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PubMed1977

Evidence to the Royal Commission on the NHS. From the Royal College of General Practitioners.

1. It is the right of everyone in the UK to have access to personal and continuing primary health care of a high standard (para. 4.1).2. The primary health care service should be built on general practice (paras 2.3 to 2.10, 4.1 to 4.3).3. The nature of the most important health problems today means inevitably that the main burden of care will fall on the primary health service (paras 3.2 to 3.7).4. It follows that the NHS must be reorientated around primary health care; the functions and size of the hospital service will then depend on the responsibilities of the primary health care sector (para. 4.2).5. It also follows that primary health care must attract a higher priority in the allocation of resources (paras 4.4, 5.2 to 5.8).6. Setting standards of performance is a high priority for all the health professions and the NHS itself (paras 3.6, 3.7).7. In medicine, professional standards will not improve unless medical education is radically reshaped by the implementation of the recommendations of the Committee of Enquiry into the Regulation of the Medical Profession (para. 5.4).8. Inadequate care by some general practitioners today is acknowledged (paras 2.12, 2.13); the main causes are examined (para. 2.15) and remedies are suggested (paras 4.4, 5.4 to 5.6).9. The special problems of primary care in parts of conurbations are described (paras 2.14 to 2.17); a proposal to deal with this exceptional situation is made (para. 5.7).10. Primary health care should be provided normally by functionally integrated teams of general practitioners, nurses, health visitors and, where appropriate, social workers, supported by receptionists and secretarial staff (paras 2.4, 2.10).11. Within the primary health care team ultimate responsibility must rest with general practitioners (para. 4.1).12. To provide good primary health care we need:i) Appropriate manpower (para. 5.2).ii) Adequate premises (para. 5.3).iii) Effective education (paras 5.4, 5.5).iv) A modern record/information system (para. 5.6).13. General practitioners should remain independent contractors so that patients have an independent medical adviser in a State dominated health service (para. 4.7).14. The administration of the NHS should work on the principle that bureaucratic interventions between patients and the health professions should be kept to an absolute minimum (para. 4.4).

Attitude of Health Personnel↗
PubMed1995

Telephone advice about an infant given by after-hours clinics and emergency departments.

AIMS: Studies have shown that telephone calls for advice constitute a significant portion of the workload of emergency departments in the United States and the United Kingdom. Reviews of the appropriateness of telephone advice given in emergency departments in the United States indicate that the information given is often inadequate or inaccurate. We performed a study to evaluate the telephone advice given in New Zealand. METHODS: We identified 30 public hospital emergency departments and 20 private accident and emergency clinics. Twenty-six towns and cities were represented. We telephoned each of them and requested advice about the management of a fictitious febrile infant. RESULTS: We were given medical advice by 36 of the centres. In the remaining 14 the caller was referred to an oncall duty doctor or general practitioner for further information. In the 36 departments providing advice, the information was given by a doctor in 5 of the cases, by a nurse in 26, and by a receptionist or unidentified respondent in 5. On average, the caller was asked 3.76 questions about the patient before advice was given. Even if a number of questions were asked, correct advice did not necessarily follow. Thirty five of the advice givers requested the age of the infant, but 16 of them gave inadequate advice despite this knowledge. We judged the advice given to be inadequate in 16 of the 36 institutions that provided it. There was no difference in the standard of advice given by private and public institutions. DISCUSSION: This study demonstrates that there are deficiencies in the quality of telephone advice given by emergency departments and private accident and emergency clinics in New Zealand.

Emergency Medical Services↗
PubMed1986

Academic group practice. The patient's perspective.

