["Hospitalism" in general practice of the established physician? General practice germs - infections - antibiotics].
Explore the source record for details and available documents.
Anti-Bacterial Agents↗
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.
Annual night visiting rates in 129 general practices in one family health services authority: association with patient and general practice characteristics.
BACKGROUND: Rates of night visiting by general practitioners have increased steadily over the last 30 years and vary widely between general practices. AIM: An ecological study was carried out to examine night visiting rates by general practices in one family health services authority, and to determine the extent to which differences in night visiting rates between practices could be explained by patient and practice characteristics. METHOD: The study examined the variation in annual night visiting rates, based on night visit fees claimed between April 1993 and March 1994, among 129 general practices in Merton, Sutton and Wandsworth Family Health Services Authority, London. RESULTS: Practices' annual night visiting rates varied from three per 1000 to 75 per 1000 patients. The percentages of the practice population aged under five years and aged five to 14 years were both positively correlated with night visiting rates (r = 0.38 and r = 0.35, respectively), as were variables associated with social deprivation such as the estimated percentage of the practice population living in one-parent households (r = 0.24) and in households where the head of household was classified as unskilled (r = 0.20). The percentage of the practice population reporting chronic illness was also positively associated with night visiting rates (r = 0.26). The percentages of the practice population aged 35 to 44 years and 45 to 54 years were both negatively associated with night visiting rates (r = -0.34 and r = -0.31, respectively) as was the estimated list inflation for a practice (r = -0.31). There was no significant correlation between night visiting rates and the distance of the main practice surgery from the nearest hospital accident and emergency department. There was also no association between night visiting rates and permission to use a deputizing service. In a stepwise multiple regression model, the multiple correlation coefficient was 0.56 with four factors (percentage of the practice population aged under five years, percentage aged 35-44 years, percentage who were chronically ill and estimated list inflation) explaining 32% of the variation in night visiting rates. CONCLUSION: Only about one third of the variation in night visiting rates between practices could be explained by patient and practice variables derived from routine data. Population-based research using data collected on individual patients and practices is required to improve current understanding of the patient and practice characteristics that influence the demand for night visits and of why night visiting rates vary so widely between practices.
Adolescent↗
Teaching practical procedures in general practice. A primer for supervisors of medical students and registrars.
BACKGROUND: Practical procedures are central to many general practitioners' job satisfaction and their ability to provide comprehensive care. Despite this, students lack opportunities to learn skills and fewer GPs perform them. OBJECTIVE: This article develops a framework for teaching practical skills and their assessment in general practice. DISCUSSION: True competence means more than performing a task in isolation: knowledge, skills and attitudes are needed to perform in the workplace. Teaching should be closely related to assessment in general practice. A four stage method of instruction can facilitate learning of task skills. This should be followed by a series of case discussions, scenarios or simulations to teach and assess the learners' ability to manage tasks in the work environment. Linking teaching, assessment and feedback is integral to improving learning opportunities in general practice.
Clinical Competence↗
DETERMINATION of the age/sex structure of general practice populations. (A basic requirement for epidemiological research in general practice).
Explore the source record for details and available documents.
Epidemiologic Studies↗
[The actual role of general practice in the dutch health-care system. Results of the second dutch national survey of general practice].
A second Dutch National Survey of General Practice was carried out in 2001 with the aim of providing actual information about the role of general practice in the Dutch health-care system for researchers and policy makers. Data were collected on different levels (patients, general practitioners, practices) and included morbidity (self-report and presented to general practitioners), diagnostic and therapeutic interventions, doctor-patient communication, and background characteristics. Compared to 1987 (the first National Survey), Dutch general practitioners had organized their work more efficiently. Patients were less satisfied (78% satisfied) about the organizational aspects of general practice care than about the care actually provided (90% satisfied). Dutch general practitioners provide high-quality care: on average, their performance was in 74% of cases in accordance with national guidelines. Communication in general practice had become less social and more medically oriented compared to 1987. General practice still acts in a gatekeeper role; this is illustrated by 96% of contacts handled solely by the general practitioner.
Adult↗
Changes in general practice organization: survey of general practitioners' views on the 1990 contract and fundholding.
