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Biomedical subjects

C Bridges-Webb

Publications and source records attributed to C Bridges-Webb.

At least 19 recordsLinked to original sources
PubMed1992

Reasons for encounter and diagnosed health problems: convergence between doctors and patients.

This study of 521 encounters in 25 urban general practices in Australia, compares both patient and doctor reported reasons for encounter (RFE) and diagnoses. Although doctors and their patients generally agreed on the overall distribution of RFE and diagnoses that arose, there was disagreement in at least 30% of paired comparisons within individual encounters. There was better agreement for RFE than for diagnoses. This may have been partly due to differences in the classification systems used. However, it suggests that diagnoses recalled by patients at later household interview are at best only a rough approximation of the diagnoses recorded by the doctor. These findings are important both for patient care and for the conduct of general practice morbidity research.

Attitude of Health Personnel↗
PubMed1991

How representative are patients in general practice morbidity surveys?

This study examined differences arising from the sampling of patients from general practice and household surveys. When 25 general practitioners, who agreed to participate in one week morbidity survey in inner western Sydney, were compared with all general practitioners (192) identified in the area, they were not significantly different in terms of socio-demographic variables and practice details. When the demographic characteristics of a sample of patients at 539 encounters with the 25 participating general practitioners were compared with those of a sample of 500 patients identified from a household survey who had consulted with any general practitioner within 2 weeks of the interview, few differences were found. Few significant differences were found in the reasons for encounter and diagnoses treated as recalled by the patients of the two groups. No differences were found in management--specifically prescription, investigations and referral--or with respect to health status. This study suggests that sampling of patients from randomly selected general practitioners can produce useful representative samples for studies of morbidity even when doctor participation rates are as low as 29%.

Adult↗
PubMed1991

Using general practitioners to measure community morbidity.

Randomly-selected patients drawn from randomly-selected General Practitioners (GPs) (two-stage cluster sample) were compared with a sample of the general population, who had visited a GP, selected using close approximations to standard household survey methods (area probability) of the Australian Bureau of Statistics. If GP patients drawn in this way resemble a random sample of the Australian community who have recently used GP services, then confidence should increase in this much cheaper method as a source of morbidity statistics. Interviews focused upon each person's last visit to the GP, with questions about reasons for attending, diagnoses and treatments, and various demographic items. In univariate analyses of 22 demographic items, 17 consultation items and 27 diagnoses and treatments, only five items were differently distributed between the GP patients and the area sample. Pairs of data items were also similar in the two groups. Items were examined using multidiscriminant analysis, to determine those that discriminated between the two groups and to calculate predicted group membership on the basis of these items. This analysis correctly classified only 56.7% of study subjects into their true group (GP patient or area sample) when based on items that were differently distributed between the groups, and 53.3% when all items were used, indicating that discrimination was only slightly better than chance. This result increases the confidence with which GP patients can be used to estimate levels of morbidity in the community if random selection is used to select GPs and if their patients are also randomly selected.

Bias↗
PubMed1991

Reported measles immunisation and serological immunity in children attending general practitioners.

To determine the feasibility of serological testing for measles immunity in children attending general practitioners and to assess the validity of establishing immune status by reported immunisation history compared with serology, a cross-sectional descriptive study was conducted in general practices in the Illawarra area south of Sydney, New South Wales. Participants were 234 children under 15 years attending general practitioners. 87 per cent of children were reported to have been immunised against measles, but 46 per cent of these children were seronegative for measles antibody using an ELISA test on finger-prick blood. This could not be explained by inaccurate reporting of immunisation. No causes other than failure to seroconvert or inadequate specificity of the test on the blood samples were evident. Failure to seroconvert as a result of inadequate adherence to cold chain requirements is a possibility that needs further investigation. The results further question whether a single vaccination is adequate to achieve the public health aims of measles immunisation programs.

Adolescent↗
PubMed1991

Asthma management in general practice.

