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Qualities of a good training practice--perceptions of advanced general practice registrars.

BACKGROUND: General practice registrars report satisfaction with their placements in Australian training practices. However, more needs to be known about which criteria comprise this global satisfaction. METHOD: A questionnaire was sent to 61 general practice registrars in Western Australia who had recently completed a 6 month advanced term in a training practice, seeking feedback on the practice. They were asked to mark the training practice on a scale of one (lowest) to 10 (highest) according to how well the training practice met a range of criteria. RESULTS: General practice registrars who rated their training practice highly believed the required amount of effective teaching and supervision had been provided to them during the placement, and adequate time made available for consultations, case reviews, discussion, and tuition. DISCUSSION: General practice registrars rating their training practice highly were more likely to have been allowed time to undertake outside education activities. Registrars not rating their training practices highly may be compromised by clinical service commitments. Registrars who believed members of the practice staff (medical and nonmedical) other than the general practice trainer had contributed to their learning were more likely to rate their training practice highly.

Adult↗

Trends in psychotropic prescribing in general practice and general medical patients.

Psychotropic drug prescribing in 1280 medical inpatients between 1973-75 was compared with that in 1200 similar patients during 1982-83. Three benzodiazepines accounted for 64% of prescriptions in 1973-75 and nine benzodiazepines for 82% of prescriptions in 1982-83. Over the decade, use of psychotropic drugs fell from 56% to 38% (P less than 0.001), primarily due to a reduction in patients treated only in hospital (34% vs 16%, P less than 0.001). Before admission, the proportions of patients receiving these drugs were similar (17% vs 18%). During admission, concomitant administration of similar drugs declined from 22% of patients in 1973-75 to 11% in 1982-83 (P less than 0.001), while concurrent prescribing before admission increased from 13 to 19%. The marked fall in psychotropic drug use and in inappropriate concomitant therapy indicates an encouraging trend towards more rational drug use at least in hospital. This was achieved without fiscal control and further rationalization of prescribing habits may be achieved by self-audit within the profession without legislative action.

Adolescent↗

Otitis externa in UK general practice: a survey using the UK General Practice Research Database.

BACKGROUND: Otitis externa is a common clinical problem in general practice and yet there are remarkably few data available on the demographic characteristics of patients with this condition and the approaches used by general practitioners (GPs) in the United Kingdom (UK) to manage it. AIM: To define the descriptive epidemiology of otitis externa in the general population, to describe the first-line drug treatment used by UK GPs, and to determine factors related to second disease episodes. DESIGN OF STUDY: Epidemiological data survey. SETTING: All cases of otitis externa occurring in 1997 in practices contributing data to the UK General Practice Research Database. METHOD: Data were extracted on age, sex, date of episode of otitis externa, treatment prescribed, co-existing diagnoses of eczema and diabetes, referral to ear, nose, and throat departments and occurrence of subsequent episodes of disease. Arbitrarily a second episode of disease was defined as persistence if it occurred at 28 days or fewer after the first episode and recurrence if it occurred at more than 28 days after the first episode. RESULTS: A diagnosis of otitis externa was common in all age groups and, except in the elderly, was more common in females than males. There was an increase in disease episodes at the end of the summer in all age groups except the 60 years and over group. In the majority of cases GPs prescribed ear drops (85%), but a significant proportion of patients were also prescribed oral antibiotics (21%). Referral to secondary care was uncommon (3%). Among patients prescribed ear-drop formulations, those containing both steroid and antibiotic or steroid alone were used most commonly and were associated with the lower rates of disease persistence but not recurrence. Among patients prescribed antibiotics, penicillins were prescribed most commonly. Disease persistence rates, and to a lesser extent disease recurrence rates, were higher in patients prescribed oral antibiotics. CONCLUSION: Otitis externa is a common condition and GPs can expect to see an excess of cases at the end of the summer. Topical ear drops are the most common treatment used in the UK. Patients prescribed steroid or steroid/antibiotic combination ear drops have fewer subsequent consultations for otitis externa over the following 28 days.

Adolescent↗

Community and participation for general practice: perceptions of general practitioners and community nurses.

A central theme of health policy has concerned the public's participation in primary health care services, both as individual consumers and collectively as communities. In the U.K. primary care increasingly centres on general practice. This paper reports an exploratory study undertaken with practice teams in inner city Sheffield about community participation. The study design was influenced by a grounded theory approach to data collection and analysis. The main data collected was from interviews of 23 general practitioners, 20 practice nurses, 11 health visitors and 7 district nurses. Concepts of community and participation were explored by interview with these primary care workers. Typologies of community and participation for general practice are presented in the findings, along with associated strategic positions and political tensions. The discussion highlights a number of tensions and issues concerning community participation when primary care is organized around general practice.

