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M M Kochen

Publications and source records attributed to M M Kochen.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Evaluation of the educational curriculum in psychosocial fields and general medicine in human medicine subjects--results of a total Germany pilot study in the 1995 summer semester].

With the discussion of the quality of medical education in Germany the importance of evaluating the curriculum has grown. A working group of representatives of the German scientific societies for general medicine and the so-called "psychosocial" disciplines in medical education had adapted a questionnaire from Harvard Medical School and tested this version for the first time in summer 1995. 56 teachers and 1250 students took part in this pilot study. The instrument proved to be sufficiently valid to evaluate the quality of different types of teaching lessons. The disciplines (Medical Sociology, Medical Psychology, Social Medicine, General Medicine, Psychotherapy/Psychosomatics) were valued equally with concern to their relevance for medical education. They got significantly better values for quality of teaching and teaching engagement of the professors. It is recommended to notice these results in the actual debate on the reform of the medical curriculum and to include other disciplines in further evaluative investigations.

Curriculum↗
PubMed1995

[Factors influencing the prescribing of nootropic drugs. Results of a representative inquiry in Lower Saxony].

AIM OF INVESTIGATION: To discover (1) to what extent patients' wishes and the extent of any abnormality of brain performance influence the frequency with which "nootropic" drugs (those thought to affect brain activity, e.g. piracetam, pyritinol, or improve cerebral circulation, e.g. xanthine derivatives, Ginkgo biloba, secale alkaloids, calcium antagonists) are prescribed; (2) the medical practitioner's expectations of the effectiveness of such medications. METHOD: In a personal interview, 145 family doctors and 14 neurologists in private practice in the Göttingen area of Germany (participation rate: 83.2% of those asked to participate) were questioned about fictitious cases (case 1: mild memory problem with or without expressed wish for medication; case 2: moderate dementia, of Alzheimer or multi-infarct type). The previously arranged interviews, which took place in the doctors' practice rooms, consisted of standardized open questions to the written case reports. RESULTS: Regardless of the wish of the patient and the extent and type of the abnormal brain function about 70% of all participating doctors would prescribe those drugs, even though about 56% had doubts about their effectiveness. About 28% expected a positive effect on brain performance. A nearly equal proportion of doctors would continue an existing drug regimen as would prescribe one. CONCLUSION: The prescription of the named group of drugs is influenced less by medical criteria than by factors which concern doctor-patient relationship.

Adult↗
PubMed1995

How do academic heads of departments of general practice organize patient care? A European survey.

BACKGROUND: Compared with other clinical disciplines, academic general practice is in a difficult situation with respect to patient care. There are at least three different possible models of working arrangements for heads of departments of general practice: to work in a surgery in a medical school; to work in a surgery in the community, separate from a part-time university post; or to work part-time in a surgery in the community, separate from a university post. AIM: A study was undertaken to explore these models and to gain an understanding of academic teachers' organization of patient care in Europe. METHOD: A total of 77 heads of departments in universities in 12 European countries were sent a questionnaire enquiring about important characteristics of their department, the number of patients they treated per week and how they allocated their time. RESULTS: Sixty nine heads of department (90%) responded. Of respondents, 55% worked part-time in a surgery, separate from a university post, nearly one third worked mainly in a surgery, separate from a part-time university post, and 16% worked in a surgery in a medical school. Those working in a surgery with only a part-time university post spent most time in patient care compared with those working in other models (mean of 57%). Respondents working in a surgery in a medical school spent most time on administration (34%); they spent 22% of their time on patient care and 20% on education. Respondents working in a surgery in a medical school spent 25% of their time on research, those working in a surgery separate from a part-time university post spent 12% of their time on research, and those working mainly in a university with a part-time practice post spent 24% of their time on research. Those working mainly in a university post spent only 17% of their time in patient care. CONCLUSION: Working in a surgery in a medical school represented a well-balanced model of time allocation between patient care, research and education and seemed to be a good approach for the integration of general practice into medical schools. Working part-time in a surgery with a university post is an appropriate model for academic integration, but patient care seemed to be neglected. Those doctors working mainly in the community with a part-time university post were able to provide continuity of care and to come into close contact with the everyday problems of general practitioners. However, they might have to struggle for academic recognition.

