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Biomedical subjects

B R McAvoy

Publications and source records attributed to B R McAvoy.

At least 19 recordsLinked to original sources
PubMed1999

Our Healthier Nation: are general practitioners willing and able to deliver? A survey of attitudes to and involvement in health promotion and lifestyle counselling.

BACKGROUND: The recent Green Paper, Our Healthier Nation, identifies professional advice on healthier living as a key component of its national contract for health. General practitioners (GPs) are ideally placed for this work. However, previous research has reported a discrepancy between patients' expectations of lifestyle advice from GPs and their receipt of such advice. AIMS: To describe GPs' current attitudes to and involvement in health promotion and lifestyle counselling, and to track changes in these areas over recent years. METHOD: A postal questionnaire survey of a random sample of 430 GPs, one per practice, from all general practices in Leicestershire, Derbyshire, and Nottinghamshire. GPs who had not responded after two weeks received a reminder telephone call plus two follow-up questionnaires. RESULTS: Four hundred and eleven GPs were eligible for the survey, which yielded a response rate of 68% (n = 279). GPs reported spending an average 16% of practice time on prevention and 79% reported educating patients about lifestyle risk 'most' or 'all of the time'. Solo GPs spent more time on prevention than GPs from group practices. Most enquiries and interventions related to smoking behaviour. GPs felt most effective in changing patients' use of prescription drugs, and the largest reported difference between current and potential effectiveness in helping patient change lifestyle behaviour, after information and training, related to reducing alcohol consumption. CONCLUSIONS: Despite an increasing workload, GPs remain positive about health promotion and lifestyle counselling. Over the past 10 years, there has been an increase in routine enquiries about lifestyle behaviour, but confidence about effectiveness in helping patients changes lifestyle behaviour remains low. More training and support concerning lifestyle intervention is required by GPs in order for them to contribute effectively to the Government's health promotion programme.

Adult↗
PubMed1998

'So much post, so busy with practice--so, no time!': a telephone survey of general practitioners' reasons for not participating in postal questionnaire surveys.

BACKGROUND: Response rates by general practitioners (GPs) to postal surveys have consistently fallen, compromising the validity of this type of research. If postal survey work is to continue we need to understand GPs' reasons for not participating and respond appropriately. AIM: To investigate GPs' reasons for not responding to postal surveys. METHOD: A qualitative study was carried out to determine GPs reasons for not participating in postal surveys, which were drawn from a telephone survey of 276 non-responders to a postal questionnaire survey. Practitioners' comments were recorded and reasons for their non-response quantified using content analysis. RESULTS: Primary reasons for GPs not replying to the postal survey were that questionnaires had got lost in paperwork (34%), that GPs were too busy for the extra work involved (21%), and that questionnaires were routinely 'binned' (16%). Higher practice workloads, including increased administration, meant that participation in research had become a low priority. GPs provided some suggestions for researchers that would increase their chances of questionnaires being returned. CONCLUSIONS: Researchers need to be aware of the pressures of service general practice and to rationalize the amount of research material sent to GPs. GPs were most likely to respond to postal surveys that had a high interest factor, that involved localized research relevant to general practice, and that incorporated a personalized approach by researchers, including good-quality explanatory information.

Attitude of Health Personnel↗
PubMed1996

General practice postal surveys: a questionnaire too far?

A primary care led NHS, driven by evidence based practice, needs to build on a firm foundation of research in primary care. As researchers are making increasing use of questionnaire surveys to assess general practitioners' views and attitudes, so response rates to questionnaire surveys among general practitioners are dropping. The reasons include lack of perceived relevance of the research and lack of information and feedback about it, and researchers need to be more aware of the realities of everyday practice. Approaches that might reverse this trend include monitoring all research activities going on in an area to ensure that practices are not overused, giving general practitioners incentives to participate, and improving the relevance of research and the quality of questionnaires.

Family Practice↗
PubMed1993

Increasing the uptake of cervical smears: strategies implemented among general practitioners in Auckland.

AIM: To evaluate three strategies designed to increase the uptake of cervical smears among specified groups of women through a collaborative partnership between the Auckland Area Health Board and selected Auckland general practitioners. METHOD: Using action-based research general practitioners and practice nurses were engaged to initiate ways of inviting women in their practices to have cervical smears. Both formative and process evaluations were made. Concurrently, outcomes were measured in terms of call/recall systems, uptake rates and cost barriers. RESULTS: Where financial incentives were given to establish call/recall systems for older women, overall uptake rates increased by 21%, and by 154% for women over 45 years. Over one third of a targeted group of women aged between 60 and 70 years responded to an invitation to have a free smear. Of these 109 women, fourteen, with a median age of 67 years, had their first smear. Almost two thirds indicated that cost had never been a barrier. CONCLUSIONS: The determining factor for women having a cervical smear in all three strategies was a personal invitation from their general practitioner or practice nurse. Invitations were dependent upon having accurate call/recall systems. This evaluation of the collaborative process between Auckland Area Health Board and local general practitioners demonstrated how manager and provider partnerships can benefit the consumer.

Adult↗
PubMed1992

Benzodiazepine use in general practice--is it a problem?

AIMS: The aim of this study was to describe benzodiazepine use in a general practice. METHODS: A prevalence study in an Auckland general practice was undertaken to describe the benzodiazepines prescribed, patterns of use and compliance. An associated case control study compared benzodiazepine users and nonusers. RESULTS: The age standardised prevalence rate of benzodiazepine use in this Auckland general practice was 3.4% for patients over 20 years of age. The benzodiazepine users described were predominantly elderly (70% over 60 years of age) and female (62.5%). They had significantly more medical and psychiatric complaints than matched controls. Triazolam and diazepam accounted for 60.9% of the benzodiazepines prescribed. Over one-third of the patients using benzodiazepines were concurrently prescribed other psychotropic medications, primarily tricyclic antidepressants. CONCLUSION: This rate suggests an overall decline in benzodiazepine use since previous studies. Benzodiazepines continue to be prescribed predominantly in the elderly, a group at considerable risk from side effects. Doctors should continue to inform their patients about the side effects of benzodiazepines, the risks of dependence and difficulties of withdrawal.

