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PubMed1996

Views of pregnant women on the involvement of general practitioners in maternity care.

BACKGROUND: The reorganization of maternity services in England following the report Changing childbirth is likely to impinge upon general practitioners' contribution to maternity care. Professionals and managers are increasingly expected to take account of patients' views when reorganizing services. AIM: This study aimed to elicit women's views about the involvement of general practitioners in maternity care and to establish the extent of continuity provided by general practitioners. METHOD: A prospective cohort postal questionnaire survey was undertaken in the Bath health district to elicit the views of pregnant women about the general practitioner's role in maternity care, the continuity provided, patient satisfaction and the general practitioner-patient relationship. Responses were rated on five-point Likert scales. Women completed questionnaires at 24 and eight weeks before the birth and at two and eight weeks after the birth. RESULTS: Of 164 women entering the study (28 of whom were booked for home delivery and 136 for hospital delivery), 116 (71%) completed all four survey questionnaires. Of respondents 68% agreed that general practitioners play an important role in routine antenatal care and 53% that they have an important role in normal labour. These opinions appeared to be stable over time. Most women (73%) were cared for throughout their pregnancy by one general practitioner whom they knew well; such continuity was desired by nearly all the women in the study. Approximately three quarters of women were satisfied with the antenatal, postnatal and overall care provided by their general practitioner. Over half of respondents (56%) wished to get to know the doctor who would be present at the birth: the general practitioner was involved in 19 labours (16%), being present at the birth for only nine women. Women delivering at home were significantly more likely to agree with the statement that they knew the doctor present at the birth compared with those women delivering at hospital. Most women (91%) had their final six-week postnatal check with their general practitioner. CONCLUSION: Most women in this study believed that general practitioners are important in maternity care, providing continuity of antenatal and postnatal care but not of intrapartum care. These beliefs might be an indicator of the future situation in the United Kingdom when more women give birth at home and under non-consultant care. The vocational training and continuing education of general practitioners should accommodate their possible future roles in maternity care.

Adult↗
PubMed1988

Referral patterns to an ophthalmic outpatient clinic by general practitioners and ophthalmic opticians and the role of these professionals in screening for ocular disease.

Case notes of 1113 consecutive new patients referred to a consultant ophthalmologist at a district general hospital were reviewed to determine the source and efficacy of referrals and the current screening practices of general practitioners and ophthalmic opticians. General practitioners initiated referral in 546 cases (49%) and ophthalmic opticians referral in 439 (39%). Visual loss or visual disturbance was the most important single reason for referral (345 cases; 31%), followed by suspected glaucoma (145 cases; 13%), abnormalities of binocular vision (140; 12.5%), disorders of eyelids or ocular adnexa (127; 11%), and red eye (86; 8%). General practitioners referred many more patients with disorders of the eyelids and adnexa and ophthalmic opticians many more patients with suspected glaucoma. Ophthalmic opticians were far more likely than general practitioners to refer patients with suspected glaucoma correctly. A total of 180 patients (16%) were referred from ocular screening, in 149 cases by ophthalmic opticians and in 10 by general practitioners. Seventy patients had glaucoma or incomplete features of glaucoma, all of them referred by ophthalmic opticians. Of eight diabetic patients referred by ophthalmic opticians, three had asymptomatic disease and in two diabetes was diagnosed as a result of ocular screening. No patient was referred for asymptomatic diabetic retinopathy from screening by general practitioners. Ophthalmic opticians were more likely than general practitioners to diagnose retinopathy requiring photocoagulation. Use of a community based service to screen for glaucoma could save unnecessary consultant outpatient appointments. A similar service could facilitate detection of diabetic retinopathy at a stage when treatment is most effective.

Adolescent↗
PubMed1989

Oncology as part of the vocational training of general practitioners in The Netherlands.

