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PubMed1988

Dissatisfaction in general practice: what do patients really want?

In 31 general practices in Adelaide, approximately 100 consecutive adult patients aged 15-64 years completed a 21-item questionnaire that related to their dissatisfaction with aspects of the care that was provided in the practice. Fourteen of the practices were "solo" practices, five practices were two-person partnerships and 12 practices involved three or more partners. The 21 items divided naturally into five groups: "architecture", "receptionists", "accessibility", "quality" and "communication". Factor analysis of the responses provided support for the idea that "receptionists", "accessibility" and "communication" were independent issues for the respondents and that "quality" was less discrete and was embedded in a factor which we have labelled "mechanics". For nearly all items, the mean dissatisfaction values for the practices were greatest in the larger practices and least in the two-person practices, with solo practices occupying an intermediate position. The main dissatisfaction related to accessibility and communication. These issues are explored in the light of current trends in the organization of primary medical care.

Adolescent↗

PubMed1987

Regina v. Salford Health Authority, Ex Parte Janaway, 12 February 1987.

The applicant was a receptionist for a health centre who refused to type letters for physicians referring patients for abortions. She challenged her dismissal by the health centre, arguing that she was legally authorized to refuse to type abortion referral letters by Section 4(1) of the Abortion Act 1967, which provides that no person may be required to "participate in any treatment authorized by this Act to which he has a conscientious objection." The Court rejected her argument, holding that the treatment to which the Act referred was medical treatment related to abortion and that she had no part in such treatment.

Abortion, Induced↗

PubMed2005

Testing the exportability of a tool for detecting operational problems in VA teaching clinics.

BACKGROUND: Recurrent operational problems in teaching clinics may be caused by the different medical preferences of patients, residents, faculty, and administrators. These preference differences can be identified by cultural consensus analysis (CCA), a standard anthropologic tool. OBJECTIVE: This study tests the exportability of a unique CCA tool to identify site-specific operational problems at 5 different VA teaching clinics. DESIGN: We used the CCA tool at 5 teaching clinics to identify group preference differences between the above groups. We averaged the CCA results for all 5 sites. We compared each site with the averages in order to isolate each site's most anomalous responses. Major operational problems were independently identified by workgroups at each site. Cultural consensus analysis performance was then evaluated by comparison with workgroup results. PARTICIPANTS: Twenty patients, 10 residents, 10 faculty, members, and 10 administrators at each site completed the CCA. Workgroups included at minimum: a patient, resident, faculty member, nurse, and receptionist or clinic administrator. APPROACH: Cultural consensus analysis was performed at each site. Problems were identified by multidisciplinary workgroups, prioritized by anonymous multivoting, and confirmed by limited field observations and interviews. Cultural consensus analysis results were compared with workgroup results. RESULTS: The CCA detected systematic, group-specific preference differences at each site. These were moderately to strongly associated with the problems independently identified by the workgroups. The CCA proved to be a useful tool for exploring the problems in depth and for detecting previously unrecognized problems. CONCLUSIONS: This CCA worked in multiple VA sites. It may be adapted to work in other settings or to better detect other clinic problems.

Ambulatory Care Facilities↗

PubMed1991

The development of a patient satisfaction questionnaire in the ambulatory setting.

Patient satisfaction is of critical interest to medical care providers. The main objective of this study was to evaluate the psychometric properties of a patient satisfaction questionnaire. A preliminary 80-item questionnaire was created, and a random sample of 268 family practice patients participated. Subjects rated items on a 4-point Likert scale (strongly disagree, disagree, agree, strongly agree). Items were subjected to a principal components varimax rotated factor analysis and five factors (60 items) were extracted, accounting for 47.5% of the variance. These factors were: satisfaction with physician, dissatisfaction with practice management, physician availability, receptionist behavior, and wait time. Alpha reliability coefficients for factors 1-5 were: .96, .93, .89, .84, and .78, respectively. All items correlated highly with total scores on the respective factors. Factor intercorrelations were all significant (P less than .001) and in the expected direction. Patients with a higher level of education were significantly less satisfied about physician availability than patients without a high school education (P less than .05). Implications of the findings are discussed.

Adult↗

PubMed1993

General practitioners and fever: a study on perception, self-care and advice to patients.