Europe↗
PubMed1995

COOP-WONCA charts: a suitable functional status screening instrument in acute low back pain?

BACKGROUND: Functional status is considered an important measure of health status in primary care. The COOP-WONCA charts, which comprise six single-item scales, have mainly been used to determine functional ability in chronically ill patients. AIM: A study was carried out to determine whether the charts are able to measure the degree of functional impairment associated with acute illness and the improvement in functional ability accompanying the process of recovery. METHOD: A total of 95 patients presenting with acute low back pain were recruited from 15 single-handed general practices in northern Germany. At presentation and at two-week follow up, these patients completed self-administered questionnaires which included the COOP-WONCA charts. The charts ask patients to use the timescale of the past two weeks when rating their condition. Baseline and follow-up measurements of the charts were compared and correlations of chart scores with patients' measurements of pain intensity on a visual analogue scale, general practitioners' ratings of impairment and patients' measurements of recovery were analysed. RESULTS: Only the chart measuring change in health revealed a deterioration in functional ability associated with the onset of pain and an improvement in functional status at follow up. Two of the other charts indicated a deterioration at follow up. Only the chart measuring change in health was correlated with ratings of pain and impairment at baseline. At follow up, strong correlations were found between general practitioners' assessments of impairment, patients' ratings of pain and patients' ratings of recovery for all scales except for those measuring social activities and daily activities. The patients interpreted the instructions for using the COOP-WONCA charts differently; some included the period of acute back pain while others did not. CONCLUSION: Of the six charts only the change in health chart proved to be a suitable scale for measuring short-term changes in functional ability among general practice patients with acute low back pain. This may partly be a result of patients misunderstanding the instructions. If the COOP-WONCA charts are used with acutely ill patients, the fixed two-weeks timescale is not appropriate. It is suggested that patients consider their present complaints when rating their condition.

Activities of Daily Living↗
PubMed1994

Diagnosis of dementia in primary care: results of a representative survey in lower Saxony, Germany.

To investigate whether an early diagnosis of dementia is established, whether a differentiation is made between vascular and primary degenerative etiology, and whether treatable causes of dementia are considered in primary care, we performed a survey using three written sample case histories describing slight memory impairment (case 1) or moderate dementia (case 2a: vascular dementia; case 2: degenerative dementia of Alzheimer type). The combinations 1 and 2a or 1 and 2b were randomly assigned and presented to ambulatory-care physicians (145 general practitioners and primary care internists and 14 neuropsychiatrists in private practice) in Göttingen and rural surroundings by a trained investigator who then performed a standardized interview. The study was representative (response rate 83.2%). For the sample case with slight memory complaints 13.8% of all physicians arrived at a primary diagnosis of depression and 44.0% considered depression for differential diagnosis. Senile dementia of Alzheimer type was considered less often. In the sample cases with moderate dementia according to established scientific criteria, there was a striking under-diagnosis of dementia, and in both cases an over-diagnosis of underlying vascular etiology. Treatable causes of dementia, such as possible drug interactions and substance abuse, were considered only by a minority of physicians. In conclusion, memory deficits seem to be regarded mainly as consequences of disturbed cerebral perfusion, and dementia as well as depression and drug adverse effects seem to be under-diagnosed in primary care.

Aged↗
PubMed1994

Attitudes of primary care physicians towards the use of a drug formulary--preliminary results of a study in Germany.

