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At least 991 records · Page 55Linked to original sources
PubMed2005

Teaching on the run--general practice training between consultations.

BACKGROUND: General practitioner teachers play a growing role in medical education. Much of the teaching is done during and between patient consultations, ie. 'on the run'. This presents challenges in terms of time available for teaching, teacher training and feedback on teacher performance. Australian Government funded programs have been developed to train clinical teachers in hospital settings; these might be adaptable to the general practice setting. OBJECTIVE: This article describes a project aimed to adapt current programs to the needs of GP teachers, and present them in workshops around Tasmania. DISCUSSION: The adapted program was well received by workshop participants, who reported significant increase in knowledge and skill in teaching, and a change in attitude to teaching in their practices. The program will be continued and expanded to encourage more GPs, general practice registrars and senior medical students to teach on the run.

Australia↗
PubMed1999

Patient participation groups in general practice in the National Health Service.

General practice remains the organizational hub of first level health services in the United Kingdom. Patient participation groups are probably the most well known model for public participation in this setting and, although still not widespread, they have been a slowly expanding area of development for almost three decades. This paper sets out to critically asses patient participation groups in general practice by considering the context of their development and reviewing the research literature about groups. Critical issues needing more study and key methodological challenges are then discussed. Patient participation groups have been a somewhat shifting and contested phenomenon, embracing trends and changing as policy priorities have changed over the years. There is some evidence to think that they might have potential as a local element within a public participation strategy in the National Health Service. However, the field studies are very limited and more research of a better quality is needed. The state of knowledge is not adequate to be able to say with any confidence if or how such groups should be developed. A better understanding is needed of the public's perspectives on this and other models of participation. There are many other questions to do with patient participation groups' purpose, equitable access, and effectiveness that need to be addressed. The methodological challenges include issues of how to involve all stakeholders in the research process; and how to study less tangible aspects of general practice organization, such as culture and power, that effect the public's participation.

Journal Article↗
PubMed2004

[The practice guideline 'Atrial fibrillation' from the Dutch College of General Practitioners; a response from the perspective of general practice].

The practice guideline 'Atrial fibrillation' (AF) from the Dutch College of General Practitioners is a clearly written survey on the diagnosis and treatment of AF in general practice. Rapid cardioversion is no longer an indication for acute referral in AF. As AF, heart failure and COPD often occur simultaneously among elderly people, the exact cause of the symptoms can be unclear. In these complicated cases, with the risk of polypharmacy, a single consultation between general practitioner and cardiologist would be more effective. For control of the rate of ventricular contraction during the treatment of AF, lipophilic beta-blockers are preferable to hydrophilic beta-blockers because the pharmacokinetics in elderly people are substantially different. When there is a high risk of thrombo-embolic complications with AF, treatment with coumarin derivatives is advised. However, little research has been done on this subject among elderly people in a general practice setting. In this age group, the risk of complications due to treatment with coumarin derivatives is sometimes higher than the advantages it offers. This is why the GP should always consider carefully whether or not elderly people with AF should be treated with coumarin derivatives.

Age Factors↗
PubMed2002

The relation between sale of antimicrobial drugs and antibiotic resistance in uropathogens in general practice.

BACKGROUND: Overuse of antimicrobial drugs has resulted in an alarming increase in bacterial resistance in most countries. The relevance for general practice is unknown. OBJECTIVE: To evaluate the impact of the sale of antimicrobial drugs on bacterial resistance as found in uropathogens from general practice. SETTING: General practice in Belgium and Norway. METHODS: Observational study. RESULTS: The sale of antimicrobial drugs indicated for use in the treatment of urinary tract infection was four times higher in Belgium than in Norway (18.5 vs 4.4 DDD/1000 inhabitants/day). The antibiotic resistance reported by microbiological laboratories as valid for general practice was significant higher in Belgium than in Norway (ampicillins (44% vs 27%), co-trimoxazole (28% vs 17%), fluoroquinolones (12% vs 2%) and nitrofurantoin (16% vs 11%, p < 0.0001 for all). However, the antibiotic resistance found in urine samples from dysuric women in general practice was similar (trimethoprim 14% vs 12%, co-trimoxazole 14% vs 11%, nitrofurantoin 7% vs 3%), except in the case of ampicillins (30% vs 19%, p < 0.05). CONCLUSION: The impact of the antimicrobial sale on resistance in uropathogens seems less than expected at the general practice level, even though local microbiological reports mention fairly high antibiotic resistance data. Adapted methods for following-up bacterial resistance evolution in general practice are needed.

Acute Disease↗
PubMed1991

A new hospital general practice teaching unit.

