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Biomedical subjects

A N Thomson

Publications and source records attributed to A N Thomson.

At least 19 recordsLinked to original sources
PubMed1999

An evaluation of a surveillance system for patients discharged from the acute psychiatry unit in southern Tasmania.

OBJECTIVES: The aim is to evaluate the current community follow-up, or health surveillance, system for patients discharged from the acute psychiatry unit into the community in southern Tasmania. METHOD: We developed a conceptual model which considered community mental health follow-up as analogous to an epidemiological surveillance system. The surveillance system was evaluated by prospectively following recorded contacts between the system and a cohort of 100 patients consecutively discharged from the acute psychiatry unit. Main outcome measures were attendance at follow-up appointments, patient re-engagement and hospital readmission. RESULTS: There is no formal system of follow-up and no policy relating to non-attenders of follow-up appointments after psychiatric hospitalisation. There is no defined role for private medical practitioners and agencies in the community. Of the 97 patients considered to need community follow-up, 11 patients were lost to follow-up after 3 months, while another 15 remained in the system because of hospital readmission. A further seven patients returned to the system during the following 2 years (six in year 1 and one in year 2) due to readmission. There is appropriate policy about the content and timing of discharge summaries; most summaries were sent promptly. CONCLUSIONS: After discharge from the acute psychiatric unit, there was inadequate community follow-up of those patients for whom follow-up was considered necessary. Research is needed to determine whether increased patient follow-up is beneficial. Stakeholders should decide whether formal follow-up or health surveillance is necessary.

Adolescent↗
PubMed1999

Rectal bleeding in general practice patients.

OBJECTIVE: To determine the prevalence of observed rectal bleeding in general practice patients, the health seeking behaviour of those with rectal bleeding, and what rectal bleeding 'means' to patients in terms of perceived health risk. METHOD: Self administered questionnaire survey of general practice patients aged 50 years and over in northern Tasmania recruited as they visited their general practitioner (GP). RESULTS: The reported lifetime prevalence of rectal bleeding in our sample was 33% (299 of 903 respondents). It was more common in younger people, becoming less common with increasing age. Many respondents do not examine for bleeding. Only 45% of respondents with rectal bleeding consulted their GP about the most recent bleed. Patients were more likely to consult if they reported blood in the toilet pan and if they sought advice from a family member. There were significant differences between the meaning of bleeding for GP consulters and non consulters. This may have important implications for health education. CONCLUSION: Colorectal cancer (CRC) is a common problem managed by a combination of screening and case finding. With the high prevalence of rectal bleeding and low consultation rates for this problem there is potential to enhance the effectiveness of early detection of CRC through general practice based public health and education campaigns.

Adult↗
PubMed1997

Identifying the active general practice workforce in one division of general practice: the utility of public domain databases.

OBJECTIVE: To identify the non-specialist medical practitioner workforce engaged in active general practice in the region served by the Division of General Practice-Northern Tasmania and to determine the usefulness of public domain databases for enumeration of individual non-specialists providing general practice services. METHODS: A masterlist of the active general practice workforce was compiled by obtaining the names and addresses/postcodes of all non-specialist medical practitioners who were listed in at least one of nine public domain databases and who were confirmed by selected local medical practitioners to be in active general practice in the three months prior to 30 June 1994. This masterlist was used in calculating the sensitivity and positive predictive value (PPV) of each of the nine databases for enumerating non-specialist practitioners in active general practice. RESULTS: Combining the databases resulted in a list of 475 practitioners, which was refined to 139 practitioners who, by our criteria, were in active general practice. Databases had a range of sensitivities and PPVs, but those with high sensitivity tended to have low PPVs, and vice versa. The most useful database for enumerating these practitioners was the mailing list for Australian Family Physician (sensitivity, 94%; PPV, 0.79). CONCLUSIONS: When used alone, no single database had both high sensitivity and high positive predictive value for identifying the active general practice workforce. Combining multiple databases may improve precision. Developing methods to identify recent departures from local active practice has the potential to improve the PPV of existing highly sensitive databases.

Australia↗
PubMed1995

Attitudes toward sexual contact between general practitioners and their patients.

AIMS: To examine attitudes toward sexual contact with patients including seductive and sexually demeaning verbal behaviour. METHODS: Anonymous questionnaire mailed to a nationwide randomised sample of 217 general practitioners. A response rate of 88% was obtained. MAIN OUTCOMES MEASURES: Attitudes were appraised through responses about the acceptability of sexual contact with current and former patients. Knowledge of colleagues engaging in sexual contact, seductive or sexually demeaning behaviour was also assessed. Disposition toward reporting colleagues was explored. RESULTS: Ninety per cent of general practitioners indicated that it was never permissible to have sexual contact with a current patient. Twenty per cent agreed that it was never permissible to have sexual contact with a patient even when treatment had been terminated. While only 4% and 6% respectively knew of a general practitioner who had engaged in seductive or sexually demeaning verbal behaviour, 32% had personally known of a colleague who had engaged in sexual contact with a patient. Participants were divided in their attitudes toward reporting colleagues for sexual misdemeanours with patients. CONCLUSION: The results have implications for the development of guidelines and the training of general practitioners.