Although the concept of a drug formulary in primary health care is known for more than 10 years it was only recently that the drug budget of the new German Health Legislation has drawn doctors' attention to the use of such formularies. The loose-leaf form "Göttingen formulary" has been specifically compiled for the need of primary care doctors. It contains less than 300 drugs and drug combinations (including pseudo-placebos). This formulary was ordered by 830 colleagues from November 1992 until the end of May. In June 1993 we sent a semi-structured questionnaire to the users to learn about their experience with and attitude towards the formulary and about changes in their prescribing habits. Until the end of August 223 questionnaires have been returned. Seventy-four % of the respondents were general practitioners with considerable experience (more than 10 years in practice: 77%). The majority were satisfied or very satisfied with the drugs selected for the formulary and found the list helpful or very helpful (68%). Sixty-seven % indicated that the use of the formulary changed their prescribing habits; 70% appreciated an official (governmental) positive list. Although this study did not use a representative sample and the response rate was rather low until the cut-off point, it is noteworthy that the overall appreciation of a drug formulary for primary health care was very positive. The great majority of the respondents were convinced that an individual drug formulary does not render an official positive list superfluous.

Attitude of Health Personnel↗
PubMed1993

[Attitudes and empirical referral data of West German family physicians].

The large inter-doctor variation in referrals to specialists known from previous research can only partly be explained by differences in presented morbidity, in practice setting or in general practitioners' (GPs') attitudes to their own work. The objective of this study was to analyse GPs' attitudes towards their own work and their influence on referral behaviour. This work is a follow up of the European study of referrals from primary to specialist care carried out in nine countries. We present an analysis of the West German part involving the same sample as in the European referral study. To 75 GPs a questionnaire with 26 items was sent, which validity and reliability was measured in studies before. 71 GPs took part in the study (response rate 95%). GPs with a high referral rate perform some technical procedures less frequently than GPs with a low referral rate. Many GPs consider their clinical responsibilities to be greater than their actual performance would suggest. In general, GPs tended to minimize risks. Significant correlations between attitudes and referral rates were found for 7 items only. GPs attitudinal consensus had no firm association to their referral behaviour (as measured by the instruments used). To explain this finding structural and financial aspects of the health care system should be taken into account. Further investigations about the referral process including a qualitative approach are necessary.

Adult↗
PubMed1993

Complementary medicine: are patients' expectations being met by their general practitioners?

Complementary, or alternative, medicine has increased in popularity among patients during the past 20 years. The purpose of this study was to determine whether general practitioners met their patients' expectations with regard to complementary medicine. In a postal survey all 71 accredited general practitioners in the district of Kassel, Germany, received a structured questionnaire about their experience with complementary medicine. Forty (56%) replied. In 10 of these practices 310 patients were interviewed about their attitudes towards and expectations of such treatment. Of the responding doctors 95% used, at least occasionally, some form of complementary medicine (most commonly herbal medicine, neural therapy or homeopathy). All but three patients accepted the value of complementary medicine, 58% of them (especially younger, more highly educated patients and those from rural practices) preferred it to orthodox medicine and 40% of the patients had received some form of complementary therapy. Nearly 70% of the patients requested that complementary medicine be practised by their general practitioner more frequently than at present. There was no significant link between patient satisfaction with the doctor and patients' view of, or demand for, complementary medicine. Although both patients and practitioners were interested in complementary therapy, there was a gap between the willingness, or the ability, of general practitioners to use complementary medicine and the patients' demand for these alternative forms of treatment.

Adult↗
PubMed1993

[A method for determining the denominator in general practice--results of a pilot study].

In countries with fee for service billing and direct access to specialist care the general practitioner does not know key figures of the population he serves. As the role of general practice in health-service-research, quality assurance activities and the construction of sentinel-networks is becoming more important, valid methods to determine the denominator are needed. Results from five practices suggest that yearly contact groups should be used as a common denominator for general practice in our health care system. For certain groups of patients (e. g. the elderly > 60 yrs.) even quarterly contact groups can give sufficient information to forecast the yearly contact group.

Adolescent↗
PubMed1993

[The European study for counseling in HIV antibody testing in general practice: results of the German project section].

