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PubMed1999

[Cross-sectorial cooperation regarding cancer patients in a recently started care program. Ideas and themes based on focus group interviews with general practitioners and oncologists].

This study identified ideas for an improved collaboration between general practitioners and oncologists regarding patients with cancer. A qualitative research-method with focused group interviews was chosen. The results demonstrated that both oncologists and general practitioners would like the general practitioners to take more active part in the total care programme for cancer patients. Some of the needed improvements were more detailed referral letters including description of treatment plans, information about what the patient had been told and general information about the specific cancer disease. Both parts desire bilateral information exchange and a dialogue about the distribution of tasks. Both parts are willing to collaborate but this is at present restricted due to lack of knowledge of each others' working areas and the oncologists' impression that general practitioners need more medical knowledge regarding specific aspects of cancer. A randomized intervention study using ideas from this study may clarify if it is possible to improve the collaboration and thereby the cancer patients' satisfaction with care.

Clinical Competence↗
PubMed1992

Excision biopsy of malignant melanoma by general practitioners in south east Scotland 1982-91.

OBJECTIVE: To examine the management of patients who had a malignant melanoma excised initially by general practitioners in south east Scotland over the past 10 years and to assess the impact of the April 1990 contract on this. DESIGN: A retrospective case-control study. SETTING: South east Scotland. SUBJECTS: All patients in south east Scotland who had malignant melanomas excised by general practitioners in 1982-91. OUTCOME MEASURES: Demographic details of patients; Breslow thickness, clearance of excision. RESULTS: 42 patients had malignant melanomas excised by general practitioners in 1982-91: 15 in 1982-9 and 27 in 1990-1. These patients were significantly younger than those who had their tumours excised initially in hospital. Although the longest diameter of melanomas excised by general practitioners was significantly less than of those excised in hospital, the Breslow thicknesses were similar. Completeness of initial excision was doubtful or incomplete in nine (23%) general practitioner excisions compared with 4% of hospital excisions, but the time interval between excision biopsy and wide excision was similar. Pathology requests accompanying excision biopsies mentioned melanoma as a possible diagnosis in 15% (6/40) of general practitioner cases compared with 79% of hospital cases. Thirty nine general practitioners responded to a questionnaire and only 12 had considered melanoma in the differential diagnosis. CONCLUSIONS: General practitioners need to think more often of malignant melanoma when they excise pigmented lesions and when they consider this tumour a possibility should perform an excision biopsy with a lateral clearance of at least 2 mm.

Adult↗
PubMed2001

Randomized controlled trial of general practitioner tutor visit or mailing to encourage general practice-based education.

OBJECTIVES: Evaluation of a general practitioner tutor visit, or mailing, with regard to the amount of practice-based education occurring in general practices. DESIGN: An initial survey of all practices in the Mersey Deanery was undertaken. General practices which replied were randomly allocated to receive a GP tutor visit (n=38), to receive a mailing (n=38) or to a control group (n=36). Visits carried out by tutors covered a loosely agreed format. All practices were sent a follow-up survey identical to the original one at 6 months after the intervention. SETTING: General practices in the Mersey Deanery, north-west England. SUBJECTS: General practices which had replied to an initial survey. RESULTS: The amount of both specifically arranged and informal practice-based meetings increased in all groups. No changes were statistically significant. CONCLUSIONS: This study illustrates the difficulty of assessing educational interventions by randomized controlled trials. Such interventions are often expensive, complex and difficult to standardize. A substantial amount of practice-based education is taking place.

Education, Medical, Continuing↗
PubMed1994

Quality of minor surgery by general practitioners in 1990 and 1991.