Attitude↗
PubMed1995

Social and sexual contact between general practitioners and patients in New Zealand: attitudes and prevalence.

BACKGROUND: Doctor-patient social and sexual contact is increasingly acknowledged as an issue of importance for the medical profession. However, there is little research concerning general practitioners on this topic. AIM: A study was undertaken to obtain data on social and sexual contact between general practitioners and their patients. METHOD: An anonymous questionnaire was mailed to a nationwide randomized sample of 217 general practitioners in New Zealand. RESULTS: A response rate of 86% was obtained. Dating and sexual contact with patients was considered to be sometimes or usually acceptable to 35% and 10% of general practitioners, respectively. Of respondents, 6% reported having dated a patient, 4% reported having had sexual contact with a patient at some point during their career and 2% reported having engaged in sexual contact with a former patient. General practitioners who had personally known of a colleague who had engaged in sexual contact with a patient were more likely to believe this behaviour had negative consequences than general practitioners who themselves reported having engaged in sexual contact with a patient. CONCLUSION: The study results have implications for developing behavioural guidelines and educational interventions for general practitioners.

Adult↗
PubMed1994

Can one be a good doctor and have a sexual relationship with one's patient?

This paper presents a qualitative exploration of social and sexual contact between general practitioners and their patients. Social contacts have been implicated in the development of sexual relationships between members of the mental health professions and their patients. However, there has been little examination of the implications for general practitioners. Six focus groups were conducted by teleconference with New Zealand general practitioners. Participant anonymity was maintained. Questions focused on issues of social and sexual contact in general practice. Major themes were extracted from the data. A range of definitions of 'patient', 'sexual contact' and 'social contact' were offered by the participants which demonstrated that 'grey areas' existed for them in relation to social and sexual relationships with patients. Mandatory reporting of colleagues for alleged sexual misconduct was not supported, informal mechanisms being preferred. General practitioners need to be aware of potential boundary violations in their practice. These issues are also important to address in the teaching of medical students, continuing medical education, and in the development of appropriate guidelines for general practice.

Attitude of Health Personnel↗
PubMed1994

Reliability of consumer assessment of communication skills in a postgraduate family practice examination.

Examinations of competence which may affect career prospects require measures which are of high reliability, and which can be demonstrated to be valid. In a New Zealand summative postgraduate examination of competence in family practice the doctor-patient communication skills of candidates were assessed by nonmedically trained nominees of community organizations. The assessments were based on direct observation of the candidates' encounters with simulated patients. To estimate the reliability of the consumer examiner, after the examination the examiners re-scored a random selection of video-taped candidate encounters. The test-retest correlations of consumer scoring were demonstrated to be at a level consistent with adequate examination reliability (confidence interval 0.59-0.98). Consumers may be valuable as a resource for the training and assessment of the communication skills of medical practitioners.

Clinical Competence↗
PubMed1994

Attitudes of general practitioners in New Zealand to pharmaceutical representatives.

BACKGROUND: Pharmaceutical representatives are a vital component of the marketing of pharmaceutical products and an important source of prescribing information for general practitioners. AIM: A study was undertaken to explore the attitudes of New Zealand general practitioners to pharmaceutical representatives. METHOD: A questionnaire survey of 100 general practitioners was undertaken to which 67 general practitioners responded. RESULTS: The provision of practical prescribing advice by representatives and gifts relevant to medicine were seen as desirable activities by many respondents. However, gifts of value considerably greater than suggested acceptable in recent guidelines for general practitioners were also highly favoured by some practitioners. CONCLUSION: Current ethical guidelines setting out the relationship between pharmaceutical representatives and medical practitioners are inadequate and should be based on the need for the general practitioner to become an unbiased promoter of patient health.

Adult↗
PubMed1993

The prevalence of bad headaches including migraine in a multiethnic community.

AIM: Overall and ethnic specific prevalences of bad headache including migraine, for the New Zealand population, are unknown. A study was carried out in South Auckland to estimate prevalence and to explore ethnic differences in doctor attendance for the diagnosis and management of bad headaches. METHODS: Telephone interviews were administered to respondents selected by random digit dialing of households. RESULTS: 40.6% of the respondents suffered from bad headaches. 54.5% of these had the characteristics of bad headache with features symptomatic of migraine. Trends in the prevalence of bad headache with features symptomatic of common migraine, peaked between the ages of 30-49 years in both men and women. A difference was seen in the prevalence of bad headache with aura, with or without common migraine features, when ethnic groups and gender were examined. The difference in prevalence of aura was particularly noticeable between Pacific Island men and women. Although there was no difference between ethnic groups in doctor attendance, headaches were more likely to be labelled as migraine in Europeans than in the Polynesian groups. CONCLUSION: Ways in which people perceive and report their bad headaches have a bearing on management by general practitioners. Although no overall ethnic predominance was seen, there was a gender difference amongst Pacific Island people in reporting bad headaches with aura. The labelling process, and thus the management by general practitioners does demonstrate likely ethnic differences.

