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PubMedDate not supplied

Job stressors and coping strategies as predictors of mental health and job satisfaction among Irish general practitioners.

Previous research has shown that many general practitioners were experiencing stress levels detrimental to their well-being. To examine coping strategies of Irish general practitioners and the possible impact of their stress on mental health and job satisfaction. Anonymous questionnaires were posted to 226 general practitioners in the Western Health Board. Just over one third of stressors caused moderate to considerable stress. Coping was important in the stress process. Sometimes, coping strategies predicted stress-related outcomes better than stressors. General practitioners' mental health was slightly better than that of a normative group. They tended to be satisfied with all aspects of the job, except hours of work. The provision of counselling services for general practitioners suffering from stress should be encouraged. Stress-management strategies should include training in coping skills and time management. The increased use of co-operatives could help alleviate the stress of out-of-hours work.

Adaptation, Psychological↗
PubMed2001

[One year's written drug information to a general practitioner].

BACKGROUND: It is a general impression that by far the greater part of drug information to general practitioners is provided by drug manufacturers rather than by independent sources. However, the extent of such information has not previously been quantified in Norway. MATERIAL AND METHODS: All written drug information received by a general practitioner in 1999 was registered. RESULTS: A total of 5,669 pages of drug information were received. Of these, 5,115 pages (90.2%) came from drug manufacturers. On average, 12 pages with drug advertisements and information on six different pharmaceutical products were received every day. INTERPRETATION: This study verifies that a very high proportion of the drug information to a general practitioner is provided by the pharmaceutical industry.

Advertising↗
PubMed1994

What makes general practitioners do child health surveillance?

The contribution of different general practitioner characteristics, views, and experiences to the likelihood of their providing child health surveillance (CHS) was determined and their perceived training needs discovered. Family health service authority administrative data on the study population was combined with a postal questionnaire survey. Subjects were all general practitioners in three district health authorities in the North West Thames region. There were striking differences between districts in the proportion of practitioners undertaking CHS. General practitioners with paediatric training were three times more likely to do CHS. Women doctors were twice as likely to do CHS as men. The personal views of general practitioners were significantly associated with whether or not they undertook CHS. The CHS fee did not appear to be the major motivating factor. There was considerable demand for further training. The proportion of general practitioners undertaking CHS is likely to increase with the proportion of women and vocationally trained doctors. More local training is wanted, both by general practitioners already doing CHS and by those who would like to do it. Health authorities need to ensure that such training is convenient and continuing.

Adult↗
PubMed2000

Managing child and adolescent mental health problems: the views of general practitioners.

OBJECTIVE: To investigate issues influencing the role of general practitioners in managing child and adolescent mental health problems. DESIGN: A postal questionnaire survey inviting respondents to rate statements about managing child and adolescent mental health issues. SETTING: Population of urban Scottish general practitioners. SUBJECTS: General practitioner principals. RESULTS: Of the 56% who responded, 31.3% reported that child and adolescent mental health services (CAMHS) were easy to access. Only a minority agreed that users' concerns prevented them from referring to CAMHS, and that these were more likely with young people or parents than with children. The number of respondents who considered their knowledge base, experience or training in this area to be adequate was particularly low. CONCLUSION: There may be a significant mismatch between what is expected of general practitioners in relation to child and adolescent mental health problems and what general practitioners themselves feel they are equipped to deliver.

Adolescent↗
PubMed1996

[A general practitioner as artisan].

For the general practitioner to practice his craft he must be able to combine attitudes, knowledge and skills in a lifelong process of learning. In this connection, reflection about his own practice is important, alone or together with colleagues, because his is a lonesome place of work, without the same network to rely on as his colleagues in hospital. The demands with regard to the craft of general practice depend to some extent on where in Norway the practice is located, but there are some practical skills that every general practitioner should possess, and critical reflection on one's own practice is important for developing them. Such skills are also necessary for communication with the hospitals. These days, the general practitioner has to deal with many problems that were solved earlier in hospital. The family practitioner has to connect all the threads from the different specialists. To do this well, he must develop his "craftsmanship", so as to maintain his credibility and the trust of the community.

Clinical Competence↗
PubMed1998

Do general practitioner hospitals reduce the utilisation of general hospital beds? Evidence from Finnmark county in north Norway.