BACKGROUND: The 1990 contract for general practitioners encouraged them to undertake minor surgical procedures in their practices. AIM: A study was undertaken to determine whether the subsequent expansion of general practitioner minor surgery activity was accompanied by changes in quality of care. METHOD: Data were analysed relating to minor operations conducted in 22 practices during April-June 1990 and April-June 1991. RESULTS: The volume of general practitioner minor surgery increased by 41% between the two study periods. Waiting time, accuracy of diagnosis, use of histology, adequacy of excision, complications and the need for corrective treatment in hospital did not change significantly between the two periods. CONCLUSION: The findings do not support suggestions that the expansion of general practitioner minor surgery activity following the 1990 contract has been associated with an erosion of quality of care.

Clinical Competence↗
PubMedDate not supplied

Patient's and general practitioner's different views on patient's depression.

Differences between patient's and general practitioner's view on patient's depressive syndromes was investigated in a prospective birth cohort study of 70 year old people (n=1032) in Turku City, Finland. The aim of this study was to find factors which are typical for people having depressive syndromes in old age and help medical and nursing staff to identify depressive syndromes in the general aged people. The study consisted of a structural postal questionnaire including patient's perception of his depression, an interview made by a public health nurse included mini-mental state examination (MMSE) and the self-rating depression scale of Zung, an interview and comprehensive clinical examination by a general practitioner. Out of the 847 persons who completed the depression test, 12.6% showed symptoms of depressive syndrome. The views of those who scored more than 45 points in the Zung depression scale on their own depressiveness differed from the general practitioner's opinion. In the general practitioner's examination and interview 58% of the subjects had no depressive symptoms even though the test results indicated that they were depressed. The depressed group stood out most clearly in two questions: Do you feel you are needed and do you have future plans? When the same questions were repeated 5 years later, the difference was still statistically significant between depressed and non-depressed group (P<0.0001). The data indicated that medical and nursing staff should take self-assessments seriously and look into them in closer detail. General practitioners and nurses should learn to ask right questions and use short depression scale systematically in order to facilitate the detection of depressive syndromes.

Journal Article↗
PubMed1996

Characteristics of practices, general practitioners and patients related to levels of patients' satisfaction with consultations.

BACKGROUND: Despite interest in the relationship between patient satisfaction and consultation performance, there is little information about how other characteristics of general practitioners, practices and patients influence satisfaction with consultations. AIM: To identify characteristics of patients, practices and general practitioners that influence satisfaction with consultations. METHOD: In 1991-92, a consultation satisfaction questionnaire (CSQ) was administered to 75 patients attending each of the 126 general practitioners in 39 practices. Further questionnaires were used to collect information about the practice (such as total list size, training status, fundholding status and presence of a personal list system) and about the general practitioners (age, sex, whether vocationally trained, a trainer or a trainee, and the number of patients booked in the appointment system per hour). Stepwise multiple regression was undertaken to identify characteristics of patients, practices or general practitioners that influenced satisfaction. RESULTS: The mean of the response rates to the patient questionnaire for each general practitioner was 76.6%, with a standard deviation (SD) of 17.8. Practice characteristics associated with falls in satisfaction were an increasing total list size, the absence of a personal list system and its being a training practice. If more patients were booked in the appointment system per hour, satisfaction with the perceived length of consultations fell. Patient characteristics associated with falls in satisfaction were increased age and an increased proportion of male patients. The only characteristic of general practitioners associated with lower levels of satisfaction was increasing age. The sex of general practitioners did not influence satisfaction. CONCLUSIONS: The findings of this study give further support to the importance of a personal service in determining patient satisfaction in general practice. General Practitioners need to review the organization of practices to ensure an acceptable balance between the requirements of modern clinical care and the wishes of patients. Future studies should take account of the many variables that can influence patient satisfaction.

Adult↗
PubMed1996

Non-pharmacological management of hypertension: results from interviews with 100 general practitioners.