In 1986 an educational program in Oncology for General Practitioners was developed at the University of Amsterdam. This program will be implemented within the general practitioners' vocational training. In this program the various goals of the general practitioner have been categorized: prevention; diagnosis by the general practitioner; diagnosis by the specialist; therapy; and guidance and care. All these goals have been further subdivided in more concrete skills to give form to the various aspects of the task of the general practitioner. These skills have been related to the different types of cancer. A number of related skills will be illustrated in the program for a specific type of tumor. Hence, a so-called basic educational program is formed. The various basic educational programs, in which different types of tumors are used for illustration, consist of program-units of 90 minutes. Relevant aspects of specific types of malignancy, which are not dealt with in the basic educational program, will be added to the basic educational program as supplements.

Curriculum↗
PubMed1996

The menopause and hormone replacement therapy: Australian general practitioners' self-reported opinions, attitudes and behaviour.

OBJECTIVES: We describe the attitude and views of general practitioners towards the menopause and hormone replacement therapy (HRT) in metropolitan Brisbane, Australia. METHODS: A total of 216 general practitioners were nominated by a random sample of urband-welling women aged 45-54 years who formed the Brisbane Women's health study. A 20-30 minute face-to-face questionnaire with the general practitioners was administered and analysed by demographic characteristics. RESULTS: There was a 93% response rate. Management of the menopause and HRT was routinely undertaken by general practitioners for their own patients. After deciding to initiate HRT, > 60% of general practitioners ordered five investigations or more. They may have confused the risk of thrombo-embolism from oestrogens used in the post-menopause with that for contraception. There were differences between male and female practitioners in some areas. Male general practitioners, in particular, reported more difficulty with tailoring and adjusting regimes. CONCLUSIONS: Specific areas for further education are explored to meet the educational needs of general practitioners.

Adult↗
PubMed1991

Interaction between diabetic patients, their general practitioners and a hospital diabetic clinic.

OBJECTIVE: The aim of this study was to examine the sociodemographic data of diabetic patients referred to our clinic and to correlate these with characteristics of their individual general practitioners. How these factors affect the interaction between patients, general practitioners and a hospital diabetic clinic was evaluated. DESIGN: Prospective recruitment of consecutive referrals. SETTING: The diabetic clinic of a teaching hospital located in the inner city suburbs of Sydney. PATIENTS: Two hundred and forty-six patients with diabetes (10% insulin dependent), aged 20-86 years, participating in our Shared Care Project, a randomised controlled study on various methods of following up diabetic patients. INTERVENTIONS: Data for the study were gathered by interview and questionnaire during first assessment at the clinic. MAIN OUTCOME MEASURES: Clinical and sociodemographic characteristics of patients; the location of general practitioners, their diagnostic equipment and type of practice; and the level of detail recorded in referral letters from general practitioners. RESULTS: Diabetic patients of migrant background who cannot speak English are older and have less formal education. They see their doctors more often and seek out general practitioners who speak their language, even if it means travelling longer distances. Patients referred from 24 hour medical centres are younger, more educated and have less contact with their doctors both in duration and frequency of visits when compared with patients whose general practitioners operate in conventional sole or partnership practices. Many patients have more than one general practitioner, making communication with hospitals difficult. In their referral letters, general practitioners usually concentrate on hypertension, hypercholesterolaemia and metabolic aspects of diabetes, but under-emphasise diabetic complications; they make insufficient use of measurement of the glycosylated haemoglobin level to assess diabetic control while over-using glucose tolerance testing in making the diagnosis. The referral letter often does not contain enough information to help clinical decision making. CONCLUSIONS: Demography of patients and characteristics of general practitioners are important factors which can affect their interaction with public hospitals. Bearing in mind the work load of general practitioners and the diverse nature of patients, hospitals must implement systems which make it easier for general practitioners and patients to interact with them.

Adult↗
PubMed1989

General practitioners' recognition and management of psychiatric illness.

