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At least 127 records · Page 7Linked to original sources
PubMed1998

Influence of social problems on management in general practice: multipractice questionnaire survey.

OBJECTIVES: To find how often social problems influence clinical management in general practice, how management is changed, and how the characteristics of patients, doctors, and the doctor-patient relationship influence this management. DESIGN: Multipractice survey of patients consulting general practitioners. Doctors completed a questionnaire for each patient. SETTING: General practices in Buskerud county, Norway. SUBJECTS: 1401 consecutive adult patients attending 89 general practitioners. MAIN OUTCOME MEASURES: How often management of patients was influenced by different types of social problem and main reasons for consultation; frequency and intercorrelation of different types of management applied; odds ratios for social problems' influence on management, controlled for by characteristics of doctors, patients, and their relationship. RESULTS: In 17% of all consultations the doctors' knowledge of patients' social problems influenced their management, stressful working conditions being the most frequent influencing type of problem. Knowledge of social problems influenced management more often when the doctor knew a patient well, but less often the longer a doctor had worked in a practice. When social problems influenced management, the commonest types of management offered were extra time for consultation (51%), advice (42%), authorisation of sick leave (28%), and prescription of a psychotropic drug (20%), while referral to community services was used in 2.6% of these consultations. Prescription of a psychotropic drug was positively correlated with use of extra time, and was made more often by female doctors. CONCLUSIONS: Patients' social problems influenced choice of management in at least a sixth of consultations. Prior knowledge of the patient, the doctor's time in present practice, age and sex of the patient, and sex of the doctor significantly influenced management of patients.

Adult↗
PubMed2006

Prenatal office practices regarding infant feeding choices.

The objective of this study was to determine the obstetric care providers' roles in breast-feeding promotion during prenatal care. A questionnaire addressing breast-feeding issues was sent to family practitioners (FP), obstetric-gynecologists (OB/GYN), and nurse midwives (NM) in Iowa, USA. All NM, 97% of FP, and 85% of OB/GYN reported asking infant feeding preference-usually only at the first prenatal visit. NM (73%) were most likely to provide extensive breast-feeding counseling. OB/GYN (68%) and FP physicians (90%) reported doing their own breast-feeding counseling. Breast examinations targeting future breast-feeding problems were done in 82% to 84% of patients. NM practices shared more information supportive of breast-feeding. Nearly all providers offered prenatal classes, but only 41% of FP offered breast-feeding classes. Free formula samples were available in 73% of FP, 54% of OB/GYN, and 36% NM offices. Pamphlets on formula feeding and also breast-feeding were readily available. Overall NM (64%) reported being strong breast-feeding advocates compared to only 13% of FP and 7% of OB/GYN. In conclusion, little promotion of breast-feeding occurs in most prenatal practice settings.

Bottle Feeding↗
PubMed1999

[Promoting health in health care organizations and hospitals? A survey of the French community in Belgium].

Health promotion concept and practices have brought many significant changes even in disease management and care settings. In the Ottawa charter, health promotion is defined as "the process of enabling people to increase control over, and to improve, their health". However, care settings are in contradiction with this process on several levels (focus on disease and not enough on health, concern more on cure than on care, etc.). The emergence of health promotion practices has been deeply questioning these features. Care institutions start to reconsider their role and missions. However, changes are slow and there has been much resistance. What is the current situation of health promotion in French speaking Belgian care institutions in 1998? The WHO EUROPE HEALTH PROMOTING HOSPITALS' (HPH) project, which officially started in 1991, aims at "promoting positive health and well-being in hospitals and beyond that, in the community". For each participating hospital, the implications of membership have an important influence on the institution and care project, because it implies adherence to the principles of the Ottawa charter on health promotion, and to the philosophy and objectives of HPH. Belgium joined the WHO project and the HPH network in 1996. It was necessary to review the situation of health care institutions in the French speaking community of Belgium in order to understand the evolution over the last years, to assess health professionals expectations and the feasibility of some actions, and to provide political decision makers with information likely to influence future decisions and choices in a positive way. This article presents the descriptive results of a survey carried out on nursing and patient education departments in health care institutions. Half of 105 hospitals answered the questionnaires sent. Out of these answers, 150 projects and actions were identified and briefly described by the institutions, which had the possibility to present a maximum of five actions. The main topics addressed were chronic diseases, psychology (conflict management, aggressiveness, ill-treatment), maternity, screening, prevention and vaccination. Regarding perspectives, 78% of actions concern disease and/or risks of disease (therapeutic or preventive perspectives) and 22% concern the maintenance or improvement of health. 90% of listed and described actions are permanent, and only 10% are selective (limited), which suggests an evolution of projects and their integration in practices. Concerning the number of projects, two aspects were analysed: the number by institution and the evolution over the last twenty years. On average, there are 3.2 actions per institution. As for the evolution, 7% of hospitals said they had at least one education action/project in 1980, 60% in 1990 and 98% in 1998. This amazing and remarkable evolution occurred simultaneously to the development of education committees, of patient education co-ordinators and/or resource persons. In this field, there was also a remarkable evolution since the creation of the first committees in 1983. Amongst the elements encouraging the development of information and health education initiatives and actions mentioned by hospital managers, the first one is a demand from the public (and patients). It is the first time, since the existence of such surveys that this factor is mentioned as the most important.

