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At least 505 records · Page 28Linked to original sources
PubMed2005

The impact of medical students on rural general practitioner preceptors.

INTRODUCTION: As universities rely more heavily on rural GPs to precept medical students, the formation of symbiotic partnerships benefiting students, universities and GPs, becomes imperative. In order to develop and consolidate these partnerships universities must understand who their rural GP preceptors are and how precepting impacts on them. METHODS: A review of the literature was undertaken to determine the significant themes of student impacts from articles where conclusions were clearly based on empirical findings. RESULTS: Forty-three articles were included in the final review, but only nine specifically looked at impacts on rural GPs. Impacts were categorized into six domains: personal; time; patient care; professional relationships and professional development; business and infrastructure; and recognition and remuneration. CONCLUSIONS: Literature specifically addressing the impact of precepting on rural GPs is scarce. Further studies are required to evaluate the relationship between the quality of teaching delivered to students, the type and length of student attachments and the likely impacts on rural GPs.

Australia↗
PubMed2005

More physicians in public health: less public health work?

AIM: The object was to assess changes in work priorities in local public health medicine in Norway over the period from 1994 to 1999. METHODS: Two cross-sectional studies were undertaken of physicians working in local public health medicine in all Norwegian municipalities, using a postal questionnaire. RESULTS: Half of the physicians working in public health in 1999 were recruited after 1994. Although the number of physicians working in public health increased from 505 in 1994 to 555 in 1999 (10%) an estimation of the total weekly hours worked decreased by 3.7% from 8,715 hours in 1994 to 8,386 hours in 1999. The vast majority of physicians worked in combined posts (87%), and they reduced their engagement in public health by 2.6 hours on average from 1994 to 1999. The reduction depended on remuneration model, speciality in community medicine, and municipality size. CONCLUSIONS: Local public health in Norway was under pressure in the 1990s. For public health physicians, preventive medicine lost out to clinical work. No promising signals of change in the professional or political framework or in incentives for public health work are seen.

Adult↗
PubMed1998

Clinical perspectives on gamete and embryo donation.

Clinical staff involved in assisted reproduction frequently encounter ethically complex clinical problems. Such difficulties often relate to the use of donor sperm, eggs or embryos. Despite a fall in the number of donor insemination (DI) cycles performed in the UK over the last few years, which is partly explained by the availability of intracytoplasmic sperm injection (ICSI), there is still a considerable demand for the treatment both in natural cycles and in IVF. The burden on clinics in providing sound recruitment and screening strategies for donors is enormous and is the subject reviewed in this report. If remuneration of donors were withdrawn, as proposed by the Human Fertilisation and Embryology Authority (HFEA), the capacity to maintain a clinical service would be in doubt. Advances in technology are now pushing to the extremes the limits of what is socially acceptable. Those involved in providing clinical services face decisions on rationing the limited funds available to treat patients, which in some instances may impinge on patient autonomy. Clinical ethics committees may have a role in assisting providers in reaching decisions regarding access to treatment. Inequity of access to treatment may relate to the inability to pay for treatment, with the consequent danger of different ethical standards applying to different sectors of the population.

Journal Article↗
PubMed2005

Mental health research in general practice.

OBJECTIVE: To explore problems in carrying out a mental health research project in the general practice setting. METHOD: Open-ended interviews were conducted with general practice stakeholders, focusing on impediments to the conduct of mental health research in general practice and possible means for improving the participation of general practitioners in such research. Participants in the consultations were members of five divisions of general practice, senior staff within an academic department of general practice, four general practitioners and a research group engaged with general practice research. The discussions were recorded in detailed interview notes, and key issues and themes emerging from consultations were derived by the researchers. RESULTS: Three main themes summarized most of the issues reported through the consultations, including structural issues (e.g. disruption of practice, time limitations and lack of remuneration), process issues (e.g. researcher-general practice communication, researcher-imposed issues and need for partnerships) and content issues (e.g. study design, study procedures and methods). CONCLUSIONS: The consultations revealed similar findings to previously published reports concerning general practice research, with an emphasis on the need for partnerships between researchers and general practice organizations in the conduct of such research.

