and were instructed to soften the earwax with oil each night before sleeping and to block the auditory meatus with a wad of cotton, for three days. They were asked to come back after three days for the second attempt of syringing. For both strategies the mean number of syringing attempts (and 95% confidence interval) was calculated and compared by testing the difference between the means using a t-test for independent samples. All ears in which the wax was still persistent after another five syringing attempts were given the value of 6 in the calculations. RESULTS: The mean number of syringing attempts needed per patient in the intervention group was 3.0 (95% CI = 2.4 to 3.6) and for the control group, the mean was 2.4 (95% CI = 1.7 to 3.1). The difference between means (0.6, 95% CI = 0.3 to 1.5) was not statistically significant (P = 0.18). CONCLUSION: A patient with persistent earwax can stay in the waiting room following the initial series of five attempts at syringing, with water instilled in the ear canal. After 15 minutes, the earwax is removed as easily as in the usual strategy using oil instilled for three days. The strategy using water as a dispersant for persistent earwax is quick and more convenient for the patient.

Cerumen↗
PubMed1998

A modified framework for rural general practice: the importance of recruitment and retention.

Whilst definitions of what constitutes general practice vary according to purpose, the pivotal role of general practitioners as key providers of health and medical services is acknowledged. Recent concerns to address both what general practitioners and their patients want and get from general practice stem from a recognized need to include stakeholder concerns about the adequacy of general practice alongside workforce issues such as recruitment and retention. Nowhere is this need so crucial as in rural areas where the range of health services is limited and major inequities exist in the availability of general practitioners. An extended framework for evaluating what general practitioners and their patients expect and receive from general practice, with particular reference to rural general practice in Australia is presented. Three inter-related dimensions of recruitment, retention and a whole patient/whole family approach to health care are suggested as underpinning this framework. The significance of each dimension to ensuring the provision of quality general practice care in rural communities, and the links between them, are outlined in the proposed framework.

Australia↗
PubMed2003

Diagnostic uncertainty in general practice. A unique opportunity for research?

General practice encounters often involve vague symptoms, potentially representing illness in its early stage. Managing such undifferentiated symptoms is difficult, but one of the key tasks of the general practitioner is to discover serious disease at an appropriate stage whilst also minimising over-investigation. Although the diagnostic process and methods of coping with uncertainty in general practice have been described, the early course of disease, especially undifferentiated presentations, is poorly understood. There is still much to learn about diagnosis in general practice, and important contributions could be made by researchers in any primary care setting.

Biomedical Research↗
PubMed2003

Sustaining quality general practice in a flawed market.

BACKGROUND: Recent years have seen an increasing corporatization of general practice. OBJECTIVE: This paper considers how divisions of general practice should respond to the corporatization of general practice. DISCUSSION: Corporate models are an economically rational outcome of structural features of Medicare funding for Australian general practice. One limitation of these structures is that they are indifferent to quality. Corporate general practice competes with divisions of general practice at some level because it provides an alternative organisational structure and service values for large numbers of general practitioners. Accepting this, the challenge for divisions becomes one of differentiating themselves from the corporate model through a focus on promoting and encouraging quality practice.

Australia↗
PubMed2004

Monitoring mortality in general practice in Grampian, Scotland.

Information on the distribution of mortality and morbidity in general practice is scarce, and not easily accessible either by health authorities or individual general practices. Although the assessment of population mortality is a standard public health measure, colleagues in public health, information sciences and general practice rarely undertake such activity related to general practice populations. Mortality information can be used for various purposes. Examples are providing background data for clinical audits or alerting practitioners to quality issues in the healthcare industry or even suggesting environmental hazards. We measured the experience of mortality in all generally practices in Grampian in the years 1991 to 1999. All practices were notified of their actual and expected mortality over this period of time and asked for comment. Only three general practices had excess mortality experience in both the periods 1991 to 1995 and 1996 to 1999. Only a minority of practices commented on the results. It appears that a high presence of nursing homes in a practice might skew the results; this phenomenon will be central to further inquiry. Future methodology for recording death in general practice should take account of this, as well as providing an account of the qualitative aspects of patients' need for a dignified satisfactory death.

Adolescent↗
PubMed1997

Integration of undergraduate and postgraduate general practice education--does it work?

Academic general practice remains a small part of most medical schools. One topical method of creating larger units is to integrate the undergraduate and postgraduate education roles. This paper describes the structure of the General Practice and Rural Health Unit at the North Queensland Clinical School, where education, clinical service and policy development roles are combined to create one of Australia's larger academic general practice centres. Issues which have facilitated and challenged the development are discussed in this reflective paper describing the first 3 years of operation.

