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At least 253 records · Page 14Linked to original sources
PubMed1996

[Symptoms of urinary tract infections in general practice. A comparison of diagnostic criteria and treatment among general practitioners, microbiologists and urologists].

General practitioners' criteria for good clinical practice vary, and it is unknown whether systematic education by specialists could be expected to reduce variation. The aim of this was to describe general practitioners', microbiologists' and urologists' criteria for diagnosis, treatment, and follow-up of women with symptoms of urinary tract infection. Based on these examples, advantages and disadvantages of using specialists as consultants in GPs' peer-group-based CME (continued medical education) are discussed. Three short case vignettes were presented in a questionnaire to GPs, microbiologists and urologists with prechosen choice of diagnostic, treatment, and follow-up strategy. A total of 154 (77%) GPs, 45 (51%) microbiologists, and 54 (61%) urologists answered the questionnaires. There was considerable variation in proposed strategy both within each specialty and between the specialties. Microbiologists, and to some extent urologists, would more often than the GPs treat a 30-year-old woman via telephone advice and prescription, while they more often tended to ask a 10- and 60-year-old woman to come to the clinic for examination. The GPs, more than the other doctor groups, would ask the patients to return for follow-up. Continuous medical education of GPs based on small-group peer discussions and with specialists as consultants in the groups cannot be expected to lead to less variation in choice of medical strategy.

Denmark↗
PubMed2004

[The practice guideline 'Acute cough' from the Dutch College of General Practitioners; a response from the perspective of general practice].

The practice guideline 'Acute cough' from the Dutch College of General Practitioners stresses the fact that a cough of less than 3 weeks' duration seldom heralds serious pathology. However, for sound reassurance of patients presenting with a cough of short duration, the general practitioner needs to know much about the signs and symptoms connected to low-prevalence serious pathology in these patients. The practice guideline distinguishes upper and lower respiratory tract infections and defines serious lower respiratory tract infection. The diagnostic value of symptoms and laboratory findings like a sedimentation rate or C-reactive protein in order to make such distinctions, is not explained in detail. Antibiotics are reserved for serious lower respiratory tract infection with the exception of acute bronchitis, croup and bronchiolitis, which can be treated without antibiotics. Recommendations for treatment of acute bronchiolitis with bronchodilators or corticosteroids, and croup with corticosteroids are based on consensus. This practice guideline can be considered as a clear and valuable piece of work for all physicians in primary and secondary care.

Acute Disease↗
PubMed1995

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

1. The attitudes of general practitioners and hospital physicians to the management of hypertension in the elderly, were examined by responses to a postal questionnaire distributed within the Northern Region, concerning the management of a healthy 75 year old male non-smoker with sustained diastolic or isolated systolic hypertension. 2. Two hundred and fourteen (64%) general practitioners and 127 (70%) hospital physicians responded to the questionnaire. General practitioners stated they would most commonly measure to the nearest 2 mm Hg (47%) as compared with nearest 5 mm Hg (61%) by physicians; P < 0.05. When measuring diastolic blood pressure 16% general practitioners and 31% physicians would use phase IV sounds; P < 0.01. 3. Median levels of hypertension, confirmed by repeated readings, at which antihypertensive therapy would be commenced were similar: 180 (150-230)/100(90-120) mm Hg vs 180 (150-200)/100 (90-120) mm Hg; median (range). The stated use of non-pharmacological methods to lower blood pressure before starting drug therapy was similar (74% vs 63%). General practitioners were more likely to prescribe a thiazide diuretic (70% vs 54%) and less likely to prescribe a calcium channel blocker (14% vs 28%) as first line therapy; data for diastolic hypertension, P < 0.001. 4. Considerable variation exists amongst both general practitioners and physicians in their stated assessment and management of a healthy elderly non-smoking male with sustained hypertension. General practitioners and physicians have similar stated thresholds for treating hypertension but differ in their choice of first line therapy. (ABTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗
PubMed2005

A model of supervision in mental health for general practitioners.

OBJECTIVE: If general practitioners (GPs) are to provide effective ongoing care to patients with mental health difficulties, it is argued that they need access to effective supervision. This paper aims to describe a specific framework for the provision of supervision to GPs involved in mental health-related work in a rural area. CONCLUSIONS: An innovative model of supervision is currently being trialled with GP practices in the Bendigo area of country Victoria. It is essential for a formal supervision framework to be available for GPs in mental health, so that effective outcomes in primary mental health care are maximized, facilitating better support for GPs and better outcomes for patients with mental health difficulties.

Adult↗
PubMedDate not supplied

Self-reported antibiotic compliance: emergency department to general practitioner follow up.