Family Practice↗
PubMed1998

Prevalence, incidence, and clinical characteristics of hepatitis G virus/GB virus C infection in Scottish blood donors.

The prevalence, incidence, clinical features, and natural history of hepatitis G virus (HGV) or GB virus C (GBV-C) were investigated in a non-remunerated blood donor population to determine its clinical significance and its impact on blood safety. Of 1020 regular blood donors, 23 (2.25%) were positive for plasma HGV/GBV-C RNA. Alanine aminotransferase levels were lower than in uninfected donors (median, 20 IU/mL; 32 IU/mL in controls; P=.015). Clinical examination produced no other evidence for hepatitis or for shared nonhepatic diseases. Fifteen of 17 donors excreted HGV/GBV-C in saliva (mean level, 8x103 copies of RNA/mL). Testing of previous donations indicated an incidence of 170-200 new infections with HGV/GBV-C per 100,000 donor-years. The absence of further clinicopathologic data and the limitations of current polymerase chain reaction-based methods for screening suggests that it is neither necessary nor practical to commence screening.

Adult↗
PubMed2004

Role of infectious diseases consultants in management of antimicrobial use in hospitals.

The Infectious Diseases Society of America Emerging Infections Network (EIN) surveyed its members to characterize antimicrobial restriction policies in their hospitals and the involvement of infectious diseases consultants in this process. Of the 502 respondents (73%), 250 (50%) indicated that their hospital pharmacies would not dispense certain antimicrobials without approval of infectious diseases consultants. Moreover, 89% agreed that infectious diseases consultants need to be directly involved in the approval process. At hospitals with control policies, commonly restricted agents included lipid formulations of amphotericin B, carbapenems, fluoroquinolones, piperacillin-tazobactam, and vancomycin. Only 46 EIN members (18%) reported remuneration of infectious diseases consultants for participation in the approval process. Pediatric infectious diseases consultants were more likely to practice in hospitals with restriction policies than were adult infectious diseases consultants (64% vs. 45%; P<.001). Similarly, teaching hospitals were more likely to have antimicrobial-control policies than were nonteaching facilities (60% vs. 17%; P<.001).

Anti-Infective Agents↗
PubMed2006

Minimally invasive treatment of ureteropelvic junction obstruction: optimizing outcomes with concomitant cost reduction.

With the seemingly exponential increase in the use of minimally invasive techniques in urology, cost-benefit comparisons will continue to play a major part in establishing services and in improving those that already exist. The management of ureteropelvic junction obstruction is a focus of significant attention. An effective way of optimizing the economy of management is to understand the implications in terms of the success of each mode of treatment. Subsequently, costing models should be developed and applied in large-scale multicenter studies with the aid of health economists. The long-term benefits can then be assessed by also including patient's perceived quality of life. Economic assessment will not be enough to promote cost-effective practices. The take-up of any techniques will always be influenced not only by patient preference and surgeon expertise but also, perhaps ironically, by the way hospitals and surgeons are remunerated. In addition, the impact of the time taken to train a surgeon to carry out laparoscopic dismembered pyeloplasty competently may play a significant role. Until these issues are resolved, definitive recommendation for the treatment of ureteropelvic junction obstruction will continue to be made on an individual basis.

Costs and Cost Analysis↗
PubMed1996

Energy expenditure of urban Colombian women: a comparison of patterns and total daily expenditure by the heart rate and factorial methods.