OBJECTIVE: To describe the type and level of non-pharmacological management offered by general practitioners for essential hypertension. DESIGN: An open-ended interviewer-administered survey using a standard case of a 60-year-old man with essential hypertension. Seventy interviews were conducted face-to-face and 30 by telephone. SETTING: Auckland general practices. SUBJECTS: A random sample of 100 Auckland general practitioners. MAIN OUTCOME MEASURES: Aspects of the medical histories of patients, physical examination, laboratory testing and treatment relevant to non-pharmacological management. RESULTS: There was an 84% response rate. Most general practitioners reported offering non-pharmacological management at the first consultation before prescribing medication. However, few offered detailed programmes. Dietary therapy, restriction of alcohol consumption and exercise were suggested by most general practitioners. Restriction of sodium intake and behavioural therapy were less popular non-pharmacological interventions. The median number of visits of patients to a general practitioner before drugs were prescribed was five, which is in keeping with guidelines. The median number of days from the first visit to prescription of drug therapy was 42 (range 2-341). The clinical advice given by the majority of participants was consistent with current guidelines on the treatment of hypertension but the range of advice given was wide. CONCLUSIONS: The results suggest that general practitioners are aware of non-pharmacological interventions for the management of hypertension. They report making routine use of non-pharmacological therapies for blood pressure reduction and other health benefits early in the clinical process before considering pharmacological therapy. These non-pharmacological therapies are not delivered with well-defined and detailed programmes.

Alcohol Drinking↗
PubMed1988

A group-based training programme for general practitioners: a Norwegian experience.

There are approximately 3000 general practitioners in Norway, serving a population of slightly above four million people. A three year postgraduate education scheme for general practitioners has been in effect since 1973, to be replaced by a five year vocational training programme from January 1985, making general practice a fully recognized specialty from that date. The educational requirements consist of one year of hospital training, four years of training in general practice, and a total of 400 hours of course education, mainly in clinical subjects. The core element of the training is attendance at a group-based structured educational programme of two years' duration. This article describes the concepts and content of this decentralized group-based education, as well as some of the conflicting considerations which eventually led to this new Norwegian model of general practice training. The first evaluation studies indicate that the educational programme has met a long standing need among general practitioners.

Curriculum↗
PubMed2005

General practitioners and mental health staff sharing patient care: working model.

OBJECTIVE: The paper describes a shared care programme developed by mental health services and general practitioners for shifting patients with chronic psychiatric disorders to the care of a general practitioner. The programme is characterized by: (i) a dedicated mental health service general practitioner liaison position to manage the programme and provide support to both patients and doctors; (ii) a multidisciplinary care planning meeting that includes mental health staff, the patient, the general practitioner and a carer; and (iii) a jointly developed individual management plan that specifies patient issues, strategies to deal with these issues, persons responsible for monitoring and a review date. METHODS: The shared care protocol, the results of a review of patient mental health indicators and general practitioner satisfaction with the programme are described. RESULTS: Outcomes to date suggest that patients' mental health is not compromised and may be enhanced by transfer to general practitioners within the shared care model. Indicators of mental health outcomes (Health of the Nation Outcome Scale and Life Skills Profile scores) show improved patient symptomatology and functioning in most cases. CONCLUSIONS: The programme fits the model of recovery-based mental health services and complies with current local, state and Commonwealth policies that encourage integrated and collaborative approaches by mental health services and general practitioners in delivering mental health care to persons with chronic mental illness.

Australia↗
PubMed1993

Factors that influence general practitioners' choice of hospital when referring patients for elective surgery.

To describe the factors that influence general practitioners' choice of hospital when referring patients for elective surgery in three specialties, a postal questionnaire was distributed in January 1991 to 449 doctors who had referred patients to one of six hospitals in the North Western Regional Health Authority. Responses were received from 260 general practitioners (58%). Of the respondents 95% selected 'local and convenient' as a factor that commonly influenced their choice of hospital for at least one specialty and 65% mentioned this across all three specialties. Seventy four per cent mentioned patient preference as influencing choice for at least one specialty and 57% across all three specialties. Only 32% of doctors mentioned waiting times for appointment across the three specialties and 26% waiting times for surgery across the three specialties. When asked to select the single most important factor 'local and convenient' was selected by 33% of general practitioners for a least one specialty, the general standard of clinical care by 28% and waiting time for appointment by 23%. Patient preference was only selected by 6% of doctors as the most important factor. It is of note that 33% of general practitioners perceived there to be no choice of hospital for at least one specialty and 14% thought this to be the single most important influence on choice for at least one specialty. Approximately half the general practitioners (49%) considered it always or often appropriate to give their patients a choice. Most general practitioners received waiting time information from hospitals in their own health district but fewer received such information from hospitals outside their district.(ABSTRACT TRUNCATED AT 250 WORDS)

