The fresh new contract for general practitioners. General practitioners are in impossible position.
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Contract Services↗
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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.
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Variations in use of cardiac services in England: perceptions of general practitioners, general physicians and cardiologists.
OBJECTIVE: To explain why those who live some distance from tertiary cardiac centres make less use of coronary angiography and revascularisation than those who live close by, and why people living in particular wards within certain districts make less use of services than might be expected from their level of need. METHOD: Semi-structured interviews with 24 general practitioners (GPs) in two English health districts (Morecambe Bay and East Lancashire), five general physicians working in district general hospitals, and four interventional cardiologists working in tertiary centres. Transcripts of audiotape recordings were analysed using the constant comparative method. RESULTS: Those living far from tertiary centres are usually referred to general physicians before they are referred for angiography. The general physicians tend to be more conservative in their approach to treatment than interventional cardiologists. GPs working near tertiary centres are able to refer directly to interventional cardiologists. There are also logistical and economic reasons for inequitable use of services. Some GPs perceived that patients of South Asian descent undergo fewer investigations than might be expected because of communication or other difficulties. CONCLUSION: Use of cardiac services would be more equitable if there were interventional cardiologists based in district general hospitals who could perform angiograms for their own patients in the tertiary centres. Patients might also benefit in angiograms could be conducted in selected district general hospitals. Further qualitative research, involving both doctors and patients, is needed to explore other reasons for relatively low rates of investigation and revascularisation in certain groups of patients.
Attitude of Health Personnel↗
[The general practitioner teaching general practitioners. Traumatology of the locomotor system in the general practitioner's office].
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Diagnostic Imaging↗
Detection of patients with high alcohol intake by general practitioners.
General practitioners have the potential to treat patients with alcohol problems effectively. Despite the medical implications of excessive alcohol intake, it appears that general practitioners are not sufficiently aware of the drinking habits of their patients. The aim of the study was to investigate the accuracy of 56 randomly chosen general practitioners in detecting which of their patients had a high alcohol intake. Altogether, 2081 patients were recruited in general practitioners' waiting rooms, where they answered questions about their drinking habits. After the consultations general practitioners were asked to indicate the patients' levels of alcohol intake. The results showed that general practitioners correctly identified only 27.5% of patients who were classified as "high risk" drinkers, using Australian Medical Association criteria. They correctly identified only 45.2% of patients who were classified as "moderate to heavy" drinkers, defined by them as drinkers who consume four or more standard drinks a day. These findings have important implications for clinical practice since they indicate that general practitioners are failing to perform adequately in an important area of preventive medicine. This issue needs to be addressed in undergraduate and postgraduate medical education.
Adult↗
General practitioners forum. General practice in Canada and the relationship between the Canadian general practitioner and the hospital services.
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Canada↗
Attitudes to community psychiatry among urban and rural general practitioners.
General practitioners' requirements for community psychiatric services may differ according to the area in which they practise. A questionnaire survey of general practitioners' attitudes to community psychiatric services is reported from three contrasting areas: an inner city urban area, a new town and a rural area. General practitioners in all areas wanted more consultation with psychiatrists, and 53-68% wanted regular psychiatric outpatient clinics in their surgeries. There was enthusiasm for community psychiatric nurses and for help with psychotherapy. In the rural area general practitioners favoured surgery based psychiatric outpatient clinics and arranging emergency hospital admissions themselves; in urban areas domiciliary visits from psychiatrists to help with emergencies were favoured. These results appear to reflect the greater geographical distance between primary and hospital based secondary care in rural as opposed to urban areas. Overall, general practitioners wanted more support from community psychiatric services in carrying out their primary therapeutic role especially in rural areas far from hospital-based psychiatric services.
Attitude of Health Personnel↗
Treatment advice in primary care: a comparative study of nurse practitioners and general practitioners.
AIM: This paper reports a study comparing the content of talk about treatments by nurse practitioners and general practitioners in order to understand how this might be related to satisfaction. BACKGROUND: Studies show that satisfaction with nurse practitioner care is high when compared with that given by general practitioners. Clinical outcomes are similar. Nurse practitioners spend statistically significantly longer on consultations, and spend more time discussing treatments as well as social and emotional aspects of patients' lives. METHODS: Based on transcripts of audiotaped consultations, clinicians' talk about treatment was compared across 18 matched pairs of nurse practitioner and general practitioner consultations where 'same day' appointments were sought. Case studies of six paired consultations were analysed in depth. The data were collected in 1998 in the United Kingdom. RESULTS: A statistically significantly greater proportion of nurse practitioners' talk concerned treatments, with talk about how to use treatments and discussion of side effects contributing most to the difference. Nurse practitioners also recommended a greater number of treatments. Qualitative comparison of case study pairs suggested that nurse practitioners demonstrated greater concern with the acceptability and cost of treatments to patients. CONCLUSIONS: Nurses offered more holistic care to these patients and it is likely that this, and the greater provision of information, led to the higher levels of satisfaction found by other investigators. General practitioners are more focused on gathering information directly relevant to diagnosing and treating the immediate presenting complaint. Both types of practitioner may benefit from seeing the detailed illustrations of different approaches provided.
