Search PubMed⌕ Search

Biomedical subjects

G Bury

Publications and source records attributed to G Bury.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Hepatitis C infection among drug users attending general practice.

BACKGROUND: The prevalence of hepatitis C (HCV) infection among injection drug users is high and addiction-related care is increasingly being provided by GPs in Ireland. AIMS: To determine the prevalence and associated factors of HCV infection among injecting drug users attending general practice. METHODS: The records of 571 patients attending 42 general practices in the Eastern Regional Health Authority (ERHA) area for methadone maintenance treatment were reviewed. RESULTS: The HCV status was recorded in 380 cases (67%). Of these, 193 had a test performed by their GP, 74 had been tested by another service and 113 had no evidence of being tested, but HCV status was recorded based on information provided by the patient himself. A total of 276 cases were identified as being HCV positive (prevalence 73%), with no difference in prevalence between the three sources of information (p = 0.12). A history of injecting drug use was the major determinant of testing for HCV. CONCLUSIONS: While a large proportion of drug users attending GPs for methadone maintenance treatment are known to be HCV positive, a considerable number have not been tested. Barriers to testing need to be explored to facilitate comprehensive screening.

Adult↗
PubMedDate not supplied

Undergraduate medical students' experience in general practice.

BACKGROUND: Increasingly, undergraduate medical education is becoming community-based. Logbooks are a useful tool in documenting the range of clinical exposure and learning opportunities available to students during clinical training, particularly where the role of new clinical settings for training medical students is being explored. AIMS: To describe the clinical experience of medical students during an undergraduate programme in general practice at an Irish University. METHODS: Medical students in the fifth year of medical school were asked to record data from 20 consecutive consultations during a clinical attachment in general practice. RESULTS: A total of 186 students (82% of total) recorded data on 3,710 consultations. The patient population encountered was similar in demography and morbidity profile to other general practice populations, with hypertension, preventive immunisation and cough the most frequently encountered diagnostic labels. Respiratory illness and circulatory illness were the most frequently encountered primary and secondary presentations, respectively. An active role was adopted by students in almost half of all consultations. CONCLUSIONS: This paper provides evidence that general practice in Ireland is a setting in which medical students can both encounter a wide range of clinical problems and engage in active learning processes.

Education, Medical, Undergraduate↗
PubMedDate not supplied

Profile of attendance at a maternity hospital emergency room.

BACKGROUND: Direct presentations to secondary care that could have been managed in primary care have been the subject of much study. Social factors may influence the decision to present directly to secondary care services. AIM: To determine the profile and primary care service use of patients attending a maternity hospital emergency room (ER). METHODS: A self-administered, questionnaire based, cross-sectional study was performed over a period of one month. RESULTS: Of 350 patients attending the ER, 343 (98%) completed a questionnaire. Mean age of patients attending was 28 years (range 16-65). Thirty seven per cent were eligible for free medical care and 39% belonged to socio-economic group six. Fifty nine per cent attended outside normal hours, 31% had a female general practitioner (GP) and 38% were referred by a GP to the ER. Twenty eight per cent had seen their GP in the previous three days, 31% had consulted a GP with their current problem and 58% felt "comfortable" or "very comfortable" attending their GP with a gynaecological complaint. CONCLUSIONS: This study indicates that the service is responsible for a considerable workload, with a low level of use of primary care services by those attending.

Adolescent↗
PubMedDate not supplied

Methadone maintenance in general practice: impact on staff attitudes.

BACKGROUND: The evaluation of a structured protocol for the discharge of stabilised patients on methadone maintenance to general practice provided an opportunity to evaluate the impact on the attitudes of general practitioners (GPs) and practice staff. AIM: To assess attitudes, expectations and experience among GPs and practice staff before the introduction of structured methadone maintenance and six months after its introduction. METHODS: A postal questionnaire was sent to 31 GPs and 23 receptionists in 23 Dublin general practices before the patient's first visit and six months later at the end of the study period. Outcome measures were staff attitudes, incidence of disruption, perceived difficulties in providing care and in prescribing methadone, and stress levels. RESULTS: There was a generally positive attitude to provision of methadone in general practice for stabilised patients, although it was not anticipated to be problem free. Following six months involvement attitudes were similar; stress levels were unchanged, but fewer GPs anticipated problems in delivering the service. All continued to participate in the scheme. CONCLUSION: GPs and receptionists in this sample had mixed views about methadone maintenance which were unchanged by six months experience of the service. The study illustrates important issues in the recruitment and support of general practice in meeting this need.

Adult↗
PubMedDate not supplied

Prevalence of fatigue in general practice.

