PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “General Practice”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources
PubMed2006

Prevalence of STI related consultations in general practice: results from the second Dutch National Survey of General Practice.

BACKGROUND: The role of the GP in the care of sexually transmitted infections (STIs) is unclear. AIM: We studied the prevalence of STI related consultations in Dutch general practice in order to obtain insight into the contribution of the GP in STI control. DESIGN OF STUDY: A descriptive study. SETTING: The study took place within the framework of the second Dutch National Survey of General Practice in 2001, a large nationally representative population-based survey. METHOD: During 1 year, data of all patient contacts with the participating GPs were recorded in electronic medical records. Contacts for the same health problem were clustered into disease episodes and their diagnosis coded according to the International Classification of Primary Care. All STI and STI related episodes were analysed. RESULTS: In total, 1 524 470 contacts of 375 899 registered persons in 104 practices were registered during 1 year and 2460 STI related episodes were found. The prevalence rate of STI was 39 per 10 000 persons and of STI/HIV related questions 23 per 10 000. More than half of all STIs were found in highly urbanised areas and STIs were overrepresented in deprived areas. Three quarters of all STIs diagnosed in the Netherlands are made in general practice. An important number of other reproductive health visits in general practice offer opportunities for meaningful STI counselling and tailored prevention. DISCUSSION: GPs contribute significantly to STI control, see the majority of patients with STI related symptoms and questions and are an important player in STI care. In particular, GPs in urban areas and inner-city practices should be targeted for accelerated sexual health programmes.

Adult↗
PubMed1999

Patients' priorities with respect to general practice care: an international comparison. European Task Force on Patient Evaluations of General Practice (EUROPEP).

BACKGROUND AND OBJECTIVES: Improving the sensitivity of general practice to patients' needs demands a good understanding of patients' expectations and priorities in care provision. Insight into differences in expectations of patients in different cultures and health care systems may support decision-making on desirable models for care provision in general practice. An international study was conducted to determine priorities of patients in general practice care: which views do patients in different countries have in common and which views differ? METHODS: Written surveys in general practices in the UK, Norway, Sweden, Denmark, The Netherlands, Germany, Portugal and Israel were performed. Samples of patients from at least 12 practices per country, stratified according to area and type of practice, were included. Patients rated the importance of 38 different aspects of general practice care, selected on the basis of literature analysis, qualitative studies and consensus discussions. Rankings between countries were compared. RESULTS: A total number of 3540 patients (response rate on average 55%) completed the questionnaire. Patients in different countries had many opinions in common. Aspects that got the highest ranking were: getting enough time during the consultation; quick services in case of emergencies; confidentiality of information on patients; telling patients all they want to know about their illness; making patients feel free to talk about their problems; GPs going to courses regularly; and offering preventive services. However, differences between opinions of patients in different countries were also found for some of the selected aspects. A confounding effect of patients' characteristics may have played a role in these differences. DISCUSSION: The study provides information on what patients expect of and value in general practice care. It shows that patients in different cultures and health care systems may have different views on some aspects of care, but most of all that they have many views in common, particularly as far as doctor-patient communication and accessibility of services are concerned.

Adult↗
PubMed2001

Research output of Australian general practice: a comparison with medicine, surgery and public health.

OBJECTIVES: To compare the productivity of Australian general practice in terms of research publications with the productivity of other medical disciplines. DESIGN: A survey of Australian general practice, medicine, surgery and public health publications carried out by manual searching of specific journals and an electronic search of the US National Library of Medicine's "PubMed" database. MAIN OUTCOME MEASURES: The number of original research publications by Australian general practitioners, physicians, surgeons and public health physicians during 1999; the relative publication rate of Australian general practice, medicine, surgery and public health over the period 1990-1999. RESULTS: Of original research articles published in 1999, GPs authored 65% (17/26) in Australian Family Physician and 3% (3/90) in the Medical Journal of Australia; physicians published 4% and 37%, respectively. The electronic search identified 54 research articles relating to Australian general practice published in 1999 in 21 different journals, only two of which were primary care journals. Over the period 1990-1999, there was a publication rate of one general practice [discipline] article per 1000 GPs in practice per year. Corresponding rates for medicine, surgery and public health were 105/1000, 61/1000 and 148/1000, respectively. CONCLUSIONS: There is considerable disparity between the level of research output of general practice and that of the disciplines of medicine, surgery and public health. If we are to have effective general practice research, we urgently need to develop research skills, a supportive infrastructure and a culture that nurtures research.