The effect upon patient satisfaction of a reorganization of a traditional medical clinic into a group practice model was examined in a controlled trial in which both patients and physicians were randomized. The group practice model, unlike the traditional clinic, provided decentralized registration, 5 days/week clinic coverage, and night/weekend phone coverage. Residents worked in small groups with an attending physician, a nurse practitioner, and a receptionist. This reorganization resulted in a substantial decrease in charges and utilization for patients in the experimental group. A panel of 302 patients was interviewed prior to the reorganization and 1 year later. Patients in the experimental groups perceived improvements in access to their physicians as well as decreases in clinic waiting time and decreases in the lag time between requesting and obtaining an appointment. General health perceptions and other satisfaction measures were unchanged. The authors conclude that a group practice organization can result in decreased patient charges without substantially altering patient satisfaction.

Academic Medical Centers↗
PubMed1999

Consultant strategies for the gastroenterologist.

Effective communication skills and the ability to respond to the needs of referring physicians are critical for the maintenance and enhancement of a referral base. One challenge is to determine the reason for the consultation and to respond to the referring physician's interests. The consultation letter should be formatted effectively and the "turn-around time" should be as brief as possible, perhaps by fax as well as mail. Prioritizing the differential diagnosis and diagnostic studies can be helpful to the referring physician. Strategies should be developed to address procedural referrals you may believe are inappropriate. A decision should be made as to whether the consultant or the primary care physician informs the patient of a serious disease diagnosis. Referral guidelines should be developed to assist primary care physicians to determine when a patient should be referred to the gastroenterologist or other specialist. Receptionists should avoid turning away new patients because of a "full schedule" and must determine if other arrangements can be made. A proper response to "hallway consultations" by referring physicians is important. Consultants should make efforts to increase their visibility in the medical community, either by newsletter or lectures to the medical staff. Every effort should be made to avoid speaking disparagingly about other physicians. Consultant strategies should be taught to house staff and fellows in a formal lecture format, in the outpatient clinics, and on hospital rounds.

Communication↗
PubMed1997

Obstetricians' receptiveness to teen prenatal patients who are Medicaid recipients.

OBJECTIVE: To test the accuracy of various physicians' participation in Medicaid models. DATA SOURCES/STUDY SETTING: Primary data on 221 obstetricians and gynecologists in the Chicago area by telephone interviews over a four-month period. These data were combined with secondary data from the American Medical Association Master File (1993) and U.S. Census data (1990). STUDY DESIGN: Telephone interviewers posing as the older sisters of a pregnant teenager who is a Medicaid recipient sought information regarding the care provided in a first prenatal care appointment (e.g., appointment duration, tests administered, delivery privileges, appointment availability). DATA COLLECTION/EXTRACTION METHODS: A "receptionist helpfulness" variable was developed through pretesting on obstetricians in another city. Inter-interviewer reliability was enhanced through common interview technique education. PRINCIPAL FINDINGS: Only 81 obstetricians (36.7 percent) accepted new Medicaid patients. This finding is lower than previous research on physician participation in Medicaid. There was strong empirical support for both dimensions-cost containment and limited access-of the physicians' receptiveness model, the model introduced with this research. There was limited support for the dual market and residential segregation models of physician participation in Medicaid. CONCLUSIONS: It is argued that this study's research design is more accurate in reflecting the barriers that a pregnant Medicaid-eligible patient encounters when seeking office-based prenatal care. As such, combining the physicians' receptiveness model with other physician participation in Medicaid models provides a more complete picture of access barriers to prenatal care for our most needy populations.

Adolescent↗
PubMed2001

Prescription of analgesics in general medical practice.