England↗
HIV infection and South-West general practitioners.
General practitioners in the Severn Faculty of the Royal College of General Practitioners were asked about their knowledge and practice in dealing with HIV infected patients. 62% responded to our anonymous questionnaire. Overall, four-fifths of the doctors expressed confidence in their ability to advise HIV antibody positive patients on sexual activity, drug abuse and domestic activities. Only 61% were confident of their ability to advise such patients on pregnancy. Differences in screening policy and measures of awareness were related to location of practice by county within the Region and to the presence of HIV infected patients on individual lists. The findings are discussed in relation to previous surveys of general practitioners in the UK.
Acquired Immunodeficiency Syndrome↗
Guidelines on the management of asthma. Statement by the British Thoracic Society, the Brit. Paediatric Association, the Research Unit of the Royal College of Physicians of London, the King's Fund Centre, the National Asthma Campaign, the Royal College of General Practitioners, the General Practitioners in Asthma Group, the Brit. Assoc. of Accident and Emergency Medicine, and the Brit. Paediatric Respiratory Group.
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Acute Disease↗
Weekly Returns Service of the Royal College of General Practitioners.
General practitioners in 69 practices in England and Wales monitor the spread of epidemic diseases in the community through the Weekly Returns Service (WRS) of the Royal College of General Practitioners, which has existed for over 30 years. Participating general practitioners summarise diagnoses and consultation/episode type (new episodes/ongoing consultations) for a defined population (currently about 570,000) and data are extracted to provide the 'weekly return', which includes age specific weekly incidence of new episodes of selected illnesses. The service has been used extensively to measure the burden of influenza and total acute respiratory illness in the community and the impact of enteric infections. It also provides information about illnesses for which there are no other major data sources--for example, chickenpox, scabies, and (historically) mumps. The entire network is electronically linked. Direct links with microbiological laboratories are being forged in order to integrate clinical and microbiological data in defined populations.
Communicable Disease Control↗
Detoxification from alcohol at home managed by general practitioners.
General practitioners have an important role in identifying and responding to problem drinkers, but no study has attempted to document their use of detoxification at home. A questionnaire was mailed to all general practitioners in Exeter Health District (n = 168) that was concerned with how they managed patients who presented with problems related to alcohol. The 145 (86%) responses showed that collectively they were identifying many more cases of problem drinking than any other local treatment agency. Of the estimated 230 patients a year for whom detoxification was arranged, half were managed at home, 40% in a local psychiatric hospital, and 9% in a local general hospital. Of those who were managed at home, 38% were unsupervised, a close relative held the medication for 45%, and 17% were supervised by a nurse. Fifty six percent (81) of doctors favoured chlormethiazole (Heminevrin) treatment, and many (17%) were prepared to prescribe this for longer than 10 days. Three quarters of the respondents thought that there was a need for specialist community services, such as community alcohol teams, to support general practitioners by supervising detoxification at home.
Alcoholism↗
[Ethnicity in practice guidelines of the Dutch College of General Practitioners].
General practitioners (GP's) in the Netherlands increasingly see patients with differing ethnic backgrounds. A literature review has been published stating that too little attention was paid to ethnic differences in the references and recommendations of the practice guidelines of the Dutch College of General Practitioners (NHG). The recommendations in the guidelines often do not need adaptation to deal with the ethnic-specific problems that were identified. Looking at the references in the guidelines only is insufficient to make an appropriate weighing of evidence, because the acceptance of evidence is subject to several considerations pertaining to relevance and validity. In addition, extrapolation of research from other countries to the Netherlands is often difficult because of socioeconomic and behavioural differences. It was suggested that the composition of the guideline working group had a large influence on the amount of attention paid to ethnic-specific aspects. However, the guideline-setting process for Dutch GP guidelines includes a large number of internal and external review steps, as well as an open discussion afterwards. This should identify major flaws, if present. Guideline-setting organisations should be supported in the development of sensitive and specific search strategies for this subject. Researchers on ethnic differences in health care can identify and transfer existing evidence to guideline developers. They may also comment on (drafts of) guidelines. The emphasis should be on implementing the guidelines rather than on changing them in a marginal fashion, and on supporting the general practitioners working in lower-class districts where many patients are from different ethnic backgrounds.
Ethics, Medical↗
Older persons' definitions of good health: implications for general practitioners.
General practitioners are the major providers of health-care services for the older population in Australia. Care that is provided for older persons within the general-practice setting remains crisis-orientated. Nevertheless, many of the disabling health problems of older persons neither can be "solved" nor cured. Therefore, the older population is a unique population in which to study what constitutes good health and ways in which good health can be maintained. This article describes the perceptions of a group of older persons about their health. They define good health in a remarkably non-medical way. General practitioners need to take into account this knowledge when considering ways to improve the health of these patients.