The heart rate and factorial methods of measuring both total daily energy expenditure (TDEE) and the daily pattern of energy expenditure (EE) were compared in nonpregnant, nonlactating women aged 19-43 y living in urban conditions of economic deprivation. The methods were applied on each of 2 successive days. There were no significant differences between the 2 d by either method. Women who worked at their household chores at home (n = 29) and those who also worked for remuneration (at work) in various kinds of employment (n = 23) were compared. The factorial method gave values for TDEE and for the pattern of EE that were significantly lower than those obtained by the heart rate method. This was related to lower values for EE for certain activities obtained from the literature than for values measured in these subjects. Women at work had significantly higher values for both TDEE and for the pattern of EE than did those at home. The TDEE at home by the heart rate method was 8.83 +/- 1.94 MJ/d and at work was 9.99 +/- 1.91 MJ/d (P = 0.036); this difference disappeared when adjusted for body weight or fat-free mass. Physical activity levels were 1.83 +/- 0.43 for women at home and 1.90 +/- 0.46 for women at work, which indicate moderate to heavy work. The factorial method should be used with measured EE values in the present subject population. The heart rate method can detect differences in TDEE and in the pattern of EE between women engaged in different activities and may offer an experimental approach to the study of the effects of daily variations in EE on nutritional energy intake.

Adult↗
PubMed1994

Quality assurance in general practice: the state of the art in Europe.

Quality assurance' (QA) is an important new development in general practice. In order to describe the state of the art in this field a preliminary survey was performed by the WONCA European Working Party on Quality in General Practice (EQuiP) in 17 European countries. The results revealed considerable differences in the systems and organization of general practice care [such as practice form, list size, the role of the general practitioner (GP), remuneration], which will have an impact on setting up QA. The preliminary findings demonstrated that most countries are only just beginning the implementation of QA. Nevertheless, there are many valuable developments and experiments concerned with the methodology, procedures and structures for it. In order to accelerate the speed of adoption of QA and to avoid the repetition of mistakes, policy makers and GPs from different parts of Europe should study examples in their fellow countries. A clearing house of QA projects in general practice can help to inform them on valuable developments.

Europe↗
PubMed2001

Pre-registration house officers in general practice: the views of GP trainers.

BACKGROUND: Recent changes have led to an upsurge of interest in pre-registration rotations in general practice. In 1998, a national pilot programme of >40 new rotations incorporating general practice was implemented. OBJECTIVE: The aim of this study was to explore the experiences of GPs involved in the four pilot rotations established in South Thames region. METHODS: Semi-structured interviews were conducted with trainers and partners. RESULTS: The supervisory workload for pre-registration house officers (PRHOs) was much greater than that required by registrars. All GPs felt that increased remuneration was important for the future viability of the scheme. The majority of GPs remained supportive of the scheme, although a minority were concerned about the value of the experience gained by PRHOs. There were a few instances in which inadequacies in patient management had to be dealt with subsequently by trainers. The supervisory implications of such events will need to be addressed. CONCLUSION: This significant development in medical education has important implications for GPs and their patients which need further exploration through long-term evaluations.

Attitude of Health Personnel↗
PubMed1989

General practitioner involvement in non-procedural medicine in public hospitals in Melbourne, Australia.

This study is a survey of general practitioners practising in an area in Melbourne, Australia, where there are two medium sized public hospitals with limited general practitioner admitting rights. A questionnaire was mailed to the 207 general practitioners practising in the study area; 167 (81%) responded. Seventy one per cent of respondents had public hospital admitting rights and 73% aimed to manage as many medical patients in hospital as possible. The main reasons given for such involvement were patient expectation, professional satisfaction and the benefits to patients, beyond that of reassurance, which followed from continuity of care. About half of respondents (52%) agreed that their role was a liaison or coordinating one alongside hospital specialists. Fifty-four per cent of respondents overall had in fact managed at least two medical patients in public hospitals in the past 12 months. Lack of availability of general practitioner beds and specialist dominance in public hospitals rather than inadequate time or remuneration were perceived to be the main barriers to hospital practice. Almost three-quarters of respondents (72%) believed general practitioners would be excluded from public hospitals in the foreseeable future. They blamed specialist dominance and general practitioner apathy equally for this predicted state of affairs. A debate on the desirability or otherwise of such an exclusion is overdue within the medical community in order to consider what will otherwise be a fait accompli.