The aim of this study was to examine the frequency of prescription of analgesic drugs by General Practitioners in Austria, the reasons for which they are prescribed, as well as relevant organizational details. A questionnaire was designed to prospectively collect data from 14 participating General Practitioners over a period of at least 20 days each. The type of analgesic drugs prescribed during direct (doctor) or indirect (receptionist) consultations was recorded, coded according to the ATC classification and separated into first and repeat consultations. Furthermore, the diagnostic terms and the individual intensity of pain perception by the patients were noted. During 7248 consultations recorded, 1083 prescriptions of analgesics were issued. The majority of first prescriptions are issued during direct consultations, whereas a large number of repeat prescriptions are prepared for the doctor's supervision by the receptionists via indirect consultations. Almost half of the patients receive repeat prescriptions. In both, direct and indirect consultations with patients, approximately every 7th contact results in the prescription of an analgesic drug. The antirheumatic drug group is the most frequently prescribed group of painkillers whereas opioids are rarely prescribed. Selection of drugs is not clearly related to the degree of pain experienced by individual patients. Problems of the musculo-skeletal system rank first among the classifications leading to prescription of an analgesic. Pain needs quick and efficient therapy. Prescriptions of analgesics in General Practice ought to be issued in such a way as to serve this large group of patients without, however, taking extensive risks: repeat and first prescriptions issued during indirect consultations have to be precisely recorded and need the doctor's personal supervision.

Analgesics↗
PubMed1993

Legal aspects of management of ocular trauma.

Patients suffering from blunt ocular trauma pose several legal challenges for primary eye care practitioners. Although optometrists in private practice are under no legal duty to examine patients with ocular trauma, failure to do so breaches ethical considerations. When an optometrist undertakes examination of an injured patient, a medical standard of care will be applied, and "Good Samaritan" statutes afford no shield from liability for negligence committed during the course of examination and treatment. If specialized care is necessary, a timely referral must be arranged. Practitioners are liable for the acts or omissions of employees, and receptionists who schedule appointments should be able to triage patient complaints so that same-day appointments are scheduled for patients requiring urgent assessment and care. Documentation of the disposition of these patients is essential; forms are an ideal way to record and preserve essential information.

Eye Injuries↗
PubMed1995

[On-duty medical service regulation in Norway, Sweden, Finland and Denmark].

Out of hours services are under discussion in the Nordic countries, and their organisations in Norway, Sweden, Finland and Denmark are compared in the article. Only in Denmark all such services are free of charge. In Denmark and in most parts of Norway, the patient must first phone a call-in service manned by a physician who acts as receptionist cum dispatcher. House calls are very rarely made in Sweden and Finland but account for approximately 20 percent of the out of hours workload in Norway and Denmark.

Denmark↗
PubMed2003

The association between satisfaction with services provided in primary care and outcomes in Type 2 diabetes mellitus.

BACKGROUND: Patient satisfaction is of increasing importance, is taken into account when planning services, and is used by healthcare providers as a measure of healthcare quality. Satisfaction with medical care, including diabetic care, has been associated with various health-related behaviours and outcomes that have a direct bearing on health and illness. The association between satisfaction and health outcomes is poorly understood. AIM: The aim of the study was to determine whether there is an association between satisfaction in patients with Type 2 diabetes and the outcome of their diabetic care, and to determine the contribution of different aspects of satisfaction with the primary care. METHODS: Patients with Type 2 diabetes were identified from two general practices in Leeds. PATIENTS: scores on the General Practice Assessment Survey Questionnaire (GPAS) were correlated with the outcome of care, as measured by HbA1c level collected from patients' medical records. RESULTS: Data from 106 patients were analysed. There was a generally high satisfaction rate for all GPAS domains. The correlation between different GPAS domains and HbA1c level showed significant positive correlations (P < 0.001) for continuity of care, trust and overall satisfaction; and positive correlations (P < 0.01) for access, receptionists, interpersonal care, communication skills, knowledge of patient about the doctor, technical care, and practice nursing. CONCLUSION: The findings from this study demonstrate that there is an association between satisfaction and outcome in diabetes, which goes across all the GPAS domains. This suggests that processes that can act to increase patient satisfaction may be contributing to improved clinical outcomes. More development work is needed in this field to explore and elucidate the complex relationship between satisfaction and clinical outcomes.

Adult↗
PubMed2006

"You have to cover up the words of the doctor": the mediation of trust in interpreted consultations in primary care.