BACKGROUND: General practitioners' views on two major changes in the organization of general practice--the 1990 contract for general practitioners and fundholding, introduced in 1991--have not been researched in any great detail. AIM: A study in 1993 sought to investigate the views of general practitioners from group practices and of single-handed general practitioners, in family health services authority areas with different socioeconomic characteristics, on the 1990 contract for general practitioners, fundholding and the effects of these two changes in general practice organization. METHOD: One general practitioner partner from each of 323 group practices in six family health services authority areas of England was invited for interview and 142 single-handed general practitioners in the study areas were sent a postal questionnaire. The interview and questionnaire sought general practitioners' views on the 1990 contract and fundholding, reasons for their opinions, and views on the effects of these reforms on workload and the quality of service. Other information was recorded on fundholding status, workload pressures, outreach clinics, budget surpluses, retirement plans, and opinions on a salaried service. RESULTS: A total of 260 group practice general practitioners (80%) participated in the study and 80 single-handed general practitioners (56%) returned questionnaires, 78 of which could be analysed. Over half of all respondents were opposed or strongly opposed to both the 1990 contract and fundholding. However, despite this opposition, a sizeable minority of group practice practitioners (38%) agreed that the quality of services provided had improved or considerably improved since the 1990 contract. Workload appeared to have increased, with the proportion of respondents who reported being always under pressure increasing from 12% in 1987 to 41% in 1993. All but one respondent considered administration to have increased. Some respondents were considering early retirement. One of the solutions proposed to alleviate problems in inner city general practice, a salaried service, received little support, even from those general practitioners working in areas which might be expected to benefit. CONCLUSION: Dissatisfaction of general practitioners with the National Health Service reforms was expressed in continued opposition, in concerns about workload and levels of administration, and in a desire to retire early. Suitable ways of improving general practitioner morale must be sought.
Attitude of Health Personnel↗
[General practice, internal medicine, general medicine].
Explore the source record for details and available documents.
Family Practice↗
[Self-reported level of skills in practical procedures following internship in general practice].
BACKGROUND: Previous reports have demonstrated variable and partly insufficient skills in standard practical procedures among young doctors who have served their internship. The present study examines the development of interns' self-reported level of skills in practical procedures during internship in general practice in relation to quantity and quality of supervision, gender and the size of the community they served in. MATERIAL AND METHODS: Between 1996 and 1999, all doctors going through internships in Norway were asked to indicate their level of skills in 88 practical clinical procedures before and after internship in general practice. Of 575 interns asked, 439 replied (76 %). RESULTS: All interns reported a significant overall improvement in self-reported practical skills during internship in general practice. Supervision and feedback was also significantly better in general practice than in internships in hospital. INTERPRETATION: The quality of the general practice internship in Norway is superior to the quality of hospital training. Supervision and feedback is a standard part of the education of general practitioners and represents a valuable tradition. A combination of internship in hospitals and in general practice is necessary for acquiring adequate skills in practical procedures.
Adult↗
[Diagnostic activity in general practice. 1. Patients' contact patterns in rural and urban general practices].
Contact with patients was described retrospectively for a period of five years by means of careful notes from the case records in five general practices in urban and rural areas chosen at random as a representative spot test. A total of 968 persons in group 1 of the Danish National Health Insurance (98-99% of the population), 485 men and 483 women or 9.7% of the group 1 insured persons over the age of 30 years had 10,410 consultations. This corresponds to 2.15 consultations per annum for persons in group 1 insurance. 91% of the patients visited the consultation. 17% of all the patient, twice as many women as men, were responsible for 50% of all the consultations. Women had 45% more consultations than men. Women in the age group 35-54 years constituted the group where most persons of the group visited general practice and this group had also the greatest total number of consultations, viz 30% of the total. Significantly more women than men had many consultations in this age group while significantly more men than women had only few consultations in the age group between 35-44 years. Expressed in percentages, the age group 55-64 years showed greatest similarity between men and women. Half of the men and slightly more than one third of all the women consulted their practitioners once per annum or more rarely. Patients of 75 years or over consulted their general practitioners most frequently.
Adult↗
Cervical smears: comparison of knowledge and practice of a general practice sample with a high-risk group.
Successful cervical screening programmes depend on the participation of an informed target population. A national cervical screening programme is shortly to be introduced in the Republic of Ireland. We compare the knowledge, attitudes and practice of 395 Irish urban women with 323 high-risk women, genitourinary medicine (GUM) clinic attenders. There was little difference in knowledge between the 2 groups. Fifty-five per cent of the general practice (GP) sample and 45% of the GUM sample correctly identified the purpose of a smear. Eighty-three per cent of both groups had had at least one smear but only 59% of the high-risk group had had a smear before attending the GUM clinic. Both groups expressed a preference for a female provider. Socio-economic grouping is the strongest predictor of knowledge and uptake of cervical smears and high-risk women were less likely to have opportunistic cervical smears. Information programmes to encourage participation in screening programmes must build on pre-existing knowledge and focus on the relevance and acceptability of the test.
Adolescent↗
Content of general practice.