The formation of the latest General Practice Teaching Unit in an Australian hospital is part of a national trend to teach undergraduates and post-graduates about some parts of general practice using patients separated at triage from the accident and emergency departments. Planning this unit required much negotiating between several institutions and a set of guidelines on organisational relationships was created. Innovative features of the Modbury General Practice Teaching Unit include payment of teachers to attend compulsory medical education workshops, dividing the Family Medicine Programme trainee's time between the unit and a neighbouring practice and payment of non-academic general practitioner teachers by the South Australian Government, which eliminates the risk that service interferes with teaching. The Modbury General Practice Teaching Unit is currently the only hospital based unit of this kind in South Australia.

Clinical Clerkship↗
PubMed1992

Use of thermometers in general practice.

OBJECTIVE: To identify the attitudes of general practitioners towards the use of thermometers in general practice. DESIGN: Postal questionnaire survey. SETTING: All general practitioners in the catchment area of Frimley Park Hospital, Surrey. SUBJECTS: 145 general practitioners. MAIN OUTCOME MEASURES: Answers to questions covering a variety of aspects concerning the use of thermometers in general practice. RESULTS: 116 (80%) doctors replied. Seven doctors did not have any method of taking a patient's temperature; up to 12 more doctors did not use their thermometers and 56 doctors used them infrequently, less than once a fortnight. Mercury glass thermometers were most commonly used (80 doctors; 69%), but only 8% of doctors used them correctly. Six doctors failed to clean their thermometers between patients. The study failed to identify the roles of axillary and rectal temperature readings. CONCLUSION: There is a wide variation in attitudes towards the use of thermometers in general practice.

Attitude of Health Personnel↗
PubMed1997

Validation of current practice and a near patient testing method for oral-anticoagulant control in general practice.

When oral anticoagulant control is monitored in general practice, venous blood samples are usually transported to a central laboratory for determination of international normalized ratio (INR). An alternative is near patient testing by a commercial method. In a rural general practice 27 km from a central haematology laboratory, whole blood samples were drawn from patients receiving oral anticoagulants and analysed by three methods: after centrifugation, plasma separated and frozen in liquid nitrogen, transported to the laboratory, thawed and immediately analysed (control); courier transport of citrated sample to the laboratory for analysis (routine); near patient testing of whole blood sample (NPT). Maximum temperature achieved and time to analysis for routine samples were recorded. 306 complete sets of data were obtained. Comparison between the routine method and the control method revealed acceptable agreement. On multiple regression analysis, maximum temperature achieved did not contribute to differences observed but time to analysis of over 5 hours did make a significant contribution. Comparison between the NPT method and control method showed acceptable agreement, with persistent under-recording by the NPT method. The routine method for INR determination was validated as robust and reproducible with the proviso that needle-to-analysis time should be kept below 5 hours. The NPT method was valid under conditions of normal general practice. Strict quality control of NPT methods is essential if performance is to be comparable with that of established methods.

Anticoagulants↗
PubMed2004

Quality of diagnostic coding and information flow from hospital to general practice.

AIMS: To describe the transfer of patient information from hospital to general practice and compare the quality of coding of patient diagnoses in hospital and general practice systems. METHOD SETTING: Wellington Hospital and patients registered with 12 general practitioners (GPs) from two local computerised general practices. Discharge and outpatient letters for the period June to August 2003 were analysed and diagnostic coding compared between letters and electronic health records (EHR) in hospital and general practice. A questionnaire was sent to 167 consultants and 112 GPs from Wellington city region with a 71% response rate. RESULTS: GPs received 55% of 284 discharge letters and 97% of 612 outpatient letters with a mean time of 9.4 days (range 0-70 days) and 14 days (range 0-120 days). The mean number of diagnostic codes recorded in discharge letters was 2.9 per letter, in the GPs' EHR 0.9 per letter, and in the hospital EHR 3.5 per letter. GPs were sent new diagnostic information in 30% of discharge and 36% of outpatient letters. There was more coding agreement between GPs' EHR and discharge letters than between the hospital EHR and discharge letters (65% versus 35%). GPs duplicated coding for 71% of all letters, and 74% of diagnoses were coded within the classification section of the GPs' EHR. More GPs than hospital doctors coded patient diagnoses (85% versus 15%), had any formal training in coding (25% versus 2%), and thought coding improved patient care (75% versus 50%). Most doctors in both groups experienced considerable delay of information flow and favoured an electronic transfer of information. CONCLUSIONS: There is delay in information flow from hospital to general practice and poor comparison of diagnostic coding across the two systems. Attitudinal differences and inefficient coding practices will need to be addressed to produce an integrated information system between hospital and general practice.