STUDY OBJECTIVE: To assess whether populations with access to general practitioner hospitals (GP hospitals) utilise general hospitals less than populations without such access. DESIGN: Observational study comparing the total rates of admissions and of occupied bed days in general hospitals between populations with and without access to GP hospitals. Comparisons were also made separately for diagnoses commonly encountered in GP hospitals. SETTING: Two general hospitals serving the population of Finnmark county in north Norway. PATIENTS: 35,435 admissions based on five years' routine recordings from the two hospitals. MAIN RESULTS: The total rate of admission to general hospitals was lower in peripheral municipalities with a GP hospital than in central municipalities without this kind of institution, 26% and 28% lower for men and women respectively. The corresponding differences were 38% and 52%, when analysed for occupied bed days. The differences were most pronounced for patients with respiratory diseases, cardiac failure, and cancer who are primarily or intermediately treated or cared for in GP hospitals, and for patients with stroke and fractures, who are regularly transferred from general hospitals to GP hospitals for longer term follow up care. CONCLUSION: GP hospitals seem to reduce the utilisation of general hospitals with respect to admissions as well as occupied bed days.

Adolescent↗
PubMed1988

Do general practitioners miss dementia in elderly patients?

General practitioners and community nurses were asked to rate the likelihood of dementia for each of their elderly patients. Cases of dementia were identified by research psychiatrists using the Cambridge mental disorders of the elderly examination (CAMDEX), a new structured diagnostic interview. General practitioners correctly identified dementia as at least a possibility in 121 of the 208 cases found. Nevertheless, they mistakenly rated as demented several patients suffering from functional psychiatric disorders, in particular depression. Community nurses correctly identified dementia as at least a possibility in 64 of the 74 demented patients known to them, but they incorrectly suspected dementia in a greater proportion of instances. Both general practitioners and families appeared to have low expectations of what general practice has to offer demented elderly people. General practitioners should take the initiative in diagnosing dementia in very elderly patients who show signs of the condition. In some cases it may be secondary to treatable disorders, and in others all that may be required are understanding, support, and advice to families.

Aged↗
PubMed2002

Impaired glucose tolerance: qualitative and quantitative study of general practitioners' knowledge and perceptions.

OBJECTIVE: To investigate general practitioners' knowledge of and attitudes to impaired glucose tolerance. DESIGN: Mixed methodology qualitative and quantitative study with semistructured interviews, focus groups, and questionnaires. SETTING: 34 general practitioners in five primary care groups in the north east of England. RESULTS: All the general practitioners had knowledge of impaired glucose tolerance as a clinical entity, but they had little awareness of the clinical significance of impaired glucose tolerance and were uncertain about managing and following up these patients. Attitudes to screening were mixed and were associated with reservations about increased workload, concern about lack of resources, and pessimism about the effectiveness of lifestyle interventions. Some general practitioners felt strongly that screening patients for impaired glucose tolerance and subsequent lifestyle intervention medicalised an essentially social problem and that a health educational approach, involving schools and the media, should be adopted instead. A minority expressed a positive attitude towards a pharmacological approach. CONCLUSION: Awareness of impaired glucose tolerance needs to be raised, and guidelines for management are needed. General practitioners remain to be convinced that they have a role in attempting to reduce the incidence of type 2 diabetes by targeting interventions at patients with impaired glucose tolerance.

Attitude of Health Personnel↗
PubMed1999

[Communication between general practitioners and hospital interns at emergency admissions].

Communication between general practitioners and hospital interns serves as basis for the first in-hospital treatment of emergency admitted patients. The purpose of this study is to describe how this communication currently functions in Norway. The study was carried out by personal and focus group interviews with general practitioners and hospital interns, and questionnaire responses from 532 doctors. Both general practitioners (93%) and hospital interns (84%) claim that the general practitioner's information is usually valuable for the initial hospital treatment. 89% of the general practitioners and 65% of the interns (p < 0.01) responded affirmatively to general statements characterising the existing communication as good. However, 58% of the interns are of the opinion that there are many unnecessary referrals to the hospitals, and 47% respond that the general practitioners often refer a patient in order to get rid of a problem they should have been able to handle themselves. The interns single out simple problems with the referral letters, such as illegible handwriting, and left-out or unsorted information. This critical view can in part be explained by the sense of isolation, lack of autonomy and high work load that interns experience in their obligatory hospital year. We recommended that interns are invited to participate when hospital doctors and general practitioners meet.

Communication↗
PubMed2000

A practical guide to occlusal management for the general practitioner.

The general dentist has a unique role as the gatekeeper of dental care. In this role, the generalist is called upon to be the primary diagnostician and is charged with the responsibility for triaging patients. Classification systems devised by many of the dental specialties are valuable tools for the diagnosis of diseases and conditions specific to the specialty, but no classifications have been directed to the general dentist. This paper describes a system being used at the University of California at San Francisco School of Dentistry that enables the general dentist to classify a patient's stomatognathic system as either physiologic or nonphysiologic and then guides the clinician toward appropriate treatment decisions.