Education, Medical, Continuing↗
PubMed1999

Randomised controlled trial of general practice based asthma clinics.

OBJECTIVE: To compare the effects on asthma morbidity of asthma clinics based in general practice with standard general practice care. DESIGN AND SETTING: A randomised controlled trial in eight general practices. Patients, general practitioners and outcomes assessors were not blinded to treatment allocation. PARTICIPANTS: 195 patients with asthma aged 5-64 years; 191 completed the trial. INTERVENTION: Three asthma clinic sessions over six months involving nurse counselling, education about asthma management, spirometry and consultation with the general practitioner. MAIN OUTCOME MEASURES: Patients reporting days lost from work or school, number of days lost, the presence of morning or nocturnal asthma symptoms, use of an action plan, medication use, current smoking, hospitalisation, and emergency visits. RESULTS: Asthma clinics were associated with a greater reduction in nocturnal symptoms, an increase in the ownership of peak flow meters and an increase in the number of patients commencing or resuming smoking. Both control and intervention groups showed similar improvement in days lost from work or school, the presence of symptoms, use of an action plan and taking reliever medication. CONCLUSION: Our study does not show that asthma clinics are more effective than standard general practice care in reducing asthma morbidity. It is uncertain how much of the improvement in outcomes was due to the asthma clinic, the influence of the study itself upon patients and practitioners, or other factors, such as the tendency for a patient's asthma management to improve over time.

Absenteeism↗
PubMed1994

Contribution of academic departments of general practice to undergraduate teaching, and their plans for curriculum development.

BACKGROUND: In 1991, the General Medical Council suggested the development of a new undergraduate curriculum, on a 'core plus electives' basis. The combination of National Health Service reforms and the rising profile of academic departments of general practice had led to a consideration of general practice as an alternative teaching environment. These departments now face escalating expectations from their medical schools of their ability to provide additional community based teaching. AIM: The aim of this study was to investigate the present contribution of academic departments of general practice to undergraduate teaching and their plans for curriculum development, including the introduction of community-based clinical skills teaching. METHOD: A questionnaire was circulated in June 1993 to all academic departments of general practice in the United Kingdom and Eire. RESULTS: Twenty seven out of 28 questionnaires were returned. Twenty two departments provided pre-clinical teaching and all provided a clinical practice attachment. Eight medical schools were organizing community-based clinical skills teaching, and in two this formed the basis for a community-based medical attachment. Eight planned to reduce the factual content of their curricula and introduce problem-based learning while nine were contemplating a 'core plus electives' option. Fourteen medical schools had primary care input in teaching basic clinical skills and an additional seven planned to introduce this. Problems encountered by the general practitioner tutors in teaching clinical skills included insufficient time and resources and poor self-esteem; they identified a need for good central and peripheral organization. CONCLUSION: Compared with a 1988 study, academic departments of general practice are increasingly involved in teaching both general practice and general medical skills at undergraduate level. Curriculum change is occurring rapidly, with an increasing trend towards community teaching; the implications for both academic departments and general practitioner tutors are discussed.

Curriculum↗
PubMed1993

[A view of general practice].

What happens during our consultation and what are the determining factors or specific practice patterns in general practice? Six Swiss general practitioners discuss this questions based on a random sample of 300 descriptions of unbiased consultations. Further information obtained from the patient after the consultation by questionnaire and a recorded semi-structured interview was analysed. In the following article the methods are presented.

Data Collection↗
PubMed2005

Providing welfare advice in general practice: referrals, issues and outcomes.

General practices in the UK are increasingly hosting welfare advice services on their premises to address patients' social and economic needs. In this paper, the authors present the outcomes of a service providing welfare advice across 30 general practices in inner-city Bradford. A retrospective study of all patients referred for advice during the initial 24 months of the project was conducted. The following information was collected: patient demographics, source of referrals, advice issues raised and income generated through benefit claims. The advice workers saw 2484 patients dealing with over 4000 welfare advice issues. Demand for the service varied widely across practices, reflecting practice list size and engagement with the service by practice staff. The main source of referrals was general practitioners (28%), and disability-related welfare benefits constituted the largest category of advice issues. Sixty-nine per cent of patients seen for advice were of south Asian ethnic origin. The advice workers raised pound sterling 2,389,255 in welfare benefit claims for patients, primarily through disability-related benefits. Approximately one in four patients referred for advice benefited financially. It is concluded that the service is an excellent strategy by which primary care organisations address the social, economic and environmental influences on the health of their population.

Adolescent↗