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Biomedical subjects

R Grol

Publications and source records attributed to R Grol.

108 records · Page 6Linked to original sources
PubMed1993

Development of guidelines for general practice care.

The setting of standards for general practice care is receiving increasing attention in many countries. However, various problems have been noted in the procedures used for the development of guidelines. In this paper, a model for developing guidelines that fit into the specific general practice situation is presented. This model attempts to integrate current experiences in this area. Ideally, the development of guidelines should take place on various levels (central, local, practice and individual), each level involving different aims and methods. Thorough procedures must be used, in which attention is paid to the scientific validity of the guidelines, the reliability of the results, the clinical applicability, and in particular, the acceptance and adoption of the guidelines in practice.

England↗
PubMed1992

Computerization of general practices and quality control. Blood glucose regulation in type 2 diabetics investigated in the Registration Network family practices.

The extent to which computerized medical administration facilitates quality control was studied using as an example the quality of blood glucose regulation in diabetics supervised by general practitioners in 11 computerized practices. Systematic use of the general practice computer rapidly provided an unequivocal answer that 37% of such patients were not regulated in accordance with the guidelines for type 2 diabetes mellitus of the Dutch College of General Practitioners. The extra workload for the participating general practitioners was minimal. Automated recording of problem lists, as applied in the general practices belonging to the Registration Network, facilitates access to data on chronic diseases and risk factors for purposes of research, quality control and quality assessment.

Blood Glucose↗
PubMed1991

Patient education in family practice: the consensus reached by patients, doctors and experts.

Patient education is a central aspect of the GP's work, but it is not clear what type of information and guidance should be given to patients during consultations. As the existing literature did not offer any clear solutions to this problem, a consensus study was carried out using a panel of GPs, patients and experts/policymakers in the field of health education. After three cycles of questioning involving written questionnaires and written feedback, the panel reached a consensus on 35 priorities and recommendations concerning patient education carried out by the GP. A consensus method of this type is a valuable tool for setting standards when scientific findings are not available, and contrasting views play a role in the definition of what constitutes adequate performance.

Delphi Technique↗
PubMed1990

Disease-centred versus patient-centred attitudes: comparison of general practitioners in Belgium, Britain and The Netherlands.

The attitudes of general practitioners in Belgium, Britain and the Netherlands have been sought to determine if they are patient-centred or disease-centred (that is, doctor-centred). The results indicated that many of the doctors held disease-centred attitudes, which in previous studies in the Netherlands and Belgium had correlated with increased prescribing of symptomatic medication, shorter consultation time, inadequate patient records and poorer standards of care within the consultation. Doctors in Belgium had the highest level of disease-centred attitudes, Dutch doctors the lowest. Possible explanations for these differences include differences in the doctor-patient relationship that exist between these countries. Although the results must be interpreted with some care, they should form a basis for discussions about doctor-patient relations and medical education in each country.

Attitude of Health Personnel↗
PubMed1990

Peer review in primary care.

In a district of the town of Nijmegen in the Netherlands, 322 family physicians were approached to take part in an intensive peer review programme: 73% agreed to take part. The problems doctors experienced at the start of the programme were: a dislike of being criticized and doubts about such an investment of time. As the programme got going most of the problems shrank in size whilst the problem of changing their practice routines to meet certain guidelines for quality of care imposed by the programme grew. Nevertheless, for the large majority participation was a very valuable experience. By means of a gradual and personal approach towards doctors, systematic procedures for assessment and feedback, variation in topics and methods, and good organization and guidance it is possible to make quality assurance by means of peer review into a valuable aspect of the daily work of many care providers.

Attitude↗
PubMed1990

Attitudes to risk taking in medical decision making among British, Dutch and Belgian general practitioners.

The attitudes of groups of general practitioners in Belgium, the UK and the Netherlands to risk taking in medical decision making have been determined. The results indicate that many doctors seek to minimize the risks that they take when treating patients. Doctors in Belgium had the highest levels of 'no risk-taking' attitudes with 60% preferring not to take risks; Dutch doctors had the lowest levels with only 24% preferring not to take risks. Possible explanations for this difference include the differences in doctor-patient relationship and the systems of medical education in these two countries.

Attitude of Health Personnel↗
PubMed1990

National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards.

The Nederlands Huisartsen Genootschap (NHG), the college of general practitioners in the Netherlands, has begun a national programme of standard setting for the quality of care in general practice. When the standards have been drawn up and assessed they are disseminated via the journal Huisarts en Wetenschap. In a survey, carried out among a randomized sample of 10% of all general practitioners, attitudes towards national standard setting in general and to the first set of standards (diabetes care) were studied. The response was 70% (453 doctors). A majority of the respondents said they were well informed about the national standard setting initiatives instigated by the NHG (71%) and about the content of the first standards (77%). The general practitioners had a positive attitude towards the setting of national standards for quality of care, and this was particularly true for doctors who were members of the NHG. Although a large majority of doctors said they agreed with most of the guidelines in the diabetes standards fewer respondents were actually working to the guidelines and some of the standards are certain to meet with a lot of resistance. A better knowledge of the standards and a more positive attitude to the process of national standard setting correlated with a more positive attitude to the guidelines formulated in the diabetes standards. The results could serve as a starting point for an exchange of views about standard setting in general practice in other countries.

