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Results for “GENERAL PRACTICE”

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PubMed1989

Clinical psychology: a consultative approach in general practice.

General practitioners tend to regard psychologists as an alternative resource for patients. This paper describes an approach to clinical psychology in general practice in which a team of psychologists works with a general practitioner on a consultancy basis. In this way the psychologists and general practitioner work together, with the general practitioner retaining responsibility for the patient. The method pays special attention to the context in which the problems occur, and to the set of relationships in which difficulties are experienced. The relevance of brief focused work is discussed and illustrated with clinical examples.

Family Practice↗
PubMed1991

How well do family practitioner committee and general practice records agree? Experience in a semi-rural practice.

General practice notes may be inaccurate for various reasons. A study was carried out in one semi-rural practice to investigate the agreement between records held by the family practitioner committee and those kept in the practice. Details on the practice notes and the family practitioner committee list were compared for 800 patients. The details examined included name, sex, date of birth, address and National Health Service number. While 58% of records agreed, discrepancies occurred in 339 records (42%). The most common discrepancies concerned the patient's address (30.6%), date of birth (9.4%) and NHS number (8.0%). Nearly 5% of the practice notes appeared to be for patients who were no longer on the practice list or dependent on its care. These findings have implications under the new general practitioner contract where screening programmes, target related payments, and increased capitation fees require accurate practice records.

Documentation↗
PubMed1999

Estimating and generalizing with clustered sampling in general practice.

General practice research focusing on patients may involve risk factors, morbidity, medication use or patient satisfaction. When collecting information about patients it is often easier, cheaper and more appropriate to enlist the support of a number of general practitioners (GPs) who provide access to a number of patients. Such studies utilise a 'cluster sampling' (CS) design, as clusters or groups of patients around a GP are used for the investigation. In analysing data from these studies it is necessary to consider the impact that the study design will have on the variance structure of data collected.

Australia↗
PubMed1985

Wheezing presenting in general practice.

General practice records of 1058 children were studied to determine the incidence, prevalence, natural history, diagnosis, and treatment of wheezing presenting in the first 21 years of life. Up to 7 years of age, boys were more likely to present with wheeze and to have recurrent episodes. Later there was a higher incidence in girls and a substantial rate of remission among boys, both contributing to changes in prevalence during later childhood and adolescence. All those diagnosed as asthmatic and two thirds of those with recurrent wheeze received bronchodilator treatment.

Adolescent↗
PubMed1984

Screening for asymptomatic bowel cancer in general practice.

General practitioners screened 4284 asymptomatic people aged over 40 to compare the incidence of large bowel cancer and polyps with a control general practice (4288 patients). Compliance was best in young women (60%), and overall it was 42%. Twenty six patients who had a positive Haemoccult test result (1.5% of those screened) were examined by colonoscopy and 10 had polyps. The incidence of cancers in the two groups was similar but in the control (unscreened patients) practice no polyps were found.

Adult↗
PubMed2004

Organisational change theory and the use of indicators in general practice.

General practices are making greater use of indicators to help shape and develop organisational arrangements supporting the delivery of health care. Debate continues concerning what exactly such indicators should measure and how they should be used to achieve improvement. Organisational theories can provide an analytical backdrop to inform the design of indicators, critique their construction, and evaluate their use. Systems theory, organisational development, social worlds theory, and complexity theory each has a practical contribution to make to our understanding of how indicators work in prompting quality improvements and why they sometimes don't. This paper argues that systems theory exerts the most influence over the use of indicators. It concludes that a strategic framework for quality improvement should take account of all four theories, recognising the multiple realities that any one approach will fail to reflect.

Family Practice↗
PubMed1989

HIV prevention in general practice.

General practice provides many opportunities for health education and for giving advice that may help prevent the spread of HIV infection. This article looks at some of the opportunities and problems.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Use of the objective structured clinical examination for assessment of vocational trainees for general practice.

General practice training schemes currently have no structured methods of assessment and most rely on a variety of subjective ratings of performance. In West Cumbria the ;objective structured clinical examination' has been used to assess training performance in areas covered by small group teaching during the preceding terms. Consultation skills, interpretation of clinical data and a number of aspects of practice management were tested. The examination was conducted in the local postgraduate centre and assessed 20 trainees. Each trainee received feedback of his performance on each problem set and also an overall comparison with his peers.This method of assessment appeared to be well received by trainees and was practicable within the limited resources available. In addition, the variety of problems set allowed for a broad range of trainees' performances to be assessed.

Education, Medical, Graduate↗
PubMed1963

The adequacy of medical education for general practice: a general practitioner's viewpoint.

Medical education as a preparation for general practice is assessed from the viewpoint of the general practitioner. The historical development of Canadian medical education and its present functioning are reviewed. The doctor in general practice, although aware of the existing inadequacies of his system of preparation, is loath to relinquish control of the pattern he has built up for himself. It has served the community well and he fears many of its advantages will be lost if replacement, rather than repair, is attempted. Certain inadequacies are discussed and the correction of these is urged as of vital importance to the Canadian people.

Canada↗
PubMed1952

The management of ureteral stone; a guide for physicians in general practice.

General practitioners are usually the first to observe a patient with ureteral stone, and often they practice in communities where consultation with a urologist is not immediately available. Study of the records of 423 patients with ureteral stone observed in private practice indicates that by following a definite system for diagnosis, relief of pain, determination of contralateral function, control of infection, and prophylaxis, general practitioners can manage the disease in the great majority of cases, and can determine when treatment by a specialist is imperative.

Calculi↗
PubMed1995

Care of schizophrenia in general practice: the general practitioner and the patient.

