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PubMed1990

General practitioner referral rates to district psychiatry and psychology services.

The number of referrals made to a district psychiatry service by each of the local general practitioners over a five year period was counted and a large variation in general practitioner referral rate was found. Ten referral letters from each of the general practitioners were independently assessed for the amount of detail included and a mean score for each general practitioner obtained. A significant negative correlation was found between referral rate and amount of detail in referral letters, that is low referrers wrote very detailed letters. The procedure was repeated over an 18 month period including referrals to the district psychology service. Referral rate to the psychologists was positively correlated with detailed referral letters, that is those who referred many patients to the psychologists wrote detailed letters. This study has indicated a wide variation in the use of the psychiatry and psychology services by general practitioners which cannot be explained solely on the basis of a general referral tendency. It is likely that constructive liaison between psychiatrists and general practitioners, especially those who refer a large number of patients, could enhance the care of patients with psychiatric disorder in general practice.

Clinical Competence↗

PubMed1988

AIDS and the general practitioner: views of patients with HIV infection and AIDS.

An unselected series of outpatients infected with the human immunodeficiency virus (HIV) who attended two London hospitals were interviewed to assess their relationship with their general practitioner. Although most of the 192 patients were registered with a general practitioner, the doctors of only one half knew of the diagnosis. Patients feared a negative reaction from their general practitioner or were concerned about confidentiality. Although those who had told their doctor had received favourable reactions, few general practitioners attempted to counsel or educate their patients. The patients who previously had been open about their homosexuality were not more likely to have told their general practitioner of their HIV infection. Although most did not think that general practitioners were well informed about AIDS, half of the patients wished that general practitioners could take a bigger part in their care.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Epilepsy management: the general practitioner's perspective.

The opinions of general practitioners are considered important in the management of people with epilepsy. As part of an evaluation of the Comprehensive Epilepsy Service at The Queen Elizabeth Hospital in South Australia, 120 general practitioners were surveyed about their opinions of the Service and epilepsy issues using self-administered questionnaires. This enabled their opinions about the Service and epilepsy management to be elicited for future planning of effective service provision. The results of the evaluation showed that the Service needed to have a higher profile in the community regarding its existence and role. GPs considered they should manage the care of patients with epilepsy but a cooperative approach between GPs and the Service was important for successful management of difficult cases. Education about epilepsy for the patient and GP was also considered to be important for successful service provision. The GP's involvement in evaluation is essential for influencing the way in which health care services are delivered with regard to availability and accessibility for both themselves and their patients and should be encouraged to ensure effective epilepsy patient management.

Anticonvulsants↗

PubMed2006

Dementia in primary care: the first survey of Irish general practitioners.

OBJECTIVE: To investigate General Practitioners' (GPs) attitudes and practices in relation to screening, diagnosing, and disclosing a dementia diagnosis to patients. DESIGN: National postal survey. PARTICIPANTS: A random sample of 600 GPs from a national database of 2,400. RESULTS: Of the 600 GPs surveyed, 60% returned questionnaires of which 50% (300) were useable. GPs reported diagnosing on average four new cases of dementia annually. A multivariate analysis revealed that females diagnosed significantly fewer cases annually (t=5.532, df=289, p<0.001). A large majority of GPs reported performing thyroid function tests (77%), B(12) (75%) and Folic acid tests (75%) to out rule reversible causes of cognitive impairment. The most reliable signs and symptoms of dementia identified were memory problems (58%). Main barriers to diagnosis were difficulty differentiating normal ageing from symptoms of dementia (31%), lack of confidence (30%) and the impact of the diagnosis on the patient (28%). GPs' age (chi(2)=14.592, df=3, p<0.005) and gender (chi(2)=11.436, df=3, p<0.01) were significantly associated with barriers to diagnosis. Only 19% claimed they often or always disclosed a diagnosis to a patient. Over one-third of GPs (38%) reported that the key factor influencing their disclosure patterns was their perceptions of the patient's level of comprehension. Most GPs (90%) had never undergone any dementia specific training and most (83%) expressed a desire for this. CONCLUSIONS: GPs experience difficulty diagnosing and disclosing a diagnosis of dementia to patients. To improve dementia care in Ireland, there is an urgent need to develop an active and more systematic approach to GP training in dementia care.

Adult↗

PubMed1986

Swedish physicians' perspectives on work and the medical care system: the case of district general practitioners.

Interviews with district general practitioners in a large Swedish city in 1978-1979 solicited their perspectives on the frustrations and satisfactions they felt in their work, and on the successes and failures of the Swedish medical care system. With respect to work, four themes emerged: medical routine, patient centered care, overwork and isolation. Five themes emerged with respect to the system: financing, relationships with hospitals and specialists, involvement in political decision making, the size of districts and care centers. These themes are discussed with relation to the influence of the social situation of practice to the influence of the social situation of practice and the conditions for physician satisfaction.

Ambulatory Care↗

PubMed2002

Effects on depression pharmacotherapy of a Dutch general practitioner training program.