BACKGROUND: Fatigue is an important symptom in general practice due to its association with physical, psychological and social problems. AIM: To determine the prevalence of fatigue as an unsolicited symptom during general practice consultations. METHODS: A random sample of GPs practising in Ireland was invited to provide data on consultations held over one day. Data were recorded on the presence of fatigue as a main or supporting symptom, social and demographic characteristics. RESULTS: Data were recorded by 89 GPs on 1,428 consultations. The prevalence of fatigue was 25%. It was the main reason for attending the doctor in 6.5% and a secondary reason in 19%. Sixty-two per cent of patients were female and 48% were eligible for free GP services. The mean age was 47.1 years. The presence of fatigue was associated with: attending a female GP, being female, attending a GP who had been qualified for fewer years and attending the GP frequently. CONCLUSION: The prevalence of fatigue reported in this study is over three times higher than that reported in earlier work. Doctor characteristics appear to be as important as patient characteristics in determining fatigue.

Family Practice↗
PubMedDate not supplied

Guidelines for the management of hepatitis C in general practice: a semi-qualitative interview survey of GPs' views regarding content and implementation.

BACKGROUND: Hepatitis C is a common infection among people who attend GPs for methadone maintenance treatment. AIM: To determine the views of GPs towards clinical guidelines for the management of hepatitis C among current or former injecting drug users in advance of their implementation. METHODS: A purposive sample of 14 GPs (10% of the total prescribing methadone at the time the guidelines were developed) was invited to review a pre-publication draft of the guidelines and interviewed regarding content, presentation, perceived barriers to implementation and suggested interventions to facilitate effective implementation of the guidelines. RESULTS: GPs indicated the guidelines were useful but suggested aspects of presentation should be clarified. Organisational issues were identified as the principal barriers to effective implementation, with the provision of additional nursing support the principal intervention suggested to facilitate implementation. CONCLUSIONS: Interviewing intended recipients may be an important step in ensuring clinical practice guidelines are effectively implemented.

Attitude of Health Personnel↗
PubMedDate not supplied

Schizophrenia in general practice: a national survey of general practitioners in Ireland.

BACKGROUND: Chronic schizophrenia is challenging to manage in primary care. AIMS: We sought to establish the views of General Practitioners about managing patients with chronic schizophrenia in primary care. METHODS: A cross-sectional, postal survey questionnaire of a randomly selected sample of 20% of GPs was carried out. RESULTS: Most GPs (97.2%) have at least one person with schizophrenia attending their practice. A substantial number of GPs (22.2%) treat cases of schizophrenia without specialist input following an initial referral to psychiatric services. Almost all (88.7%) advised patients who had experienced multiple relapses to remain on medication indefinitely. One third of GPs reported that they always experience difficulties managing patients with schizophrenia in their practice. Non-adherence with prescribed medication and loss to follow-up were the commonest impediments to treatment encountered. CONCLUSION: GPs require appropriate back up from specialist services to enable their management of chronic schizophrenia.

Adult↗
PubMedDate not supplied

General practice out-of-hours co-operatives in Ireland-emergency service or not?

BACKGROUND: Since 1998, Irish general practice has developed 11 out-of-hours co-operatives, covering almost 40% of the population.The co-operatives vary in terms of triage mechanisms, treatment centres and domiciliary visits but no data exist on their role in the management of emergencies in the community. AIMS: To describe the role of co-operatives in the management of emergencies, both in quantitative and qualitative terms. METHOD: A questionnaire survey for a 12-month period completed by all 11 co-operatives described structures and activity levels. Semi-structured interviews with senior management and GPs at five randomly selected co-operatives explored their understanding of the role of co-operatives. RESULTS: The incidence of emergencies is very variable (10% of all contacts-virtually nil) with general reliance on the skills of triage staff rather than use of protocols to identify emergencies. Eight of 11 co-operatives provide a domiciliary service with some responding to calls from ambulance services and Gardai for medical assistance. There are very limited liaison structures with ambulance services at any level. Interviews with staff reveal concern with a perceived role as a service dealing with 999 type calls rather than with emergencies encountered in the course of normal general practice work. CONCLUSIONS: Clarification is urgently required of the extent to which GP co-operatives and ambulance services support each other. Examples include procedures for passing calls between services, mutual understanding of each others roles and development of common procedures.

After-Hours Care↗
PubMedDate not supplied

Socio-economic gradients in self-reported health in Ireland and Northern Ireland.