Attitude of Health Personnel↗

Monitoring health inequalities through general practice: the Second Dutch National Survey of General Practice.

BACKGROUND: For the second time a plan to monitor public health and health inequalities in the Netherlands through general practice was put into action: the Second National Survey of General Practice (DNSGP-2, 2001). The first aim of this paper is to describe the general design of DNSGP-2. Secondly, to describe self assessed health inequalities in the Netherlands. Thirdly, to present differences in prevalence of chronic conditions by educational attainment using both self-assessed health and medical records of GPs. Finally, inequalities in 1987 (DNSGP-1) and 2001 will be compared. METHODS: Data were collected from 96 (1987) and 104 (2001) general practices. The data include background information on patients collected via a census, approximately 12,000 health interview surveys per time point and more than one million recorded contacts of patients with their GPs in both years. The method of statistical analysis is logistic regression. RESULTS: The analyses shows that the lower educated have significantly higher odds of feeling unhealthy and having chronic conditions in 2001. Diabetes and myocardial infarction (GP data) showed the largest difference in prevalence between educational groups (OR 2.5 and 2.4, self-reported data). The way the data is collected (self-assessment versus GP registration) hardly affects the magnitude of the educational differences in the prevalence of chronic conditions. The pattern of health inequalities across chronic conditions in 1987 and 2001 hardly differs. Diabetes doubled in prevalence and health inequalities were not significant in 1987, but compared to the other conditions were largest in 2001 (OR 1.1 versus 2.5). CONCLUSION: Health inequalities were shown to be substantial in 2001 and persistent over time. Socio-economic differences were shown to be similar using self-assessed health data and GP data. Hence, a person's educational attainment did not appear to play a part in presenting health problems to the GP.

Adult↗

General practice east of Eden: an overview of general practice in Eastern Europe.

AIM: To review the status of family medicine in Eastern European countries, specifically the position of the discipline within the health care system, its academic status, and expected trends in the development of the discipline. METHODS: We used available data in the literature and information gathered from personal contacts with members of European Society of General Practice/Family Medicine (ESGP/FM) expert groups, European Academy of Teachers in General Practice (EURACT), and European General Practice Research Network (EGPRN). Personal interviews with key informants from countries that do not have members in these organizations were used. We also performed a Medline search using terms "primary health care" and "family medicine". RESULTS: It was difficult to get standardized information about the issues addressed. In some countries, contact persons and articles were impossible to find. Because of that, information from some countries is lacking (e.g. Belarus, Ukraine, the Kavkaz states and Central Asian republics). The information from the 14 countries showed that family medicine was formally widely recognized as a specific discipline. In 13 of them, there were some programs of vocational training. In 10 countries, academic recognition has resulted in rapid development in the past two decades, especially after 1989, but in Bulgaria and Moldova we found no evidence of family medicine departments. CONCLUSION: The position of general practice in most Central and Eastern European countries is formally adequate, but a lot of effort will still be needed to achieve the desired level of its recognition and quality.

Europe, Eastern↗

National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards.

The Nederlands Huisartsen Genootschap (NHG), the college of general practitioners in the Netherlands, has begun a national programme of standard setting for the quality of care in general practice. When the standards have been drawn up and assessed they are disseminated via the journal Huisarts en Wetenschap. In a survey, carried out among a randomized sample of 10% of all general practitioners, attitudes towards national standard setting in general and to the first set of standards (diabetes care) were studied. The response was 70% (453 doctors). A majority of the respondents said they were well informed about the national standard setting initiatives instigated by the NHG (71%) and about the content of the first standards (77%). The general practitioners had a positive attitude towards the setting of national standards for quality of care, and this was particularly true for doctors who were members of the NHG. Although a large majority of doctors said they agreed with most of the guidelines in the diabetes standards fewer respondents were actually working to the guidelines and some of the standards are certain to meet with a lot of resistance. A better knowledge of the standards and a more positive attitude to the process of national standard setting correlated with a more positive attitude to the guidelines formulated in the diabetes standards. The results could serve as a starting point for an exchange of views about standard setting in general practice in other countries.

Attitude of Health Personnel↗

What problems do patients present with outside normal general practice surgery hours? A prospective study of the use of general practice and accident and emergency services.