Australia↗
PubMed1999

Evaluating payment mechanisms: how can we measure unnecessary care?

There has been substantial concern that linking hospital or physician remuneration to the amount of care provided will encourage excessive provision of health care. Studies that seek to explore this relationship require methods to measure unnecessary care. This paper presents and discusses a method used to assess the magnitude of unnecessary care in the context of an evaluation of the impact of paying bonuses to physicians employed in public hospitals in Shandong Province, China.

Adolescent↗
PubMedDate not supplied

The 1990 GP contract: modelling variation in minor surgery provision.

Logistic regression was used to determine the extent to which general medical practices undertake the maximum amount of minor surgery activity allowed for in the GP contract. Data on activity for 89 practices in the Grampian region of Scotland was available for two consecutive financial years: 1992-93 and 1993-94. Comparison of the regression models developed in each year showed that rural location and practice size were consistently associated with the maximization of minor surgery activity under the terms of 1990 GP Contract. In 1993-94 practices with a greater proportion of deprived patients were also more likely to be 'maximizers'. Quantitative modelling allows the performance of GPs to be assessed and also helps to identify factors which are a barrier to service development. It seems likely that, in Grampian, GPs who were able to exploit fully the provisions of their contract were those whose patients had the greatest capacity to benefit from minor surgery. Currently the GP contract is nationally negotiated, but in the future local negotiated remuneration is likely to become widespread. Modelling will have an important role in the design and monitoring of incentive structures, and help to ensure that service provision equates to local needs.

Contract Services↗
PubMed2005

Diagnostic imaging pathways: development, dissemination, implementation, and evaluation.

ISSUE: There are signs of inappropriate application of medical imaging to diagnosis. Inappropriate imaging is a threat to effective diagnosis and effective allocation of resources. The development and deployment of knowledge-based clinical decision support systems is one strategy to reduce inappropriate imaging. DEVELOPMENT OF IMAGING PATHWAYS: A suite of 78 imaging pathways was conceived both as a decision support and educational tool. The pathways were drafted by imaging specialists, but further developed and modified, based on graded evidence and input from requesting clinicians. An electronic environment was developed to contain and deliver the pathways. DISSEMINATION AND IMPLEMENTATION: Imaging pathways were distributed via a hospital local area network and on compact disk. A multifaceted approach was used to raise general awareness of the pathways, followed by intensive 'marketing' activities. Two groups of clinicians were targeted; hospital-based clinicians and general practitioners. EVALUATION: There was increased awareness of imaging pathways. Clinicians judged them to be useful for education and decision support. The method of electronic delivery was adequate. Knowledge of diagnostic imaging and requesting behaviour tended to become more aligned with the pathways. The central objective to reduce inappropriate medical imaging seems to be achievable. LESSONS LEARNED: There is scope to improve the content and the electronic environment, achieve better integration into decision-making processes, and achieve better compliance. A linkage between imaging pathways and electronic requesting could provide alerts to 'non-compliant' requesting. The assignment of a higher cost, or a lower remuneration, to non-authorized and non-compliant imaging would provide tangible incentive to comply, unless there are compelling clinical contraindications.

Attitude of Health Personnel↗
PubMed1998

A critical assessment of high-earning orthodontists in the General Dental Services of England and Wales (1990-1991)

Cases from the Dental Practice Board's 2 per cent random sample of completed cases which had been treated by orthodontic practitioners with high gross earnings, were compared to all the cases within the sample from other practitioners. They were assessed using the PAR index and IOTN. High earning orthodontists treated slightly more cases with lower objective need for treatment, but treated no more cases 'Unnecessarily' than other practitioners. They used more fixed appliances, and had marginally better levels of residual need for treatment at finish, although this was at least partially explained by lower levels at start. Generally, their standards were not substantially different to other practitioners. Appliance type had a marked effect on outcome, as did levels of malocclusion and need for treatment at start. Both groups of practitioners performed similarly (better) with dual arch fixed appliances: however, overall standards could only be described as mediocre. There is no justification to single out high earning orthodontists for special scrutiny. However, it may be beneficial if the system of remuneration in the General Dental Services could be modified to give more positive incentive to quality, rather than simply quantity of treatments.

