General practitioners' views of students: students' views of general practitioners.
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Biomedical subjects
Publications and source records attributed to B Fatovich.
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This paper reports a trial which assessed the clinical effectiveness of adding a behavioural self-management programme to the existing management of chronic headache by general practitioners (GPs). Eighty-seven chronic headache sufferers, referred to the study by 35 GPs, were randomly allocated to either a self-care group or a GP-control group. Headaches, drug usage, visits to health-care providers and time off work were self-monitored daily by all subjects for 4 weeks prior to intervention, for 4 weeks during intervention, and for 4 weeks immediately after intervention. Additionally, self-monitoring was carried out for two further 4-week periods, one at 6 months and one at 12 months post intervention. Headache records showed that the self-care program significantly enhanced GP management. This effect was well maintained. However, drug usage, visits to health-care providers and time off work did not differ significantly between the treatment and control groups. 'No-show' rates, defined as those referred by a GP but who did not attend, were high--largely due to time requirements of the self-care program. However, drop-out rates, defined as those who left the self-care groups were low. It was concluded that this behavioural self-management program was a clinically effective adjunct to general practice management of headache but its use is likely to be limited due to problems of patient enrollment.
If research is to be of any use the phenomena being studied must be clearly defined. Almost 30 years ago the difficulty of classifying primary care problems using the International Classification of Diseases (ICD-8) was demonstrated. This led to the development of the International Classification of Health Problems in Primary Care-2-Defined which is based on ICD-9. Despite the work that has gone into the development of ICHPPC-2-Defined, relatively little work has been undertaken to assess the validity and reliability of its use. This paper describes the results of such a study conducted as a preliminary to the use of ICHPPC-2-Defined in a study of consulting patterns in general practice. The participating general practitioners were trained in the use of ICHPPC-2-Defined and then coded problems which they identified in a set of clinical vignettes. Following the coding exercise, a review session was held in which difficulties and errors in the use of ICHPPC-2-Defined were discussed. Subsequently, the general practitioners were required to code two more sets of vignettes, which included some problems repeated from the preceding sets. Comparisons were then made of changes in the validity and reliability of coding from one round to the next. The results of the study suggest that the reliability and validity of morbidity data collected using ICHPPC-2-Defined can be increased by training sessions for the coders which focus on the main sources of error in the use of ICHPPC-2-Defined.(ABSTRACT TRUNCATED AT 250 WORDS)
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