BACKGROUND: This study was designed to address some current issues concerning the use of general practice and accident and emergency (A & E) services outside normal surgery hours. METHOD: Six general practices in Nottingham (with a combined population of 46,698 patients) were recruited to take part in the study. Over a six month period, data were collected on patient contacts with general practice services and the local A & E department outside normal surgery hours. RESULTS: General practice services dealt with 63 per cent of first contacts over the course of the study. There were 3181 (136 per 1000 patients per year) contacts with general practitioners and deputizing service doctors (of which 1009 (31.7 per cent) were dealt with by telephone alone) and 1876 (80 per 1000 patients per year) attendances at the A & E department. There were marked differences in the distribution of problems that patients presented to the two types of service. The proportion of presentations dealt with by telephone alone by general practice services varied with the type of presentation. However, the use of the telephone was not particularly high, even for problems such as a sore throat. CONCLUSIONS: Given the differences in presentations to both general practice and A & E services there may be limited scope for altering patients' consulting patterns without making significant changes to service provision. However, there may be scope for increasing the proportion of general practice contacts dealt with by telephone alone.

Accidents↗

Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices.

OBJECTIVE: To identify the socioeconomic determinants of consultation rates in general practice. DESIGN: Analysis of data from the fourth national morbidity survey of general practices (MSGP4) including sociodemographic details of individual patients and small area statistics from the 1991 census. Multilevel modelling techniques were used to take account of both individual patient data and small area statistics to relate socioeconomic and health status factors directly to a measure of general practitioner workload. RESULTS: Higher rates of consultations were found in patients who were classified as permanently sick, unemployed (especially those who became unemployed during the study year), living in rented accommodation, from the Indian subcontinent, living with a spouse or partner (women only), children living with two parents (girls only), and living in urban areas, especially those living relatively near the practice. When characteristics of individual patients are known and controlled for the role of "indices of deprivation" is considerably reduced. The effect of individual sociodemographic characteristics were shown to vary between different areas. CONCLUSIONS: Demographic and socioeconomic factors can act as powerful predictors of consultation patterns. Though it will always be necessary to retain some local planning discretion, the sets of coefficients estimated for individual level factors, area level characteristics, and for practice groupings may be sufficient to provide an indicative level of demand for general medical services. Although the problems in using socioeconomic data from individual patients would be substantial, these results are relevant to the development of a resource allocation formula for general practice.

Adolescent↗

Perceived and presented morbidity in general practice. A study with diaries in four general practices in The Netherlands.

In four general practices in The Netherlands, 277 respondents reported in a diary on perceived morbidity during four weeks. Data of presented morbidity were provided by the general practitioners in these practices, who were accustomed to morbidity registration. As a mean, one complaint was reported every three or four days. Most complaints concerned disorders of the musculo-skeletal system, psychological disorders, and disorders of the upper respiratory tract and the digestive tract. About one-third of all complaints led to medicine taking. According to the GPs' records, one in five of the respondents consulted their GP. Approximately 10% of the complaints were reported to the GP. There was a connection between family members with respect to the frequency of reporting complaints. Because of selection of participating practices, families and respondents, the result can not be applied to the Dutch population as a whole. The results of this study agree with most of the literature on this subject.

Family Practice↗

Dyspepsia in general practice in Denmark. A 1-year analysis of consulters in general practice.

OBJECTIVE: To estimate the incidence rate of patients with dyspepsia in general practice, related to age, gender and dwelling and to classify the patients into dyspepsia subgroups. DESIGN: In a background population of 123,610 persons under the National Health Insurance System a systematic, prospective registration of dyspepsia patients consulting in general practice was done. Each patient was subject to a structured interview covering 18 dyspepsia symptoms and six alarm symptoms. A diagnostic chart was used to classify the patients into subgroups. SETTING: General practice: 93 general practitioners in 63 centres in Denmark. PATIENTS: Patients consulting the general practitioner with dyspepsia as their main complaint. RESULTS: 4215 dyspepsia patients were registered within 1 year. The annual incidence rate of dyspepsia was 3.4%. Alarm symptoms were present in 11.7% of the patients. The highest incidence rates were related to middle age, female gender and rural dwelling. Of these 34% had dysmotility-like, 30% had reflux-like, 17% ulcer-like and 3% uncharacteristic dyspepsia, while 16% were classified into two or more groups. Dysmotility-like dyspepsia was predominant in women and reflux-like dyspepsia was predominant in men. CONCLUSIONS: Within 1 year 34 patients out of 1000 will seek medical advise in general practice with a new episode of dyspepsia. Based on the registration of symptoms 28 of 34 can be classified into a single subgroup of dyspepsia; 4 of 34 patients will present with one or more alarm symptom.

Adolescent↗