Australia↗
PubMed2000

Integrating counselling into general practice.

BACKGROUND: General practice counselling has many significant differences to counselling in other settings. General practitioners have long term relationships with their patients involving physical as well as mental health care. General practitioners are often the first point of contact for distressed patients who may not perceive their problem to have a psychological basis. There are barriers to counselling including time management and cultural expectations of the consultation. OBJECTIVE: To outline a practical biopsychosocial model for counselling in the general practice setting using the knowledge and skills unique to each GP. Theoretical and practical barriers to counselling commonly encountered in general practice are discussed. DISCUSSION: Assessing the problem in a biopsychosocial format highlights strengths and skills the patient already possesses and involves consideration of physical sensations, emotions, behaviours, key relationships, family, social roles and resources. Counselling in general practice requires flexibility and an ability to adapt available resources to address patient needs in an individually appropriate way.

Counseling↗
PubMed1999

Clinical practice guidelines and Australian general practice. Contemporary issues.

BACKGROUND: This paper summarises recent important clinical practice guideline initiatives in Australia which have direct relevance to Australian general practice. OBJECTIVE: Activities of the National Health and Medical Research Council (NH&MRC), professional groups and the Commonwealth Department of Health's General Practice Strategy including relevant outputs of the General Practice Evaluation Program are examined in detail. This paper provides criteria for GPs to assess whether a clinical practice guideline is likely to be practical and useful for them. It examines the future development of guidelines and emphasises the need for a clearer understanding of the GP role in this and highlights strategies for overcoming barriers to implementation. DISCUSSION: While a great deal of effort has been invested in clinical practice guideline development and implementation, further development and focussed effort on dissemination is needed if they are to fulfill their potential to improve clinical practice. Australian general practice presents a number of challenges and barriers to successful uptake including lack of computerisation, attitudinal barriers and variable coverage of clinical issues in existing guidelines. Concern about the nature and purpose of guidelines is also frequently expressed.

Australia↗
PubMed1999

Clinical information for research; the use of general practice databases.

General practice computers have been widely used in the United Kingdom for the last 10 years and there are over 30 different systems currently available. The commercially available databases are based on two of the most widely used systems--VAMP Medical and Meditel. These databases provide both longitudinal and cross-sectional data on between 1.8 and 4 million patients. Despite their availability only limited use has been made of them for epidemiological and health service research purposes. They are a unique source of population-based information and deserve to be better recognized. The advantages of general practice databases include the fact that they are population based with excellent prescribing data linked to diagnosis, age and gender. The problems are that their primary purpose is patient care and the database population is constantly changing, as well as the usual problems of bias and confounding that occur in any observational studies. The barriers to the use of general practice databases include the cost of access, the size of the databases and that they are not structured in a way that easily allows analysis. Proper utilization of these databases requires powerful computers, staff proficient in writing computer programs to facilitate analysis and epidemiologists skilled in their use. If these structural problems are overcome then the databases are an invaluable source of data for epidemiological studies.

Bias↗
PubMed1998

Quality indicators for general practice: which ones can general practitioners and health authority managers agree are important and how useful are they?