Attitude of Health Personnel↗
PubMed2002

Integrating Western medicine and Traditional Chinese medicine in GP surgeries and the community: a review of the two pilot schemes.

The popularity of complementary medicine has been relentless over the past decade. Among the most popular are Traditional Chinese Medicine (TCM) which has a long and unbroken history. This article reports on two integrated health care pilot schemes where TCM and Western medicine are merged, to varying degrees, for the benefits of patients. One of the schemes focuses on general medicine whilst the other focuses on mental health. The authors conclude that the integrated schemes have many advantages and, on the whole, are beneficial for patients. The issues involved and learning points are discussed.

Complementary Therapies↗
PubMed2006

Does proximity to clinic affect immunization rates and blood pressure?

OBJECTIVE: Primary care clinics are frequently placed in neighborhoods to improve access. Little is known whether or not this improves outcomes. We sought to determine if childhood immunization rates and adult blood pressure (BP) levels are related to proximity of home to clinic. METHOD: We conducted a retrospective chart review in a community family medicine clinic in a neighborhood grocery store (CC) and a hospital-based family medicine residency clinic (HC) in Milwaukee, Wisconsin. Randomly selected subjects included children aged 2-5 years (n = 151 CC; 241 HC) and adult continuity patients (n = 197 CC; 242 HC). ARC-GIS was used to geocode patient home addresses, and distances were analyzed using Kruskal-Wallis, Spearman's rank correlation, or Mann-Whitney test. Proportion of primary immunization by age 2 and age at completion, numerical BP, and proportion abnormal BP were each correlated to distance and driving distance to clinic. RESULTS: Median driving distance of patient to clinic was significantly less for CC than HC (children = 1.47 versus 2.35 miles, p < 0.0001; adults = 1.53 versus 3.12, p < 0.001). For each clinic, and for all subjects combined, and for subsets by gender, ethnicity and insurance status, there was no significant correlation between proportion immunized by age 2 or age at completion and linear or categorical driving distance (or linear distance) to clinic (p = 0.12-0.99), or between BP values or proportion abnormal and distances to clinic (p = 0.44-0.97). CONCLUSIONS: In this urban area, proximity of home to clinic did not correlate with primary immunization completion or blood pressure in either a hospital-based or a community clinic.

Adult↗
PubMed2004

General practitioners' knowledge of post-traumatic stress disorder: a controlled study.

BACKGROUND: Post-traumatic stress disorder (PTSD) is common, is associated with substantial morbidity, and is often not recognised in primary care. AIM: To explore whether general practitioners (GPs) have significant gaps in their knowledge of PTSD. DESIGN OF STUDY: A controlled study. SETTING: Primary care in two Scottish regions. METHOD: A validated postal questionnaire consisting of clinical vignettes for PTSD, acute stress reaction, and depression was used to gather the data. The primary outcome measures were the proportion describing 'best practice' management of PTSD and the comparison of this with the control condition, the proportion describing 'best practice' management of depression. The secondary outcome measures were comparisons of PTSD and depression by recognition, drug treatment, and referral. RESULTS: Two-thirds (67.5%) of GPs included PTSD in their differential diagnosis for the PTSD vignette, and 86.8% made a referral to secondary care for the PTSD case. A minority of GPs (42.9%) and only 54.1% of a comparison group of psychiatrists specified the drug treatment of choice for PTSD, a selective serotonin reuptake inhibitor. Only 28.3% of GPs had the knowledge to recognise PTSD and prescribe appropriately, compared with 89.8% for depression (P <0.001). Only 10.2% of GPs described best practice for PTSD, compared with 47.7% for depression (P <0.001). CONCLUSION: Lack of knowledge is among the reasons for less than ideal recognition and management of PTSD in primary care. Further research should aim to explore the implementation of PTSD guidelines in primary care.

Antidepressive Agents↗
PubMedDate not supplied

'Yarning for better health'. Improving the health of an Aboriginal and Torres Strait Islander population.

