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PubMed1992

Screening for cervical cancer: attitudes and policies among Auckland general practitioners.

OBJECTS: to survey Auckland general practitioners and evaluate their attitudes and policies toward screening for cervical cancer. METHODS: an interviewer administered questionnaire asking questions based mainly on the recommendations of the 1985 Working Party on screening for cervical cancer and on some issues resulting from the Cartwright Inquiry. RESULTS: the response rate was 96% of the 100 general practitioners approached. The mean screening interval was 24.1 months. Eighty-eight percent of Auckland general practitioners used a recall system for cervical cancer screening. Doctors more likely to report adherence to the recommendations of the Working Party on screening for cervical cancer were: members and associates of the Royal New Zealand College of General Practitioners; doctors with less than 15 years experience; female doctors; doctors with a diploma of obstetrics and doctors in group practices. CONCLUSIONS: the majority of Auckland general practitioners adhere to the recommendations of the 1985 Working Party on screening for cervical cancer although there is some evidence of overscreening. Areas for improvement include the need for more general practitioners to have a recall system and the need to increase the rate of referral for women with two consecutive smears showing mild dysplasia.

Age Factors↗
PubMed1995

Rotterdam general practitioners report (ROHAPRO): a computerised network of general practices in Rotterdam, The Netherlands. Rotterdam's HuisArtsen Project.

STUDY OBJECTIVE: Dutch public health services are charged with collective preventive care for the population--care that should, by law, be based on epidemiological data. General practices potentially offer important data for this purpose, particularly since more and more use a computer. This study aimed to assess whether it is possible to obtain useful epidemiological data from this source. DESIGN: In 1990, the Rotterdam Municipal Health Service, in collaboration with the Erasmus University Rotterdam, started a computerised sentinel practice network. The main features of this and a specific small investigation are described. SETTING: The following institutions cooperate in the network: Municipal Health Service Rotterdam Area; Departments of General Practice and of Medical Informatics, Erasmus University Rotterdam; Rotterdam District Association of General Practitioners. PATIENTS: Data are currently collected from 20 general practitioners and > 40,000 patients. In a specific project, the distribution of cardiovascular risk factors in different ethnic groups was compared. MAIN RESULTS: It was possible to build up a regional epidemiological registration system in this manner. In the cardiovascular project we found striking differences between ethnic groups. The risk profile for Turkish men, in particular, was less favourable. The health service also uses the system to improve cooperation between public health and primary health care (for example, in cervical screening, influenza vaccination). CONCLUSION: Computerised general practices offer great possibilities for research and for preventive activities in which public health care and general practitioners can cooperate.

Adult↗
PubMed1995

General practitioner registrars' views about a career in general practice.

BACKGROUND: Current low morale in general practice and the fall in the number of general practitioner registrars (trainees) has led to concern about the decline in popularity of general practice as a career. AIM: A study was performed to evaluate the career intentions of general practitioner registrars and the factors underlying their decisions. METHOD: An anonymous postal questionnaire seeking both quantitative and qualitative data was sent to 138 registrars during June 1993. All were registrars at practices in the south west region of England. Outcome measures used were the popularity of different types of general practice work and identification of variables and emergent themes considered important in career choice. RESULTS: A total of 101 registrars returned questionnaires (73%). Of the respondents, 96% expressed an interest in general practice as a career. However, registrars expressed considerable uncertainty about the future of general practice and therefore their career. Continuity of care and a holistic approach were considered valued aspects of work in general practice. Increased workload, increased out-of-hours work and erosion of professional autonomy emerged as negative aspects of a career in general practice. Of the respondents, 91% considered time for leisure activities an important factor when considering future career, 72% would have been glad to do away with 24-hour cover and 99% agreed that general practitioners increasingly fear litigation. CONCLUSION: Although registrars were interested in general practice as a career they had many concerns and expressed uncertainties. The future popularity of general practice is likely to depend on addressing these concerns and on the clarification of the future direction of the profession.

Adult↗
PubMed1988

Computerized family practitioner committee records--a data base for general practitioners.

In the primary care environment the role of preventive medicine is assuming increasing importance and general practitioners need accurate and up-to-date information about their practice population. Computerization of family practitioner committee registers should provide a readily accessible data base from which data about groups of patients within the practice area can easily be extracted. This paper describes a study carried out in Northumberland, which set out to establish the type of information which would be of interest to general practitioners and how it could be produced.It was found that a data base holding only registration data was of limited value to general practitioners, although useful for identifying target groups for screening programmes and showing demographic trends within the practice. The doctors felt that the inclusion of medical data would make the register a far more effective resource.

Ambulatory Care Information Systems↗
PubMed1992

[What does the higher concentration of general practitioners mean for fee-for-service reimbursement].