All 53 of the general practitioners from one community health area of the Hunter region of New South Wales were interviewed about patients with psychiatric illnesses who had presented to their practices. Four main themes were covered: personal data which included details of medical and psychiatric training and experience; attitudes to psychiatric illness; pharmacological management; and the effectiveness of existing services. Ninety-four per cent of the general practitioners felt that dealing with psychiatric problems was an integral part of their role as a general practitioner and 60% of the general practitioners believed that their management of these problems was adequate. Patients with personality problems and those with hypochondriasis were identified as their most difficult patient groups, while inability to refer quickly was cited as the major obstacle to successful psychiatric treatment. An increased awareness of the hazards of psychotropic drugs and of the proper uses of these agents existed. Finally, private psychiatrists and the mental hospitals were criticized for not providing an adequate back-up service for this group of general practitioners.

Adult↗
PubMed1993

Analysis of referrals of mental health problems by general practitioners.

The majority of people in the community who have a psychiatric disorder will consult their general practitioner. Referrals from general practice to specialist services are, however, relatively rare. The filter between primary care and specialist care has been characterized by Goldberg and Huxley as the least permeable of the filters separating psychiatrists and other specialists from the populations they serve. These referrals form the subject of this study in the Netherlands. Using a large database of doctor-patient contacts, the proportion of mental health disorders resulting in a referral and the characteristics of the patient and general practitioner that are involved in such a referral have been determined. In addition, the type of mental health institution or specialist to which referrals were directed and the characteristics influencing this choice were examined. Only 6% of patients presenting with a psychiatric disorder during surgery hours were referred to specialist care. Younger patients, male patients and patients with severe diagnoses had a greater probability of being referred. The percentage of patients referred was higher in urban areas than in rural areas. Doctors with a limited task perception regarding mental treatment tended to refer more often. Although the diagnosis did have some relationship with the institutions to which patients were referred (psychotic conditions to psychiatric services and social/material problems to social workers), the most prevalent diagnoses (neurotic conditions and relationship problems) seemed to be more or less randomly distributed over the various possibilities. Preferences appeared to be related to the existence of regular meetings between general practitioners and specialists and a positive evaluation by general practitioners of the institution concerned.

Adult↗
PubMed1996

Motivation of general practitioners attending postgraduate education.

BACKGROUND: The 1990 Contract encouraged general practitioners to participate in continuing medical education by providing a financial incentive. AIM: The study was designed: to determine the motivation of general practitioners attending education events; and to compare motivation and reasons for attendance pre- and post-Contract at commercial and non-commercial meetings, and at the different educational categories of Disease Management (DM), Health Promotion (HP) and Service Management (SM). METHOD: Two structured questionnaires were used. The first was sent to all general practitioners in the West of Scotland and asked about motivation pre-1990 Contract and the second, post-Contract, looked at motivation and reasons for attending a course as part of post course assessment. This latter was part of a much larger study evaluating continuing medical education. RESULTS: A total of 1161 practitioners responded to questionnaire I and 552 general practitioners attended 27 randomly selected postgraduate meetings. Finance was a motivator in 3.8% pre-Contract, and this increased to 33.3% post-Contract and was the most commonly stated reason for attendance in 81.3%. Financial incentive had the biggest influence on those attending HP sessions (91.5%), then SM (87.2%) and finally DM (78.6% (chi 2 = 8.68; P < or = 0.013). It was also important to 73% attending drug-company-sponsored meetings compared with 83.7% going to non-commercial ones. Interest was a good motivator both pre- and post-Contract, but more so for DM than other categories and drug company as opposed to non-commercial meetings (chi 2 = 9.4; P < 0.002). Lack of knowledge became a less-important motivator post-Contract, and doctors felt least knowledgeable in SM (62.2%), as opposed to DM (57.9%) and HP (23.6%) (chi 2 = 38.8; P < 0.001, with each differing significantly from both others). Doctors found the topics provided by the pharmaceutical companies more interesting (chi 2 = 9.4; P < 0.002) and the hospitality provided more alluring than scheme meetings (chi 2 = 28.6; P < 0.001). CONCLUSIONS: Finance has a major effect on attendance at postgraduate meetings but may not be a good incentive for learning. Planning for education must take into account the different motivational factors for the different categories. Reasons for attending commercial meetings differ from non-commercial ones and these events should be closely monitored.