Eight general practitioners participated in a survey of content of general practice. This is useful as an indicator or morbidity in the community as well as of workload of general practice. A total of 3164 consultations were recorded, of which 2764 (87%) were because of an illness and the rest (13%) for other reasons like medical examinations, antenatal check, family planning advice, pregnancy tests, pap smear and vaccination. The old and the young have high consultation rates for an illness, men consulted as often as women. The most common illness seen was upper respiratory tract infections, accounting for 37% of all illnesses. Other common minor illnesses were skin infections (6%), genito-urinary infections (5%), minor musculoskeletal (6%) and gastrointestinal (6%) complaints as well as minor injuries and cuts (4%). Major disorders form an unusually low proportion (18%) of all illnesses seen, in comparison with figures from United Kingdom. The common major disorders seen were hypertension, asthma, chronic rheumatic disorders and diabetes. Circulatory disorders were remarkably rare, accounting for only 1% of illnesses. Psychological disorders, both major and minor, were also rarely seen, accounting for only 1% of illnesses which is in marked contrast with figures from the United Kingdom. Factors contributing to these notable findings are discussed.
Family Practice↗
The development of a screening tool to identify carers in a general practice by a large-scale mailed survey: the experience in one Scottish general practice.
AIMS AND OBJECTIVES: To determine the feasibility of a screening tool to identify carers in a general practice. BACKGROUND: The need to support informal carers is well established in policy and practice, but many carers continue to lack the support they need. Identifying carers is a fundamental precondition to providing them with support. Studies often recruit carers who are members of carers' organizations or via the care recipient in receipt of services. However, as nearly 60% of carers receive no support from the statutory services, this group of carers may not be representative of the majority of carers. This paper describes the results of a study undertaken to identify a broader group of carers in a general practice in a large Scottish city. DESIGN AND METHODS: A quantitative research design was employed using a mailed screening survey to identify carers within a general practice. Carers were systematically identified, independent of the care recipient, using a screening tool developed by the researcher which was sent to all adult patients registered with the practice. RESULTS: The response rate was 69%. Overall, 11% of the surgery population identified themselves as carers with a mean age of 55 years. The carers were involved in a range of caring activities of varying levels and duration. CONCLUSION: The screening exercise was time consuming and costly. However, it would be feasible and useful to identify carers in smaller groups. RELEVANCE TO PRACTICE: This study tackles issues that are pertinent to health policy and practice. Carers were systematically identified from a general practice population and included those at an early stage of the caring role, prior to being involved with service providers, as well as those established in their role. If carers are identified early in their caring career the primary health care team is more able to support them proactively.
Adolescent↗
Psychiatric morbidity in a military general practice.
The General Health Questionnaire of Goldberg was used as an indicator of morbidity in three groups of a Military General Practice in British Army of the Rhine. Group 1 consisted of 299 service and civilian consecutive new attenders at the General Practice. Group 2 of 80 attenders for routine medical examination and Group 3 of a community sample of 446 soldiers from units in the practice area. Patients presenting for consultation at the practice were shown to have higher GHQ scores and percentage positive scores than the community sample, which in turn showed higher mean scores than those referred to the practice as non-complainants for routine medical examination. Service personnel showed lower mean scores than dependants or civilians. There were significant differences in scores between groups by rank in soldier attenders, those of junior non-commissioned officer rank having lower mean scores and lower percentage high scores than others.
Adult↗
The use and overlap of AED and general practice services by patients registered at two inner London general practices.
BACKGROUND: The improvement of general practitioner (GP) availability has been suggested as a factor influencing the rise in attendance rates at accident and emergency departments (AEDs) in the United Kingdom, particularly in innercity areas. However, previous studies suggest that only 3-6% of patients attempt to contact their GP before attending the AED, and measures of the availability of appointments in the surgery are not associated with AED self-referral rates. AIM: To examine the overlap of services between general practice and AEDs, and the characteristics of patients who attend at both sites. METHOD: A prospective observational study, set in east London, of all AED attendances from two group practices located within two kilometers of the Royal London Hospital, over a seven month period in 1994. RESULTS: Of 1785 attendances analysed, 80% were self referrals. Rates of hospital admission (18.1%) and outpatient referral (9.5%) reflect national figures. There was a significantly higher proportion of attendance from those of white ethnicity among children under 16. Using the Sheffield process-based classification, 43% of adult attendances were categorized as primary care attendances. Within this category the rate of attendance declined with age. Twenty-five point eight per cent of primary care attendances occurred between 10.00 pm and 8.00 am. Among self-referrals to the AED, 16% were seen by their GP in the previous two weeks for a similar problem. Frequent attendance at the AED was associated with a significantly higher consultation rate at the GP surgery (F = 19.6, df = 5, P < 0.0001). Less than 2% of attendances were recalled to the AED for follow-up. A minority (14%) of attendances resulted in a communication with the GP. The seven-month AED attendance rates for the two practices were significantly different (72 per 1000 (95% CI 67-78) and 111 per 1000 (95% CI 105-116), despite similar practice organization and markers of social deprivation. CONCLUSIONS: AED attendance rates were below the national average. GP referral and admission rates to AEDs from inner urban practices mirror national rates. High rates of primary care attendance occurred in younger age groups, with more than expected occurring out of hours. The reduction in case follow-up within the AED must be supported by improvements in communication with GPs, and an expansion of practice-based nursing. Practices that are geographically close, and with similar sociodemographic features, may have different AED attendance rates. This has important implications for resource allocation in primary care.
