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PubMed1975

Analysis of general anxiety scale for children and draw-a-person measures of general anxiety level of elementary school children.

Sarason's (1960) General Anxiety Scale for Children was used as the criterion measure of trait anxiety in a study investigating fifth- and sixth-graders' (ns equals 15) human figure-drawing performance. Figures drawn were man, woman, and self. Significant differentiation by the figure-drawing scores on the sex criterion was obtained for some indices; however, no significant relationships were found between subjects' human figure-drawing scores and their anxiety level as measured by the General Anxiety Scale for Children.

Anxiety↗
PubMed1990

Psychological problems with hair loss in general practice and the treatment policies of general practitioners.

Scalp hair loss problems and the policies of general practitioners were studied by sending questionnaires to 374 physicians, of whom 21% responded. About 50% of the patients, according to their physicians, had psychological problems which predominantly comprised low self-esteem in the male patients and fear and anxiety in the female patients. The general practitioners followed the same policy for patients with psychological problems and for those without. The findings suggest that many alopecia patients need more psychological support from their physicians.

Adaptation, Psychological↗
PubMed1986

Use of antibiotics in general practice in Denmark. Prescribed daily dose, duration of treatment and number of treatments in general practice.

Prescribed daily dose (PDD) and duration of treatment is estimated for the most commonly used antibiotics in a multipractice study. In 1979 574 general practitioners and in 1983 625 general practitioners recorded 7 681 respectively 8 182 prescriptions of antibiotics over a five-day period. PDD and the number of treatments were compared with Defined Daily Dose (DDD) and DDD/1 000 inhabitants/day from the official statistics of drug consumption. It was found that these commonly used units were rather misleading with regard to the daily dose actually prescribed and the number of treatments given in a certain period.

Adolescent↗
PubMed1989

Perceived and presented morbidity in general practice. A study with diaries in four general practices in The Netherlands.

In four general practices in The Netherlands, 277 respondents reported in a diary on perceived morbidity during four weeks. Data of presented morbidity were provided by the general practitioners in these practices, who were accustomed to morbidity registration. As a mean, one complaint was reported every three or four days. Most complaints concerned disorders of the musculo-skeletal system, psychological disorders, and disorders of the upper respiratory tract and the digestive tract. About one-third of all complaints led to medicine taking. According to the GPs' records, one in five of the respondents consulted their GP. Approximately 10% of the complaints were reported to the GP. There was a connection between family members with respect to the frequency of reporting complaints. Because of selection of participating practices, families and respondents, the result can not be applied to the Dutch population as a whole. The results of this study agree with most of the literature on this subject.

Family Practice↗
PubMed1995

The concept of individualized hypertension care in general practice and outpatient clinics. The general practitioner hypertension practice study (III).

OBJECTIVE: To examine test ordering practice among general practitioners and hospital medical specialists according to the concept of individualized hypertension care. DESIGN: Mailed hypothetical case histories, with reference panels to categorize tests. SETTING: Uppsala-Orebro region in mid-Sweden. SUBJECTS: General practitioners (N = 90) and hospital medical specialists (N = 69) in randomly sampled primary health care centres and hospitals. MAIN OUTCOME MEASURES: Test ordering scores. RESULTS: 84% of invited GPs and 72% of specialists participated. According to reference panel standards, primary care physicians performed 75% of obligatory tests and specialists 88%. Superfluous tests constituted a larger proportion of the practice of hospital specialists (11-28%) than GPs (2-12%) in the six cases. Summarized examination scores revealed a wide practice variation within and between the two physician categories, specialists scoring significantly higher in three cases. Standardization of practice was more common among specialists, and differed significantly regarding serum potassium test, chest X-ray and ECG. Both groups deviated from current guidelines by omitting metabolic parameters. CONCLUSION: There is considerable practice variation in individualized hypertension care, which might influence treatment outcome. Practice audit and continuing medical education could contribute to care standardization according to guidelines.

Adult↗
PubMed2001

Gonorrhoea screening in general practice: perceived barriers and strategies to improve screening rates.

