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PubMed1990

A study of communication between general practitioners and specialists.

A random sample of referral letters from general practitioners to outpatient departments of general medicine, dermatology, neurology, and gastroenterology at an Amsterdam teaching hospital were analysed together with the specialists' replies for 144 referrals. The pairs of letters were judged by a panel of four general practitioners and four specialists. Letters were assessed according to quality and content, clarity, request for return to general practitioner care, time intervals between referral and consultation and between consultation and the specialist's reply. The judges were also asked to assess whether in their opinion the letters were of value in teaching or were discourteous. Though in general intraobserver agreement on what constitutes a good letter was low, deficiencies were revealed in the quality of letters and there were delays in transmission and missed educational opportunities.

Clinical Competence↗
PubMed1990

General practitioners' detection of depression and dementia in elderly patients.

In a study of 11 general practitioners' detection of dementia and depression in 101 elderly patients it was found that general practitioners were more accurate in their detection of dementia than depression. The general practitioners did not identify 12 of the 15 patients assessed as depressed by a Diagnostic Interview for Depression, but their assessments of dementia corresponded quite well with the results of dementia tests. The general practitioners' knowledge of the symptoms and signs of dementia and depression was limited. If the patient talked to the general practitioner about feeling depressed, sad or irritable, the depression recognition rate increased.

Activities of Daily Living↗
PubMed1996

Drug prescribing practices of general practitioners and paediatricians for childhood diarrhoea in Karachi, Pakistan.

Observations were made of 996 encounters between children with diarrhoea and practitioners (28 paediatricians, 62 general practitioners) in Karachi, Pakistan. Oral rehydration salt (ORS) was prescribed in more than 50% of encounters by 53% of general practitioners (GPs) and 61% of paediatricians. Sixty-six percent of GPs and 50% of paediatricians prescribed antibacterials, 60% of GPs and 28% of paediatricians prescribed antidiarrhoeals and 39% of GPs and 32% of paediatricians prescribed antiamoebics in more than 30% of their encounters. Looking at all the encounters, we observed that ORS was prescribed in 52 and 51%, antibacterials in 41 and 36%, antidiarrhoeals in 48 and 29%, and antiamoebics in 26 and 22% of encounters by GPs and paediatricians, respectively, Cotrimoxazole was the most frequently prescribed antibacterial by both types of practitioners. Antidiarrhoeals were prescribed more often by GPs than by paediatricians. In 77% of their encounters, GPs dispensed drug formulations known as "mixtures' made in their own dispensing corners. The mean duration of encounters between patients and GPs was 3 +/- 2 minutes and between patients and paediatricians was 9 +/- 4 minutes. These results indicate inadequate prescription of ORS and excessive prescription of antibacterials, antidiarrhoeals and antiamoebics. Intervention strategies need to be planned to improve the prescribing practices of both groups.

Amebicides↗
PubMed1989

General practitioners' opinions about their responsibility for medical tasks: comparison between England and The Netherlands.

A questionnaire survey compared a sample of 371 general practitioners in the Avon region of England with 74 general practitioners in the east of the Netherlands. A list of 14 medical tasks--six technical tasks and eight chronic disease management tasks--was presented and the doctors indicated whether each task was totally, often, sometimes, seldom or not at all the responsibility of the general practitioner. The results show that English general practitioners felt more responsibility for chronic problems than the Dutch doctors whereas Dutch general practitioners felt more responsibility for technical tasks than the English. Fewer general practitioners in both countries felt responsible for technical tasks than for chronic disease. Reasons for the differences in terms of the structure of general practice and training are discussed.

Adult↗
PubMed1991

[General practitioners' attitude to prescription of psychopharmaceuticals. Autonomy versus paternalism, education and understanding of disease].