Education, Medical, Continuing↗
PubMed1999

[Do general practitioners want to manage chronic hepatitis C and take part in hepatitis C health networks? A national survey].

OBJECTIVES: To assess information that general practitioners had on hepatitis C and on the hepatitis C network in hospitals and private practice. METHODOLOGY: A national telephone survey of 604 general practitioners was conducted between March 18 and 23, 1998. RESULTS: Screening and management of hepatitis C was important for 89% and 97% of general practitioners. Screening was performed in relation to the relative risk (IV drug users 89%, blood transfusion before 1991 88%). General practitioners wanted more information on treatment (54%), patient counselling (42%) and the potential risks of the disease (42%). Of 604 general practitioners, 6% were involved in a hepatitis C network, while 21% were involved in another network (drug users 9%, AIDS 8%). Of the 94% general practitioners who were not part of the network, 33% were willing to join a hepatitis C network. Only 56% were aware of a hepatitis C network (press article 30%, mailing 17% or local meeting 12%). The difficulties for the involvement of general practitioners were: lack of time, topics not adapted to daily practice and geographic constraints (74%), too few patients in their practice (52%), no need (38%), the idea itself of a network and lack of information (28%). CONCLUSION: General practitioners screen patients at risk of hepatitis C. They want to be better informed about treatment, patient counselling, and the potential risks of hepatitis C. They are less involved in hepatitis C networks than in other networks (drug, AIDS). However, one third of general practitioners would like to be involved in a hepatitis C network. These results could be useful for implementing post-graduate courses and general practitioner training.

Adult↗
PubMed1988

Referring patients to geriatric day hospitals: a survey of general practitioners' opinions.

Many geriatric day hospitals are under-utilized. A survey of general practitioners' opinions on referral systems to day hospitals in east Surrey produced an 85% response rate. Of the 80 general practitioners who responded 58% referred occasionally, 39% frequently and 4% never. When asked about referring patients directly to the day hospital via the coordinator instead of via the consultant geriatrician, 58% of general practitioners said they would like to have direct access, and 87% were in favour of other health workers involved with the elderly initiating referrals with the general practitioner's consent. Rehabilitation was mentioned as the main reason for referral by 76% of general practitioners, medical assessment by 56% and social care by 48%. Comments received suggested that the hospital day was too long and that early rising associated with attendance caused stress in the elderly attenders. It is concluded that the present system of referral via the consultant is not always satisfactory and that a referral card system which permits general practitioners to refer directly to the geriatric day hospital may increase utilization.

Aged↗
PubMed1996

Prescription of antidepressants by general practitioners: recommendations by FHSAs and health boards.

BACKGROUND: In order to cut costs of prescribing by general practitioners family health service authorities (FHSAs) and health boards in the UK have been instructed to improve the quality and cost-effectiveness of prescribing by general practitioners in their area by tailoring advice to individual general practices. AIM: As over 95% of patients suffering from depression are treated by their general practitioner, a study was set up to investigate the effectiveness of the advice given by FHSAs and health boards to general practitioners on treatment of depression and prescription of antidepressant drugs. METHOD: The recommendations on prescription of antidepressants of professional advisors from all 117.FHSAs and health boards in the UK were elicited by telephone. Those who had produced written information for the general practitioners in their area regarding depression and antidepressants prescribing during the study period were asked to send a copy to the researchers. RESULTS: An excellent response rate (100%) was obtained to the telephone survey, and all of the bodies that provided their general practitioners with written information on depression and prescription of antidepressants sent in copies. Most of the documents received were informative and accurate; however, others provided information that was incorrect. CONCLUSION: Bulletins and newsletters from FHSAs and health boards are capable of influencing the prescribing patterns of general practitioners in their area, and must contain accurate and up-to-date information if they are to improve the management of depressed patients in the community.

