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PubMed1984

Home care for patients with suspected myocardial infarction: use made by general practitioners of a hospital team for initial management.

Two hundred and sixty three general practitioners were offered the use of a hospital based service consisting of a medical senior house officer, a nurse attached to a coronary care unit, and a specially equipped ambulance estate car to help with the initial management of patients with suspected myocardial infarction who might be suitable for home care. One hundred and sixty nine general practitioners registered as potential users of this service; during 22 months they called the hospital team to see 271 patients, 235 of whom the team suspected had indeed suffered a myocardial infarction. During the same period, however, these general practitioners also admitted 317 patients with suspected myocardial infarction directly to hospital. Other general practitioners admitted 323 patients and deputising doctors 258. A further 529 patients with suspected infarction were admitted without the intervention of a general practitioner. Of the patients seen by the team, 54 required immediate admission to hospital; 17 of the remaining patients who initially appeared suitable for home care later required admission to hospital. In a large city such as Nottingham the provision of hospital based facilities to help general practitioners with home management is unlikely to make an appreciable impact on the overall pattern of care of patients with suspected myocardial infarction.

Aged↗
PubMed1999

Against women: are we looking after our general practitioners? GPs' views of the 1990 part-time contract.

A postal survey was conducted looking at the roles and experiences of General Practitioners on part-time contracts. This involved their perception of the attitudes of their colleagues and patients to their part-time status, and the consequences of these for their professional development. Of the 130 General Practitioners with part-time contracts in the one Regional Health Authority that was being surveyed 77.7% responded; 74.3% of the respondents were women. Of the women General Practitioners who responded to this particular question, the predominant age-bands were 31-40 years [41.4% (41)] and 41-50 [19.2% (19)], whilst male General Practitioners were more evenly spread across the age bands. The results showed that the majority of General Practitioners took up part-time contracts to enable them to look after their dependants, though a sizeable minority wished for free time or to relieve stress from a full-time contract. Forty percent said that they felt excluded from decision making about continuity of patient care and practice policy. Just under forty percent also stated that their workload was excessive in comparison with their full-time counterparts. Further, many expressed the opinion that they were financially penalised. The cost effective correlation between the increased availability of General Practitioners (particularly women) for patient care, and the costly medical education and training of such General Practitioners not being 'wasted' for several years was also noted together for the need for ongoing (or continual) medical education and training. The findings of this survey suggest there are many unresolved issues involved in satisfactory part-time contracting arrangements for General Practitioners. This particularly affects women General Practitioners. Whilst the RCP policy statement addresses education and training for general practice, the question of not losing out in relation to training opportunities and promotion is not addressed. The unresolved effects of the intra-professional differences in opportunities may affect the inter-professional functioning of the primary health care team and ultimately continuity and quality of care for patients.

Adult↗
PubMed1989

General practitioners' use of community psychiatric nursing services: a preliminary survey.

A questionnaire on general practitioners' use of community psychiatric nursing services was sent to a random sample of 100 general practitioners in two contrasting areas, Croydon and Cambridgeshire. General adult services were widely available though used less often by Cambridgeshire general practitioners than Croyden doctors. Apart from services for the elderly, specialist services were uncommon. Over a third of doctors reported that their adult services were based in a psychiatric hospital. Less than a quarter of general practitioners had access to primary care based nurses. The pattern of responses demonstrates the wide variety of ways in which general practitioners relate to community psychiatric nurses, even where the psychiatric nursing services are long-established. There remains a need for more consistent and coherent policies about the ways in which community psychiatric nurses are employed in primary care.

Adult↗
PubMed1993

Effects of a community mental health service on the practice and attitudes of general practitioners.

Recent years have seen closer links developing between general practitioners and mental health specialists. A study was undertaken in Manchester to determine the effects of a new community mental health service on the practice and attitudes of general practitioners. Ten doctors had access to the community based psychiatric team over a three year period while another 10 doctors continued to use hospital services. Those with access to the team were significantly more satisfied with the specialist support services, and were more likely to give high priority to community psychiatric nurses and psychiatric social workers working as part of a primary health care team than those without access to the service. Those with access were more willing than those without access to share with psychiatrists the care of patients with chronic neurotic disorders. The community mental health team was considered particularly helpful in reducing the burden posed by patients with neurotic and psychosocial problems, but this resulted in the general practitioners doing less counselling themselves. The study did not find that the new service had an effect on the general practitioners' ability to detect or manage psychiatric illness.

