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At least 1,045 records · Page 58Linked to original sources
PubMed2006

Responses to homeopathic treatment in National Health Service general practice.

OBJECTIVE: To assess homeopathic consultations in NHS general practice over a 12-month study period; to analyse the conditions treated homeopathically and assess the responses to homeopathy prescribed in a standard 10 min GP consultation. METHODS: Data on each homeopathic consultation over 12 months were recorded: including patient details; condition/diagnosis; response score; prescribed medicine; prescribing strategy; medical specialty category. Clinical response was scored using a modified version of the Glasgow Homeopathic Hospital Outcome Scale. RESULTS: Over the 12-month study period, a total of 5,331 consultations were conducted within the general practice; 489 (9%) of these consultations were homeopathic. A wide variety of conditions were treated homeopathically, 78% of patients had a positive clinical response, 19% no response, 3% negative response. Analysis of the prescribing strategies demonstrated that 73% of the homeopathic prescriptions were issued using the 'problem-based' strategy. The remainder were 'patient-based' (19%), 'context-based' (4%) and 'combined' (4%) strategies. CONCLUSIONS: This study illustrates the varied and successful application of homeopathy within the general practice setting. Response scores reveal the beneficial effects of homeopathic treatment. This study supports the use of homeopathy within NHS general practice, delivered in a 10 min consultation.

Adolescent↗
PubMed2003

Setting standards based on patients' views on access and continuity: secondary analysis of data from the general practice assessment survey.

OBJECTIVES: To examine patients' views on access and continuity in general practice to derive quality standards. DESIGN: Secondary analysis of data from general practice research studies and routine quality assessment activities undertaken by practices and primary care trusts. SETTING: General practice. PARTICIPANTS: General practice patients. RESULTS: Satisfactory standards of access were next day appointments with general practitioners and a 6-10 minute wait for consultations to begin. A satisfactory level of continuity was seeing the same general practitioner "a lot of the time." Standards varied with the analytic method used and by sociodemographic group. CONCLUSIONS: Standards expected by patients in primary care can be derived from linked report-assessment pairs. Patients may have expectations of access that are in excess of government targets. Patients also have high expectations of continuity of care. It is unclear the degree to which such standards are reliable or valid, how conflicts between access and continuity should be resolved, or how these standards relate to other priorities of patients such as high quality interpersonal care.

Adolescent↗
PubMed1998

A decade of caring for drug users entirely within general practice.

BACKGROUND: The government encourages general practitioners (GPs) to become involved in caring for drug users. However, in some areas of the country, including Bedford, secondary care support is inadequate. GPs in these areas have to decide how to cope with such patients entirely within general practice. AIM: To assess the characteristics and quality of care given without secondary care support to drug users by one practice in Bedford over a decade. METHOD: A search was made of the practice computer for all patients with a problem title of 'addiction drug' between 1986 and 1995. The age, sex, social characteristics, and drug history were recorded. RESULTS: One hundred and ninety-two patients were found, of which 155 took part in the practice programme; i.e. they consulted more than three times. Forty-three patients (37%) who took part and were prescribed Methadone were prescribed this drug as ampoules. Sixty-three patients (40.6%) who took part in the programme stopped using drugs. Thirty-two (33.6%) of the Methadone users became abstinent. A higher proportion of women (13-48%) than men (19-27.7%) stopped using Methadone (P = 0.019). Among patients who had a stable lifestyle, a higher proportion had been prescribed ampoules than mixture (22 out of 28: 78.6%; P = 0.001). Similarly, of those who had a job, eight out of 11 (72%; P = 0.037) had been prescribed methadone ampoules. Two-thirds of all patients prescribed amphetamines stopped using drugs. CONCLUSION: Long-term care of drug users entirely within general practice is feasible. Among those prescribed methadone ampoules, a higher than average proportion had stable lifestyles and had a stable job.

Adolescent↗
PubMed2004

The contribution of demographic and morbidity factors to self-reported visit frequency of patients: a cross-sectional study of general practice patients in Australia.

BACKGROUND: Understanding the factors that affect patients' utilisation of health services is important for health service provision and effective patient management. This study aimed to investigate the specific morbidity and demographic factors related to the frequency with which general practice patients visit a general practitioner/family physician (GP) in Australia. METHODS: A sub-study was undertaken as part of an ongoing national study of general practice activity in Australia. A cluster sample of 10,755 general practice patients were surveyed through a random sample of 379 general practitioners. The patient reported the number of times he/she had visited a general practitioner in the previous twelve months. The GP recorded all the patient's major health problems, including those managed at the current consultation. RESULTS: Patients reported an average of 8.8 visits to a general practitioner per year. After adjusting for other patient demographics and number of health problems, concession health care card holders made on average 2.6 more visits per year to a general practitioner than did non-card holders (p <.001). After adjustment, patients from remote/very remote locations made 2.3 fewer visits per year than patients from locations where services were highly accessible (p <.001). After adjustment for patient demographics, patients with diagnosed anxiety made on average 2.7 more visits per year (p = 0.003), those with diagnosed depression 2.2 more visits than average (p <.0001), and those with back problems 2.4 more visits (p = 0.009) than patients without the respective disorders. CONCLUSIONS: Anxiety, back pain and depression are associated with greater patient demand for general practice services than other health problems. The effect of sociodemographic factors on patient utilisation of general practice services is complex. Equity of access to general practice services remains an issue for patients from remote areas, while concession health care card holders are attending general practice more frequently than other patients relative to their number of health problems.

Adolescent↗
PubMed1994

A randomized trial of immediate discharge of surgical patients to general practice.