BACKGROUND: General practitioner (GP) follow up is important in the management of patients who are discharged from an ED. OBJECTIVES: To determine the antibiotic compliance and GP follow-up compliance rates in a population of patients seen and discharged from the ED with an antibiotic prescription. To test the hypothesis that the ability to nominate a GP is associated with improved antibiotic and GP follow-up compliance. DESIGN: A prospective cohort study enrolling consecutive adults who were discharged from the ED with antibiotic prescriptions over a 3 month period. Patients were divided into those who nominated a GP at the time of ED presentation and those who did not. Two weeks after enrollment, patients were contacted and asked standardized questions regarding compliance. RESULTS: In total, 123 patients were enrolled into the study. Of patients 76% were able to nominate a GP upon ED presentation. Analysis revealed that those patients who were able to nominate a GP had better compliance to follow up instructions (85 vs 44%, P < 0.01) and improved antibiotic compliance (99 vs 88%, P = 0.01). CONCLUSION: The majority of patients who were seen and discharged from the ED with an antibiotic prescription were able to nominate a GP and this was associated with improved follow-up compliance and antibiotic compliance. Improving follow-up compliance and thus the quality of patient care would involve identifying those patients who present to the ED who are unable to nominate a GP.

Adolescent↗
PubMed1977

Diagnostic policies of minor depressive illness by two differently trained groups of general practitioners.

Two homogeneous general practitioner groups were differently trained for approaching minor depressive illness. One group was presented the depression problem in a traditional manner while the other was led to particularly emphasize the importance of the doctor-patient relationship, according to Balint's suggestions. Both groups adopted the same case record form. The structural analysis of diagnostic judgement based on the logistic transformation of recorded data made it possible to evidence several qualitative differences between the groups, probably deriving from the different training.

Age Factors↗
PubMed2006

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

The usefulness of tympanotomy tubes in children with otitis media with effusion who also have speech and language retardation is doubtful in view of the natural development. The second revision of the practice guideline 'Otitis media with effusion' from the Dutch College of General Practitioners is still not in complete agreement with this. The indications for performing an adenoidectomy are now more limited. Pneumatic otoscopy and tympanometry are diagnostic aids that may deserve a permanent place in the general practitioner's medical practice in the future.

Acoustic Impedance Tests↗
PubMed2006

[The program initiative "general practice" of the Conference of the German Federal Health Ministers. Successes of interventions and possible reasons for the shortage of general practitioners].

The number of general practitioners has clearly decreased over the last 10 years in Germany. The situation is more critical in Eastern Germany compared to Western Germany. The article shows the results of the "program initiative to secure primary care in general practice" of the Conference of the Federal Health Ministers. The authors focus on the situation in Saxony-Anhalt, where they are founders of the Institute of General Medicine at the Universities of Halle-Wittenberg and Magdeburg. They also work as general practitioners.

Curriculum↗
PubMed1992

Pharmacy beyond the dispensary: general practitioners' views.

OBJECTIVES: To ascertain general practitioners' attitudes to an extended role for community pharmacists. DESIGN: Postal questionnaire to a 1 in 6 sample of general practitioners in the Northern, West Midlands, and Oxford regions (total sample size 1087). MAIN OUTCOME MEASURES: Attitudes towards specific extended roles, pharmacist prescribing of particular drugs, the role of the pharmacist, and the relationship between the professions. RESULTS: 744 questionnaires were returned in a usable form, an overall response rate of 68.4%. Attitudes varied, from a majority in favour of pharmacists reporting adverse drug reactions to a majority against their supervising repeat prescriptions (81% and 36% in agreement respectively). A similar range of attitudes was shown to pharmacist prescribing, from 84% in agreement with their prescribing nicotine chewing gum (deregulated since the survey) to 11% agreeing to their prescribing cimetidine. About half the respondents thought general practitioners should be allowed to dispense and a third that pharmacists "should stick to dispensing." 27% agreed that pharmacists were too influenced by commercial pressures to give unbiased advice. CONCLUSIONS: Most doctors would favour an extension of the activities of community pharmacists but worry about their role in screening and counselling patients and in prescribing. Despite relationships being generally felt to be good, there may be a need for better communication and cooperation locally and for proper evaluation of initiatives to extend the role of the pharmacist.

Attitude of Health Personnel↗
PubMed1991

Contribution of general practitioners to hospital intrapartum care in maternity units in England and Wales in 1988.