To investigate their perception of fever problems, self-care and information given to patients, a random sample of 100 Norwegian general practitioners were interviewed in 1989-1990 by telephone. More than two-thirds of the general practitioners would define fever as a body temperature above 38.0 degrees C. One-third would wait with antipyretic drug therapy for children until the temperature was above 39.5 degrees C. When dealing with fever in their own children, one-third would not follow their own recommendations to parents with febrile children. 43% Had not discussed guidelines for the management of febrile patients with their receptionists. Only 7% had discussed such guidelines with the local pharmacists. Lack of consistency in the information given to patients may result in confusing advice. General practitioners, their receptionists and the local pharmacists should discuss and define guidelines for fever management and information to patients and parents. These should include information about antipyretic therapy and consultation behaviour.

Adult↗

PubMed1987

Effects of problem-based scheduling on patient waiting and staff utilization of time in a pediatric clinic.

The patient scheduling system in a pediatric outpatient clinic was changed from time-based to problem-based in an A-B-A-B reversal design. During baseline, time-based scheduling was in effect with patients being scheduled in 15-min periods regardless of presenting problem. During intervention, a receptionist matched client problems with time slots so that a more extensive treatment was allocated more time. Problem-based scheduling resulted in a substantial decrease in mean number of minutes spent in clinic across all presenting problems. Waiting time increased to baseline levels when problem-based scheduling was removed and decreased again on reintroduction of the program. A follow-up check conducted 1 month after the end of the second intervention phase revealed that the effects were maintained. The problem-based schedule also resulted in an increase in the proportion of extra time that medical staff had available and produced a positive consumer response.

Ambulatory Care↗

PubMed1995

What type of general practice do patients prefer? Exploration of practice characteristics influencing patient satisfaction.

BACKGROUND: General practice is currently experiencing a large number of developments. Studies of patient satisfaction are required to guide the changes that many general practitioners are introducing. AIM: A study set out to examine the characteristics of general practices that influence patient satisfaction. METHOD: In 1991-92, a surgery satisfaction questionnaire of demonstrated reliability and validity was administered to 220 patients in each of 89 general practices. A further questionnaire completed by a member of practice staff collected information about practice characteristics including total list size, number, age and sex of practice partners, training status, fundholding status, presence of a practice manager and whether there was a personal list system. Stepwise multiple regression analyses were undertaken to identify those practice characteristics that influenced patient satisfaction. RESULTS: The mean of the response rates of patients completing questionnaires in each practice was 82%. An increasing total list size of patients registered with practices was associated with decreasing levels of general satisfaction and decreased satisfaction with accessibility, availability, continuity of care, medical care and premises. The presence of a personal list system was associated with increased levels of general satisfaction and increased satisfaction with accessibility, availability, continuity of care and medical care. Training practices were associated with decreased levels of general satisfaction and decreased satisfaction with availability and continuity of care. CONCLUSION: The patients of practices in this study preferred smaller practices, non-training practices and practices that had personal list systems. Practice organization should be reviewed in order to ensure that the trend towards larger practices that provide a wider range of services does not lead to a decline in patient satisfaction. General practitioners should have personal list systems and consider the creation of several personal teams within the practice consisting of small numbers of doctors, receptionists and practice nurses.

Adolescent↗

PubMed1996

Improving the uptake of breast screening: one initiative in east London.

Attendance for breast screening in inner city areas is considerably below the national target. Previous research in Tower Hamlets, East London, indicated that a personal approach from the GP surgery could encourage women to attend. Practices were sent a list of women who had not responded to two invitations. Receptionists and health advocates were trained to enable them to contact women. The Breast Screening Mobile Unit remained on site so that women could make appointments to attend. Uptake for practices participating in the scheme was 55%, and 31% for those who did not participate.

Breast Neoplasms↗

PubMed1993

Audit of a system for dealing with a practice's laboratory test results.

In order to improve efficiency in a non-computerized practice of 4700 patients the system for dealing with laboratory test results and communicating them to patients was audited over a two-week period. The audit involved a questionnaire for the practice team, a postal questionnaire to 36 patients, and an analysis of doctors' and receptionists' workload when dealing with laboratory test results. A new system was introduced, with two receptionists logging investigation details into a newly designed results book, and with date/process stamping of results. The new system was re-audited using another practice questionnaire and analysis of doctors' and receptionists' workload and found to be as effective as the old system but less time consuming, largely owing to the layout of the new results book. All members of the practice team were more satisfied with the new system. The function of a results book and its role in doctor-patient communication is discussed.

Diagnostic Services↗

PubMed2001

The maintenance of confidentiality in primary care: a survey of policies and procedures.