OBJECTIVE: To investigate perceived barriers to gonorrhoea screening in general practice and suggest strategies to overcome them. DESIGN: Questionnaire-based survey. SETTING AND PARTICIPANTS: All 47 general practitioners (GPs) authorised to prescribe subsidised HIV drugs under the Pharmaceutical Benefits Scheme in inner, eastern and northern Sydney. MAIN OUTCOME MEASURES: Agreement on a five-point Likert scale with statements about attitudes and practices in relation to gonorrhoea screening of homosexually active men, and views on how testing rates could be increased. RESULTS: 32 GPs responded (68%). Perceived barriers to gonorrhoea testing included structural measures imposed by the Federal Government to limit pathology testing by GPs (the Medicare "three-test rule") (17 respondents agreed or strongly agreed), pressure from the Health Insurance Commission (HIC) to minimise pathology testing (15), concerns about confidentiality of notification procedures (8), clinical time pressure (8), and concerns about recriminations against HIV patients with gonorrhoea (6). Suggested measures to increase testing were education of gay men to request testing (25), relaxation of the three-test rule (25), easier tests (23), anonymous notification procedures, review of HIC policy on screening, and training about testing (21 each). CONCLUSIONS: Sydney GPs with high HIV caseloads perceived structural barriers to gonorrhoea testing and supported a range of achievable strategies to overcome these. As the sustained epidemic of gonorrhoea in Sydney may be directly promoting HIV transmission, these strategies should be considered urgently.

Adult↗
PubMed1985

General medical care and the education of internists in university hospitals. An evaluation of the teaching hospital general medicine group practice program.

Fifteen general internal medicine group practices in university teaching hospitals were studied to evaluate their primary care services and education. Data were collected over 9 months from physicians, patients, and medical records, and by observation. All institutions had closed their general medical clinics. Many patients being treated in group practices were very sick; 57% had hypertension; 21% were diabetic; and 45% could not work. Most were satisfied with their care. Care for acute problems from a health care provider in the practice was available quickly; regular physicians were harder to see. House staff and faculty spent little time in the practices. Few practices used teams; most used traditional attending and house staff models. Practice physicians could not easily determine when patients were seen in the institution's emergency department or were hospitalized. Quality of care standards were not uniformly met. Finally, the structure of academic centers appeared to inhibit the practices' performance, suggesting a need for further appraisal of relationships between university hospitals and their ambulatory care units.

Appointments and Schedules↗
PubMed1992

General internal medicine and general internists: recognizing a national need. Federated Council for Internal Medicine.

The Federated Council for Internal Medicine (FCIM) comprises the American Board of Internal Medicine, American College of Physicians, American Society of Internal Medicine, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, and the Society of General Internal Medicine. The Council was established in 1975 to speak with a collective voice for the specialty of internal medicine. In 1992, the Council developed the following statement in conjunction with its endorsement of a target of 50% of internal medicine residency graduates entering the practice of general internal medicine.

Career Choice↗
PubMed2003

General internal medicine and geriatrics: building a foundation to improve the training of general internists in the care of older adults.

Internists--"doctors for adults"--provide most of the medical care given to older Americans, especially those with serious chronic disease. Nonetheless, the United States lacks an adequate physician workforce with mastery in caring for older persons and with expertise in building knowledge about how best to provide this care. This supplement aims to strengthen the physician workforce by fostering incremental and sustained improvements in the training of internal medicine residents in the care of older adults and in the development of geriatrics-oriented general internal medicine faculty. It identifies 3 major barriers to these improvements: lack of adequately trained teachers and mentors, the belief that explicit training in geriatrics has little to offer the generalist, and inadequate funding. Three strategies offer particular promise in overcoming these barriers: engaging directors of internal medicine residency programs, funding centers to promote collaboration between teaching and research programs in general internal medicine and geriatrics, and providing substantial incremental funding on the national level to pay for the time required to care for frail older patients and to teach and do research about this care. The barriers and strategies identified in this supplement may also inform efforts to enhance the skills of practicing physicians and improve training and faculty development in family medicine and other disciplines.

Aged↗
PubMed1998

[The Dutch 'Rand General Health Rating Index for Children': a questionnaire measuring the general health status of children].