Antidepressive Agents↗
PubMed2002

[The Dutch College of General Practitioners' practice guidelines, "Examination of the neonate": response from the perspective of general practice medicine].

With the publication of the Dutch College of General Practitioners' practice guideline 'Examination of the neonate', a discussion which has lasted several decades has been brought to an end. Up to now a second neonatal examination by the general practitioner on the third, fourth or fifth day after a midwife-assisted birth was recommended. The arguments in support of this recommendation were based on the following: (a) the limited expertise of midwives in the past, (b) the experience that general practitioners had in examining children, although this experience was not specifically related to the defects for which neonates should be checked, and (c) the government bodies' wish to restrict the number of hospital deliveries by giving greater structure to the organisation of midwife care, which in practice, did not lead to large changes. Based on three studies, the practice guideline recommends that a second examination is of no added value.

Clinical Competence↗
PubMed1989

Practice activity analysis: collaboration between general practitioners and a family practitioner committee.

The Brent and Harrow family practitioner committee has supported a scheme to enable general practitioners to collect data relating to their practice activity. This paper reports on the operation of the scheme involving 76 general practitioners from 22 practices and the findings. Practice nurse activity was also included. The family practitioner committee undertook an analysis of the data and provided each participating general practitioner with a print-out of his or her consultation rates over a range of activity, enabling general practitioners to make comparisons both with their partners and with the averages for all the practices participating in the scheme. The essential aim is to provide structured information which enables general practitioners to look more objectively at their activity. The family practitioner committee gave an assurance that the figures would not be used to criticize individuals.

England↗
PubMed2002

General practice research: attitudes and involvement of Queensland general practitioners.

OBJECTIVES: To determine general practitioners' (GPs') attitudes towards and involvement in general practice research. DESIGN: Postal survey and semi-structured interviews conducted from May to September 2001. PARTICIPANTS AND SETTING: 467 of 631 GPs in four Queensland Divisions of General Practice responded to the survey (74% response rate); 18 selected GPs were interviewed. MAIN OUTCOME MEASURES: Survey - attitudes to research; access to information resources; and involvement in research. Interviews - the need for general practice research; barriers against and factors enabling greater participation in research. RESULTS: 389/463 (84%) GPs, especially younger and more recent graduates, had positive attitudes to research, but only 29% wanted more involvement. 223/462 (48%) were aware they had access to MEDLINE, although presumably all those with Internet access (89%) would have free access via PubMed. Barriers included the general practice environment (especially fee-for-service funding), and the culture of general practice. Enabling factors included academic mentors; opportunities to participate in reputable, established research activities relevant to general practice; and access to information resources. CONCLUSIONS: Although Australian general practice has a weak research culture, about a third of GPs would like to increase their involvement in research. However, the research must be perceived as relevant, and structured to minimise the inherent barriers in the environment and culture of general practice.

Adult↗
PubMed1992

General practitioners' attitudes to computer-generated surgical discharge letters. Members of the Department of General Surgery, Fremantle Hospital.

OBJECTIVE: To assess general practitioners' attitudes to a computed-generated general surgical discharge letter. To identify the six most important items of information in an ideal discharge letter. DESIGN: One hundred and thirty general practitioners who had received at least six computer-generated surgical discharge letters in one year were circulated with a questionnaire. RESULTS: Most general practitioners approved of the computer-generated discharge letter which included all six of the most important items of information they requested. Eighty-four per cent wished to see a similar computer-generated discharge system extended into other areas of hospital practice.

Attitude of Health Personnel↗
PubMed1984

General practitioner and health promotion: what patients think.