Analysis of Variance↗
PubMed1999

Contact between people with learning disability and general practitioners: a cross-sectional case note survey.

BACKGROUND: This paper describes primary care consultation rates in a sample of people with learning disability. The study was carried out as part of a wider survey of primary care for this population group in response to concerns over quality of care and debate between general practitioners (GPs) and the local health authority over the need for additional remuneration for caring for people with learning disability. Estimates of consultation rates in the literature to date are conflicting and we sought to provide local data on the number and type of contacts with the primary care teams to inform this debate. METHOD: A primary care case note review was carried out of 112 people with learning disability aged over 18, identified from an administrative sample of 967 people known to health and social services. Contact rates (with practice nurses or GPs) were calculated and indirectly standardized for age using data from the fourth National Morbidity Survey in General Practice (MSGP4). RESULTS: Standardized consultation ratio in men was 156 (95 per cent confidence interval (CI) 142-172), in women was 111 (95 per cent CI 102-121) and for both sexes was 127 (95 per cent CI 120-135). Average contact rate was 4.6 per person per year. Eighty per cent of contacts were with GPs. Eighteen per cent (95 per cent CI 11-25 per cent) of subjects consulted, on average, more than once every two months. Limited information on underlying cause of learning disability and severity was available. Consultation rates were independent of age and sex, and were not increased in people with Down's syndrome or epilepsy compared with the rest of the sample population. Consultation rates were highest in people living in staffed group homes (p = 0.01). The presence of special arrangements between practices and residential facilities did not appear to increase service contact, but this finding is prone to measurement bias. CONCLUSIONS: Contrary to the findings of previous studies, people with learning disability consult primary care teams more frequently than the general population. However, this should not be taken as supporting calls for additional resources without addressing the effectiveness and appropriateness of health care offered.

Adult↗
PubMed1995

Self-sufficiency and blood transmitted diseases.

The Council of Europe and the EEC Council of Ministers have strongly promoted self-sufficiency for plasma products on the basis of voluntary non-remunerated donors. Several European countries have a programme of self-sufficiency with plasma products, either with national fractionation plants (e.g. Belgium, Finland) or based on contract fractionation (e.g. Norway, Slovenia). Advantages of national self-sufficiency includes epidemiological factors, economical factors and also ethical and moral issues. Self-sufficiency is one of the basic conditions for reducing the hazard of transmission of infectious diseases. Norway has been self-sufficient with coagulation factors since 1981. Price mechanisms and market forces have been important factors in ensuring the necessary plasma volume, and fractionation methods rendering high yields of factor VIII are initially preferred. This policy has resulted in a low prevalence of antibodies against human immunodeficiency virus (6%), hepatitis B virus (28%) and hepatitis C virus (41%). No Norwegian haemophiliacs have been infected with hepatitis A through FVIII concentrates.

Blood Banks↗
PubMed1981

Community office experience for family medicine residents.

Departments of family medicine have certain responsibilities for administering and supporting an office-based program for family medicine residents. A firm belief in the importance of the program and the provision of adequate financial remuneration for preceptors are necessary for the program to succeed. The problems and issues related to setting up such a program are described in this article. The role of the family preceptor is an active one. He will probably need to make alterations to his practice to accommodate the resident. Evaluations of a recent program by both residents and preceptors are discussed. They indicate that ongoing teaching seminars as described in this paper help in preparing and monitoring such programs.

Community Medicine↗