General practitioners play an important role in counselling for HIV-Tests. There is little known yet about the background of the decision process which results in doing the HIV-test. The EUROSENTINEL-study on requests for HIV-testing started in 1990 and is in the meanwhile carried out in 7 sentinel-networks in six european countries. In the beginning of 1991 the german part started in 36 practices in the north of Hessia. In the first year of the study these 36 practices recorded 327 consultations about HIV-testing. The initiative to counsel was taken in 64.2% by the patient and in 35.8% by the doctor. In male patients the main reasons for the consultation were heterosexual contacts and administrative or legal reasons. In female patients it were fear of HIV-infection without any risk and professional exposure. In 86.2% of patients the consultation was followed by a HIV-test. Seven Tests (2.5%) were positive. All HIV-positive patients belonged to the classical risk groups. The results are discussed in comparison to those of other european networks. It can be concluded that general practitioners play an important role in primary prevention of HIV-infection and in counselling people who are worried by the AIDS epidemic.

AIDS Serodiagnosis↗
PubMed1992

General practitioners' attitudes towards future developments in practice computing--a representative survey in the north of Germany.

A postal questionnaire was sent to a random sample of general practitioners in Lower Saxony, Germany to assess how general practitioners regard newly developed but not yet implemented options of practice computers and future applications such as expert systems and information retrieval systems. Replies were received from 276 (response rate 73.6%) general practitioners. Replying doctors were younger (P < 0.05) but they did not differ by sex, practice location, type of vocational training and grade of computerization from non-responding GPs. Twenty-eight per cent of the practices were computerized. Doctors who currently used a computer and those who intended to do so within the next 5 years were significantly younger than those doctors who did not intend to computerize their practice (P < 0.001). Female doctors were less willing to buy a computer than their male colleagues (P < 0.05). A computerized drug database and a medical library ranked best from 8 options given. Overall attitudes to all features were positive, except for an expert system giving criteria for referrals to specialist care. Doctors already working with a computer and those intending to buy one were significantly more positive about future options for computers than those doctors who do not intend to use a computer (P < 0.01). GPs' attitudes about new features of practice computers in general were positive but even more so about those options which are already available. Referral to a specialist seems to be a crucial point for GPs--they apparently do not want to be guided by a computer here.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1991

How do patients with HIV perceive their general practitioners?

OBJECTIVE: To study the perceptions of patients with HIV of their general practitioners in terms of knowledge, abilities, confidence, and satisfaction. DESIGN: Questionnaire survey of inpatients, outpatients, and members of a self help group. SETTING: Two city hospitals, three outpatient clinics, and one AIDS self help group in Munich and Berlin, Germany. SUBJECTS: All 402 patients available between 1 September 1988 and 31 May 1989. MAIN OUTCOME MEASURES: General practitioners' attitudes towards the patients' HIV status; patients' experience of treatment rejection; reception in the general practitioner's office; the doctor's perceived knowledge about HIV and AIDS. RESULTS: 394 of 402 patients consented to interview; 87% were registered with a general practitioner and 91% of those indicated that the doctor was aware of their HIV diagnosis. The overwhelming majority of patients (94%) had a friendly or at least neutral reception in the general practitioner's surgery and only six patients' general practitioner changed his or her behaviour for the worse because of the HIV diagnosis. Two thirds of patients said they would consult first with their primary care doctor for a physical problem, but only 13% would do so for psychological problems. Over a third of the patients did not routinely inform other doctors or medical staff about their HIV status, but there was no significant correlation between this concealment and ever having been rejected by a doctor (7%) or a dentist (12%). CONCLUSION: Most patients expressed a high degree of satisfaction with their general practitioners in terms of confidential issues, attitudes, knowledge, and management.

Attitude of Health Personnel↗
PubMed1991

Medical students knowledge of HIV infection and AIDS. Members of the Association of University Teachers in General Practice.

To evaluate the knowledge on infection with the human immunodeficiency virus (HIV) a questionnaire survey was carried out in West German medical students attending general practice courses. Lecturers of 19 medical schools agreed to participate and 1665 completed questionnaires were returned. The analysis of students' answers showed some remarkable deficiencies. The data suggest that teaching of this subject in medical school may be insufficient. General practitioners could possibly contribute to reaching a higher level of knowledge.

Acquired Immunodeficiency Syndrome↗