A postal survey of selected general practitioners from Brisbane, Melbourne, Sydney and rural New South Wales was conducted to compare general practitioners' self-reported asthma management practices with the Asthma Management Plan (1989) of the Thoracic Society of Australia and New Zealand. The results suggest that most general practitioners know and practise appropriate asthma management. Room for improvement, however, was detected in the following areas: 1. appropriate understanding of the use of theophyllines, 2. the use of preventive medications such as inhaled steroid and sodium cromoglycate, 3. use of crisis planning for severe asthma attacks, 4. lung function measurement.

Administration, Inhalation↗
PubMed1990

"Just one shot" is not enough--measles control and eradication.

The epidemiology of measles in Australia has changed in the last decade due to control of the disease by increased immunization rates. Elimination of endemic measles is possible, but has still to be attempted. A partially immunized population results in disease in an older population, with the possibility of contracting measles in the childbearing years. For elimination of measles to occur, a second dose of measles-mumps-rubella vaccine should be introduced. Changes in the immunization protocol would need to be monitored with reliable population-based data on seroconversion rates and disease incidence. Reliable documentation of immunization is a prerequisite for any legislative initiative in the field of immunization. In order to maximize the impact of immunization programmes, the social and cultural contexts within which immunization occurs should receive greater consideration.

Adolescent↗
PubMed1990

Diagnosis and antibiotic treatment of acute otitis media: report from International Primary Care Network.

STUDY OBJECTIVE: The relation between a history of disorders suggestive of acute otitis media, symptoms, and findings of an examination of the tympanic membrane and doctors' certainty of diagnosis. Also, to examine differences in prescribing habits for acute otitis media among doctors from different countries. DESIGN: Questionnaires were completed by participating doctors for a maximum of 15 consecutive patients presenting with presumed acute otitis media. SETTING: General practices in Australia, Belgium, Great Britain, Israel, The Netherlands, New Zealand, Canada, Switzerland, and the United States. PATIENTS: 3660 Children divided into the three age groups 0-12 months, 13-30 months, and greater than or equal to 31 months. MAIN OUTCOME MEASURES: General practitioners' responses to questions on their diagnostic certainty and resolution of patients' symptoms after two months. RESULTS: The diagnostic certainty in patients aged 0-12 months was 58.0%. This increased to 66.0% in those aged 13-30 months and 73.3% in those aged greater than or equal to 31 months. In all age groups diagnostic certainty was positively associated with the finding of a tympanic membrane that was discharging pus or bulging. Redness of the membrane and pain were also associated with certainty in patients aged 13-30 months, and a history of decreased hearing or recent upper respiratory infection was positively associated in patients aged greater than or equal to 31 months. The proportion of patients prescribed antibiotics varied greatly among the countries, from 31.2% in The Netherlands to 98.2% in both Australia and New Zealand, as did the duration of treatment. Patients who did not take antibiotics had a higher rate of recovery than those who did; the rate of recovery did not differ between different types of antibiotic. CONCLUSIONS: Doctors' certainty of diagnosis of acute otitis media was linked to patient's age. Improved criteria or techniques for diagnosing acute otitis media, especially in very young children, need to be developed. Antibiotic treatment did not improve the rate of recovery of patients in this study.

Acute Disease↗
PubMed1990

Recognition of depression in the elderly: a comparison of general practitioner opinions and the Geriatric Depression Scale.

As part of a larger study, 133 subjects aged 70 years and over were screened for depression using the Geriatric Depression Scale, a 30-item questionnaire, as the screening instrument. Cognitive status was assessed using the Mini Mental State Examination. The subject's own general practitioner was asked his/her opinion as to whether the subject was depressed. Poor agreement was found between depression as measured by the Geriatric Depression Scale and the general practitioner's assessment. Possible reasons for this include the difficulty of finding a satisfactory operational definition of depression for use by general practitioners, the problems of identifying depression in the elderly, the arbitrary definition provided by the scale and the confounding of depression, as measured by the scale, with cognitive status.

Aged↗