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Biomedical subjects

P L Heywood

Publications and source records attributed to P L Heywood.

10 recordsLinked to original sources
PubMed2000

'I always seem to be there'--a qualitative study of frequent attenders.

BACKGROUND: Much is still unknown about the consultation behaviour of frequent attenders, including why they consult as often as they do and why they consult in the patterns that they do. AIM: To determine why frequent attenders to general practice consult in the patterns that they do. METHOD: A qualitative study based on semi-structured interviews. Twenty-eight frequent attenders were purposively sampled from three practices; 13 exhibited a 'burst and gap' pattern of attendance and 15 exhibited a 'regular' pattern of attendance. RESULTS: A two-part model is proposed. The first part encompasses each individual decision to consult and is based around eight questions that may be asked as part of the decision-making process (these concern the perception of the general practitioner's [GP's] role, past experience of symptoms and consulting, comparison with others' consulting, relationship with the GP, balancing fears, lay consulting, individual reasons, and whether it was a symptom that they would not normally consult for). The second part determines the pattern of consulting and has four major themes: predominantly medical reasons for attending, experience of what happens during the consultation, accessibility of the GP, and periods of not consulting. Two further themes are proposed: 'multiplicity', whereby the reasons for consulting lead to further consulting for related and unrelated problems, and 'passivity', whereby consulting seems to be out of control. CONCLUSIONS: The reasons underpinning each individual decision to consult were complex. The control that GPs were perceived to have over the pattern of consulting, for example concerning prescribing, review visits, and in addressing further help-seeking behaviour, may provide more possibilities for developing intervention strategies than targeting frequent attenders themselves. An understanding of the processes behind the consulting behaviour of frequent attenders may lead to more functional consultations and better clinical care as a result.

Adult↗
PubMed2000

Frequent attenders' consulting patterns with general practitioners.

BACKGROUND: Despite the growing literature on frequent attendance, little is known about the consulting patterns of frequent attenders with different doctors. To develop appropriate intervention strategies and to improve the clinical care of frequent attenders, a full understanding of these consulting patterns is essential. AIMS: This paper has three aims: to determine whether frequent attenders consult more with some doctors than others; to determine how many different doctors frequent attenders consult with; and to determine whether frequent attenders exhibit greater continuity of care than non-frequent attenders. METHOD: Analysis of a validated dataset of 592,028 consultations made by 61,055 patients from four practices over 41 months. Comparisons between the consulting patterns of the frequent attenders, defined as the most frequently consulting 3% of the population by practice, with non-frequent attenders and the overall practice populations. RESULTS: There was considerable variation in the numbers and proportions of consultations with frequent attenders between individual doctors. Most of the frequent attenders consulted with most or all of the doctors within practices over the timeframe. Frequent attenders exhibited more continuity of care than non-frequent attenders. CONCLUSION: The reasons why some doctors have more consultations with frequent attenders is unclear. Some doctors may actively encourage frequent attendance. While many frequent attenders have clear allegiances to one doctor, many also consult widely with a large number of doctors. The consequences of such behaviour are unknown. These findings have important implications in the development of appropriate interventions for reducing problematic frequent attendance.

Continuity of Patient Care↗
PubMed1998

An assessment of the attributes of frequent attenders to general practice.

BACKGROUND: Although it is thought that frequent attendance to general practice is associated with high use of health services, there is little information on the health of these patients, their use of health services or their perceptions of their service use. OBJECTIVES: We aimed to define and identify the frequent attenders aged between 20 and 65 years in a general practice population and to characterize their attributes and use of services. METHODS: We carried out a retrospective analysis of case-notes to identify a study population for interview and to be administrated the Patient Satisfaction Questionnaire, General Health Questionnaire (GHQ-28) and Nottingham Health Profile (NHP). The study was set in a UK teaching general practice of 12 400 patients. The subjects were 132 patients who attended 12 or more times in the study year and 102 age- and sex-matched control patients of normal consulting frequency. RESULTS: The mean frequency of attendance of very frequent attenders (VFAs) at 15 times per year was five times that of control patients. A total of 86% of very frequent attenders (VFAs) are female; 60% are married, compared with 78% of controls. Only half of VFAs thought they consulted more often than average, although 82% of 55 patients who consulted more than 24 times in 2 years recognized that they consulted more often than average. Ninety-four per cent of VFAs and 39% of controls had a chronic health problem. VFAs received prescriptions from more therapeutic groups than controls and overall received five times as many prescriptions. The rate of referral to hospital specialists was five times greater for VFAs than for controls. There were no differences on the Patient Satisfaction Questionnaire; 52% of VFAs and 29% of controls were depressed on GHQ-28; and VFAs showed distress on all modalities of well-being on NHP. CONCLUSIONS: This population of VFAs has high levels of physical and psychological ill health. They consult five times as often as the norm, receive five times as many prescriptions and are referred to hospitals five times as often. It remains unanswered whether this represents good general practice containment of the problem or is a poor use of the resources. Given the high levels of depression and low levels of well-being, perhaps strategies should be adopted to tackle these first. If the average consulting rate of VFAs could be reduced by one consultation per year, it would represent an overall reduction of 1% in the GP's practice workload for this age group.