The object of this investigation was to illustrate the attitudes of general practitioners to prescription of psychotropic drugs and to mental illness. The qualitative research interview method was chosen as the method employed here. Fourteen general practitioners were interviewed while one did not wish to participate. A marked difference was found between the attitudes of the general practitioners to respect the autonomy of the patients or to act paternally. The paternal general practitioner could either prescribe psychotropic drugs on his own initiative or refuse prescription. General practitioners who respected autonomy were relatively restrictive in their prescribing habits so that respect for autonomy was by no means expression for free prescription of psychotropic drugs. Their goal was that the patient should be placed in a situation where he/she could choose and determine personally. The general practitioners considered that their undergraduate and postgraduate training in treating patients with mental illness was inadequate. Taking into consideration how frequently patients with conditions of this nature are seen in general practice, this must be regarded as a serious deficit in medical training. A number of general practitioners have, however, received postgraduate training in this subject. General practitioners did not consider patients who consulted them with mental conditions as mentally ill but they did not have an alternative disease model by which they could classify the problems and complaints of these patients.

Attitude of Health Personnel↗
PubMed1997

A survey of general practitioners' views on autopsy reports.

AIMS: To study the views of general practitioners on the quality and utility of autopsy reports, and on autopsies in general. METHODS: For a period of six months, a questionnaire was enclosed with each autopsy report sent to a general practitioner from the mortuary at Manchester Royal Infirmary. RESULTS: Most (93.3%) general practitioners found the autopsy report useful, and many (66.7%) thought the bereaved relatives would do so too. However, only a minority (25.2%) would discuss the report with the relatives. A considerable proportion (20.0%) found the cause of death surprising, and a significant number (10.4%) felt the report would modify their future clinical practice. There was approval of autopsies in general, with most (88.6%) agreeing that autopsies reveal lesions not detected in life, and many (74.4%) indicating that loss of the autopsy would impair severely the monitoring of clinical standards. CONCLUSIONS: General practitioners appreciate autopsy reports, which may have a significant impact on clinical practice. Autopsy reports provide both case audit and information for relatives.

Adult↗
PubMed1991

Admission to child health surveillance lists: the views of FHSA general managers and general practitioners.

OBJECTIVES: To find out the sources of advice that were helpful to managers of family health services authorities in drawing up the criteria for admission of general practitioners to the child health surveillance lists; to determine the criteria used for admission of general practitioners to the family health services authorities' child health surveillance lists; to find out the changes general practitioners have made in child health surveillance in their practices; to determine the experiences of general practitioners relating to admission to the child health surveillance lists and to training in child health surveillance. DESIGN: Survey by postal questionnaire. SUBJECTS: General managers of all family health services authorities in England and Wales; all general practitioners in Yorkshire and Humberside. RESULTS: Managers of 80 of 93 family health services authorities replied (86%). A total of 62 (78%) found local community paediatricians helpful in compiling criteria for admission to child health surveillance lists, and 46 (57%) found national guidelines helpful. Fifty seven (71%) accepted general practitioners who had completed an approved course, and 45 (56%) accepted those with three or more years' experience of child health surveillance. Of the 1966 questionnaires sent to general practitioners, 1233 were satisfactorily completed (63%). Of the 919 respondents who had applied to be put on child health surveillance lists, 673 (73%) had been permanently accepted; of these, 441 (65%) had done an approved course and 375 (56%) had had three or more years' experience of child health surveillance. Of the 145 (16%) not accepted, 57 (39%) had done an approved course and 71 (49%) had three or more years' experience. Respondents reported variable quality and availability of courses in child health. CONCLUSIONS: Acceptance of general practitioners on to child surveillance lists has not been carried out consistently despite national guidelines setting out criteria for acceptance.

Child Health Services↗
PubMed2001

Why general practitioners do not implement evidence: qualitative study.

OBJECTIVES: To explore the reasons why general practitioners do not always implement best evidence. DESIGN: Qualitative study using Balint-style groups. SETTING: Primary care. PARTICIPANTS: 19 general practitioners. MAIN OUTCOME MEASURES: Identifiable themes that indicate barriers to implementation. RESULTS: Six main themes were identified that affected the implementation process: the personal and professional experiences of the general practitioners; the patient-doctor relationship; a perceived tension between primary and secondary care; general practitioners' feelings about their patients and the evidence; and logistical problems. Doctors are aware that their choice of words with patients can affect patients' decisions and whether evidence is implemented. CONCLUSIONS: General practitioner participants seem to act as a conduit within the consultation and regard clinical evidence as a square peg to fit in the round hole of the patient's life. The process of implementation is complex, fluid, and adaptive.

