Biomedical subjects
Publications and source records attributed to H Britt.
Upper respiratory tract infection is the second most frequently managed problem in general practice in Australia. This paper provides an overview of its management in general practice and compares the results with those of an earlier study.
When the patient presents with the words, "I've got a pain in the gut", what are the most common diagnoses and how often does the problem remain undiagnosed? This paper describes what usually happens at encounters initiated by patient presentation of abdominal pain and is based on the results of the Australian Morbidity and Treatment Survey 1990-1991.
This paper is a summary of a report of a comparison of country and metropolitan general practice undertaken by the Family Medicine Research Unit, University of Sydney, and published as a supplement to the Medical Journal of Australia. The identified differences were not consistent across small medium and large country towns. The morbidity patterns were similar between all areas, but country GPs were generally busier and undertook more hospital and procedural work.
Hypertension is the most frequently managed problem in general practice in Australia. This paper provides an overview of its management in general practice and draws some comparisons with an earlier study.
OBJECTIVE: To provide a description of country general practice in Australia, and to determine the extent to which country and metropolitan general practice differ in terms of the characteristics of the practitioners, the morbidity managed, treatments provided and the availability of support services. METHOD: A survey requiring the recording of details of all direct and indirect patient encounters on encounter forms by a sample of general practitioners (GPs). Each GP recorded for two one-week periods separated by an interval of six months, between October 1990 and October 1991. The recording weeks were spread as evenly as possible throughout the year. SAMPLE: Participants were drawn from a list of medical practitioners in Queensland, NSW and Victoria who provided more than 1500 general practice Medicare items of service during the previous year. The sample was stratified within States by population of postcode, into metropolitan areas and three country strata: "small country towns" (population less than 5000); "medium country towns" (5000-15,000); and "large country towns" (more than 15,000). The total country sample is referred to as "country areas". Planned sample size was 180 country GPs (20 in each stratum in each State) and 60 metropolitan GPs (20 in each of the three State capital cities). The final data set was weighted to be representative of the distribution of the source population. DATA COLLECTION: The variables studied included: GP characteristics; practice isolation factors; patient age, sex and status to the practice; patient reasons for encounter (up to three per encounter); problems managed (up to four); drugs prescribed and other treatments provided (up to four per problem); tests and investigations ordered and referrals made at these encounters; and planned follow-up. Data were centrally coded. Participation rate: The final sample of 231 GPs (177 country and 54 metropolitan) recorded information during 435 recording weeks (336 country and 99 metropolitan). These practitioners represented 50.7% of those contacted and available, the response rate being better in country (57.5%) than in metropolitan (36.5%) areas. A practice profile questionnaire which included questions regarding the doctor and the practice was completed by 97.4% of participants, while a questionnaire on distance from support services was completed by 93.8% of country participants. The final weighted data set included 51,741 encounters with country GPs and 11,351 with metropolitan GPs. RESULTS: The general practitioners: Country GPs were less likely to be female or to conduct consultations in a language other than English, and were more likely to do some work on a salaried or sessional basis. GPs from small country towns were older, more likely to be in solo practice, and more likely to belong to a professional organisation. "Remoteness" of towns: Nearly all towns were within 25 km of a hospital, but far fewer small and medium country towns were within 50 km of a base hospital than large country towns. X-ray services were almost universally available within 50 km, and with the exception of small country towns so were pathology services. Access to medical specialists and to a lesser degree other health professionals decreased with population size--patients in 30% of small towns had to travel over 100 km to see many specialists and some health professionals. Self-reported procedural work: GPs in small and medium country towns were more likely than those in large towns to report performing procedural work, the largest difference being in the area of em
The adoption of "Read Clinical Codes" for computerised patient records could profoundly alter the nature and quality of Western medicine in the next decade. The increasing awareness of the need for a standardised coding system has led to the funding of a pilot project to test Read codes in Australian general practice. Read codes are a comprehensive nomenclature of clinical terms incorporating over 100,000 codes in a structured hierarchical form. Designed by a general practitioner, they are now owned, controlled, and developed by the British National Health Service (NHS). Selected as the basis for clinical coding across the NHS, they form the cornerstone of computerised patient records. Computer use has been encouraged in general practice in the UK, with financing schemes and functional inducements resulting in 70% of practices being at least partly computerised, and 84% of these using Read codes. Their promotion has been backed by a major development program to broaden the codes to include all clinical specialities, nursing, and professions allied to medicine. The codes will require significant adaptation for Australian use, including the development of an administrative chapter and a pharmaceutical classification. The impact of information management systems on health care in the UK has relevance for the continuing development of the Australian National Health Information Strategy and for future record keeping in general practice in Australia. If the trial proves successful, the adoption of Read codes as a standard for information management in patient medical records will need to be considered.