BACKGROUND: This study compares, in clinical and economic terms, out-patient follow-up with immediate discharge to general practice of patients undergoing any one of 29 defined surgical procedures. METHODS: A randomized controlled trial was undertaken in which patients recruited from two general surgery wards in Ninewells Hospital, Dundee, were randomized to follow-up care in the out-patient clinic or in general practice. Outcome was measured as clinical effectiveness in terms of morbidity and mortality; economic costs to the hospital compared with general practice; patient benefits and satisfaction; and General Practitioners' (GPs') opinions of the system. RESULTS: A total of 455 patients were randomized to outpatient and 454 to general practice follow-up. They were followed up for a minimum of six months. There were no differences in readmission rates, mean number of operations or mortality. The difference between the groups in the total health service costs was very small (2.68 pounds per patient more for those receiving out-patient follow-up). More of the general practice group preferred general practice care than the out-patient group preferred out-patient care (p = 0.03). The patient's travel costs and travel and treatment time were greater for the out-patient group (27.99 pounds, 113 min) than for the general practice group (24.90 pounds, 82 min). The GPs felt they had been given adequate information in the discharge documentation and were willing to accept immediate discharge as normal policy, although they expected it to increase their workload. If immediate discharge were instituted, the time saved in an out-patient clinic session of 40 patients would be an estimated 54 minutes, enough to see three extra new patients. CONCLUSION: General practice based follow-up care for this group of patients is as effective as, but less costly than outpatient care and is acceptable to GPs. Because of only small differences in costs between the two forms of follow-up, real gains to the health service will depend on the use of the time freed by a reduction in follow-up appointments in the out-patient clinic.

Aftercare↗
PubMed2002

[Renaissance of general practice].

Special research work has taught that general practice (family medicine) is a specialization of its own. It requires specific education and vocational training. As far as universities and administrative bodies have accepted it no doctor can start practising family medicine unless he has passed a vocational training of many years duration. That fact together with a successful continued research concerning applied general practice should initiate a true renaissance of general practice.

Austria↗
PubMed1996

Real world data--retrieval and validation of consultation data from four general practices.

OBJECTIVE: We aimed to retrieve data on consultations from general practice databases and to develop and use appropriate methods of validation for these data. METHOD: MIQUEST software was used to retrieve the data from four practices. The data were validated by comparing them with figures generated by practice-based searches, measuring the uptake of recording of consultations over time, and comparing records of consultations in the case notes with those on the practice computers. RESULTS: The required data were retrieved from general practice databases, but the path to success was difficult, and typified by uncertainty and unpredictability. The recording of consultations on the computers of four practices was more complete than the recording in the paper case records. There was a time period in the early months of computer use when the recording of consultations was less complete. There were differences in the completeness of recording consultations between practices, doctors, and patients. CONCLUSIONS: This study confirms the potential of general practice databases for research, demonstrates how MIQUEST software can be a useful tool in retrieving data from general practice databases, and indicates how the completeness of data recording permitted further analysis for the purposes of our study.

Data Collection↗
PubMed1989

The influence of practitioner and practice characteristics on service activity levels in a New Zealand general practice sample.

The impact of practitioner and practice-related characteristics on service activity levels in general practice is assessed. It is hypothesized that while initial medical contact is largely patient-initiated and hence influenced by broader social factors, the subsequent provision of services within the medical system is more likely to be determined by organisational and professional factors. The data are drawn from a one per cent sample of all weekday general practice office encounters in the Hamilton Health District recorded over a twelve-month period from February 1979. The average encounter involved three services: typically a history or examination, a prescription and a request for follow-up. Activity levels were measured as the number of services received from the general practitioner by patients in the course of the medical encounter. The broad social characteristics of patients had little impact on activity level. Descriptors of patient health condition, and related attributes such as age and gender, were only moderately predictive of the number of services received. Practitioner and practice-related characteristics seemed to exert little influence, even after controlling for case mix. The strongest predictor of the number of services provided was the identity of the patient's doctor. Of the 30 per cent of variation in total service use explained by the model, half was accounted for by practitioner identity.

Age Factors↗
PubMed2004

Are general practice registrars prepared for immunisation? A cross sectional survey.

OBJECTIVE: To describe undergraduate formal training on immunisation as remembered by general practice registrars and its perceived helpfulness. SETTING AND METHODS: Self completed questionnaire by all general practice registrars in advanced general practice terms (second 6 months of general practice) in New South Wales during 2002. RESULTS: Formal undergraduate training in immunisation was reported by 68% (84/123) of respondents. The 20% who remembered formal practical training were significantly more likely to rate it as helpful (OR: 1.7 p<0.05). Only 33% recalled a practical session offered by one university during an undergraduate paediatrics rotation. The most frequent training request was for practical experience, and the most commonly used print resource was the Australian Immunisation Handbook. DISCUSSION: General practice registrar access to a training session on practical immunisation techniques and childhood immunisation before commencing the basic general practice term might be helpful. Registrars should automatically receive a copy of the Australian Immunisation Handbook which might address perceived education needs.

Attitude of Health Personnel↗
PubMed1990

Near patient testing in general practice: a review.

Until recently, technological advances in general practice have generally been thought of as the applications of microcomputers in practice organization and record keeping. Advances in miniaturization and versatility of diagnostic technology will have a similarly large impact on the way general practitioners practice medicine in the next decade. This article reviews some of the newer tests that are already available to general practitioners, particularly in diagnostic biochemistry and microbiology. Preliminary evaluative work and research studies in general practice are also described.

Blood Chemical Analysis↗