BACKGROUND: The aim of the study was to assess the face validity of quality indicators being proposed for use in general practice by health authorities. METHOD: A national survey of health authorities was carried out to identify quality indicators being proposed for use in general practice. A two-stage Delphi process was used to establish general practitioners' (GPs') and health authority managers' views on the face validity of identified indicators. A total of 240 separate indicators identified by health authorities and the NHS Executive as potential markers of the quality of general practice care were assessed. Indicators related to access, organizational performance, preventive care, care for a small number of chronic diseases, prescribing and gatekeeping. The subjects were a purposive sample of 47 health authority managers and 57 general practice course organizers. RESULTS: Thirty-six indicators received median validity scores of 8 or 9 out of a maximum possible score of 9. Of this set, 83 per cent was rated identically by both groups of respondents. Prescribing and gatekeeping indicators generally received low validity scores. CONCLUSION: Acceptable face valid indicators were identified for all domains except gatekeeping. However, the indicators rated by the sample do not cover all aspects of care. No indicators were proposed for use by health authorities relating to effective communication, care of acute illness, health outcomes or patient evaluation. Although it is possible to develop indicators of general practice care which have face validity in the view of both GPs and managers, these will be very partial measures of quality. In the indicators used in this study, no explicit distinction was made between indicators designed to assess minimum standards with which all practices should comply, and indicators which could be used to reward higher levels of performance. Failure to separate these will result in antagonism from practitioners to quality improvement initiatives in the NHS, and a failure to engage the profession in improving quality of care.

Attitude of Health Personnel↗
PubMedDate not supplied

[Health Search--Research Institute of the Italian Society of General Practice: the creation of a research database in general practice].

OBJECTIVE: To describe a database used in general practice by analysing the characteristics of the physicians providing the data and the completeness of the data recording on the basis of the indicators of interest (smoking habits, weight, height, and the prevalence of hypertension). DESIGN: Descriptive study and multiple linear regression analysis of the relationships between structural variables and outcomes. SETTING: General practitioners (GPs) belonging to the Italian Society of General Medicine (SIMG), and enrolled in Health Search (HS). POPULATION: Six hundred and ninety-five voluntarily enrolled GPs and their patients. PRINCIPAL OUTCOMES: Descriptive statistics (mean and median values, standard deviation, frequencies) concerning the general characteristics of the GPs, the ways in which they connect to the network and their use of the clinical data management software, and epidemiological measures concerning the prevalence of hypertension among their patients, and the recording of weight, height and tobacco smoking habits. RESULTS: The geographic distribution of the GPs is homogeneous: 317 in Northern Italy (12.52 physicians per 10(6) patients), 134 in Central Italy (12.30 physicians per 10(6) patients) and 244 in Southern Italy and the Islands (11.89 physicians per 10(6) patients). Five hundred and ninety-five (85.6%) are males; their mean age is 46.7 years (SD +/- 3.8); the mean number of patients per physician is 1128; 69% have at least one post-graduate specialisation; 49% practise alone; and they work for a mean of 30 hours per week (SD +/- 13). Five hundred and fifty-three GPs were actually connected to the network as of January 2003. The data relating to the years 2000-2001 show an increase in the number of connected physicians (34 in 2000 and 261 in 2001) and in the number of connections (a median of 12 in 2000 and 17 in 2001). The GPs contact more than 80% of their patients every year. The frequency of the recording of data concerning smoking habits, weight and height increases in proportion with the frequency of connections. The prevalence of hypertension among the patients included in the survey is 5.4%. Multiple regression analysis showed that the variability in the prevalence of hypertension was not influenced by the frequency of PC use but by the different structure of the age classes of the patients. CONCLUSIONS: This study of the variables relating to GPs, their clinical practices, and their use of computerised records (examined by means of the chosen indicators) shows that the regular and complete recording of the principal data of health interest is feasible insofar as it is not biased by the characteristics of the GPs, and advantageous. The construction of the database therefore represents a first step towards the initiation of routine research into general practice in Italy.

Biomedical Research↗
PubMedDate not supplied

ENT and general practice: a study of paediatric ENT problems seen in general practice and recommendations for general practitioner training in ENT in Ireland.