Community Mental Health Services↗
PubMed2005

Assessing diagnostic skill in dermatology: a comparison between general practitioners and dermatologists.

This retrospective study was conducted to assess and compare the diagnostic accuracy between referring general practitioners and dermatologists with regard to skin conditions. Six hundred and fifty-six consecutive general practitioner referrals to a private dermatology practice and a dermatology outpatient department were assessed. The concordance rate in diagnoses from a wide spectrum of dermatological diseases was compared between general practitioners and dermatologists. Referring general practitioners agreed with dermatologists' clinical diagnosis and histology (when available) in 42% of cases. The concordance between general practitioners and dermatologists in the setting of non-biopsied cases is 45%. One hundred and fifty-one of 656 (23%) conditions had histological confirmation. Overall, general practitioners agreed with the histological diagnosis in 24% of cases and dermatologists agreed with the histological diagnosis in 77% of cases.

Clinical Competence↗
PubMed1995

Clinical guidelines in primary care: a survey of general practitioners' attitudes and behaviour.

BACKGROUND: In the United Kingdom little is known about general practitioners' attitudes to and behaviour concerning clinical guidelines. AIM: A study was performed to investigate these two under-researched areas. METHOD: In 1994 a postal questionnaire on clinical guidelines was sent to all 326 general practitioner principals on the list of Lincolnshire Family Health Services Authority. The questionnaire consisted of 20 attitude statements and an open question on clinical guidelines, as well as surveying characteristics and behaviour of respondents. RESULTS: Of the 326 general practitioners sent questionnaires, 213 (65%) replied. Most respondents (78%) reported having been involved in writing inhouse guidelines. An even greater proportion (92%) reported having participated in clinical audit. Respondents were generally in favour of clinical guidelines, with mean response scores indicating a positive attitude to guidelines in 15 of the 20 statements, a negative attitude in four and equivocation in one. The majority of respondents felt that guidelines were effective in improving patient care (69%). Members (or fellows) of the Royal College of General Practitioners had a more positive attitude than non-members towards guidelines. They were also significantly more likely than non-members to have written inhouse guidelines, as were those who had participated in audit compared with those who had not participated in audit. A substantial minority (over a quarter) of general practitioners were concerned that guidelines may be used for setting performance-related pay, or that they may lead to 'cookbook' medicine, reduce clinical freedom or stifle innovation. There was also concern that guidelines should be scientifically valid. CONCLUSION: This study suggests that many general practitioners in the Lincolnshire Family Health Services Authority area have produced written inhouse guidelines. This is largely sustained by positive attitudes about the effectiveness and benefits of clinical guidelines. The positive attitude of RCGP members supports it in its continuing role in developing, implementing and evaluating guidelines in primary care. The question of whether incorporation of guidelines into clinical audit is an effective means to disseminate systematic research-based guidelines warrants further study.

Attitude of Health Personnel↗
PubMed1997

[Quality assurance in rheumatology. Evaluation of a team work model between general practitioners and a rheumatologist].

The intention of the project was to heighten the theoretical and practical skills of general practitioners in the care of patients with musceloskeletal problems. Six general practitioners and a rheumatologist participated. The rheumatologist joined the general practitioners at two health centres, which he visited on two occasions with an interval of six months. The patient and case history were presented by the local physician, and an additional historical and physical examination was performed by the rheumatologist. The physicians were trained in relevant examination techniques. The study was evaluated by means of questionnaires to the doctors and interviews with six patients. The theoretical knowledge of the general practitioners increased by an average of 23%. Both general practitioner and rheumatologist observed improvement in examination techniques. This parameter was not specifically evaluated. The patients appreciated the way in which they were treated. They found that the first and second line health care served as a smooth-working team. The cost of this project was low. The model is being continued at the request of the general practitioners.

Clinical Competence↗
PubMed2006

General practitioners with special interests: evolution and evaluation.

General practitioners with special interests (GPSIs) have emerged in the UK as a government initiative aimed at improving access in specialities that traditionally have long waiting times for investigations and treatment. This represents, to some extent, a formalisation of existing working practices of general practitioners who had obtained specialist experience during hospital training. GPSIs are working in a wide range of clinical areas including coronary heart disease, drug abuse, echocardiography and sexual health. Similar changes at the primary-secondary care interface are taking place in other European health systems. Key issues in the development of these services include the assurance of high-quality health care, clinical governance and risk management, cost-effectiveness and impact on outpatient care, and the work and role of specialists. It is possible that these new opportunities for general practitioners and other health care professions will aid recruitment and retention of staff in primary care, enhance education and encourage commissioners of services to look carefully at unmet needs in their health economies. Further challenges include the need to train a cadre of practitioners and to provide the research evidence on which to base continued investment in this promising initiative.