The density of general practitioners has increased steadily in Norway. By the end of 1989, there were 1,339 inhabitants per general practitioner. General practitioners are partly remunerated per item of service, i.e., by reimbursement from the National Insurance Fund and partly by patient co-payment. The article analyses the connection between density of general practitioner and level of fee-for-service reimbursement. The average general practitioner received about 60% higher fee-for-service reimbursement in 1989 than in 1985. This increase is markedly higher than the nominal changes in the tariff. The increase was somewhat higher in areas with a relatively low density of general practitioners. Also, in each of the years 1985-1989, the average fee-for-service reimbursement was slightly higher in areas with a low density of general practitioners. The variations have only a slight impact on the gross revenues of general practitioners. Three models explaining the use of general medical services are outlined. The results can be interpreted in the light of changes in health, changes in health-related behaviour, and supplier-induced demand. Since only aggregate data are available, it is difficult to further explore possible explanations.

Fees, Medical↗
PubMed1999

[Need for rehabilitation from the viewpoint of the general practitioner].

In Germany, the general practitioner plays an important role in the allocation process of rehabilitative measures. A survey concerning the questions of need, demand and effectiveness of medical rehabilitation measures as seen from the general practitioner's perspective in Hamburg, Schleswig-Holstein und Halle/Saale (n = 956) in 1999 shows that general practitioners have a rather positive attitude towards rehabilitation in general. With regard to the different measures within the rehabilitation system they show a differentiated opinion. As they see a large percentage of over- and underuse of rehabilitation they would appreciate that their information on the patient would be more intensively taken into account in the allocation process.

Attitude of Health Personnel↗
PubMed2005

Lack of training as a central barrier to the promotion of smoking cessation: a survey among general practitioners in Germany.

BACKGROUND: General practitioners (GPs) can contribute substantially to the promotion of smoking cessation in the general population. However, engagement of GPs in helping their patients to quit remains very limited in many countries, including Germany. Therefore, new strategies to foster implementation of evidence-based methods in smoking cessation assistance have to be identified, and data for current practice of and barriers against smoking cessation promotion in general practice are needed. METHODS: A cross-sectional survey among all 657 general practitioners practising in the Rhein-Neckar Region of Germany was conducted in spring 2002 using a postal questionnaire (response rate 48%). RESULTS: The majority (54%) of GPs reported having treated less than 10 patients for smoking cessation (by any means including mere advice to quit) within the last three months, 23% of GPs never received any education or training in smoking cessation promotion, and only one-third of GPs rated their training as adequate. The factor most strongly associated with low activity in smoking cessation promotion (defined as having treated less than 10 patients within the last three months) was perceived lack of training (odds ratio 2.70, 95% confidence interval 1.68 - 4.32), followed by perceived lack of demonstration material (2.10, 1.31 - 3.39) and perceived lack of time (1.65, 1.02 - 2.66). Furthermore, there was a clear dose-response relationship between the time spent on training and the activity in smoking cessation promotion. CONCLUSION: Adequate training may be a key factor to enhance engagement of general practitioners in the promotion of smoking cessation.

Adult↗
PubMed1999

Use of diagnostic imaging services in the Central Region by general practitioners.

AIM: To record general practitioners use of diagnostic imaging facilities in areas with different levels of access. METHOD: A random sample of general practitioners from three different areas kept a prospective record for one month of all patients referred to diagnostic imaging facilities, the outcomes of these investigations and the total number of patients seen. RESULTS: Referrals for diagnostic imaging services were significantly different between the localities (p = 0.014). The area with the least restrictions on access and the highest referral rate showed the greatest variation between doctors. There was a significant difference (p = 0.047) between the localities for patients who could not be referred because of restricted access and the cost of the services. The majority (68%) of patients who were unable to access these services were referred to the hospital for admission, for an outpatient appointment or to the accident and emergency department. There was little difference between the localities in either the presence or absence of pathology, or in the proportion of patients where the diagnosis was changed as a result of the diagnostic imaging investigation. CONCLUSION: Improved access to diagnostic imaging services for patients of general practitioners would result in better patient management and prevent unnecessary hospital referrals.

Adult↗
PubMed1994

True believers? Characteristics of general practitioners in Victorian community health centres.

General practitioners have been part of multidisciplinary services in Victoria Community Health Centres (CHCs) for 20 years. This model institutionalizes a high degree of integration between general practitioners and other primary care and community service personnel. Of 51 eligible full-time general practitioners in Victorian CHCs, 46 were interviewed, using a structured questionnaire. General practitioners in CHCs were younger, less experienced and more likely to be female than other general practitioners. Nearly three-quarters were salaried. The philosophy of practice and the conditions of employment were the commonest reasons for entering CHC practice. Teamwork and the conditions of employment were felt to be the biggest advantages of CHC practice, while difficulties with management and the perceived loss of professional ownership and control were the commonest disadvantages. None reported interference from the CHC management in their clinical practice. Nearly a quarter of full-time CHC general practitioners do not undertake any formal community health promotion activities. Forty-five per cent of respondents intended to leave their CHC within the next five years. Universal health insurance has diminished the impact of CHC general practice. The philosophy of CHCs and the salaried nature of the employment continues to attract general practitioners. High staff turnover is a feature of CHC general practice, in part related to young doctors making an initial, but not long-term commitment to CHC practice. However, the loss of professional control and management difficulties should be addressed, as these may contribute to the high turnover.