Attitude of Health Personnel↗
PubMed1989

A comparative study between the use of analgesia/anaesthesia and of episiotomy in women delivered under consultant supervision or general practitioner care.

A retrospective cohort study based on obstetric records was performed, to compare the use of analgesia/anaesthesia during labour by consultants and general practitioners. The episiotomy rates for the two groups were also compared. 111 general practitioner patients were identified and these were matched with 111 consultant patients. No difference was found between the two groups for duration of stages I or II. The rates for episiotomy, 1 degree or 2 degrees tear or intact perineum were the same in each group. Women delivered under consultant supervision used more entonox than women delivered under general practitioner care, but this was counterbalanced by an increased use of pethidine in the latter group. No difference was found between the two groups with regard to the use of epidurals. There was an increased use of local anaesthetic by general practitioners. This was due to general practitioners preferring to use local anaesthetic for suturing after an epidural had worn off, whereas hospital doctors preferred to top-up the epidural to provide anaesthesia for suturing. This study supports the view that women delivered under the care of their own general practitioner in a hospital obstetric unit fare no worse than similar women delivered under consultant supervision. The former group have the advantage of continuity of care from their general practitioner.

Anesthesia, Obstetrical↗
PubMed1994

Information about patients' deaths: general practitioners' current practice and views on receiving a death register.

BACKGROUND: Although general practitioners are involved in the care of most dying patients, they do not routinely receive information about their deceased patients for whom they did not complete the death certificate, and often they rely upon informal communication channels. AIM: This study set out to assess how general practitioners obtained, recorded and used information about deceased patients and to determine their views on receiving a death register. METHOD: A questionnaire was sent to all 305 general practitioners in the Newcastle upon Tyne and Sunderland Family Health Services Authority areas. RESULTS: A total of 225 questionnaires were returned (response rate 74%). General practitioners usually first learnt about their patients' deaths from hospital discharge summaries (54%) and patients' relatives (46%) and less commonly from newspaper obituary columns (20%) and hospital telephone calls (9%). Two thirds of respondents recorded information about decreased patients, mainly listing personal details and the immediate cause of death. One third or fewer of those recording information listed contributory causes. The information was used mainly for following up bereaved relatives and notifying hospitals and other agencies. CONCLUSION: Current informal systems for handling information about patients' deaths are inadequate. General practitioners need and would welcome prompt, accurate and comprehensive information about all their deceased patients.

Death↗
PubMed1994

Integrated care for patients with asthma: views of general practitioners.

BACKGROUND: In 1989, a shared or integrated care scheme was developed for hospital outpatients with asthma, using the computerized patient record system of Grampian Health Board, Scotland. Patients with asthma attending hospital clinics were entered into this scheme and were invited to attend their general practitioner instead of an outpatient clinic for review of their asthma. Three-monthly questionnaires covering clinical aspects of asthma were sent to these patients and their general practitioners; the latter then returned them to the specialist. Patients could be recalled to the hospital clinic if either the general practitioner or consultant felt this was necessary and all patients were reviewed after one year by the specialist. The success of integrated care for patients with asthma relies on the cooperation of general practitioners. AIM: The aim of this study was to investigate how this scheme worked in general practice, and general practitioners' perceptions of it, in order to identify factors that enhance or inhibit integrated care for patients with asthma in general practice. METHOD: A qualitative survey was carried out with a random, stratified sample of 38 of the 317 general practitioners in the region. Semi-structured interviews were designed to elicit general practitioners' accounts of their operation of integrated care and their attitudes towards the scheme. RESULTS: General practitioners perceived the scheme to have several advantages: the continuity and quality of care provided was improved; and the transmission of information between general practitioner and specialist was enhanced. Regular general practitioner reviews, instigated by standard letters generated by computer, were favoured as being clearly structured. Concerns were raised about the processing of paperwork, and the possibility that unnecessary reviews might be generated. CONCLUSION: Integrated care for asthma patients is an acceptable management option among general practitioners.

Adult↗