OBJECTIVE: To ascertain the contribution of general practitioners to hospital intrapartum care in 1988. DESIGN: Confidential postal questionnaire. SETTING: All maternity units in England and Wales. MAIN OUTCOME MEASURES: Type of general practitioner unit (if any); number of bookings, transfers, and deliveries by general practitioners; participation of general practitioners in the policy and audit of the unit. RESULTS: 277 (93%) of 297 units replied. Of 611,644 deliveries, 36,043 (5.9%) were under general practitioner care. In all, 228 units permitted general practitioners to book women under their sole care: 65 were isolated, 29 alongside, and 134 integrated general practitioner units. Alongside units had significantly more bookings (568), antenatal transfers (69), intrapartum transfers (86), and deliveries (387) compared with isolated units (185, 18, 16, and 125, respectively) and integrated units (106, 18, 18, and 52) (p less than 0.001 for all differences). The percentage of women booked by general practitioners transferred either before or during labour was independent of both the type of unit and the number of general practitioner bookings. General practitioners in consultant units were significantly less likely to attend meetings reviewing perinatal mortality (p less than 0.01), and these units were less likely to have any form of general practitioner-consultant liaison committee (p less than 0.001) compared with general practitioner units as a whole. Compared with those in isolated and alongside units, general practitioners in integrated units were less likely to have taken part in deciding the unit's booking policy (p less than 0.01) and consultants more likely to be the final determinant of whether a general practitioner should be permitted to practice within the unit (p less than 0.001). CONCLUSIONS: Both the number of deliveries booked by general practitioners and the number of isolated general practitioner units have fallen. Transfer from general practitioner to consultant care was independent of the general practitioner unit's caseload or the type of unit. General practitioner units differ from consultant units in important ways and differ among themselves as well. Except in remote areas, alongside units may be the ideal type of unit to encourage general practitioners to continue to provide intrapartum care.

Delivery Rooms↗
PubMed2004

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

The Dutch College of General Practitioners' (Dutch acronym: NHG) practice guideline 'Stable angina pectoris' (second revision) provides clear guidelines for the diagnosis and treatment of patients who experience chest pains as a result of angina pectoris, especially if coronary artery disease is the underlying cause of the complaints. The practice guideline clearly indicates for which complaints the general practitioner should suspect angina pectoris and which information from the anamnesis, family history and risk factors can contribute to distinguishing between stable and unstable angina pectoris. However, the physical examination should not be omitted because this can provide important indications for coronary or pulmonary dysfunction. According to the practice guideline, the treatment policy is determined by the estimated risk of significant coronary artery disease. However, additional tests can be useful even in the case of a small risk, as these can reassure patients. The indications and contraindications for medicinal substances are clearly presented.

Angina Pectoris↗
PubMed1995

Mental health care practices and educational needs of general practitioners.

OBJECTIVES: To describe current mental health care practices of general practitioners and to identify their educational priorities and training preferences. METHOD: Self-administered questionnaire to a stratified random sample of New South Wales general practitioners. SUBJECTS: 721 full-time general practitioners, of whom 534 (74%) responded. RESULTS: Mental health problems recognised by general practitioners at least once per week were psychosomatic (93%), emotional (89%), addiction (79%), social/economic (71%) and family (69%). At least two-thirds recognised sexual problems, sexual abuse and major psychiatric problems less frequently than once per week. Sixty-four per cent of general practitioners reported that patients felt uncomfortable about being referred to psychiatrists; 53% that referral service waiting lists were too long; 51% that there were insufficient local mental health services; and 25% that communication difficulties between referring general practitioners and mental health specialists obstructed optimal care. Educational priorities were diagnostic and counselling skills, with particular emphasis on crisis, family, individual and marital counselling and strategies to prevent general practitioner burn-out. CONCLUSIONS: General practitioners are interested in improving their mental health counselling and diagnostic skills but barriers remain. Both structural and educational initiatives are essential to enhance the quality of mental health care in general practice.

Adolescent↗
PubMed1991

[Benzodiazepines--attitudes and prescription practice among general practitioners and psychiatrists].

64 general practitioners and 42 psychiatrists in central Norway answered a questionnaire which evaluated the doctors attitudes to benzodiazepines through their responses to 19 statements regarding these drugs. In addition, eight patient questionnaires were used to assess prescribing habits regarding benzodiazepines. There was considerable variation between the responses from the two groups of doctors. Psychiatrists exhibited significantly (p less than 0.001) more negative attitudes and stricter prescription habits as regards benzodiazepines than general practitioners did. Another finding was a significant and positive correlation between attitudes and prescribing habits.

Attitude of Health Personnel↗
PubMed1991

Performance of skin biopsies by general practitioners.

