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PubMed1988

Working with general practitioners.

Psychiatrists and general practitioners have found new ways of working together in the last ten years, but there have also been separate activities which could develop into rivalry. These opportunities and dangers are the central theme of this paper. Ways are considered in which the psychiatry of general practice differs from the experience of psychiatrists. Forms of help are suggested which general practitioners need from psychiatrists, whether in clinical practice or education.

Community Mental Health Services↗
PubMed1989

Utilization of the "Smokescreen" smoking-cessation programme by general practitioners and their patients.

General practitioners have been encouraged to be more active in helping their patients to stop smoking. A number of research studies overseas and in Australia has reported that they can be effective in this form of health promotion. The "Smokescreen" programme is an intensive, structured antismoking intervention that was developed for use by general practitioners in Australia. To monitor the effect of this programme, general practitioners who had attended workshops on the use of the programme were contacted 12 months later to find out what use they had made of the programme, and how effective it had been. Only 18 of the 38 doctors who initially agreed to cooperate in the study had recruited smokers to the programme and had kept records of their progress. These 18 doctors had recruited 121 smokers in the 12-month period: only 7% (approximately) of all their patients who smoked. Of these, 29 (24%) patients reported that they had stopped smoking. Reasons that were given by doctors for their inability to use the programme as fully as they had hoped included the difficulty in recruiting smokers, a lack of time, and a low rate of return by the patients for follow-up visits. These results suggest that while general practitioners should be encouraged to give brief antismoking advice, general practice may not be a suitable location for more-intensive antismoking programmes. Limited health-promotional funds may be deployed better in general community awareness and mass-media programmes.

Adolescent↗
PubMed1987

Becoming a general practitioner.

Becoming a general practitioner is too much a matter of chance. The curriculum 'walks in through the door'. This is informal and unlikely to be comprehensive. Cognitive, not behavioural skills predominate. Many tutors have little or no grounding in adult education. The career intentions of trainees tend to be overshadowed by their immediate service role. This essay explores the integrated structure of general practice training. The author draws on his experience of 10 years as tutor in Sydney suburban and Tasmanian country practice, and now as State Director of training. He is a student in the University Centre for Education. Four essentials to be considered are: a highly motivated vocational trainee, a comprehensive negotiated curriculum emphasizing behaviour, a wealth of selected experience in refined training positions, and skilled tutors. The essay makes no attempt at an exhaustive analysis of becoming a general practitioner. The purpose is to address these critical features of training, and to argue for an approach in tune with the trainee's vision; comprehensive, valid and reliable; not a matter of chance.

Attitude of Health Personnel↗
PubMed2000

Membership by Assessment of Performance: developing a method for assessing established general practitioners.

Over 200 general practitioners (GPs) and others have contributed to the development of Membership by Assessment of Performance (MAP): a new scheme for assessing established GPs. By means of a Delphi consultation with a broad cross-section of the profession, a working conference, piloting with potential candidates, and repeated checking with reference panels, the assessment was developed within two years. We report the development of MAP, including the results of the Delphi consultation, which asked 'Which aspects of a general practitioners performance are important to assess?'.

Delphi Technique↗
PubMed1976

A general-practitioner ward in a new district general hospital.

So far there are relatively few general-practitioner wards in district general hospitals in the National Health Service. The work of one such general-practitioner ward at Queen Mary's Hospital, Sidcup, is described and the advantages of this system of care for patients and doctors discussed.

Adolescent↗
PubMed1995

'Video, health education and the General Practitioner Contract'.

The 1990 General Practitioner Contract and the 1993 Contract Revision emphasised the role of health education/health promotion within primary care. In this paper, the authors suggest that a highly cost-effective approach is necessary given the premium on time available for general practitioners and members of the primary health care team to undertake such work. The views of general practitioners and the primary health care team in a random sample of general practices within all 15 Health Board areas in Scotland were sought between 1991 and 1993 regarding current experience and future potential in using video-based health education materials, with particular emphasis on the content, structure and parameters appropriate to running effective health education/health promotion programmes. This study has indicated the potential demand for high quality, appropriately targeted video-based materials for use by primary health care workers within a range of practice, community and home settings. Central to this is the need for a better system of information and dissemination of materials and a firmer evaluation framework for health education/health promotion programmes within primary care. The progress of several policy, management and research issues which arose from the findings of the study have been raised by the authors. These include implications for the NHS such as infrastructure resourcing and priority setting, programme development, information and dissemination, research and evaluation, and mechanism(s) whereby general practitioners can be better involved in this process.