Although there has been growing interest in general practitioners' participation in promoting health, little is known about the attitudes of their patients. Thus we sent a copy of a self administered questionnaire (the Health Survey Questionnaire) to 3452 patients aged 17-70 who were registered with two practices in north west London. Questions about attitudes to and perceptions of general practitioners' interest in weight, smoking, drinking, and fitness problems were included. The patients were also asked whether they thought that they had a problem in any of these areas. The response rate was 72%. Of those who responded, the proportions who thought that their general practitioners should be interested ranged from 72% in the case of fitness to 83% for weight, but only 38% thought that general practitioners had in fact been interested in fitness and only 48% thought so about weight. Forty one per cent of the respondents thought that they had a fitness problem, 42% a weight problem, and 59% of the smokers thought that they had a smoking problem. Four per cent of respondents stated that they had a drinking problem. Of those patients who said that they had a problem, the proportions who thought that their general practitioners had seemed interested ranged from 43% for fitness to 69% for smoking. The findings of this study suggest that greater participation by general practitioners in health promotion would be well received by most patients and that currently there may be considerable discrepancies between patients' expectations and their perception of their general practitioner's interest in these areas of preventive medicine.

Adolescent↗
PubMed1998

General practitioner's perceptions of the route to evidence based medicine: a questionnaire survey.

OBJECTIVES: To determine the attitude of general practitioners towards evidence based medicine and their related educational needs. DESIGN: A questionnaire study of general practitioners. SETTING: General practice in the former Wessex region, England. SUBJECTS: Randomly selected sample of 25% of all general practitioners (452), of whom 302 replied. MAIN OUTCOME MEASURES: Respondents' attitude towards evidence based medicine, ability to access and interpret evidence, perceived barriers to practising evidence based medicine, and best method of moving from opinion based to evidence based medicine. RESULTS: Respondents mainly welcomed evidence based medicine and agreed that its practice improves patient care. They had a low level of awareness of extracting journals, review publications, and databases (only 40% knew of the Cochrane Database of Systematic Reviews), and, even if aware, many did not use them. In their surgeries 20% had access to bibliographic databases and 17% to the world wide web. Most had some understanding of the technical terms used. The major perceived barrier to practising evidence based medicine was lack of personal time. Respondents thought the most appropriate way to move towards evidence based general practice was by using evidence based guidelines or proposals developed by colleagues. CONCLUSION: Promoting and improving access to summaries of evidence, rather than teaching all general practitioners literature searching and critical appraisal, would be the more appropriate method of encouraging evidence based general practice. General practitioners who are skilled in accessing and interpreting evidence should be encouraged to develop local evidence based guidelines and advice.

Attitude of Health Personnel↗
PubMed1993

[General practitioners and prevention of ischemic heart disease].

The object of this investigation was to examine general practitioners' attitudes to prophylaxis, assessment of the significance of a series of risk factors for the development of heart disease and how much emphasis they employed in attempting to alter the risk factors. In addition, the general practitioners' own health habits were investigated and it was assessed whether there was any connection between health habits and assessment of risk factors and the priorities given to these efforts. The general practitioners' advice and current behaviour as regards risk factors were investigated. The investigation was carried out as a questionnaire investigation in the County of Aarhus where all doctors received a questionnaire. A total of 313 general practitioners replied to the questionnaire which corresponds to a percentage participation of 84. The investigation revealed that general practitioners are interested in prophylaxis but find it difficult. By and large, general practitioners regarded the usual risk factors as being of great significance for the development of ischaemic heart disease and considered that it was important to alter these. A connection was present between their own health habits, assessment of risk factors and the priority awarded to these. Practitioners who had had their own serum cholesterol measured, considered that hypercholesterolaemia was important and awarded efforts to correct this greater priority than practitioners who had not had their serum cholesterol measured. The general practitioners abilities in taking case histories and giving dietary advice in cases of hypercholesterolaemia showed that they had only few deficiencies, but that there was a great scatter in their intervention limits for hypercholesterolaemia.

Denmark↗