Adolescent↗
A study of naproxen and ibuprofen in patients with osteoarthritis seen in general practice. The Manchester General Practitioner Group.
A total of 226 patients with osteoarthritis of the hip, knee or spine was entered into a general practice, multi-centre, crossover study of 500 mg naproxen twice daily and 400 mg ibuprofen 3-times daily. Patients were randomly allocated to receive either naproxen or ibuprofen first and were given each drug consecutively for 3 weeks with no washout periods. Both drugs significantly reduced from admission values the duration of inactivity stiffness, resting pain, movement pain, night pain, interference of the disease with daily activities and overall disease severity. Naproxen was superior to ibuprofen in relieving resting pain, movement pain, night pain and interference with daily activities. In the patients receiving ibuprofen first, all parameters showed a significant mean improvement after crossover to naproxen. Patients receiving naproxen first did not significantly improve further when crossed over to ibuprofen. Side-effects were reported by 64 patients. Forty-five patients had side-effects while taking naproxen and 30 while taking ibuprofen (11 patients had side-effects on both drugs). Most side-effects related to the gastro-intestinal tract. Many were mild and may not have been attributable to the treatment. One patient had a gastro-intestinal bleed while taking naproxen. Thirty-one patients (13.7%) failed to complete the study: 16 stopped while taking ibuprofen, and 15 while taking naproxen. Nine of these patients were lost for reasons not directly attributable to the treatment. Overall treatment preference significantly favoured naproxen.
Aged↗
Practical psychotherapy in general practice.
Explore the source record for details and available documents.
Family Practice↗
Active approach to recognising asthma in general practice.
The general practice medical records of 214 children born in 1977 were scrutinised for a diagnosis of asthma. In 18 (8%) of these a diagnosis of asthma had been entered. Using a scoring system based on the medical record a further group of children who were thought likely to have undiagnosed asthma was exercise tested. Twelve children (6%) had demonstrable exercise induced asthma. In addition, seven children (3%) had both frequent respiratory symptoms and borderline exercise test results, indicating that they too had clinically important airways obstruction. As expected, histories of atopic eczema, nocturnal cough, persistent cough (more than one week), and wheezing appeared often in the medical records of the children with asthma. In combinations these diagnostic clues were more than 50% predictive of asthma. A more active approach in general practice to the diagnosis of asthma in children is both necessary and possible.
Asthma↗
The rates and management of psychological problems in Australian general practice.
OBJECTIVE: General practitioners (GPs) provide the majority of care for people's mental health problems. The recently introduced Better Outcomes in Mental Health Care initiative aims to improve the quality of mental health care in general practice. This study examines current GP management of psychological problems and any changes in their management in the decade leading up to this initiative. METHOD: Current practice was examined through a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) (2000-02) data. We compared BEACH data with the Australian Morbidity and Treatment Survey (1990-1991) to investigate management changes over the past decade. RESULTS: Between April 2000 and March 2002, psychological problems were managed at a rate of 11.5/100 encounters. Problems most commonly managed were mood disorders, stress-related disorders, behavioural syndromes and disorders due to psychoactive substances. Prescriptions occurred at a rate of 69.5/100 contacts and clinical treatments at a rate of 50.0/100 contacts with psychological problems from 1990 to 1991. The management rate of psychological problems increased from 9683/100,000 encounters (95% CI=9129- 10,237) in 1990-1991 to 11 557 (11,136-11 977) in 2000-2002. Prescription rates (from 63.3, 95% CI=60.5-66.1 to 69.1, 95% CI=67.1-71.1) and clinical treatments (from 36.0, 95% CI =33.4-38.7 to 53.1, 95% CI =51.3-54.9) increased. CONCLUSIONS: This study shows that prior to the introduction of the Better Outcomes in Mental Health initiative changes had already occurred in rates and management of psychological problems in general practice. It also provides a baseline from which future research can measure the impact of the recent reforms on mental health care.
Adult↗