Adult↗
PubMed1990

Knowledge of HIV infection and AIDS, and attitudes to testing and counselling among general practitioners in Northern Ireland.

All 922 general practitioners in Northern Ireland were sent a questionnaire on human immunodeficiency virus (HIV) infection and the acquired immune deficiency syndrome (AIDS). Five hundred and ninety four general practitioners (64.4%) returned the questionnaire. Thirty eight respondents (6.4%) knew of an HIV positive patient in their practice and 93.3% felt they should be informed if one of their patients was found to be HIV positive at a genitourinary medicine clinic, even without the patient's consent. Of the respondents, 76.8% were willing to be involved in the management of AIDS patients in their practice in cooperation with hospital colleagues but only 37.5% felt confident to provide AIDS counselling and advice. Of the 368 general practitioners who did not feel confident to provide AIDS counselling and advice, 41.3% felt that they had insufficient knowledge and 79.6% felt uncertain of their counselling skills. The information gathered on the administration of injections, taking blood samples and disposal of needles indicated that further education for general practitioners is required to ensure safety at work.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The views of singlehanded general practitioners: a qualitative study.

OBJECTIVES: To examine the concerns of singlehanded general practitioners working in an inner London area and to compare the views of general practitioners in partnerships. DESIGN: Qualitative analysis of semistructured interviews with a random sample of singlehanded general practitioners and a sample of general practitioners from partnerships matched for age and sex. SETTING: The area covered by Lambeth, Southwark, and Lewisham Family Health Services Authority. RESULTS: The singlehanded general practitioners were more likely to be older, male, and first qualified abroad than general practitioners in partnerships. Their major concerns were inadequate premises, maintaining their singlehanded status, and coping with recent changes to their contract. Most were very satisfied with their solo status and did not see the provision of 24 hour care as stressful. CONCLUSION: Singlehanded general practitioners saw themselves as providing a unique service for patients, and their status as an alternative for general practitioners who were unhappy in partnerships. Such practices are unlikely to wither away as a pattern of provision. Any comprehensive development of primary care must take their needs into account.

Attitude of Health Personnel↗
PubMed1997

Management of acute asthma: gaps between opinion and recorded action by general practitioners.

OBJECTIVE: To describe the mismatch between general practitioners' recorded actions and opinions in the management of acute asthma. DESIGN: A comparison between clinical record data and questionnaire data on the ideal management of acute asthma. SETTING: The after-hours medical centre (AMC)--a service run by nearly all general practitioners in the Wellington region of New Zealand. STUDY PARTICIPANTS: Sixty general practitioners working at the AMC, treating 266 patients with acute asthma over a two-month period. RESULTS: A mismatch of over 40 percent occurred for pulse rate, respiratory rate, peak expiratory flow rate, modification of inhaled bronchodilators, and steroids, the use of nebulised medication and oral steroids. Other mismatches of interest to participating general practitioners were the prescribing of antibiotics for asthma, the difference in clinical behaviour between adults and children and the use of verbal action plans in asthma management. There was no mismatch for the recording of wheeze on auscultation in children, increasing inhaled asthma relieving drugs in adults, not using X-rays, not injecting asthma drugs, and not referring to hospital for most acute asthma. CONCLUSION: The mismatches created "gaps" between opinion and action which had face validity to participating general practitioners. The findings indicate the need for implementation of guidelines and for more research to explain how the mismatches arise.

Acute Disease↗
PubMed1995

Positive and negative factors in defensive medicine: a questionnaire study of general practitioners.

OBJECTIVES: (a) To investigate defensive medical practices among general practitioners; (b) to compare any such practices with general practitioners' understanding of certain aspects of the terms of service and medical negligence and practitioners' concerns about the risk of being sued or having a complaint lodged. DESIGN: Postal questionnaire survey. Each questionnaire was followed by a reminder. SUBJECTS: 500 systematically selected general practitioners on the membership list of the Medical Defence Union. MAIN OUTCOME MEASURES: Answers to questions on defensive medical practices, understanding of certain aspects of the terms of service and medical negligence, and concerns about the risk of being sued or having a complaint lodged. RESULTS: 300 general practitioners returned the questionnaire (response rate 60%). 294 (98%) claimed to have made some practice changes as a result of the possibility of a patient complaining. Of the defensive medical practices adopted, the most common (over half of doctors stating likely or very likely) seemed to be increased diagnostic testing, increased referrals, increased follow up, and more detailed patient explanations and note taking. Respondents practised defensive medicine as a possible consequence of concerns about the risks of being sued or having a complaint lodged. This association was particularly strong for negative defensive practices. Defensive medical practice did not correlate with any misunderstanding about the law of negligence or the general practitioners' terms of service. CONCLUSIONS: General practitioners are practising defensive medicine. Some defensive practices such as increased patient explanations or more detailed note taking are clearly beneficial. However, implementing the findings of the Wilson report may increase negative defensive medical practices.