A questionnaire survey of 225 general practitioners was carried out to establish the proportion of their workload formed by paediatric ENT problems. Approximately 50% of children seeking medical care from their general practitioners had problems in this area. Infections of the upper respiratory tract and associated organs were the most commonly dealt with complaints. The monthly referral rate by GPs of paediatric patients in their practice to an ENT outpatient clinic was 4.3%. As ENT problems are seen so commonly in general practice it is important that teaching of otolaryngology at undergraduate and postgraduate levels is emphasised. We examined the present teaching structure of ENT in Irish universities and established that the appointment of a professorial unit dramatically improved the extent of the undergraduate curriculum. Non-specialist postgraduate ENT exposure was found to be inadequate and a number of mechanisms to improve postgraduate ENT training for GPs are suggested.

Child↗
PubMed1998

Audit of populations in general practice: the creation of a national resource for the study of morbidity in Scottish general practice.

STUDY OBJECTIVE: To create a national data resource for studying morbidity in Scottish general practice, complementary to existing information systems and available for management and research purposes at national and local levels. DESIGN: The Department of General Practice, University of Aberdeen has worked since 1988 to collect and analyse computerised information at practice, regional, and national levels by distribution of a floppy disk-based software program, which extracts a predetermined dataset from each general practice computer system. SETTING: Almost 100% of patients in Scotland are registered with a general practitioner. Scotland has a national computer system, General Practice Administration System for Scotland (GPASS), used by over 75% of all Scottish practices. Escalating costs of health care and demographic changes in the national population emphasise the monetary value of the gatekeeper role of general medical practice. General practitioners' increasing involvement in the provision and purchasing of care has raised the importance of the management of populations as well as the care of individual patients. PATIENTS: Collection of major morbidity and prescribing data from up to 2.4 million patients, approximately half the population of Scotland, takes place biannually. A subset of practices (population 282,700 patients; 52 practices) are continuously collecting doctor/patient contact information (symptoms or diagnoses). MAIN RESULTS: The data collected provide information at the level of the individual patient. Morbidity, prescribing, screening, and administrative data can be linked by patient, date or postcode. The sample population studied is representative by age, sex, deprivation, and sparsity (using the postcode) of the national population. Large sub-populations of patients satisfying a selected criteria can be extracted for further study of needs assessment or of epidemiological research. CONCLUSIONS: The gatekeeping role of Scottish general practice and the predominance of GPASS favours standardisation of methods of data capture and the construction of large regional, national, and Continuous Morbidity databases. Analysis by geographical, demographic, and temporal distributions allows the changing patterns of illness and provision of health care to be studied in substantial detail to the benefit of patients, doctors, and the national health service.

Adolescent↗
PubMed2000

The factor structure of the dental fear survey applied to private general practice patients awaiting dental treatment.

OBJECTIVES: Factor analysis of the Dental Fear Survey (DFS), applied to patients awaiting dental treatment in an average private practice general dental clinic in comparison to other analyses. METHOD: A combination of secondary and primary data. The latter were obtained from 145 consecutive self-referred patients (89 women, 56 men, aged between 17 and 82 years) at a private dental clinic, responding to an anonymous questionnaire. In analyses, principal components and principal axes factor analysis were used with varimax and oblimin rotations. Cronbach's alpha was calculated. RESULTS: There were differences in factor loading patterns between materials. No generally valid pattern could be discerned. Congruence between materials was higher for communalities. Oblimin rotation resulted in highly correlated factors. Excluding items with lower loadings yielded a clear one-factor solution. Cronbach's alpha was very high (0.96) for a one-factor solution on the primary material. CONCLUSIONS: The DFS may well be used as a measure of dental fear, but the dimensionality of the measure is more doubtful according to the present result. The DFS could be reduced to a unidimensional measure. In the clinical situation, a short measure such as the Dental Anxiety Scale (DAS) could be used for screening, giving guidance about whether the patient is afraid. For those with higher scores on the DAS, the DFS could be used for purposes of greater discrimination.

Adolescent↗