Health Services Accessibility↗
PubMed1995

Assessing clinical competence: recognition of case descriptions of rheumatic diseases by general practitioners.

The objective of this study was to detect strengths and weaknesses in the diagnosis of rheumatic diseases by general practitioners in order to set up post-graduate training accordingly and to assess whether open-ended questions give results comparable with multiple choice-type questions. Fifty-one general practitioners were given eight written cases: rheumatoid arthritis (RA), ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), gout, polymyalgia rheumatica and pseudogout. Only signs and symptoms were provided. All cases were derived from real patients with a definite diagnosis. Each case was presented in both types of question formats. The cases were also presented to 23 rheumatologists. We found that in the open-ended question format 57.1% of the general practitioners gave the correct answers. Cases of RA, AS, gout and PsA were correctly diagnosed by > 70% of the general practitioners. Cases of polymyalgia rheumatica and reactive arthritis were correctly diagnosed by 55 and 39% of the general practitioners, respectively. The cases of pseudogout and SLE were correctly diagnosed by less than 11% of the general practitioners. Fifty-two per cent of the general practitioners gave the correct answers to the multiple choice-type questions. There was no statistical difference in the correct answers between the open-ended questions and the multiple choice-type questions. We concluded that assuming generalization of the results, training of general practitioners should include polymyalgia rheumatica, reactive arthritis, SLE and pseudogout.

Clinical Competence↗
PubMed2006

Pharmaceutical care and its relationship to prescribing behaviour of general practitioners.

OBJECTIVE: To study the correlation between pharmaceutical care and prescribing routines of general practitioners (GPs). METHODS: Cross-sectional study; 201 pharmacies, 408 general practices, The Netherlands, 2000/2001. The variation in prescribing behaviour was characterised using 20 validated prescribing indicators based on general practice guidelines. The general construct 'adherence to guidelines' served as the dependent variable and was formed by summing the scores of the prescribing indicators. Four possible determinants of the variation were determined on the basis of survey questions: the construct 'the pharmacist's attitude towards pharmaceutical care', and three partial constructs derived from the pharmacist's care-providing function: the care for the individual patient, the cooperation with general practitioners and the registration of the care provided. A multiple linear regression analysis was then performed. MAIN OUTCOME MEASURE: The weighted score for the prescribing indicators. RESULTS: The weighted average score for the prescribing indicators was 65% (SD 3.7). The response rate to the survey was 71%. The pharmacist's attitude to pharmaceutical care, as well as the degree to which the pharmacist provided care for the individual patient, the degree to which he cooperated with the general practitioner and the degree to which he registered the care provided were not correlated with the 'adherence to guidelines' by the general practitioner with whom the pharmacist frequently cooperated. CONCLUSION: Variations between general practitioners in the quality of prescribing, as measured by their adherence to guidelines, were not correlated with pharmaceutical care by the pharmacist with whom they cooperated on a day-to-day basis.

Drug Prescriptions↗
PubMed2005

U.K. general practitioners' beliefs, attitudes, and reported prescribing of nicotine replacement therapy in pregnancy.

Clinical guidelines recommend that U.K. health professionals prescribe NRT in pregnancy. The present study was conducted to determine (a) general practitioners' confidence in their ability to deliver a range of smoking cessation interventions, including NRT, in pregnancy, (b) the frequency with which general practitioners recall prescribing NRT in pregnancy, and (c) the factors that influence general practitioners to prescribe NRT in pregnancy. We conducted a mail survey of 368 general practitioners (family physicians) working in four districts of Nottingham, England (response rate = 68.6%). Some 27.1% of respondents recalled prescribing NRT to pregnant women (9.2% were unsure). General practitioners were less confident about their ability to prescribe NRT in pregnancy than they were of their ability to deliver other simple smoking cessation interventions in pregnancy. Most general practitioners (62%) believed NRT to be effective in pregnancy and safer than smoking (70%), but fewer (45%) believed NRT to be safe in pregnancy per se. Multiple logistic regression demonstrated that general practitioners who believed NRT use in pregnancy was safer than smoking were most likely to recall having prescribed it, OR = 4.94, 95% CI = 1.31-18.71. Many general practitioners were unsure about the safety of NRT in pregnancy, which may explain their relatively low confidence in their ability to prescribe NRT in pregnancy, compared with other interventions. The key factor influencing general practitioners' prescribing decisions was a belief that NRT use in pregnancy was likely to be safer than smoking. Empirical evidence about the safety and efficacy of NRT use in pregnancy is required to inform general practitioners' decisions about prescribing NRT to pregnant women who smoke.