Adult↗
PubMed1989

An educational program on depressive disorders for general practitioners on Gotland: background and evaluation.

General practitioners are the psychiatrists' most important coworkers in the treatment of depressive disorders. A high degree of knowledge about this illness in this group of doctors is of decisive importance. However, the value of postgraduate educational programs for general practitioners has been questioned. The Swedish Committee for the Prevention and Treatment of Depression (PTD) offered an educational program on symptoms, etiology, diagnosis, prevention and treatment of depression to all general practitioners on the Swedish island of Gotland. Lectures on suicide, depressive illness in childhood and in old age and psychotherapy of depressive states were also given. In several control periods data were collected on suicides, referrals to the local psychiatric department, emergency admissions, the quantity of sick leave used and the quantity of inpatient care due to depression. Even the prescription of psychopharmacological drugs on the island was investigated. Overall, the results indicated that general practitioners gratefully accepted the educational program and achieved increasing competence and stringency in treating and preventing depressive states. The program was associated with decreases in the use of psychiatric inpatient care and the sick leave frequency of depressed patients. The possibility of preventing suicides was positively influenced.

Curriculum↗
PubMedDate not supplied

[Circulation of pharmaceutical information among general practitioners in the region of Sousse (Tunisia)].

The general practitioner plays an essential role in the rational strategy of drug-use by the quality of his prescription which translates the validity and the relevance of his pharmaceutical information. The objective of this work is to study the different means of pharmaceutical information used by general practitioners in the region of Sousse (Tunisia). We conducted a transversal, descriptive, exhaustive survey of 140 general practitioners in private (68) and public (72) practice during 1999. Data were collected through a questionnaire. This study, with a participation rate of 78%, showed that pharmaceutical dictionaries are the major source of information for 86% of general practitioners, that medical delegates have a positive image for 84% of them and that 36% of general practitioners do not subscribe to any medical journal. Thus, general practitioners are exposed to relatively unreliable pharmaceutical information coming generally from the pharmaceutical industry.

Communication↗
PubMed1984

Usefulness of letters from hospitals to general practitioners.

In an investigation of the communication between specialist hospital departments and general practitioners 97 general practitioners were asked to say how important selected items of information that the hospital could pass on would be for management of a patient receiving chemotherapy. In addition, the records of 68 patients were examined for coverage of these topics. General practitioners considered technical topics to be more important than social ones. Hospital letters covered technical topics well, apart from details of possible side effects, but did not do the same even for the two social topics that most doctors considered to be essential--namely, what patients have been told about their diagnosis and prognosis. Letters from hospitals to general practitioners cover technical topics well but should include more information relating to the social aspects of the patient's disease.

Antineoplastic Agents↗
PubMed2000

Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care.

OBJECTIVE: To compare the cost effectiveness of general practitioners and nurse practitioners as first point of contact in primary care. DESIGN: Multicentre randomised controlled trial of patients requesting an appointment the same day. SETTING: 20 general practices in England and Wales. PARTICIPANTS: 1716 patients were eligible for randomisation, of whom 1316 agreed to randomisation and 1303 subsequently attended the clinic. Data were available for analysis on 1292 patients (651 general practitioner consultations and 641 nurse practitioner consultations). MAIN OUTCOME MEASURES: Consultation process (length of consultation, examinations, prescriptions, referrals), patient satisfaction, health status, return clinic visits over two weeks, and costs. RESULTS: Nurse practitioner consultations were significantly longer than those of the general practitioners (11.57 v 7.28 min; adjusted difference 4. 20, 95% confidence interval 2.98 to 5.41), and nurses carried out more tests (8.7% v 5.6% of patients; odds ratio 1.66, 95% confidence interval 1.04 to 2.66) and asked patients to return more often (37. 2% v 24.8%; 1.93, 1.36 to 2.73). There was no significant difference in patterns of prescribing or health status outcome for the two groups. Patients were more satisfied with nurse practitioner consultations (mean score 4.40 v 4.24 for general practitioners; adjusted difference 0.18, 0.092 to 0.257). This difference remained after consultation length was controlled for. There was no significant difference in health service costs (nurse practitioner 18.ll pound sterling v general practitioner 20.70 pound sterling adjusted difference 2.33 pound sterling - 1.62 pound sterling to 6.28 pound sterling). CONCLUSIONS: The clinical care an health service costs of nurse practitioners and general practitioners were similar. If nurse practitioners were able to maintain the benefits while reducing their return consultation rate or shortening consultation times, they could be more cost effective than general practitioners.

Adolescent↗