Choice Behavior↗
PubMed2001

The relationship between chief complaints, psychological distress, and suicidal ideation in 15-24-year-old patients presenting to general practitioners.

OBJECTIVES: To determine the prevalence of psychological distress and suicidal ideation among patients aged 15-24 years presenting to general practitioners, and the relationship between these variables and patients' chief complaints. DESIGN AND SETTING: Questionnaire survey of young people presenting to Australian general practitioners between 1996 and 1998. PARTICIPANTS: 247 general practitioners who volunteered to participate in a nationwide project aimed at teaching general practitioners to identify and treat suicidal youth; 3242 consecutive 15-24-year-old patients presenting to participating general practitioners during a specified six-week period. MAIN OUTCOME MEASURES: Patients completed three self-administered questionnaires: the General Health Questionnaire-12, the Center for Epidemiological Studies Depression Scale, and the Depressive Symptom Inventory-Suicidality Subscale. Patients' chief complaints were obtained from summary sheets completed by their general practitioners. RESULTS: While only 12% of patients presented with psychological complaints, about 50% percent had clinically significant levels of psychological distress and 22% had clinically significant levels of suicidal ideation. CONCLUSIONS: Despite presenting with primarily medical complaints, almost half of young people presenting to primary care physicians had high levels of psychological distress and almost a quarter had high levels of suicidal ideation.

Adolescent↗
PubMed1986

Findings of a national survey of the role of general practitioners in the treatment of opiate misuse: views on treatment.

An important component of government policy on services for drug misusers is to encourage general practitioners to take a more active role. There are, however, some indications that general practitioners regard drug misusers as undesirable patients, although no evidence is available. As part of a wider investigation of the role of general practitioners in the treatment of opiate misuse, a questionnaire, which was sent in mid-1985 to a 5% random sample of general practitioners in England and Wales, included a section designed to elicit their views on policy and treatment connected with opiate misuse. The results showed that although most general practitioners consider opiate misuse to be a priority concern for the Health Service, they also generally regard opiate misusers as especially difficult to manage, beyond their competence to treat, and less acceptable as patients than others in need of care. General practitioners who have qualified recently were somewhat less unfavourable in their views. These findings suggest that the effective implementation of government policy will require trying to modify general practitioners' attitudes and providing support for them.

England↗
PubMed1989

Mental health, job satisfaction, and job stress among general practitioners.

OBJECTIVE: To identify sources of job stress associated with high levels of job dissatisfaction and negative mental wellbeing among general practitioners in England. DESIGN: Multivariate analysis of large database of general practitioners compiled from results of confidential questionnaire survey. Data obtained on independent variables of job stress, demographic factors, and personality. Dependent variables were mental health, job satisfaction, alcohol consumption, and smoking. SETTING: National sample of general practitioners studied by university department of organisational psychology. SUBJECTS: One thousand eight hundred seventeen general practitioners selected at random by 20 family practitioner committees in England. INTERVENTIONS: None. END POINT: Determination of the combination of independent variables that were predictive of mental health and job satisfaction. MEASUREMENTS AND MAIN RESULTS: Women general practitioners both had job satisfaction and showed positive signs of mental wellbeing in contrast with other normative groups. Conversely, male doctors showed significantly higher anxiety scores than the norms, had less job satisfaction, and drank more alcohol than their women counterparts. Multivariate analysis disclosed four job stressors that were predictive of high levels of job dissatisfaction and lack of mental wellbeing; these were demands of the job and patients' expectations, interference with family life, constant interruptions at work and home, and practice administration. CONCLUSIONS: There may be substantial benefit in providing a counselling service for general practitioners and other health care workers who suffer psychological pressure from their work.