Adult↗
PubMed2006

[The practice guideline 'Diabetes mellitus type 2' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The publication of the practice guideline 'Diabetes mellitus' by the Dutch College of General Practitioners in 1989 marked the start of an era of publication of several guidelines that helped general practitioners using evidence-based medicine in clinical practice; the guidelines also helped to teach students. The second revision of this guideline presents many improvements, especially simplifications in the medication-schedules. However, the new recommendation to use thiazolidines is based on only one large study and has some unpractical aspects. The new guidelines do not mention preventive action, nor advice regarding early detection. Clinical practice has changed in recent years with the introduction of nurses specialising in diabetes and, despite published research on this subject, the guidelines do not give any recommendations for this. What is also missing are national clinical guidelines for doctors specialising in internal medicine. When patients do not respond to treatment according to the general practitioners' guidelines and are referred to a specialist in internal medicine, the treatment is diverse and seems to be doctor-dependent. It is important that treatment there be standardised as well so that general practitioners can refer more effectively.

Diabetes Mellitus, Type 2↗
PubMed1990

How well do general practitioners manage urinary problems in children? South Bedfordshire Practitioners' Group.

Thirteen general practitioners examined the notes of 1072 patients born in 1974 for evidence of enuresis, suspected urinary tract infection, and renal tract imaging. Of these children 63 (5.9%) had presented with enuresis -6.7% of the boys and 5.0% of the girls. Of the 63 children 65.1% had had midstream urinalysis. One hundred and ninety five children (18.2%, 64 boys and 131 girls) had experienced 303 episodes of possible urinary infections. Midstream urine samples were obtained in 80.2% of episodes and 17.7% of samples were positive. Ten boys (1.9% of the total) and 28 girls (5.2%) had proven infections. Only 14 of these 38 children (36.8%) had undergone renal tract imaging, 30.9% of the boys and 39.3% of the girls. All imaging was normal except in the case of one girl whose micturating cystourethrogram showed reflux. Fifteen other children were investigated; two further abnormalities were detected, one renal scar with reflux and one duplex system. This study demonstrates deficiencies in the investigation and follow up of children with urinary problems by general practitioners. Possible means of improvement are discussed.

Child, Preschool↗
PubMed1992

Deprivation and general practitioner workload.

OBJECTIVES: To examine general practitioner consultations by demographic and socioeconomic variables and to derive a method of measuring the impact of relative deprivation on general practitioner workload. DESIGN: The study was based on general practitioner consultations reported in the general household surveys of 1983-7, covering a sample of 129,987 individuals in Great Britain. Odds ratios for general practitioner consultations were obtained for selected variables among children (0-15 years), men (16-64), women (16-64), and elderly people (greater than or equal to 65). These were then used to derive deprivation indices specific to electoral wards for use in general practice. SETTING: Great Britain, with particular findings illustrated by English electoral wards and the conurbations of London, Manchester, Merseyside, and the West Midlands. RESULTS: Council tenure increased the likelihood of consultation significantly in all four groups. Odds ratios were raised in children, men, and women with no access to a car. Birth in the New Commonwealth or Pakistan yielded high odds ratios in men, women, and elderly people but not in children. Marginally increased consultation rates were evident in the manual socioeconomic groups in women, elderly people, and children with a single parent mother. The deprivation indices for general practice derived using these odds ratios varied substantially among English electoral wards with, for example, anticipated general practitioner consultations in the electoral ward of Hulme, Manchester, being 24% higher than the average ward in England as a result of local attributes, and consultations in the Cheam South ward of Sutton, London, 11% lower than average. CONCLUSION: This deprivation index for general practice overcomes several shortcomings expressed about the underprivileged area score, which has been adopted in the 1990 contract as a basis for allocating deprivation supplements to general practitioners. The proposed index can be applied nationwide.

Adolescent↗
PubMed2004

[The practice guideline 'Dementia' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

With growing numbers of older adults in the population, the number suffering from dementia will increase. The general practitioner has to try to determine the difference between Alzheimer's disease and vascular dementia on the one hand, and fronto-temporal dementia and dementia with Lewy bodies on the other hand, while also considering the therapeutic options now and in the future. Support for patients and their family is the responsibility of the general practitioner, who must also consider the patient's driving proficiency and the wishes for euthanasia of the demented older adult. The revised version of the practice guideline 'Dementia' of the Dutch College of General Practitioners is well suited to the work of the general practitioner. It is advisable to read the practice guideline several times and in such cases not only to use the summary card but the entire practice guideline.