We investigated policies and procedures for the maintenance of confidentiality in primary care by means of a postal survey of 109 general practices in a large non-metropolitan urban health authority in England. The response rate was 61%. Practices believed a variety of staff should be informed if a patient was HIV-positive, ranging from 'patient's own GP' (100%) to 'clerical staff' (8%). In 88% of practices receptionists occasionally or normally asked patients why they wished to see a doctor, although in 76% such conversations were audible to other patients. Ninety-nine per cent claimed to have a policy on confidentiality, although it existed in writing in 62% and was publicized in only 27%. In 88% of practices non-clinical staff had access to written patient records. Ninety-three per cent provided staff training in confidentiality, but in 34% it was confined to induction. Almost all practices had taken some steps to safeguard confidentiality, but few had explicit, formal confidentiality policies. Information sharing and non-clinical staff access to medical records were extensive, and few practices communicated their arrangements to patients. Practices need to review their policies and procedures for the maintenance of confidentiality.

Confidentiality↗

PubMed1976

Delay in the prehospital phase of acute myocardial infarction. Lack of influence on incidence of sudden death.

Prehospital delay is considered to be an important cause of out-of-hospital coronary mortality. Behavior of patients and physicians in response to the symptoms of myocardial infarction (MI) or impending out-of-hospital death (OHD) was studied for 107 consecutive acute coronary events in Framingham, Mass. Delay due to inappropriate patient behavior was the most important component of total delay. Delay related to patient-physician contact occurred in two thirds of MI cases and was more than 30 minutes in half of these. Office visits and inappropriate triage by nurses and receptionists were important factors in physician delay. However, 60% to 75% of OHDs occur so rapidly that their prevention by reduction of prehospital delay seems impossible. A strategy for reduction of delay that might be of benefit in preventing some of the remaining OHDs is described.

Acute Disease↗

PubMed1995

The rest of the access-to-care puzzle. Addressing structural and personal barriers to health care for socially disadvantaged children.

A mother brings her 2-year-old child to the office at 4:30 Friday afternoon. The child has been seen only once in the practice for an episode of otitis media. The child missed her follow-up appointment. When the receptionist asks why the child is here, the mother responds that she was able to get a ride today with a neighbor who has an appointment with another physician in the practice. The child is not covered by health insurance. The mother did not bring her immunization record and is not certain what preventive care the child has received in the past.

Child Health Services↗

PubMed1986

The urgency distribution of an accident and emergency department's workload.

The perceived urgency of 2000 consecutive patients attending the Accident and Emergency Department of the Royal Infirmary, Edinburgh, was assessed using a Linear Analogue Scale. Each patient was assessed by the receptionist, the receiving nurse and the treating doctor. The distribution of urgency rating produced for this patient group was shown to be comparable for each status of assessor, and to correlate with other outcome criteria such as admission and referral rates. The linear scale was also shown to correlate with retrospective assessment using a time-guided category scale. The accident and emergency department workload is predominantly of low urgency (90% less than 5 on a 0-10 scale). Older patients tend to have higher urgency ratings than younger patients and those referred by ambulance, either via general practitioner or 999 calls, have similarly higher urgency distributions. This study provides a basis for the development of a guided category scale for functional triage of accident and emergency departments. Other scoring systems have attempted to similarly quantify the medical component of the workload (Coira & Rothstein, 1983; Peel et al., 1962). However, the complexity of many of these scales, together with the difficulty in usage of so many different scales, begs a reappraisal of the overall triage of patients attending the emergency department. The aim of this study was to look at the perceived urgency distribution of patients presenting to the emergency department. We wished to compare the relative assessment of urgency by various levels of treating staff and to compare those assessments with the referral and outcome of these patients to provide the basis for the development of a comparative Triage Scale.

Accidents↗

PubMed1996

Practicality of recording patient ethnicity in general practice: descriptive intervention study and attitude survey.

OBJECTIVE: To assess the feasibility of recording patient ethnicity in primary care using the Office of Population Censuses and Surveys classification. DESIGN: A descriptive intervention study and attitude survey in random samples of adults and primary care staff in randomly selected practices. SETTING: Eight practices in Lincolnshire and seven in Leicester. SUBJECTS AND METHODS: When patients were asked their ethnicity by general practitioners, nurses, or receptionists data were collected for 863 of a possible 880 patients. Of 750 patients sent a questionnaire about their attitudes towards the collection of such data 489 responded. Ninety five primary care staff completed a similar questionnaire. MAIN OUTCOME MEASURES: Time taken to record a patient's ethnicity; attitudes of patients and staff towards such recording, including who should ask, who can respond for others, and whether data can be shared with secondary care. RESULTS: Recording the data took less than a minute for three quarters of patients, but even this would need an average of a week of receptionist time per general practitioner. 72% of patients and 57% of staff agreed that ethnic data could be shared with secondary care, and 73% of patients and 60% of staff felt that the data should probably be collected in general practice. CONCLUSIONS: Ethnicity recording in general practice is feasible and acceptable. Nevertheless, the role of ethnic data in assessing health need in primary care, an adequate recording system, and evidence that recording offers benefits greater than the costs need to be established.