Adult↗
PubMed1997

The Diabetes Care Support Service for general practitioners in Auckland.

AIMS: Diabetic complications can often be prevented by timely detection and intervention. Optimising diabetes care requires effective monitoring of risk factors at both practice and district level. We describe a novel method which combines district monitoring of diabetes with enhanced diabetes care by individual general practitioners. METHODS: All general practitioners in south and west Auckland (n = 291) were invited to join the Diabetes Care Support Service (DCSS). This involved the identification of all diabetic patients within the practice and the completion of an audit from with key measures of diabetes and its care. RESULTS: Audit was completed for 217 (75%) of general practitioners and 4611 diabetic patients: 39% of general practitioners completed their own audit. The proportion of completed patient assessments ranged between 35% (foot pulses) and 89% (blood pressure). The process was found to be helpful by 88% of general practitioners (who commented). CONCLUSION: The DCSS is a seamless, service-orientated approach to the delivery of diabetes care by primary and secondary services and is likely to improve care district-wide and identify the need for further interventions. Subsequent audit passes will allow the demonstration and monitoring of any changes that occur, as well as the demonstration of its feasibility and acceptability on an ongoing basis.

Blood Pressure↗
PubMed1992

Perceptions of psychological problems in general practice: a comparison of general practitioners and psychiatrists.

All general practitioners and psychiatrists working in a single health district were sent a questionnaire on their perceptions of the prevalence of psychological problems among patients consulting in general practice. One hundred and twenty-one GPs (75%) and 10 (83%) psychiatrists responded. GPs and psychiatrists agreed that up to 20% of consulting patients were likely to be clinically depressed; they also agreed on the most appropriate management, although GPs tended to be more conservative than psychiatrists would advise on making use of hospital services. GPs, however, believed non-specific psychological problems to be significantly less common than did psychiatrists. This expectation may help explain the reported failure of GPs to diagnose all psychological problems identified by formal psychiatric instruments.

Adult↗
PubMed2002

The future of general practitioners in the management of divisions of general practice.

BACKGROUND: The role of divisions of general practice has changed significantly since its inception. Divisions have evolved from simply assisting general practitioners in their practices and providing complementary support to existing health services through project work, to becoming major instruments of organisational change. OBJECTIVE: This article looks at the short history of divisions of general practice and explores options for the future that may help build a better interface between practical medicine and the growing bureaucratic, organisational and managerial demands being placed upon divisions. DISCUSSION: In the process of the change in the role of divisions we have experienced a paradigm clash between the essential work of GPs as effective medical practitioners, and their role in divisions as managers and leaders of the wider health care system change.

Australia↗
PubMed1984

[Psychiatric problems and therapeutic measures in the office of the general practitioner].

The results of a survey of mental disorders identified from General Practitioners in their offices, in a quarter of Padua are presented. The findings emphasize the role of the General Practitioner in psychiatric care delivery (12% of the patients have been judged "psychiatric case" and these patients obtain treatment from General Practitioner in 70% of the cases). About half of "psychiatric patients" present a depressive illness. In 46% of the cases the General Practitioners have pointed out a close relationship between social difficulties and psychological problems. In 59% of the cases mental and somatic disorders are closely linked together. Implications of these findings in the prospect of a collaboration between psychiatric services and primary care then discussed.

Adult↗
PubMed2002

[The Dutch College of General Practitioners' 'Irritable bowel syndrome' standard; reaction from the field of general practice].

In the recently published Dutch College of General Practitioners' standard entitled 'Irritable bowel syndrome', questions for use in establishing this difficult syndrome are provided. Being reserved during examination and using moderation in choosing a treatment regime are the most important recommendations. The emphasis should be on explaining that this is usually a harmless syndrome. This guideline is very helpful to the general practitioner.

Colonic Diseases, Functional↗