Dementia↗
PubMed2006

[The practice guideline 'Problematic alcohol consumption' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The recently revised version of the practice guideline 'Problematic alcohol consumption' from the Dutch College of General Practitioners offers realistic advice to general practitioners on how to manage problem drinkers. The number of patients with alcohol problems tends to increase among women of middle age. The proportion of patients that report an alcohol problem themselves is larger than is usually assumed. Questionnaires are oflimited value in the detection of an alcohol problem. The general practitioner should look at problem drinking as a chronic disease that demands structured disease management and monitoring. This perspective will lead to less frustration in handling both the problem and the patients.

Adolescent↗
PubMed2001

Prescribing new drugs: qualitative study of influences on consultants and general practitioners.

OBJECTIVE: To explore consultants' and general practitioners' perceptions of the factors that influence their decisions to introduce new drugs into their clinical practice. DESIGN: Qualitative study using semistructured interviews. Monitoring of hospital and general practice prescribing data for eight new drugs. SETTING: Teaching hospital and nearby general hospital plus general practices in Birmingham. PARTICIPANTS: 38 consultants and 56 general practitioners who regularly referred to the teaching hospital. MAIN OUTCOME MEASURES: Reasons for prescribing a new drug; sources of information used for new drugs; extent of contact between consultants and general practitioners; and amount of study drugs used in hospitals and by general practitioners. RESULTS: Consultants usually prescribed new drugs only in their specialty, used few new drugs, and used scientific evidence to inform their decisions. General practitioners generally prescribed more new drugs and for a wider range of conditions, but their approach varied considerably both between general practitioners and between drugs for the same general practitioner. Drug company representatives were an important source of information for general practitioners. Prescribing data were consistent with statements made by respondents. CONCLUSIONS: The factors influencing the introduction of new drugs, particularly in primary care, are more multiple and complex than suggested by early theories of drug innovation. Early experience of using a new drug seems to strongly influence future use.

Drug Industry↗
PubMed1996

One-year prospective study of cases of suspected acute myocardial infarction managed by urban and rural general practitioners.

BACKGROUND: The role of the general practitioner in the management of patients with suspected acute myocardial infarction is important and specific. It has been recommended that eligible patients should receive thrombolysis within 90 minutes of alerting medical or ambulance services. The administration of prehospital thrombolysis by general practitioners is controversial. Most research into the management of acute myocardial infarction has been hospital based and has not explored differences between urban and rural general practice. AIM: In 1993-94 a one-year prospective survey was undertaken of samples of urban and rural general practitioners to examine their management of cases of suspected acute myocardial infarction and to determine whether differences in management existed between the two settings. METHOD: General practitioners were recruited through the continuing medical education faculty network of the Irish College of General Practitioners. Participating general practitioners completed a report form for cases of suspected acute myocardial infarction. Six-week follow-up forms were also completed. RESULTS: A total of 113 general practitioners (54 urban and 59 rural) participated in the study. A total of 57 general practitioners contributed 195 cases, 49 from urban and 146 from rural areas. The mean number of cases of suspected acute myocardial infarction per participant for urban and rural doctors was 0.9 and 2.5, respectively. Median delay time from onset of symptoms to contacting the general practitioner was 90 minutes for both urban and rural patients. Median general practitioner response times for urban and rural doctors were 10 and 15 minutes, respectively. Median estimated journey times from location of the patient to hospital for urban and rural patients were 10 and 40 minutes, respectively (P<0.001). Rural doctors were more likely, in comparison with their urban counterparts, to administer aspirin (given to 40% of patients versus 16%, P<0.01) but less likely to administer intravenous morphine (26% versus 41%, P<0.05). Twenty one patients (11%) died at the scene; follow-up forms were received for 94% of the remaining patients. Of these 163 patients, 99% were admitted to hospital; 49% were discharged with a diagnosis of acute myocardial infarction and a further 25% had final diagnoses consistent with acute coronary heart disease. CONCLUSION: This study suggests that the management of patients with suspected acute myocardial infarction differs in urban and rural settings. Delay times suggest that in order to meet current guidelines, prehospital thrombolysis must become a reality in rural areas.

Adult↗
PubMed1975

Access by general practitioners to physiotherapy department of a district general hospital.

There has been much opposition, voiced most notably in the Tunbridge Report, to general-practitioner access to hospital rehabilitation services. Co-operation between general practitioners, physiotherapists, and the consultant with responsibility for the physiotherapy department at a general district hospital has provided an efficient open-access service. This service has been welcomed by the general practitioners because it supplies prompt treatment for their patients and by the physiotherapists because it enables them to minimise disability by treating musculoskeletal problems at an early stage.

Family Practice↗