BACKGROUND: Research and policy related to reducing health inequalities has progressed separately within Ireland and Northern Ireland. This paper describes the first exploration of the socio-economic influences on health on the island of Ireland since 1922. METHODS: Postal survey. RESULTS: The response rate was 52%; 11,870 respondents. Men reported more long-standing illness (LLTI) or poor general health (PGH); depression was more common amongst women. Socio-economic gradients in health were evident in both jurisdictions, with the effects of household income being particularly marked. Overall, morbidity levels were significantly better in Ireland than in Northern Ireland: adjusted odds ratio of 0.79 (95% CI 0.71 - 0.88) for LLTI; 0.64 (0.57 - 0.72) for PGH; 0.90 (0.82 - 0.99) for depression. CONCLUSIONS: There is evidence of strong and similar socio-economic gradients in health throughout the island of Ireland. This would suggest joint policy approaches or at least further comparative evaluation of the initiatives in each jurisdiction.

Adolescent↗
PubMedDate not supplied

Inner-city hospital closures in Dublin: implications for general practice.

BACKGROUND: The Meath, Adelaide and National Children's Hospitals provided more than 300,000 ambulatory care episodes in 1996, half to residents of the adjacent inner-city postal districts. With the closure of the group in 1998, alternative care arrangements must now be provided. AIMS: This paper examines the socio-economic and primary care characteristics of the communities most affected. METHODS: Data on the 13 District Electoral Divisions surrounding the hospitals are drawn from a range of published sources. RESULTS: The populations affected include 52% in social classes 5 to 7, have an average Standardised Mortality Ratio of 122, have high levels of GMS eligibility and include special care issues such as drug dependency. A total of 38 GPs cover the area. Other markers of deprivation are summarised. CONCLUSION: The areas most affected by the closures have existing high levels of deprivation and social and medical need. Initiatives to respond to the closures must address these needs.

Community Health Services↗
PubMedDate not supplied

A & E services in Ireland: the potential role of general practice in accident and emergency services.

BACKGROUND: In 1996, Irish accident and emergency (A&E) departments had approximately 1.2 million visits. General practitioners (GPs) have been shown to work efficiently in A&E. AIM: This study aimed to describe the current A&E structures in Ireland and the potential contribution of general practice. METHOD: Questionnaires were sent to all 43 Irish A&E departments seeking information on staffing levels, training posts and interest in the role of GPs within the department. RESULTS: Thirty-four (79%) hospitals responded, representing at least 71% of all A&E visits. Eleven (32%) had A&E consultants. In 16 (47%) hospitals the A&E department was supervised by other consultants; in 14 supervision was for five hours per week or less. Seven hospitals had no consultant supervision. Twenty-six (76%) had NCHDs assigned to the department. Only 11% of NCHDs were in training in A&E medicine. Six departments employed GPs but 28 said they would like to do so. Most wished GPs to see non-urgent cases but one-third wished them to see all cases. Current staffing levels had little relationship with departmental workload. CONCLUSIONS: The limited consultant supervision and small numbers of NCHDs in training for A&E medicine raise concerns about staffing. Most hospitals want GPs to work in their A&E departments. This has implications for training and for the interface between general practice and the A & E department.

Emergency Service, Hospital↗
PubMedDate not supplied

Deaths in general practice: an Irish national profile.

BACKGROUND: There is little information on general practitioner (GP) involvement in terminal care. Aim This study explores general practice experience of the care of dying patients. METHODS: One hundred and forty-two GPs offered to participate in a study of consecutive deaths during three months, to a maximum of five cases per practice. Data were collected on patient characteristics, cause and place of death, terminal care and GP notification of deaths. RESULTS: One hundred and three GPs (73%) completed data collection. Participating GPs were younger and more likely to be in group practice. There were 297 deaths reported: 34% of practices had five deaths or more but 20% had no death. Seventy-five per cent of patients had one GP consultation in the final three months, 60% had at least one hospital admission and 38.8% of deaths occurred at home. Mean home visit, surgery consultation and phone consultation rates were 5.4, 1.8 and 3.6 respectively. In 88% of cases, the GP was informed of the death within one week. CONCLUSIONS: GPs are notified rapidly of deaths in all groups and causes. In the majority, the GP has had recent clinical contact and has often been heavily involved in care. Most deaths and care occur outside the cancer-related sphere.

Adolescent↗
PubMedDate not supplied

Patients' views on out-of-hours care in general practice in Dublin.

