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Biomedical subjects

D C Morrell

Publications and source records attributed to D C Morrell.

At least 19 recordsLinked to original sources
PubMed1990

Understanding hospital referral rates: a user's guide.

Detailed referral information from one practice was used to investigate the effect of calculating referral rates in several different ways. Referral rates for individual general practitioners should be related to the number of consultations carried out and not to the number of registered patients; for whole practices list size may be used as the denominator. Most doctors will not need to control for age and sex of patients when comparing referral rates but may need to control for case mix when comparing referral rates to individual specialties. In addition, a method is described for distinguishing systematic variation between the referral rates of individual doctors from the random variation that may arise from data based on fairly small numbers of referrals. The method indicates whether systematic variation is greater than would be expected by chance, and it can be extended to indicate whether variability in referral rates is greater in one specialty than another. Because of random variation with time a year's data may not be sufficient to allow reliable interpretation of referral rates to individual specialties, except for the largest. At present there is no known relation between high or low referral rates and quality of care. Nevertheless, if doctors are to interpret their own rates of referral they need those rates to be reliable and valid. Use of the 10 guidelines described in this paper will help to prevent unwarranted conclusions being drawn from information on general practitioners' rates of referral to hospital.

Adolescent↗
PubMed1990

Analysis of referral behaviour: responses to simulated case histories may not reflect real clinical behaviour.

In an attempt to develop a measure of the referral behaviour of general practitioners, 21 simulated case histories were constructed which presented between three and six stages at which a decision was required whether or not refer a 'patient' to hospital. Twenty general practitioners completed the case histories and their responses were compared with their referral rates to outpatient departments. No significant correlations were found between the doctors' responses to the vignettes and their actual referral rates, and the repeatability of the vignettes was disappointing. The fact that the case histories appeared realistic to the doctors who completed them was not reflected in objective measures of their validity. Simulated case histories should not be used as a method of measuring doctors' behaviour without establishing their validity and reliability.

Decision Making↗
PubMed1989

A health visitor investigation of home accidents in pre-school children.

The incidence and characteristics of home accidents in pre-school children were investigated in the northern part of Lambeth with the help of health visitors. Accidents were identified using the notification system from accident and emergency departments to health visitors. The study shows that there is not an easily identifiable group of high risk children so all must be regarded as potentially at risk. It also highlights how important it is that accidents treated at hospital are notified to health visitors and some ways for improving the system are suggested.

Accidents, Home↗
PubMed1987

How can good general practitioner care be achieved?

It has been shown that to provide a high standard of care general practitioners probably need to book consultations at intervals of at least 10 minutes. In this study the maximum list size for which a general practitioner might be expected to provide a high standard of care was determined from calculations of the time spent consulting, based on various consultation rates and list sizes and assuming that consultations were 10 minutes long. If good quality care is to be provided and is to include the range of services suggested in the government's recent green paper average list sizes should probably be no more than 1750, and lower in areas of high demand and high need. In addition to this, minimum standards could be determined for such measures as facilities available in surgeries, practice records, and accessibility of doctors to ensure that basic services were offered by all general practitioners.

Appointments and Schedules↗
PubMed1986

Patterns of respiratory illness in the first year of life.

This paper describes a study of respiratory illness during the first year of life in a cohort of infants who were born between 1975 and 1978 to mothers who were registered with two inner London group general practices. The types of respiratory illness and their relation to the season of the year and season of birth of the child are examined. The relations among the frequency and type of respiratory illness and several social and family factors that have previously been shown to be associated with high levels of respiratory morbidity are also described.

Family↗
PubMed1986

The "five minute" consultation: effect of time constraint on clinical content and patient satisfaction.

An experiment was carried out in which patients who were seeking appointments for a consultation in a general practice in south London attended consulting sessions booked at 5, 7.5, or 10 minute intervals. The particular session that the patient attended was determined non-systematically. The clinical content of the consultation was recorded on an encounter sheet and on audio-tape. At the end of each consultation patients were invited to complete a questionnaire designed to measure satisfaction with the consultation. The stress engendered in doctors carrying out surgery sessions booked at different intervals of time was also measured. At surgery sessions booked at 5 minute intervals, compared with 7.5 and 10 minute intervals, the doctors spent less time with the patients and identified fewer problems, and the patients were less satisfied with the consultation. Blood pressure was recorded twice as often in surgery sessions that were booked at 10 minute intervals compared with those booked at 5 minute intervals. There was no evidence that patients who attended sessions booked at shorter intervals received more prescriptions, were investigated or referred more often to hospital specialists, or returned more often for further consultations within four weeks. There was no evidence that the doctors experienced more stress in dealing with consultations that were booked at 5 minute intervals than at consultations booked at 7.5 and 10 minute intervals, though they complained of shortage of time more often in surgery sessions that were booked at shorter intervals.

Appointments and Schedules↗
PubMed1986

The "five minute" consultation: effect of time constraint on verbal communication.

In a study in which patients were allocated non-systematically to surgeries booked at 5, 7.5, and 10 minute intervals 623 consultations were taperecorded. In surgeries booked at longer intervals doctors used the extra time to take a fuller history from their patients. In surgeries booked at 10 minute intervals doctors spent more time explaining the patient's problem, explaining the proposed management, and in discussing prevention and health education, these increases not being evident in surgeries booked at 7.5 minute intervals.

Appointments and Schedules↗
PubMed1984

Research in general practice. Sources of advice.

Regional advisers, faculty secretaries of the Royal College of General Practitioners, heads of academic departments of general practice and primary care, and heads of RCGP research units were invited to complete a semistructured questionnaire to determine the nature and availability of current sources of advice for general practitioners participating in research activities and the demands placed on the available sources in the United Kingdom. The principal source for research advice was university departments of general practice, yet these have insufficient resources to cope with requests and few have spare capacity to stimulate research. Regional advisers and faculty secretaries do not seem to be kindling a spirit of inquiry and they seem somewhat complacent about both the lack of requests for research advice from general practitioners and the difficulties of academic departments. Proper development of research capability in general practice and primary care is unlikely to occur without more resources to create training posts in academic departments and a greater spirit of inquiry in vocational training programmes, which should lead to both review (audit) and research.

Faculty, Medical↗
PubMed1980

Evaluation of a patient education manual.

A randomised controlled trial has shown that introducing a health education booklet describing the management of six common symptoms resulted in fewer consultations for the symptoms described by families receiving this booklet compared with a control group. A sample of the mothers in each group was subsequently followed up by an interview, at which a questionnaire was administered. This was designed to measure the mother's knowledge of the management of the symptoms described. The booklet did not lead to any increase in knowledge in the mothers receiving it. The questionnaire did, however, show that 76% of the mother had consulted the booklet at some time in the year of the study and 28% had consulted it in the three months before interview. The important result was a fall in the new request for care for the symptoms described in the booklet. This may be interpreted as indicating that what patients need to respond appropriately to common symptoms of illness is a simple reference manual rather than an educational programme designed to increase their knowledge about the management of illness.

Attitude to Health↗