BACKGROUND: The transfer of patients with chronic schizophrenia from large mental hospitals into the community has had an impact on the role of the general practitioner in the effective delivery of primary care services to these patients. AIM: A study was undertaken to assess the care available in general practice for patients with schizophrenia, the attitudes of general practitioners and patients to the care provided and the factors influencing patients' use of services. METHOD: Eighty three patients with a diagnosis of schizophrenia and 26 doctors in 13 London practices registered on the VAMP research bank took part in a series of structured and semi-structured interviews. This was followed by a systematic examination of the patients' case notes. RESULTS: Only 14 patients (17%) had no active symptoms according to the present state examination interview and 52 (63%) were currently taking antipsychotic medication. Fifty three patients were in contact with a psychiatrist. Approximately one quarter of patients were visited by a community psychiatric nurse; in 18 of these 19 cases, the main reason for contact was reported to be for administration of medication by depot injection. In all but one case, patients seeing a community psychiatric nurse were also being seen by a psychiatrist. Sixteen doctors reported having had a consultation in the previous month with a patient's relative, friend or member of hostel staff. There were considerable differences between patients and their doctors in their attitudes to the use of services. Of the 26 general practitioners, 23 were enthusiastic about the possibility of introducing shared care records. Of the 54 patients in contact with a mental health professional, only 18 favoured the use of shared care records. Most of the doctors (19, 73%) reported they would welcome a psychiatric liaison service in their practice; 40% of 53 patients said they would not. Patients receiving antipsychotic drugs and patients registered with inner city practices attended their general practitioners more frequently than those not taking antipsychotic medication and those registered with suburban practices. Use of antipsychotic medication (adjusted odds ratio (OR) 8.2, 95% confidence interval (CI) 2.2 to 30.7, P < 0.01), male sex (OR 5.8, 95% CI 1.5 to 22.1, P < 0.01) and active symptoms on the present state examination (OR 4.1, 95% CI 1.0 to 17.5, P = 0.06) were all predictive of current contact with mental health professionals. CONCLUSION: Family doctors were closely involved with the care of patients with schizophrenia and their relatives and were eager for increased liaison with secondary care services. Although patients were more resistant than doctors to management innovations this may reflect lack of familiarity with changes in community services. Greater input is needed by mental health professionals, particularly community psychiatric nurses, and some consideration of the burden of care in inner city practices is necessary in health service planning.

Adult↗
PubMed2001

Access to the evidence base from general practice: a survey of general practice staff in Northern and Yorkshire Region.

AIM: To identify and describe current methods of making health related research evidence accessible to general practice staff in the Northern and Yorkshire Region. METHOD: A postal survey questionnaire of general practice staff in the Northern and Yorkshire Region. RESULTS: At least one completed questionnaire was obtained from 70% of the general practices surveyed, and the individual response rate to the survey was 45%. Just under 60% of all respondents reported having no access to the NHS internet and just under 50% also reported having no access to the internet. All respondents in this survey reported greater access to paper based information than to electronic databases. However, this research provides evidence of differential access to information resources between different professions in general practice with GPs clearly having easier access than other professions to both paper based resources and electronic databases. 70% of all respondents said that they would need to be trained to use either a computer, the internet, or to search databases if the opportunity for easy access to any of these information services was available. CONCLUSIONS: At the time of this survey, general practices seemed to be struggling to set up the infrastructure and develop the skills that are necessary to make best use of available research evidence. In addition, there is a need for further investigation into the reasons why different professions working in the same practice setting have differential access to information resources available in primary care.

Computer User Training↗
PubMed1987

Screening for psychiatric illness in general practice: the general practitioner versus the screening questionnaire.

This study compares the characteristics of general practitioners and a pen and paper test in the detection of psychiatric disorder in primary care settings. A psychiatrist interviewed a stratified sample of 283 patients drawn from 590 consecutive new illnesses seen in 15 general practices. Research diagnoses could be made in between one-quarter and one-third of the consecutive new illnesses. Two different research diagnostic systems agreed quite well with one another about who should be regarded as a psychiatric 'case' - although agreement between them for individual diagnoses was less impressive. Research diagnoses of psychiatric illnesses could be made in approximately 30% of new episodes of illnesses seen. If the DSM-3 system was used as a criterion of 'caseness', the specificity of the general health questionnaire was 75.4%, and the sensitivity was 87.1%. The general practitioners had fewer false positives than the questionnaire, but they were much more likely to miss psychiatric cases. Use of the general health questionnaire could increase their sensitivity from about 50% to 95%.

Family Practice↗
PubMed1996

What do deans of medical schools and heads of departments of general practice think of preregistration rotations in general practice?

BACKGROUND: One general practice has offered preregistration rotations in general practice since 1981. Although popular with doctors who participate in the scheme, and considered a success by the associated teaching hospital, it remains the only established general practice rotation in the United Kingdom. AIM: A study was undertaken to assess the degree of interest in preregistration rotations in general practice expressed by medical school deans and heads of departments of general practice. METHOD: A questionnaire was sent to all 26 deans of medical schools and all 25 heads of departments of general practice of teaching hospitals in the UK that undertook clinical training. RESULTS: A total of 24 deans (92%) and 24 heads of departments of general practice (96%) replied to the questionnaire. The scheme was thought to be of value by 58% of deans and 79% of heads of departments of general practice. Half of the teaching hospitals thought that they might consider such a rotation in the next 3-5 years. The most frequently cited problem initiating such a scheme was financial. CONCLUSION: Given the current interest in medical teaching in the community, preregistration rotations in general practice deserve more attention.

Attitude of Health Personnel↗