BACKGROUND: Little is known regarding patients' views and levels of satisfaction with out-of-hours care in Irish general practice despite significant recent changes in service delivery. AIMS: This study aimed to record patients' experience of out-of-hours care on a specific occasion and elicit their satisfaction with out-of-hours care in general. METHODS: Patients requesting out-of-hours care in three south inner city Dublin practices in June and July 2000 were identified and sent an anonymous postal questionnaire. RESULTS: Two hundred and forty patients were identified and 58% responded to the questionnaire. The approximate call rate was 195 calls per 1,000 patients per year. Sixty-one per cent of patients used the co-operative service, 28% received a house call and 3% received telephone advice only; 86% are currently satisfied with out-of-hours care. CONCLUSIONS: The majority of patients are satisfied with the current out-of-hours service. Telephone consultation rates are significantly lower than other countries. These findings need to be considered before the widespread introduction of systems involving increased telephone consultations.

Adolescent↗
PubMedDate not supplied

Attitudes towards and experience of general practice among HIV-positive patients in the Republic of Ireland.

In order to study their attitudes to and experience of general practitioner care, 150 attenders at the only HIV specialist clinic in the Republic of Ireland were asked to complete an anonymous, self administered questionnaire. (81%) of respondents reported having a regular GP and 94% of those indicated that the GP was aware of their HIV diagnosis. The majority (64%) of patients with a regular GP reported seeing their doctor on more than 5 occasions during the previous year. Most patients were satisfied with the support which they received from their GPs. Even so, the majority of patients (72%) would go directly to the hospital clinic for any problem which they perceive to be HIV related.

Adult↗
PubMedDate not supplied

The use of basic life support kits in general practice.

Donegal is a predominantly rural area with many general practices situated considerable distances from a district hospital. Fifty Life Support Kits were supplied to General Practitioners by the Donegal Pre-Hospital Emergency Care Project in 1995 following appropriate training. This is a survey of the use of items in these kits. To determine the frequency of use of the equipment, the type and location of the incidents, the kit items utilised and patient outcome. Retrospective questionnaire survey of 49 participating GPs. 208 patient incidents were described by 46 doctors (average 4.5 per doctor) Most incidents were outside the surgery (88.24%). Road Traffic Accidents (36%) were the commonest reason for use, followed by cardiac emergencies (28%), other medical emergencies (14%) and other trauma (11%). All items except the burns sheet had been used. The most used items were cannulae, (64.7% of incidents) and fluids (50.9% incidents). Other useful items were emergency drugs, dressings, collars, airways, suction and torch. Regarding outcome, 162 patients required hospital transfer and 25 died. Eleven did not require hospital treatment. The participating doctors judged that the basic life support kits positively contributed to outcome in 79.4% of cases described. Basic Life Support kits contribute to the pre-hospital care of patients when used by GPs with immediate care training.

Accidents, Traffic↗
PubMedDate not supplied

"Why are we working so hard?" A cross-sectional survey of factors influencing GP workload in the Eastern Regional Health Authority area.

There is increasing evidence to suggest that the subjective workload of GPs in Ireland is too heavy. The aims of this study, therefore, were to identify the social and demographic issues that GPs perceive as being implicated in determining their workload. A self-administered questionnaire, inviting GPs to score a series of factors according to the degree to which it increased their workload, was sent to one-quarter of GPs practising in the Eastern Regional Health Authority (ERHA) area. The response rate was 71%. Seventy-nine (60%) felt their workload was 'too heavy,' while 109 (85%) felt they could improve the quality of care they provide, if their workload was reduced. Access to OPD services (mean score = 7.31), access to other hospital services (mean score = 7.16), and the number of elderly patients (mean score = 6.28) were considered to be the most important factors in determining workload. This paper describes the factors that impact on self-perceived workload for GPs, factors which need to be considered when planning and funding future developments in primary care.

Adult↗
PubMedDate not supplied

Analysis of care of HIV positive patients: hospital and general practice components.

Fifty-seven HIV positive adults (mostly injecting drug users) attending two inner city Dublin general practices were followed for one year to identify the general practice and hospital components of their care. Many patients had advanced disease; during the year 10/57 (17.5%) died. The group made a median of seven visits to general practice (range 0-35) and two visits to hospital HIV clinics (range 0-21). A quarter of the group (14/57) was seen only in general practice and did not attend hospital; only two patients did not attend either the HIV Clinic or the GP during the year. Hospital admission was needed for 15/57 (26.3%) patients on a total of 31 occasions with an average length of stay of 10 days per admission; 80% of these admissions were generated by 10 patients with AIDS. The indication for almost all admissions was serious physical illness or diagnostic or therapeutic procedure. Patients with symptomatic or advanced HIV disease required a higher level of care than those with asymptomatic disease. It is essential that the agencies involved in meeting this level of demand be adequately resourced and that they liaise closely.

Adult↗