OBJECTIVE: Clinimetric evaluation of the Dutch version of the RAND general health rating index for children (child RAND), measuring the general health of children. DESIGN: Descriptive. METHOD: The child RAND, containing 7 questions, was administered to parents of 124 children with asthma and of an unselected control group of 224 children, all between 6 months and 12 years of age. The parents also answered a question about the existence of complaints about health. Measurements were repeated after 24 hours and after one month. We tested internal consistency, test-retest reliability, discriminant validity and sensitivity to change. Results were compared with those of the Functional status II (FS II). RESULTS: The child RAND showed good reliability and validity. Cronbach's alpha was between 0.87 and 0.88 in the asthma group and between 0.71 and 0.80 in the control group. Test-retest reliability was 0.93 in the asthma group and 0.83 in the control group. Scores on the child RAND of children with asthma were significantly lower than those of children in the control group, and scores of children with health complaints were significantly lower than those of children without any health complaints in both groups. The sensitivity to change was lower than that of the FS II. The figures of the child RAND on the other measures of reliability and validity were comparable with those of the FS II. CONCLUSION: The Dutch child RAND is recommended as a generic measure of perceived health of children for medical research and may serve as a valuable addition to the measurement of functional health status by the FS II.

Adolescent↗
PubMed1984

Grants for residency training in general internal medicine or general pediatrics--PHS. Amendments to final regulations.

This rule amends the regulations implementing grants for residency training programs in general internal medicine or general pediatrics to conform with statutory changes made by the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35) and the Commonwealth-Covenant to Establish-Northern Mariana Islands (Pub. L. 94-241). These changes are nondiscretionary in nature. Additional amendments are for clarification.

Hospitals↗
PubMed1999

[How do patients evaluate general practice? German results from the European Project on Patient Evaluation of General Practice Care (EUROPEP)].

German results from the European Project on Patient Evaluation of General Practice Care (EUROPEP). As part of the European collaborative study, "EUROPEP" 2224 patients in Germany (response rate 77.2%) filled in a questionnaire to evaluate their general practitioners (GP's) and the care they were delivering over the last 12 month. Overall satisfaction was high: 95.4% reported that they had no reasons to change to another GP. On a five-point scale ranging from 'excellent' to 'poor' the possibility to reach the practice on the phone was evaluated best (73.8% 'excellent') and waiting times were rated worst (31.0% 'excellent'). Also less often rated 'excellent' than other items were 'preparing the patient for what to expect from specialist or hospital care' (53.3%), 'the GP's knowledge on what s/he had done or told the patient during previous contacts' (54.3%) and 'helping the patient to deal with emotional problems related to her/his health status' (54.6%). Relevant differences between practices concerning evaluation of care and sociodemografic background of their patients were detected. Patient evaluation of care can contribute to make practices an their teams more responsive to patients needs.

Adult↗
PubMed2000

Generalized essential telangiectasia in a patient with Graves' disease: should the spectrum of autoimmune diseases associated with generalized telangiectasia be expanded?

Generalized essential telangiectasia (GET), as originally described, is not associated with any underlying disease. Although patients with GET lack the typical periungual telangiectases associated with autoimmune collagen vascular diseases, these patients may have an underlying autoimmune process. We present a patient with a history of Graves' disease and low-titer anti-nuclear antibodies, who developed rapidly progressive generalized telangiectases. The gender and age of the majority of patients with GET fit well within the demographics of most autoimmune diseases. The documented occurrence of an autoimmune disease in several of the limited number of patients previously diagnosed with GET provides additional evidence that GET may be associated with an underlying autoimmune disease.

Adult↗
PubMed1999

Clinical examination for abdominal aortic aneurysm in general practice: report from the Medical Research Council's General Practice Research Framework.

At the time of the 1992-1994 annual reviews in the thrombosis prevention trial, general practitioners (GPs) carried out clinical examination for aneurysms by abdominal palpation in 4171 men. When an aneurysm was suspected, the patient was referred to hospital for further investigation. Aneurysm was suspected in 60 men (1.4%) and confirmed in 25 (0.6%), the mean diameter of confirmed aneurysms being 5.0 cm (range = 3.1-8.0 cm). Of the 25 men in whom aneurysm was confirmed, 10 (40%) underwent elective surgery and one died while under investigation. Examination by abdominal palpation for aortic aneurysm, which is not widely used in either general practice or in hospital practice, other than vascular surgery, is clinically worthwhile even though not all aneurysms will be detected by this means.

Aged↗
PubMed2000

[Six years with the general practice system--what is the opinion of general practitioners?].