Adult↗
PubMed1988

General practitioner relocation in an urban area.

One important factor affecting access to primary health care is the location of the general practitioner but it is often assumed that opportunities to influence the distribution of general practitioners are minimal owing to their low propensity to relocate. In this study in an urban area of Manchester a relatively high level of turnover over nearly five years was observed among 488 general practitioners, reflecting factors such as changes of practice within the study area (6% of general practitioners), movements to new premises without changing practice (7%), moves into (23%) and out of (20%) the study area and retirements (13%). Some characteristics of movers were examined and compared with those of other general practitioners. It is argued that levels of turnover may be predictable to some extent, but that family practitioner committees need greater knowledge of general practitioners' movements in order to influence the distribution of general practitioner services.

Career Mobility↗
PubMed1996

General practitioners' opinions of continence care training.

AIMS: To examine general practitioners' confidence in the diagnosis and management of urinary incontinence, to define their unmet continence training and educational needs, and to evaluate the current provision of continence care in general practice, including the role of practice nurses. METHODS: A pre-tested postal questionnaire was sent to 600 general practitioners throughout New Zealand to obtain information about their demography and training in incontinence management, their confidence in diagnosis and treatment, and their perceptions of met and unmet educational needs in continence care. They were also asked about current provision of continence promotion in their practice and their views on the role of practice nurses in caring for incontinent patients. Confidence data were recorded on five point scales and analysed using chi square tests. Cluster analysis was used to describe groups with different opinions on practice nurses' roles. RESULTS: The response rate from eligible contacts was 81.3%. Although most respondents provide continence care, only 2.6% offered special clinics for continence promotion. Fewer than half felt confident to diagnose the causes of incontinence. Confidence in managing incontinence in children was consistently lower than for other incontinence presentations. There was no difference by sex in confidence in caring for incontinent patients although female respondents were more likely to consider management of continence care part of a practice nurse's role (chi 2 = 47.5, p < 0.01) and to routinely ask well women about incontinence (chi 2 = 243.6, p < 0.01). Most respondents (71.9%) could not remember having had any formal training in the management of incontinence at either undergraduate or postgraduate level. Recall of postgraduate education was associated with greater levels of confidence in management of continence problems. There was general agreement that it was appropriate to include training in continence management in vocational and continuing medical education. CONCLUSION: A substantial proportion of general practitioners perceive a lack of adequate medical training in incontinence care at both undergraduate and postgraduate levels. There is a need for improved education for both general practitioners and practice nurses.

Adult↗
PubMed2006

Survey of general practitioners' attitudes toward physical medicine and rehabilitation.

This study reports the attitudes of general practitioners towards physical medicine and rehabilitation after participating in a continued medical education course in this field. Given the high prevalence of musculoskeletal disorders and number of disabled persons in the country, along with the role of general practitioners in the primary and long-term management of such patients, basic competency in rehabilitation medicine must be considered in the educational curriculum of medical students. Nevertheless, rehabilitation medicine is not taught in most universities. This study was performed to evaluate the attitude of general practitioners towards physical medicine and rehabilitation as a baseline for developing educational programs in this field. In a simple descriptive study, at the end of a continued medical education program in low back pain management, 217 questionnaires, focusing on the field of physical medicine and rehabilitation, were distributed between participants. One-hundred-and-forty-three questionnaires were analyzed. Statistical analyses were performed with descriptive and Student's t-test. The results showed that of the participants, 69 (48.3%) were female and that they graduated from 24 medical schools. Most respondents (92.2%) believed that musculoskeletal education had not been sufficient in general practitioner training courses. Of the respondents, 56.8% had visited at least one disabled patient during the previous month, while 11% had visited more than 10 in the same period, but 84.3% had not studied disabilities. Musculoskeletal physical examination was the most needed educational field cited by general practitioners. In conclusion, this study clearly documents the inadequacy of basic rehabilitation training in medical schools. The findings reveal the most needed and preferred rehabilitation areas for general practitioners, and these should be considered in the establishment of rehabilitation training programs for Iranian medical students.

Attitude of Health Personnel↗
PubMed2004

The "myths" of low back pain: status quo in norwegian general practitioners and physiotherapists.