Attitude of Health Personnel↗
PubMed1989

General practitioners' opinions about their responsibility for medical tasks: comparison between England and The Netherlands.

A questionnaire survey compared a sample of 371 general practitioners in the Avon region of England with 74 general practitioners in the east of the Netherlands. A list of 14 medical tasks--six technical tasks and eight chronic disease management tasks--was presented and the doctors indicated whether each task was totally, often, sometimes, seldom or not at all the responsibility of the general practitioner. The results show that English general practitioners felt more responsibility for chronic problems than the Dutch doctors whereas Dutch general practitioners felt more responsibility for technical tasks than the English. Fewer general practitioners in both countries felt responsible for technical tasks than for chronic disease. Reasons for the differences in terms of the structure of general practice and training are discussed.

Adult↗
PubMed1989

Effects of the vocational training of general practice consultation skills and medical performance.

The effects of the vocational training of general practitioners in the Netherlands on the consultation skills and medical performance of junior doctors were studied. Results obtained at a training institute providing systematic training in these skills (Nijmegen) were compared with those at an institute taking a problem-based learning approach (Groningen). Trainees (n = 63) audiotaped consultations and recorded their medical performance at the start and at completion of training. The skills were evaluated with the aid of validated criteria and medical 'protocols'. Data on 631 pre-training and 624 post-training consultations were compared. Changes in consultation skills and medical performance occurred at both institutes and proved more marked at the institute providing systematic training. Improved medical performance was found to be associated with improved consultation skills. Enhanced clinical knowledge was found to be related to improved medical performance and consultation skills. The most profound changes were found in junior doctors who had started at a lower level of consultation skills and medical performance.

Clinical Competence↗
PubMed1988

The effects of peer review in general practice.

This paper describes the effects of an intensive, structured programme of peer review on the behaviour of general practitioners. Trained assessors evaluated 43 doctors before and after participating in the programme. Both the medical and non-medical performance of the general practitioners was assessed using a previously tested measuring instrument. In addition, the prescribing behaviour of the participants was compared with that of a control group. After taking part in the programme, the work of the general practitioners conformed more closely to a number of criteria for good general practice care. This was particularly true for clarifying the questions and expectations of the patients, active stimulation of patient involvement, history taking and providing information and advice to patients. The greatest change occurred among general practitioners who had previously conformed least with the established criteria. During peer review participants in the project prescribed fewer drugs, such as analgesics, tranquillizers and antibiotics, than before peer review while non-participants prescribed more. The value of these changes is discussed.

Family Practice↗
PubMed1985

Work satisfaction of general practitioners and the quality of patient care.

The emotional reactions of 57 general practitioners to three aspects of work was assessed by means of questionnaires. The quality of patient care was assessed by means of observations of general practice consultations, assessment of audiotaped consulting hour contacts and an analysis of the referral and prescription figures. A distinction was made between the degree of positive and the degree of negative feelings general practitioners have about their work. Many positive feelings (satisfaction, feeling at ease) correlated with more openness to patients, more attention to psychosocial aspects of the complaints but also with a higher rate of referral to medical specialists. On the other hand, many negative feelings (frustration, tension, lack of time) correlated with a high prescription rate and with giving little explanation to patients. To some extent the way that work is experienced by general practitioners correlated with the quality of care for the patients, but what constitutes cause and effect requires further study. A reflection of a doctor's own feelings about work should become part of training, continuing education and medical audit programmes.

Drug Prescriptions↗
PubMed1985

Audit: a project on peer review in general practice.

A project of group-based peer review by general practitioners is described. Attention is given to the motivation of general practitioners to participate in audits, to the threat posed by peer review and to the use of criteria. The recruitment and motivation were successful. A total of 253 general practitioners took part, divided into 23 groups. This represented approximately 30% of all general practitioners in the area and 72% of all general practitioners specifically approached by us. The threat posed by audit disappears rapidly for most physicians once they have started auditing. The use of predefined criteria developed by 'experts', representing an optimal way of work for the general practitioner, appeared to be quite feasible in this project. From the results several conclusions are drawn as regards the planning and implementation of peer review under general practitioners.

Attitude of Health Personnel↗
PubMed1985

Attitude changes in the vocational training of general practitioners.

This investigation examined the extent to which attitudes of doctors who participated in a one-year training programme for general practice changed in intended directions by training. A large number of questionnaires, validated in earlier research, were administered to 84 trainee general practitioners (GPs) both at the start and at the end of the training year. There appeared to be a strong to very strong shift in the intended direction with regard to the demarcation of work between general practitioners and specialists, the feeling of competence at work, the fear of making mistakes, beliefs about taking risks when making medical decisions, confidence in specialist technical examinations and the way general practice work is experienced. By the end of the training students hardly differed from, or had even gone further in the intended direction than, experienced general practitioners.

Attitude of Health Personnel↗