Adult↗
PubMed1995

Investigation of burnout in a sample of British general practitioners.

BACKGROUND: Recent changes in the general practitioner contract have produced increased workload and stress, poorer mental health and reduced job satisfaction. These factors might combine to increase the level of 'burnout' among general practitioners. AIM: This study set out to examine the extent of burnout among general practitioners. METHOD: A questionnaire was sent to all 295 Northamptonshire general practitioners seeking demographic details and including the Maslach burnout inventory. The results for the inventory were compared with the results from a sample of physicians and nurses in North America. RESULTS: There was a significantly higher level of burnout among the Northamptonshire doctors compared with the North American sample. There was virtually no association between age and the level of burnout, although a small negative correlation was found between age and the depersonalization of others subscale. Part-time general practitioners showed lower levels of burnout than full-time general practitioners. CONCLUSION: This study highlights the need to look both at the extent of burnout in young doctors during their training and at those characteristics of part-time general practitioners which might prevent burnout.

Burnout, Professional↗
PubMedDate not supplied

[Balint group--aid to general practitioner].

Professional education of general practitioner is mainly focused on biomedical aspects of treating somatic diseases, while psychological components of somatic diseases, as well as doctor-patient relationship, are generally neglected. General practitioner is in healing process daily exposed to considerable frustrations in relationships with patients. Some frustrations stem from unrecognized and neglected psychological and emotional aspects of somatic diseases which manifest in the doctor-patient relationship. The aim of this work is to show that Balint group can enhance general practitioner's professional capability, as well as his professional satisfaction, teaching him how to recognize psychological needs and problems which are integral part of somatic diseases and doctor-patient relationship as well.

Adult↗
PubMed1991

[Attitudes to and knowledge of contraindications against measles, mumps and rubella vaccination. (MFR-vaccination) among general practitioners].

A questionnaire investigation among general practitioners revealed that 29% of these were less positive about vaccination for measles, mumps and German measles (MFR vaccination) than for the remainder of the vaccination programme for children. Knowledge about contraindications for MFR vaccination was incomplete. Thus, only 26% of the general practitioners would advise vaccination if the parents stated that the child was hypersensitive to eggs. Only 70-80% of the general practitioners would advise vaccination if the child had cystic fibrosis, hydrocephalus, ventricle septum defect or had a cold but was apyrexial. Conversely, only 74% and 81% replied negatively to recommend vaccination if the child had had a previous anaphylactic reaction to eggs or was receiving treatment for leukemia. The replies given by the general practitioners were compared with present guidelines for contraindications to MFR vaccination and it is concluded that general practitioners should become more familiar with the knowledge about the MFR programme available at present and that further information from the official health authorities is required.

Child↗
PubMed2006

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

The Dutch College of General Practitioners recently published an update of the practice guideline on urinary-tract infections. This guideline provides a clear overview of the medical history, the diagnostic methods and the treatment options. Sixteen management modalities are presented in relation to specific patient characteristics. However, this revised guideline warrants some minor comments. According to the guideline, the dipstick (nitrite) test and dipslide form the two cornerstones of the diagnosis of urinary-tract infections. The value of the dipslide, however, seems to have been overestimated and that of microscopic examination of the urine by skilled physicians to have been underestimated. New in this guideline compared to that of 1999 is that nitrofurantoin (the treatment of first choice in uncomplicated infections) should be given for five instead of three days. The guideline motivates this change in policy on the basis of the numerous treatment failures seen in practice. The most convincing type of evidence, however, is not available due to the lack of relevant randomised clinical trials. The introduction of the prescription of phosphomycin, which is unusual in the Netherlands, as an alternative treatment for uncomplicated infections requires supportive evidence before it will be accepted by general practitioners. This well-documented guideline provides clear guidance for the general practitioner faced with patients with urinary-tract symptoms that could be caused by infection.

Anti-Bacterial Agents↗
PubMed1998

Self-referral in a gatekeeping system: patients' reasons for skipping the general-practitioner.

In the Netherlands general practitioners act as the gatekeepers at the primary level to the more specialized and more expensive secondary health-care. As a rule, patients are required to have a referral from their general practitioners to be able to utilize these services. Not all private insurance companies, however, require a referral letter from their customers before reimbursing them for their costs or do not always exert a control whether such referral indeed had taken place. A mail-questionnaire was targeted to a specific group of 2000 privately insured patients to find out the reasons of self-referral. The findings suggest that patients self-refer to a specialist for medical complaints for which they expect to end up at the specialist anyway as they consider these problems as specific for the specialist. Complaints of patients who first visit their general practitioners, however, might be considered as less typical to the specialist. Patients who are living in relatively highly urbanized areas, who are better educated, and who expect to achieve a better quality of communication at the consultation with the specialist, more commonly skip their GPs before visiting a specialist.

Attitude to Health↗