Aged↗
New roles for general practitioners.
General practice is likely to change greatly over the next few years. Increases in care in the community and day surgery will lead to more work, and the demand for better data on practice activity will mean the development of audit and epidemiological work. To make time general practitioners will have to learn to delegate work that does not require a doctor. Fundholding has already stimulated some practices to bring services to patients rather than send patients to hospital, and this trend seems set to continue. It is important to pool resources, not only within practices but among other practices in the area--joint action will increase the ability to improve the services for patients. If general practitioners take the opportunity to gain control of the changes the morale of the profession should improve.
Career Choice↗
Need for guidelines in gastroenterology for the general practitioner.
General practitioners base their clinical strategy on evidence-based medicine and experience. When prospective randomized controlled studies have not provided an answer to a specific clinical question, or when common practice in a certain area is not well established, guidelines formulated by specialists with in-depth knowledge of the field are needed. Studies have shown that gastroenterology guidelines have improved the approach to Helicobacter pylori infection and the management of gastroesophageal reflux disease. Failure to use these guidelines by general practitioners can lead to diagnostic inconsistencies and faulty patient care. This is particularly important in Israel, where the heterogeneous patient and physician populations are characterized by differences in the interpretation of symptoms, disease prevalence, and education.
Family Practice↗
[General practitioners and smoking. General practitioners' knowledge, attitudes and smoking habits and the relationship between these assessed by a questionnaire study in the county of Aarhus].
The objects of the investigation were to investigate the smoking habits of general practitioners, their assessment of tobacco as a risk factor for ischaemic cardiac disease, attitudes to intervention to stop smoking and to assess whether there was a connection between these. The project was carried out as a questionnaire investigation in the County of Aarhus, where all of the general practitioners received questionnaires. A total of 313 general practitioners replied to the questionnaire which corresponds to 84% participation. 33% of the general practitioners smoked and nine were chain smokers. The majority of the general practitioners accepted that smoking was a risk factor for ischaemic heart disease and were prepared to make great efforts to combat smoking. A connection was present between smoking habits and attitudes: Non-smokers considered that smoking was of great significance as a risk factor for ischaemic heart disease and were prepared to make efforts to alter the smoking habits of their patients. General practitioners doubted the effect of their advice about stopping smoking.
Attitude of Health Personnel↗
Do general practitioners and general psychiatrists want to look after drug misusers? Evaluation of a non-specialist treatment policy.
A new means of monitoring drug misuse which was developed in the north west of England, but is now widely used throughout the United Kingdom, is described and evaluated. Report forms which had been specially designed and ensured the anonymity of drug misusers were widely distributed among doctors and non-medical health workers who may have had contact with drug misusers. The forms were returned post-free to a centre where they were entered on a customized drug misuse database. There were 2127 reports from the north west of England (population 3.99 million) relating to 1792 individuals over a 15-month period. However, despite intensive promotion of the project among doctors, the number of reports from doctors remained virtually unchanged over the 15 months despite a 33% increase in the overall number of reports. When the reports from three health districts, selected so as to be representative of the region demographically (total population 658,500, population aged 15-44 years 292,200), were considered there was a substantial fall (70%) in reports from general practitioners which was considerably greater than the 2% fall in all reports. In a linked study all the psychiatrists, 30% of probation officers and a one in six sample of general practitioners from the three selected health districts were approached for interview at the beginning of the 15-month period and again a year later. This structured enquiry about caseloads, treatment, and attitudes also revealed a fall in the number of drug misusers attended by general practitioners and general psychiatrists and a reduction in the services provided for them by general practitioners.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Learning priorities and attitudes towards computer-assisted learning of general medical practitioners, general dental practitioners and dental hygienists.
OBJECTIVES: The objectives of this survey were to assess the attitudes and learning priorities of general medical practitioners (GMPs), general dental practitioners (GDPs), and dental hygienists (DHs) working at Jordan University of Science and Technology (JUST), Irbid, Jordan in relation to post-graduate education, to gather information on their attitudes and skills in using computers and computer-assisted learning (CAL) and to see whether the material in this form is acceptable to participate as a means of teaching. METHODS: Data for this study was gathered via a questionnaire distributed to 63 health professionals including GMPs, general dental practitioners and DHs (mean age 24.79 +/- 2.69 years) working at JUST. RESULTS: Of the 63 participants, 80% of the participants have home computers, 38% have office computers at work and only 25% have both home and office computers. Approximately 53% of the participants had their first CAL experience at home. Seventy-three of the participants indicated that connection to Internet is necessary for their work. Seventy-one of the participants were interested in the possibility of using CAL to further improve and increase their medical knowledge. The most important topic for doctors was 'learning about new techniques which may supersede those in current use', for DHs it was 'improve knowledge or skill in radiology', and for dentists it was 'reinforcement of well established techniques commonly used in dental practice'. CONCLUSIONS: It is necessary for practicing health care professionals to update themselves by taking continuous education courses after graduation more conveniently via CAL methods.
Adult↗