PURPOSE: This article explores issues of trust in narratives of interpreted consultations in primary health care. DESIGN/METHODOLOGY/APPROACH: The paper is based on empirical data from a qualitative study of accounts of interpreted consultations in U.K. primary care, undertaken in three north London boroughs. In a total of 69 individual interviews and two focus groups, narratives of interpreted consultations were sought from 18 service users, 17 professional interpreters, nine family member interpreters, 13 general practitioners, 15 nurses, eight receptionists, and three practice managers. The study collected and analysed these using a grounded theory approach and taking the story as the main unit of analysis. It applies a theoretical model that draws on three key concepts: Greener's taxonomy of trust based on the different "faces" of power in medical consultations; Weber's notion of bureaucratic vs traditional social roles; and Habermas' distinction between communicative and strategic action. FINDINGS: Trust was a prominent theme in almost all the narratives. The triadic nature of interpreted consultations creates six linked trust relationships (patient-interpreter, patient-clinician, interpreter-patient, interpreter-clinician, clinician-patient and clinician-interpreter). Three different types of trust are evident in these different relationships--voluntary trust (based on either kinship-like bonds and continuity of the interpersonal relationship over time, or on confidence in the institution and professional role that the individual represents), coercive trust (where one person effectively has no choice but to trust the other, as when a health problem requires expert knowledge that the patient does not have and cannot get) and hegemonic trust (where a person's propensity to trust, and awareness of alternatives, is shaped and constrained by the system so that people trust without knowing there is an alternative). These different types of trust had important implications for the nature of communication in the consultation and on patients' subsequent action. RESEARCH LIMITATIONS/IMPLICATIONS: The methodological and analytic approach, potentially, has wider applications in the study of other trust relationships in health and social care. Practical implications - Quality in the interpreted consultation cannot be judged purely in terms of accuracy of translation. The critical importance of voluntary trust for open and effective communication, and the dependence of the latter on a positive interpersonal relationship and continuity of care, should be acknowledged in the design and funding of interpreting services and in the training of both clinicians, interpreters and administrative staff. ORIGINALITY/VALUE: This is the first study in which interpreted consultations have been analysed from a perspective of critical sociology with a particular focus on trust and power relations.

Communication↗
PubMed1974

Ancillary staff in general practice.

The results of a questionnaire answered by 70 secretary-receptionists in general practice are analysed. Variations in their rates of pay are described. Lack of inservice training appears to result more from paucity of opportunity than lack of enthusiasm of the secretaries themselves.

Family Practice↗
PubMed1978

Errors on doctors' prescriptions.

All prescriptions dispensed by one pharmacist during one month were examined for errors. Only 5.1 per cent of 2,237 prescription forms contained an error which meant the pharmacist had to contact the doctor. Thirty-seven per cent of prescriptions were either wholly or partly written by the receptionist. There was considerable variation between doctors and this varied from zero to 64 per cent; 4.0 per cent of prescriptions written by the doctor contained errors while those written by the receptionist were almost twice as likely (seven per cent) to do so. The majority of mistakes were obvious and trivial but five were potentially serious.It is recommended that if doctors expect their receptionists to write prescriptions they should ensure that they are adequately trained to do so. The pharmacist can be a valued and trusted colleague who serves to protect patients from doctors' errors.

Drug Prescriptions↗
PubMed1999

Improving the repeat prescribing process in a busy general practice. A study using continuous quality improvement methodology.