Radical changes planned in the New Zealand health system aim to improve its cost effectiveness, quality and consumer responsiveness. These changes will take place despite a paucity of data on the use of resources and outcomes. Data collection systems are to be introduced into hospitals and primary care with the use of the Read clinical codes (RCC) in addition to ICD-9-CM (International classification of disease--clinical modification) and ICPC (International classification of primary care). This paper discusses the proposed changes to the New Zealand health care system and describes their effect on the present and future data collection methods in general practice.
This study examined the interface between emergency departments and community general practice in terms of their delivery of primary care services. Through the collection of casemix and treatment data, and interviews with patients, information was gathered relating to the extent of primary care delivery in emergency departments, problems managed and treatments provided in the two settings and patients' characteristics and reasons for choosing to seek primary care in the emergency department. The results indicate a high proportion of primary care delivery is in emergency departments, and that there is a need for delivery in this setting to continue. The results are discussed in terms of such quality assurance issues as monitoring primary care in emergency departments and addressing patient needs.
More detailed analysis of this data will continue. It will be combined with other more specific studies to provide a more focused view of some aspects of general practice. Requests for individual analyses of selected data will be accepted by the Family Medicine Research Unit. Contact Helena Britt on (02) 745 2633. The Unit has provided Australian Family Physician with 500 copies of the full report for distribution to interested practitioners. Such copies can be obtained by contacting Mrs Judy Brook, Secretary, Australian Family Physician, 2nd Floor, 70 Jolimont Street, Jolimont 3002. Fax: (03) 289 1211. Telephone: (03) 654 3000.
Recruitment is often a lengthy process and sometimes a frustrating one. It is not simply a matter of contacting those selected and asking for this participation. After obtaining a list from which to select a sample, a contact list must be created, initial contact must be made and direct contact initiated, often requiring great powers of persuasion. It is often difficult to convince someone that your project is important. However, the time and energy expended is ultimately worth it. Just one positive enthusiastic response is enough to make you forget all the difficulties. What could be done to make it simpler in the future? Some kind of list, regularly updated, of all general practitioners would make researchers' jobs much easier by providing a reliable and current sampling frame. It would also promote general practice as a specialty. The problem of a definition of general practice is currently being considered. Overall, there needs to be more recognition of the time practitioners put in to such surveys and the additional demands it places on their already busy lives. General practice research has to be designed to fit into the practitioner's schedule. Researchers should co-ordinate their projects so that repeated requests are not made to the same practitioner. To some extent this problem is being tackled in New South Wales at present by the Royal Australian College of General Practitioners and University researchers. There is also a need for feedback from participating practitioners as to their own thoughts about the direction and design of general practice research. This would help to encourage continued participation and create goodwill for future surveys.(ABSTRACT TRUNCATED AT 250 WORDS)
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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.
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%.
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.
A retrospective study in a general practice suggests that the pattern of prescribing of co-trimoxazole in relation to the age of patient and disease is different from that of other antibiotics. This precludes drawing conclusions about relative risks of side effects from the current system of notifications of adverse drug effects.
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Although 11.3% of patients of an academic general practice unit were prescribed one of the four commonest psychotropic drugs in 1978, only 1.6% received six or more prescriptions. During the following three years further prescriptions for the same drug were issued in 61% of the patient years for which information was available. Most of the frequent recipients were elderly women. Further research is needed into the natural history of conditions for which psychotropic drugs are prescribed in general practice.