Attitude↗

PubMed1999

Insomnia in primary care patients.

STUDY OBJECTIVES: To determine the prevalence and characteristics of insomnia in primary care patients, to examine patients' help-seeking behavior, and to compare the frequency of insomnia in primary care patients to the general population. METHODS: 286 patients from primary care clinics in San Diego, California (n = 96), and in Haleiwa and Honolulu, Hawaii (n = 190) participated. Sleep study questionnaires were distributed by front desk receptionists to all patients over 18 years of age upon arrival at the clinic for an appointment with the physician. Completed questionnaires were collected at the clinic or returned by mail. Comparisons were made by using nonparametric statistics. A logistic regression analysis using backward elimination was done to develop a model showing predictors of who would consult with the physician about a sleep problem. RESULTS: The prevalence of insomnia in primary care patients was 69%, with 50% reporting occasional insomnia and 19% reporting chronic insomnia. As expected, patients with chronic insomnia had the most severe sleep complaints as well as the poorest daytime functioning, and exhibited the most help-seeking behaviors. The four predictors of discussing insomnia with a physician were how patients felt physically, number of years of insomnia, age, and income. CONCLUSIONS: The primary care population has a higher prevalence of insomnia than the general population, probably because of concomitant psychiatric and medical illnesses. Although many of the characteristics of the sleep complaints are easily detected, most patients with insomnia are not treated effectively.

Adolescent↗

PubMed2003

A public aid clinic prototype: utilizing a dental hygiene educational facility to increase access to care.

Few dentists in a rural Midwestern community participate in providing oral health care to public aid recipients. In response, faculty at a baccalaureate degree dental hygiene program located at Southern illinois University, Carbondale (SIUC) proposed, developed, and implemented the Heartland Dental Clinic to serve Medicaid participants. The unique program utilizes existing facilities, staff, and students to provide comprehensive oral health care to underserved populations. The state awarded a small grant to cover start-up costs. Two dental units were upgraded with fiber optics to allow restorative procedures. Dental hygiene students provide intake examinations and preventive care, while a staff dentist provides restorative care, dentures, and examinations. Dental technology students and faculty fabricate prostheses. A part-time clinic manager facilitates communication, patient scheduling, and billing. Two local Rotary Club members volunteer as receptionists for the clinic on the one evening per week that the clinic operates. The Rotary Club purchased educational pamphlets, a television/VCR, videotapes, and two signs for the clinic. By locating the clinic in the existing SIUC facility and utilizing dental hygiene students, a staff dentist, volunteer receptionists and dentists, student workers, and health care management interns, the clinic overhead costs have been kept to a minimum. The clinic provides a unique opportunity for dental hygiene students to experience firsthand scheduling, billing, and treating public aid patients while providing patients with an additional source for oral health care. The Heartland Dental Clinic model represents a cost effective method for increasing oral health access to underserved populations while also benefiting students in an educational program.

Clinical Clerkship↗

PubMed1996

Human resource management in general practice: survey of current practice.

BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters of practice managers reported having received some type of formal training in staff management. CONCLUSION: This study shows that practice size is a major factor associated with differences in the organization and management of staffing. Any initiatives which increase the scale of primary care functions and services would have to address the issues of communication and coordination that might be associated with such a change.

England↗

PubMed2003

A job analysis of selected health workers in a district health system in KwaZulu-Natal. Part three: Other categories of health workers.

This article described the third part of a study aimed at doing a job analysis of nurses and non-professional health workers in a district health system. This article describes the tasks of five categories of workers, their training and their work-load over an ordinary week. Interviews were done with 52 workers from three hospitals and five clinics, of whom 14 were men and 38 women. The three PHC guards had a much more varied job than the hospital security staff (also three). All of them have had specific task related training. The six General Assistants in Primary Health Care settings were almost exclusively involved in cleaning, while the 23 in hospitals added food and drink management and running errands to their work. Only one had training pertaining to the specific tasks. All three clerks were found in the PHC setting, and their tasks were mainly that of receptionist. None had specific task related training. The three Ground's Men worked at gardening and cleaning at PHC clinics, but a range of other tasks were added from time to time. Porters, of whom ten were interviewed, did mainly transporting of patients and running errands. GA's and security staff were also used to control violent patients and visitors, something for which none of them have had training. Recommendations were made about training and work redesign in the district.

Adult↗