BACKGROUND: For over 2 years--as part of a broader strategy to address the health disadvantages in the Aboriginal and Torres Strait Islander population--Brisbane South Division of General Practice (BSDGP) has been involved in providing community health education to the local indigenous community. OBJECTIVE: This article discusses the 'Yarning for better health' program. DISCUSSION: The program aims to improve the local indigenous population's knowledge of health issues, particularly preventive health, and increase through community education their awareness of the role of the general practitioner. It involves local GPs presenting on health topics to different demographics of indigenous peoples in their environments; with their input and endorsement. The BSDGP provides cultural awareness training for the presenting GPs and facilitates the education with the community groups. The program has been successful in uniting two cultures and two different approaches to health.

Australia↗
PubMed2005

Experience of hepatitis C among current or former heroin users attending general practice.

The majority of injecting drug users in Ireland are infected with hepatitis C (HCV) and many attend general practice for methadone maintenance treatment. To describe awareness and experience of HCV infection, related investigations and treatment, a semi-qualitative interview study of current or former heroin users attending a general practice was carried out. Twenty-five patients (69% of total) were interviewed, of whom 23 were on methadone maintenance therapy at the time of the interview and 22 were HCV positive. While awareness of harm reduction measures and health implications of the infection was good, continued high-risk activity was common. Negative experiences at diagnosis, of subsequent investigations and treatments received were common. Only one person had been treated for HCV. We conclude there are a number of barriers to effective HCV management among heroin users and further research is needed to improve our understanding of this issue.

Adolescent↗
PubMed2006

Early recognition and early access for acute coronary syndromes in New Zealand: key links in the chain of survival.

AIMS: We studied the behaviour of patients prior to admission to hospital with symptoms of acute coronary syndromes, and what barriers may exist to early recognition of these symptoms and to early activation of emergency medical services. METHODS: Over a 7-week period, we interviewed 100 patients admitted to the Cardiac Care Unit in Wellington Hospital with suspected acute coronary syndromes. RESULTS: Within 5 minutes of symptom onset, 46 of 100 patients believed they were having a heart attack. Sixty-two of the patients believed that they had a cardiac-related problem. Patients took a median time of 90 minutes (range 0-9600 minutes) to contact a health professional from the time of symptom onset; and a median time of 228 minutes (range 33-9633 minutes) to arrive at hospital. We observed significant differences in both these end-points according to which health professional was contacted first. Patients who presented directly to hospital arrived significantly faster (median 72 minutes) than those who first called an ambulance (180 minutes) or contacted a general practitioner (485 minutes) (p=0.001, Kruskal Wallis test). CONCLUSIONS: Considerable delays exist in the presentation of patients with symptoms of ACS to hospital. These delays are multifactorial, but the psychological intimidation of the 111 telephone system and delays incurred by inappropriate out-of-hospital management of patients with chest pain are probably significant. It is likely that these delays contribute to mortality from acute coronary syndromes.

Adult↗
PubMed1995

Community resources for psychiatric and psychosocial problems. Family physicians' referral patterns in urban Ontario.

OBJECTIVE: To document the number and pattern of psychiatric and psychosocial referrals to community resources by family physicians (FPs) and to determine whether referral practices correlate with physician variables. DESIGN: Cross-sectional survey of referrals by FPs to 34 key psychiatric and psychosocial community resources identified by a panel of FPs, psychiatric social workers, psychiatric nurses, public health nurses, and the local community information service. SETTING: Regional municipality of 434,000 persons in Ontario. PARTICIPANTS: Twenty-seven of 34 (79%) community agencies identified 261 FPs who made 4487 referrals to participating agencies (range 0 to 65, median 15, mean 17.19 +/- 13.42). MAIN OUTCOME MEASURES: Number of referrals to all agencies; variables, such as physician sex, school of graduation, year of graduation, and certificate status in the College of Family Physicians of Canada, related to referral patterns. RESULTS: Referrals to outpatient psychiatric clinics, support services, and general counseling services accounted for 96% of all referrals. Physicians' average annual referral profile was as follows: 8.6 patients to a support service, 6.3 to an outpatient psychiatric service, 1.6 to a counseling service, and 0.46 to a substance abuse service. Referral profiles of individual physicians varied greatly. Female FPs made fewer referrals than male FPs to support services, but both made similar numbers of referrals to psychiatric, counseling, and substance abuse services. The more recent the year of graduation, the greater the number of referrals to psychiatric (r = 0.158, P = 0.0107) and counseling services (r = 0.137, P = 0.0272) and the higher the fraction of referrals to psychiatric services (r = 0.286, P = 0.0001). CONCLUSIONS: Family physicians in Hamilton-Wentworth made few referrals to psychiatric and psychosocial services. Only physician sex and year of graduation correlated significantly with numbers of referrals made. Recent graduates of both sexes made significantly more referrals to psychiatric clinics and counseling services than their older colleagues.

Community Mental Health Services↗