Adolescent↗
PubMedDate not supplied

The changing face of nurses in Australian general practice.

OBJECTIVE: To describe the workforce characteristics and current responsibilities of nurses working in Australian general practice settings. DESIGN: Survey research combining qualitative and quantitative data collected through telephone interview. SUBJECTS: 222 enrolled (RN Division 2 in Victoria) and registered nurses (RN Division 1 in Victoria) working in general practice in rural and urban areas of Australia. RESULTS: General practice nurses in Australia are likely to be RNs (84.7%) who work on a part-time basis (75.3%) in a medium to large practice (93.7%). Often the nurse has worked less than five full time equivalent years (52.3%) in a general practice environment and is likely to work in a practice where at least one other nurse works (64.4%). The nurse is likely to have some post-basic formal education (65.9%), and to have participated in professional development in the past two years (94.9%). The nurse performs a diverse range of activities within the general practice. No substantial differences were found in the workforce characteristics or role of urban and rural general practice nurses. CONCLUSION: It appears that nurses working in general practice are no longer the 'handmaiden' to the doctor but are professionals who perform a vast range of clinical, administrative and organisational responsibilities within the general practice primary health care setting.

Australia↗
PubMed1986

European general practice research workshop (EGPRW). Is international cooperation worth while?

General practice is a novice in the academic world. We need to stand together both nationally and internationally to establish general practice as a true academical discipline. To strengthen our credibility we have to do research of high quality. European General Practice Research Workshop (EGPRW) is a partly unformal international body with the aim "to encourage research, to foster and coordinate multinational studies, to exchange experiences and with it develop a validated international scientific base for general practice". The group was established November 1974 and the activities during its short existence are summarised and commented.

Congresses as Topic↗
PubMed1989

[Strategies in general practice].

The strategies necessary for general practice are developed unconsciously. It is possible to taperecord and optimize them. This way protocols for general practice were created. These specific tools can be used as parameters to evaluate intuitive consulting on the medical front-line. Investigating the basic problems showed that the concept diagnosis and the regularities of cases distribution keep a central position in that new region of medical research. In the future highest priority should be given to the task to develop a defined nomenclature applicable in the innumerable cases in which by generalists an exact diagnosis can not be made.

Curriculum↗
PubMed1981

The problem-solving model of diagnosis in general practice.

The lack of vocational training for general practice in South Africa places the newly qualified doctor in practice with only the teaching hospital-based model of diagnosis at his disposal. The inappropriateness of this model for general practice is examined. Most experienced general practitioners have evolved their own systems of diagnosis, which are usually problem-solving. The appropriateness, validity, and special applicability of the problem-solving model of diagnosis to general practice is demonstrated.

Diagnosis↗
PubMed1996

Influences on prescribing in non-fundholding general practices.

BACKGROUND: The experience from general practice fundholding suggests that financial incentives may influence prescribing; guidelines and hospital prescribing are two other suggested influences. AIM: A study was undertaken to establish general practitioners' attitudes to a financial prescribing incentive scheme, the presence and use of guidelines, and the influence of prescribing initiated within secondary care. METHOD: A postal questionnaire survey of non-fundholding general practices in the former Northern Region was conducted. RESULTS: Practices' thinking and subsequent decisions about the incentive prescribing scheme were most often influenced by discussions within the practice (45%). Those practices that achieved their savings under the incentive scheme were less likely than those not achieving savings to feel that the target was not achievable, the time scale was unacceptable, and that the philosophy behind the scheme was unacceptable. Forty-five per cent of practices received advice from neither a medical nor a pharmaceutical adviser; 27% of practices received advice from both, 12% from a medical adviser only and 16% from a pharmaceutical adviser only. Of the practices that tried to make their target savings, 91% intended to increase generic prescribing; fewer than one-third of practices mentioned any other measure. Prescribing guidelines were reported by a minority of practices, although reported rates of use were high when these were present. Clinical guidelines for three conditions, asthma, diabetes and hypertension, were present in more than 50% of practices; 25% of practices had no clinical guidelines. Hospital prescribing was reported as 'always' or 'usually' influencing prescribing for diabetes by 57% of respondents, ischaemic heart disease by 55%, peptic ulceration by 49%, asthma by 42% and hypertension by 39%. CONCLUSIONS: General practitioner prescribing is influenced by a complex web of factors, with no single factor pre-eminent. To understand this area further, there is a need to take each of these areas and ascertain the match between doctors' perceptions and actual practice.

Attitude of Health Personnel↗