Adult↗
PubMed1991

1991 cervical screening recommendations: a working group report.

The Department of Health and the Cancer Society invited a working group to review the 1985 recommendations on cervical screening. Minor modifications have been made to the earlier recommendations in the light of more information about the effectiveness of different screening policies, and in the expectation that comprehensive cytology registers to ensure recall and follow up of abnormalities will be in place shortly. All women from the age of 20 up to 70 years should be offered cervical screening every three years. Any woman who has never had sexual intercourse or who has had a hysterectomy with complete removal of the cervical epithelium for a benign condition need not be screened. Women should have a second smear within one year if they have never had a smear before or if more than five years have passed since their last smear. But recall through the register should not be more frequently than three yearly for women with a history of normal smears.

Adult↗
PubMed1991

Can health education increase uptake of cervical smear testing among Asian women?

OBJECTIVES: To determine the effects of three different methods of providing health education on the uptake of cervical smear testing among Asian women, and to evaluate the acceptability of different health education materials. DESIGN: Prospective cohort study over one year of effects of written materials by post, personal visit to give written materials, and personal visit to show a video on the uptake of smear testing. Techniques included a personally administered questionnaire. SETTING: Leicester, a city with a large Asian population. SUBJECTS: 737 randomly selected Asian women aged 18 to 52 who were not recorded on the central cytology laboratory's computer as ever having had a cervical smear test. 159 declined to participate or were not contactable. INTERVENTIONS: Women were randomised into four groups: visited and shown a video (263), visited and shown a leaflet and fact sheet (219), posted a leaflet and fact sheet (131), not contacted at all (124). MAIN OUTCOME MEASURES: Cervical smear test recorded on computer within four months after intervention. RESULTS: 57 (37%, 26% of group) of the women visited and given leaflets and 80 (47%, 30% of group) shown the video attended for cervical smears. Only six (5%) of those who were not contacted and 14 (11%) of those sent leaflets had a smear test during the study. CONCLUSION: Health education interventions increased the uptake of cervical cytology among Asian women in Leicester who had never been tested. Personal visits were most effective irrespective of the health education materials used, but there was some evidence that home viewed videos may be particularly effective in one of the most hard to reach groups: Urdu speaking, Pakistani Moslems. Written translated materials sent by post were ineffective.

Adolescent↗
PubMed1990

Contraceptive services for Asian women in the UK: a review.

In Britain's multicultural society health services should be tailored to the specific needs of a variety of communities. Cultural and religious beliefs are important but should not be the only factors to be considered by those providing contraceptive services to Asians. Studies of knowledge, attitudes and usage of contraception, largely among women, and of service provision are reviewed. The need to consider alternative methods of providing services and information is stressed.

Adolescent↗
PubMed1990

Cervical cancer screening and registration--are they working?

STUDY OBJECTIVE: The aim of the study was to investigate the accuracy of one year's cervical cancer registrations and to review these women's medical records. DESIGN: The study was a survey of medical records of women registered as having a malignancy of cervix or uterus in 1985. SETTING: Cases were drawn solely from the county of Leicestershire, having been registered by the Trent Cancer Registration Bureau. PATIENTS: The study group comprised all 82 women registered as having a malignancy of cervix or uterus (part unspecified) during the study period. In one case the medical records could not be obtained, so 81 were reviewed. MEASUREMENTS AND RESULTS: Medical records were reviewed; demographic, clinical and tumour characteristics, and screening experience were noted. Errors of registration of invasive cancer resulted in a 22% overestimate: only 54 of 66 cases registered actually had this cancer. Cases over 40 years of age (n = 37) were compared to those under 40 (n = 17). Thirty two women (59%), predominantly in the older age group, had never had a cervical smear. Forty four women (81%) presented with symptoms rather than as a result of screening. There was no difference in the stage of the disease at presentation between the two age groups but eight of nine women under 35 years had poorly differentiated tumours. At 2 year follow up, 12 (71%) of the younger women were alive and asymptomatic, one had a recurrence and four were dead. The corresponding figures for the older women were 18 (50%), 5 (14%) and 13 (36%). Eight screened women had only had normal smears reported in the 5 years preceding the cancer diagnosis. Seven of these were under 45 years old and four had late stage disease. CONCLUSIONS: It will be impossible to assess the impact of newly implemented computerised call and recall systems for cervical cytology screening unless a more reliable data base can be created.

Adult↗
PubMed1988

Teaching clinical skills to medical students: the use of simulated patients and videotaping in general practice.

This paper describes the use of simulated patients in a problem-based teaching programme designed to develop the clinical skills of medical students during a 5-week course in general practice in the University of Leicester. The logistics of training and the advantages of using simulated patients are discussed. Simulated patients are practicable and acceptable in a United Kingdom medical school, and the reaction of students to their use is favourable.

Clinical Competence↗
PubMed1985

Does closing branch surgeries affect home visiting?

Home visiting rates in a rural general practice were compared for 12 months before and 12 months after five branch surgeries were closed. In villages whose surgeries were closed no statistically significant change occurred in the new or repeat visiting rates. The consulting rate at the main surgery remained constant over the two years. Although visiting rates to villages that had had a branch surgery did not change after the closures, the pattern of visiting to these villages became more rational.

England↗