BACKGROUND: In 1993 a list patient system was introduced in four Norwegian municipalities: Trondheim, Tromsø, Lillehammer and Asnes. MATERIAL AND METHODS: Questionnaire surveys were conducted among all GPs in these four municipalities in 1996 and 1999 for the purpose of examining changes in their assessment of the list patient system. RESULTS: The number of GPs generally satisfied with the list patient system declined over the three-year period. Doctors found their workload heavier in 1999 than in 1996, but their confidence in the list patient system as a tool for enhancing quality in general practice did not change over the period. GPs with too long patient lists were the most dissatisfied. The decline in confidence in the new system was strongest in Trondheim, the largest of the four municipalities and that in which the average patient list is longest. In Tromsø, the second largest municipality, with moderate to average patient lists, there were no changes in GP attitudes. INTERPRETATION: The study demonstrates some important consequences of a shortage of medical manpower in a list patient system. Local authorities will have to deal with these challenges.

Attitude of Health Personnel↗
PubMed1999

'Practice professional development plans': general practitioners' perspectives on proposed changes in general practice education.

BACKGROUND: The Chief Medical Officer has presented a report proposing a change in general practitioners' education towards a 'Practice Professional Development Plan', which, in principle, is based around formal needs assessment, practice-based learning in areas identified by those involved, and with the potential for multi-professional learning. This aims to replace the present system of a financial allowance earned by attending a certain amount of educational activity. AIM: To study the opinions of a group of general practitioners attending a course that included workshops that introduced and considered this educational initiative. METHOD: Semi-structured interviews four weeks after the course. RESULTS: Educational benefits were clearly seen, while issues such as funding and time will present difficulties in implementation. CONCLUSIONS: This proposal was seen as an improvement to the existing postgraduate educational allowance system. To maintain enthusiasm, successful introduction will depend on the issues of support and resources.

Adult↗
PubMed2000

Improving management of bereavement in general practice based on a survey of recently bereaved subjects in a single general practice.

BACKGROUND: Previous studies of bereavement in primary care have tended to concentrate on the attitudes of general practitioners (GPs) to bereavement support and little has been documented on the views of patients. AIM: To establish the role, content, and value of a protocol designed to help the newly bereaved by examining the experiences and expectations of a group of bereaved patients within a single general practice, with a view to developing patient care within this area. METHOD: A qualitative approach was adopted using a semi-structured questionnaire, data collection, and analysis consistent with the principles of grounded theory. Patients were approached by letter and those who agreed to take part in the study were interviewed at home. RESULTS: Many of those interviewed expected some form of contact from their GP after bereavement, although the nature of the contact they would have liked varied. The majority would have appreciated a letter of sympathy and none would have objected to it. Over half expressed some form of dissatisfaction either with their GP or with the hospital. Quality of information giving and communication affected bereavement outcomes for some. The role of the GP was examined and patients responded positively to practical suggestions to improve bereavement care. CONCLUSIONS: Bereavement support was seen to be an important part of the GP role by the majority of those interviewed. As a result recommendations have been made for a protocol to support the newly bereaved.

Aged↗
PubMed2001

[General practitioners' knowledge of and attitude to assessment and treatment of women with urinary incontinence. A questionnaire among general practitioners in Denmark].

INTRODUCTION: Urinary incontinence is a common problem for adult women, and the need for assessment and treatment of incontinence is expected to increase in the future. The aim of this study was to elucidate the general practitioners' (GPs) knowledge about and attitude to women with urinary incontinence. METHODS: A questionnaire was posted to 1700 randomly selected GPs in 1998 and 1999. RESULTS: A total of 1071 (63%) GPs responded at least once. Five hundred (29%) returned the questionnaire both years. About 50% expressed a positive interest in the management of urinary incontinence. Only 24% felt that their knowledge was sufficient to manage incontinence. About 50% and 66% of the GPs would probably refer a patient with stress incontinence or urge incontinence to a specialist. The GPs' proposals for assessment and treatment were mainly consistent with good clinical practice. There were only minor changes in knowledge and attitude from 1998 to 1999. DISCUSSION: GPs' interest in urinary incontinence is moderate and management is characterised by a high referral rate to a specialist. Most GPs. consider their knowledge to be inadequate. There is need for education to ensure sufficient knowledge and to change the attitude, so that first-line assessment and treatment of urinary incontinence is carried out in general practice.

Adult↗