PROBLEM: A need to improve service to patients by reducing the time wasted by reception staff so that the 48 hour target for processing repeat prescription requests for patient collection could be achieved. DESIGN: An interprofessional team was established within the practice to tackle the area of repeat prescribing which had been identified as a priority by practice reception staff. The team met four times in three months and used continuous quality improvement (CQI) methodology (including the Plan-Do-Study-Act cycle) with the assistance of an external facilitator. BACKGROUND AND SETTING: A seven partner practice serving the 14,000 patients on the northern outskirts of Bournemouth including a large council estate and a substantial student population from Bournemouth University. The repeat prescribing process is computerised. KEY MEASURES FOR IMPROVEMENT: Reducing turn around times for repeat prescription requests. Reducing numbers of requests which need medical records to be checked to issue the script. Feedback to staff about the working of the process. STRATEGIES FOR CHANGE: Using a Plan-Do-Study-Act cycle for guidance, the team decided to (a) coincide repeat medications and to record on the computer drugs prescribed during visits; (b) give signing of prescriptions a higher priority and bring them to doctors' desks at an agreed time; and (c) move the site for printing prescriptions to the reception desk so as to facilitate face to face queries. EFFECTS OF CHANGE: Prescription turnaround within 48 hours increased from 95% to 99% with reduced variability case to case and at a reduced cost. The number of prescriptions needing records to be looked at was reduced from 18% to 8.6%. This saved at least one working day of receptionist time each month. Feedback from all staff within the practice indicated greatly increased satisfaction with the newly designed process. LESSONS LEARNT: The team's experience suggests that a combination of audit and improvement methodology offers a powerful way to learn about, and improve, practice. The interventions used by the team not only produced measurable and sustainable improvements but also helped the team to learn about the cost of achieving the results and provided them with tools to accomplish the aims. The importance of feedback to all staff about CQI measures was also recognised.

Accounts Payable and Receivable↗
PubMedDate not supplied

Evaluation and recommendations from a study of a critical-care waiting room.

The intensive care unit (ICU) waiting room is a dynamic place that influences the satisfaction of families of critically ill patients. Waiting-room comfort and amenities are important, because families often spend a great deal of nonvisiting time there. A quality improvement evaluation of the ICU waiting room at Lehigh Valley Hospital, Allentown, PA, was conducted. Methods included distribution of an 18-item family survey, ethnographic observations, interviews, and assessment of the physical environment. Findings suggest that the role of the receptionist and access to food and other services were important to families and influenced their assessment of the quality of services provided by the ICU.

Academic Medical Centers↗
PubMed2002

Practice management. Gender offenders.

A postal survey of practice managers in London found that women earned 5,000 Pounds a year less than men, on average. Women who had previously worked as receptionists in the practice were particularly poorly paid. Practice management remains a female-dominated profession. Primary care trusts should seek to standardise rates of pay and promote greater equality.

Data Collection↗
PubMedDate not supplied

Recruitment in a primary care trial on smoking cessation.

The purpose of this study was to describe and compare the rates of recruitment during a randomized clinical trial on smoking cessation in two primary care practices. One site was a five-physician private family practice setting with about 15,000 patients. During 34 days, 576 patients were screened, of whom 22% were smokers. Among the smokers screened, 54% consented, 33% refused consent, and 13% were called in too early to consent. The other site was a six-physician academic medical practice with about 16,000 patients. During 53 days, 1,692 subjects were screened, of whom 16.2% were smokers. Among the smokers, 19% consented, 81% refused consent, and none were called in early. The enrollment of smokers was 3.3 times greater in the private practice than the academic practice. At the first site, study personnel screened 26.6 subjects per day, whereas the practice receptionist screened only 13.4 subjects per day (P less than .01). A randomized trial of having subjects read the informed consent versus having study personnel read it to them showed no differences in recruitment. The data suggest that private practices may have greater potential for subject recruitment than academic sites, that using study personnel improves recruitment, and that having study personnel actively involved in informed consent does not improve recruitment.

Adult↗
PubMed1975

The ophthalmologist's office: planning and practice. Effective patient scheduling.

Effective patient scheduling, a most important building block in the creation of any successful practice, can best be accomplished by (1) devising a specially designed appointment book to suit the individual needs of each ophthalmologist; (2) thorough education of the telephone receptionist in the working habits of the ophthalmologist, in the ability to evaluate ocular emergencies, in the screening of personal calls, and in the importance of "break" time for the doctor; and (3) formulation of methods to reduce lost time because of irresponsible patients.

Appointments and Schedules↗