Adolescent↗
PubMed1993

Subcutaneous sumatriptan in acute treatment of migraine: a multicentre New Zealand trial.

AIM: To assess the effectiveness of subcutaneous sumatriptan (4 mg) in the acute treatment of migraine. METHODS: A randomised, double-blind, placebo controlled study was conducted in four New Zealand centres. On developing an acute attack of migraine, patients attended a centre where they were given either sumatriptan 4 mg or placebo by subcutaneous injection. Headache severity and clinical disability were measured over a 2 hour period. RESULTS: Fifty-one patients, aged 19-58 years with common or classical migraine were treated. Twenty-eight patients received 4 mg sumatriptan and 23 patients received placebo. Pretreatment headache severity was graded moderate in 76% and severe in 24%. Thirty-two percent of patients were sufficiently disabled to require bed rest and a further 48% had severe impairment of working ability. Sumatriptan was significantly more effective than placebo in relieving or reducing headache severity after 30 minutes. Sixty-four percent improved on sumatriptan compared to 27% on placebo. Functional disability, nausea, vomiting and photophobia were also greatly reduced. Adverse effects occurred in 17% of patients receiving placebo, and 82% receiving sumatriptan, the commonest being injection site reactions. CONCLUSION: Subcutaneous sumatriptan 4 mg is an effective and well-tolerated acute treatment in adult patients with moderate to severe common or classical migraine. The efficacy rate of 64% is lower than that found in recent controlled studies using a higher dose.

Adult↗
PubMed1993

The effect of a warning about putative adverse events on drug prescribing in general practice.

Many studies have looked at factors influencing doctors' prescribing. None have done this during a time when prescribers have been just made aware of potential serious adverse events that might be caused by a commonly prescribed medication. A controversy over the safety of Fenoterol (Boehringer Ingelheim) in 1989 provided an opportunity for such a study in general practice. Practitioners were exposed to conflicting and changing views from authoritative sources, patient concerns raised by the coverage of the issue in the news media, and a need to maintain patients on effective therapy. The study demonstrated that the majority of general practitioners would act promptly and conservatively when faced with uncertainty about the safety of the medication they prescribed.

Attitude of Health Personnel↗
PubMed1993

Consumer assessment of interview skills in a family practice certification examination.

BACKGROUND: In New Zealand, the family practice certification examination includes an assessment that uses simulated patients. In 1990, for the first time, consumers participated in evaluating the performance of examinees in the simulated-patient section of the examination. METHODS: The consumer examiners and medically trained examiners observed the candidates during interactions with simulated patients. The consumers, medical examiners, and simulated patients independently scored the candidates' performances. One hundred and nine examination candidates participated in two simulations each, and the scoring behavior of each rater was compared. RESULTS: Consumer and medical examiners showed significant differences in their scoring behaviors, disagreeing on whether the candidate should pass or fail in 7.8% of interviews. In comparing the scores given by consumers, medical examiners, and the simulated patients, low inter-observer correlations were noted. CONCLUSION: Medical personnel, consumer observers, and simulated patients all provide a different perspective on the communication skills of physicians.

Certification↗
PubMed1992

Can communication skills be assessed independently of their context?

In many examinations, communication skills tend to be treated as if they are a single attribute independent of the context of the communication. However, it is clear that such assessments are confounded by candidates' knowledge or lack of knowledge of the medical issues about which they are communicating. In the 1990 Part One examination for Membership of the Royal New Zealand College of General Practitioners candidates were provided with all the essential knowledge relevant to the problem they were to communicate about. Despite this, performance was still seen to be context specific, demonstrating that such specificity is not purely knowledge related. Candidates completing the examination were observed to share information about the cases with candidates about to commerce. There was no evidence that performance was enhanced by such breaches in examination security.

Clinical Competence↗
PubMed1990

Case specificity of performance with simulated patients.

In the part one examination for membership of the Royal New Zealand College of General Practitioners (MRNZCGP) patient simulations are used to assess candidates' communication and management skills. In the 1989 examination two different scoring proformas were used to determine if the scoring method contributed significantly to the degree of case specificity that has been observed. The results of this study demonstrate significant differences in performance between cases, while interexaminer rating of performance within cases showed no significant difference. Such results indicate that the between cases differences in measured performance are indicative of real differences and are not reducible by manipulation of the scoring method.

Certification↗