OBJECTIVE: To evaluate and appraise skin biopsies performed by general practitioners and compare their performance with that of hospital doctors. DESIGN: Retrospective analysis of histology records. SETTING: University hospital. SUBJECTS: Records of 292 skin biopsy specimens obtained by general practitioners and 324 specimens obtained by general and plastic surgeons. MAIN OUTCOME MEASURES: Clinical and pathological diagnoses and completeness of excision. RESULTS: The number of specimens received from hospital surgeons and general practitioners increased over the study period; the proportion of specimens from general practitioners rose from 17/1268 (1.3%) in 1984 to 201/2387 (8.7%) in 1990. The range of diagnoses was similar among hospital and general practitioner cases, although malignancy was commoner in hospital cases (63/324 (19%) v 14/292 (5%) in general practitioner cases; chi 2 = 28, p less than 0.00001). Completeness of excision was less common among general practitioners than hospital surgeons (150/233 (3/15 malignant) v 195/232 (57/63); chi 2 = 22, p less than 0.00001). CONCLUSIONS: The increase in minor surgery has implications for the staffing and finance of histopathology departments. General practitioners must be given proper training in performing skin biopsies, and all specimens should be sent for examination.

Adolescent↗
PubMed1987

Open access to orthopaedic appliances for general practitioners.

A clinic to which general practitioners can refer patients for some types of orthopaedic appliances was opened in North Clwyd in 1983. During 1985, 956 patients were referred by 82 general practitioners; 860 patients received an appliance, and the average waiting time was less than five weeks. Most referrals were for soft collars (44%), lumbar sacral supports (30%), and dorsilumbar supports (7%). Thirty eight patients failed to attend, 54 declined an appliance, and four referrals were considered to be inappropriate. A few patients were subsequently referred to consultant outpatient clinics, 22 for physiotherapy and 34 were referred simultaneously to the open access clinic. The referral rates for general practitioners with access to community hospitals were low. Such an arrangement merits wider consideration.

Aged↗
PubMed2004

[Vaccination of general practitioners].

The vaccination of general practitioners represents significant problems for two reasons: they can be a reservoir of infectious diseases for the patients they are in contact with and their attitudes towards vaccination can influence their preventative acts and consequently the vaccination coverage of the population. The anti-influenza vaccination of the care providers is associated with a decrease of mortality amongst patients. Hepatitis B is one of the most frequent professional occupational infectious diseases and vaccination is necessary for all the professionals at risk. Concerning the whooping-cough we can observe at the present time an increase in the number of cases. The "Conseil Supérieur d'Hygiène" advises to propose vaccination of the people in contact with infants and people who have not HAD vaccination supplements in childhood. The rubella vaccination for unprotected women is also recommended for the care providers, to avoid the risk of infection and the possible implications for the foetus. The existing data in Belgium on the vaccination coverage of general practitioners is poor, but leads us to believe there is an insufficient vaccination coverage against these diseases. A study will shortly be undertaken to analyze the vaccination status of the Belgian French-speaking doctors and to further analyse their reasoning for any possible non-vaccination.

Carrier State↗
PubMed2004

Prevalence of subclinical infection by the SARS coronavirus among general practitioners in Hong Kong.

Eight general practitioners had severe acute respiratory distress syndrome (SARS) in Hong Kong during the epidemic, and others may have been infected by the SARS coronavirus without developing the full syndrome. We conducted a serological and questionnaire survey to determine the prevalence of subclinical infection by SARS coronavirus among general practitioners in Hong Kong. Participants had to be doctors actively practising in family medicine and who did not have SARS. Approximately 3200 general practitioners were invited to participate and the results of 574 were eligible for analysis. 29 samples were tested positive by enzyme-linked immunosorbent assay, but all these samples had titre < 25 by immunoflorescence assay. The prevalence for seropositivity was thus 0% (95% CI, 0.0%-0.6%). This finding documents the lack of subclinical infection by SARS coronavirus in an at-risk group in the community.

Adult↗
PubMed1980

Management of female breast disease by Southampton general practitioners.

One hundred and two Southampton general practitioners were interviewed about female breast disease. There was agreement about clinical management and the need to both teach and promote breast self-examination. The general practitioners, however, were divided as to whether any breast screening facilities were needed in Southampton. Records kept by the general practitioners of women seen with breast symptoms showed that one-quarter of all new episodes were referred to hospital at the first visit. That the general practitioners considered early diagnosis to be important was made evident from a number of the results. This attitude is encouraging in view of the evidence showing that long-term survival may be greater when delays are shorter.

Attitude of Health Personnel↗