BACKGROUND: In 2001, several myths of low back pain still were alive in the general population in Norway, myths that were not in concordance with current guidelines. OBJECTIVES: To investigate perceptions about back pain in Norwegian general practitioners and physiotherapists and to compare these with perceptions in the general population. METHODS: During June 2001, 436 general practitioners (mean age 44.8, range 26-69 years) and 311 physiotherapists (mean age 47.6, range 25-70) were asked to rate their agreement with 7 statements, corresponding to Deyo's 7 myths that formulate 7 common misbeliefs on back pain. The corresponding data from the general population of 807 individuals (mean age 45.5, range 25-70) were sampled during early spring 2001. RESULTS: There were significant differences between the general population, general practitioners, and physiotherapists for all myths, the general population being more likely to agree with all myths. The differences were maintained even after controlling for educational level in the general population. There were no differences between general practitioners and physiotherapists except for the myths "radiographs and newer imaging tests can always identify the cause of pain" and "back pain is usually disabling," whereas general practitioners were less likely to disagree with the myths. Few gender and age differences were found in the professional groups. CONCLUSION: In Norwegian general practitioners and physiotherapists, Deyo's 7 myths mostly seem to be dead and buried. However, it does not seem that this has extended to the public yet, as many myths still are alive in the general population.

Adult↗
PubMed1991

[Management programs for hypertension and diabetes mellitus. Attitudes and experiences of general practitioners].

In 1987 and 1988 treatment programmes prepared by general practitioners were sent to the 2,900 doctors working in primary health care in Norway. In March 1990 a random sample (n = 600) were sent a questionnaire. The response rate was 63%. The general practitioners were greatly in favour of such programmes. 80% had read the programmes fully or in part, and one third used them regularly (at least once a month). Young doctors with little experience used them most and reported greatest benefit from the programmes. Reading and use of the programmes were strongly associated with participation in meetings and courses where the programmes had been used, and also with whether the general practitioners had used them for teaching the staff in their practices. 40% of the doctors who had received the programmes reported changes in their practice. Most of the changes referred to the doctors' own treatment routines, and less to areas requiring organizational changes in their practices. The general practitioners also answered questions on a test case with type 2 diabetes. 80% answered in accordance with the diabetes programme. The answers of those who had read and used the programme complied best with its recommendations.

Diabetes Mellitus, Type 2↗
PubMed1998

Qualitative study of educational interaction between general practitioners and specialists.

OBJECTIVES: To identify the main barriers to effective educational interaction between general practitioners and specialists and to suggest ways of overcoming these barriers. DESIGN: Qualitative study using semistructured interviews and focus groups. A content analysis of the data was performed. SETTING: South and West Regional Health Authority. SUBJECTS: 12 general practitioner principals and 12 hospital consultants were sampled purposefully and underwent a semistructured interview; a further 16 general practitioners and 16 hospital consultants similarly sampled made up four focus groups representing the two branches of the medical profession. RESULTS: There was a mismatch between what the general practitioners wanted from specialists in educational terms, and what the specialists were providing. General practitioners wanted to learn information that was directly applicable to their clinical work and to use referrals as two way learning opportunities. They were not sufficiently explicit about their learning needs. Specialists preferred to concentrate on new developments in their subject and would benefit from learning different ways of teaching. The participants were willing to learn from each other. Three models of educational interaction were identified: traditional didactic lectures given by specialists to general practitioners, interactive clinically based teaching, and informal interaction based on referrals. CONCLUSIONS: The two main branches of the medical profession have to address several significant problems before the full potential of teaching and learning together can be realised.

Attitude of Health Personnel↗
PubMed2002

Factors associated with young adults' obtaining general practitioner services.

This paper explores factors associated with the use of general practitioner services by young adults aged 20 to 24 years. The analyses examined sociodemographic and health data obtained for a community survey of respondents who lived in Canberra or Queanbeyan in 1999 and 2000 and linked this information to Medicare records of general practitioner visits over the following six months. In line with the Andersen model of health behaviour, predictor variables were classified as measures of physical and mental health needs for such services or as factors that predispose or enable the individual to obtain those services. Those who obtained general practitioner care were more likely to be female, to have been or be undertaking higher education and to be living with children. They were also identified by their having poorer physical health, more chronic diseases, higher levels of suicidal ideation and by their regularly using marijuana. General practitioners need to be aware of the potential mental health and substance use problems experienced by consumers in this age group. Strategies are also needed to encourage young men to seek general practitioner services when they are ill.

Adult↗