Adult↗
PubMed1998

Frequency of patients' consulting in general practice and workload generated by frequent attenders: comparisons between practices.

BACKGROUND: Patients who attend frequently may present a problem for general practitioners (GPs) in several ways. The frequency of patients' consulting, comparisons between practices, and the effect of frequent consulting on the clinical workload have not been quantified previously. AIMS: To examine the distribution of the number of consultations per patient in four general practices. To estimate the clinical workload generated by frequent attenders. To model the data to demonstrate the contribution of age, sex, and practice on the likelihood of attending frequently. METHOD: Analysis and modelling of a validated data set of date records of consultations collected routinely over a 41-month period from four practices in and around Leeds, representing 44,146 patients and 470,712 consultations. RESULTS: A minority of patients consulted with extreme frequency. All practices had similar distributions but varied with respect to the numbers of frequent attenders, and the frequencies of their consulting. The most frequent 1% of attenders accounted for 6% of all consultations, and the most frequent 3% for 15% of all consultations. Females and older people were more likely to be frequent attenders. CONCLUSION: Frequent attenders have an important effect on GPs clinical workload. Between one in six and one in seven consultations are with the top 3% of attenders. Further research is needed to explain the behaviour underpinning frequent attendance in order to identify appropriate management strategies; such strategies could have an important effect on clinical workload.

Adolescent↗
PubMed1996

Real world data--retrieval and validation of consultation data from four general practices.

OBJECTIVE: We aimed to retrieve data on consultations from general practice databases and to develop and use appropriate methods of validation for these data. METHOD: MIQUEST software was used to retrieve the data from four practices. The data were validated by comparing them with figures generated by practice-based searches, measuring the uptake of recording of consultations over time, and comparing records of consultations in the case notes with those on the practice computers. RESULTS: The required data were retrieved from general practice databases, but the path to success was difficult, and typified by uncertainty and unpredictability. The recording of consultations on the computers of four practices was more complete than the recording in the paper case records. There was a time period in the early months of computer use when the recording of consultations was less complete. There were differences in the completeness of recording consultations between practices, doctors, and patients. CONCLUSIONS: This study confirms the potential of general practice databases for research, demonstrates how MIQUEST software can be a useful tool in retrieving data from general practice databases, and indicates how the completeness of data recording permitted further analysis for the purposes of our study.

Data Collection↗
PubMed1983

Data-linked groups: a method for continuing professional education.

The relationship is reviewed between standards of performance and the objectives of continuing education. The difficulties of providing continuing medical education which has objectives derived from appropriate standards are illustrated by reference to general practice. A method is described in which a number of small groups of general practitioners attend separate but simultaneous evening meetings linked to a coordinating centre by a viewdata system. In this way the same problems from general practice are presented to each group. Participants respond first as individuals then contribute to group discussion, led by a tutor, from which a consensus approach to each problem emerges. This is transmitted and received along with those from other groups, at the coordinating centre. All responses to a problem are combined there and made available to the groups on viewdata later in the evening. The validity of the exercise is discussed in relation to the type of problem used, the group-consensus and the combining of responses from a number of groups. The method appears to be attractive to general practitioners, relevant to their work and capable of providing continuing education based on appropriate standards of performance. Its possible application to continuing education in other disciplines is referred to.

Education, Medical, Continuing↗
PubMed1972

"Academic" G.P.s.

Explore the source record for details and available documents.

Education, Medical↗