BACKGROUND: General practitioners' (GPs) ability to recognize, diagnose and treat depression improved significantly after a comprehensive, 20-h training programme. This study aims to evaluate in more detail the effects of the training on GPs' pharmacotherapy of depression and related issues. METHODS: A pretest-posttest design was used. Both in the pre- and post-training phase, a sample was drawn from consecutive patients of the 17 participating GPs. In the pre-training phase we identified a sample of 31 cases with an ICD-10 depression who received an antidepressant from their GP. The sample was followed for 1 year. Outcome measures were: type of antidepressant, dosage, duration and number of target instructions given by the GP. Then we trained the GPs. In the post-training phase, we identified a new sample (n = 47) from their practices and measured the same outcomes. RESULTS: Improvements were seen in choice for modern antidepressant, adequate dosage, adequate duration, and number of target instructions given. LIMITATIONS: Observed changes can be due to a period effect, inherent in a pre-post design. CONCLUSIONS: A post-academic hands-on training of GPs can improve depression pharmacotherapy according to clinical guidelines with respect to choice of a modern antidepressant, adequate dosage, adequate duration and psychoeducation.

Adolescent↗

PubMed2000

Impact of skin cancer education on general practitioners' diagnostic skills.

Seventeen general practitioners (GPs) were evaluated to assess their ability to recognize malignant, borderline and benign skin lesions before and after a novel, cheap and quick skin cancer educational programme. They were tested without prior warning on two occasions using two sets of 30 clinical slides. Between each test the GPs were given a lecture based on an illustrated booklet of similar lesions. The results showed an improvement in the GPs' diagnostic skills (P < 0.05), but nevertheless a wide variation in diagnostic ability between GPs remained. Our study highlights a simple, effective and inexpensive method for teaching GPs the diagnostic clinical features of skin cancer. Further work is needed to improve their diagnostic accuracy in the long term.

Clinical Competence↗

PubMed2003

Dietary advice in clinical practice: the views of general practitioners in Europe.

BACKGROUND: General practitioners (GPs) can promote good nutrition to patients and advise them about desirable dietary practices for specific conditions. OBJECTIVE: The objective was to assess GPs' knowledge and attitudes in implementing preventive and health promotion activities and to describe tools used by European GPs in advising patients about dietary practices. DESIGN: A postal survey was mailed to 1976 GPs from 10 GP national colleges to obtain information about beliefs and attitudes in prevention and health promotion, and an e-mail survey was sent to 15 GPs representing national colleges to obtain information about dietary guidelines. RESULTS: In the postal survey, 45% of GPs reported estimating body mass in clinical practice, and 60% reported advising overweight patients to lose weight. Fifty-eight percent answered that they felt minimally effective or ineffective in helping patients achieve or maintain normal weight. In the e-mail survey, only 4 colleges out of 15 reported that they had published their own dietary tools, although 10 out of 15 answered that GPs use some nutritional/dietary recommendations in the office when seeing patients. Eleven out of 15 answered that both the nurse and the GP advise patients about dietary practices, with 4 answering that GPs were the only ones who advise patients. Only 5 delegates answered that they can refer their patients to trained nutrition specialists. CONCLUSIONS: GPs think that obesity is not easy to handle in practice. Most GPs have dietary tools in the office and think that nurses play an important role in advising patients.

Adult↗

PubMed1991

Chest pain: an evaluation of the initial diagnosis made by 25 Flemish general practitioners.

Twenty-five general practitioners collected information on 318 contacts of patients with a new episode of chest pain, discomfort or tightness. A list of complaints, signs and symptoms were checked, together with the initial diagnosis, made by the GP immediately after the physical examination. The initial diagnosis was compared to a follow-up diagnosis. The gain in certainty was also compared. The GP made a correct initial diagnosis in 82% of patients. In 8% there was a clinically important difference, and seven of 17 episodes of oesophageal disease were missed. For their initial diagnosis, the GP scored 74% certain, 20% uncertain and no diagnosis in 6%. For the final diagnosis, these figures were 88%, 8% and 4%.

Belgium↗

PubMedDate not supplied

Working alongside the general practitioner: a child psychiatric clinic in the general practice setting.

A monthly child psychiatric clinic was established in a primary health care centre in order to offer a more accessible service to patients, and to improve liaison with primary health care professionals. Compared with the base child guidance unit, at the health centre there was a better first attendance rate, a much higher proportion of referrals from health professionals especially general practitioners, and an increased proportion of younger children referred. If further follow-up was necessary at the child guidance unit the attendance rate was very good. The service provided, although not reducing the need for a main multidisciplinary base, offered an acceptable and accessible opportunity for children with psychological problems to be assessed and treated, and for the referring professionals to have easy communication with the child psychiatrist.

Adolescent↗

PubMed2004

An analysis of an open access general practitioner bone densitometry service.

General practitioners (GPs) are increasingly involved in the selective opportunistic case finding of osteoporosis and treatment of this condition. An open access bone densitometry service has existed for GPs in the Cardiff area since 1993. The purpose of this study was to assess the effectiveness of this service, particularly with respect to the appropriateness of bone densitometry requests and the impact of the service on hospital outpatient referrals. Over a period of 12 months, 560 patients were referred to the open access service by 154 GPs. A total of 229 (41%) patients were given a clinical diagnosis of osteoporosis. Four hundred and seventy-three (84%) referrals followed the clinical referral criteria. In 85% of cases, GPs claimed that they would have referred patients to the hospital outpatient department, if there were no open access bone densitometry service. The majority of the referrals were appropriate, and the service appears to have reduced GP referrals to the specialist clinic.

Absorptiometry, Photon↗

PubMedDate not supplied

Management and attitudes of epilepsy by a group of Sydney general practitioners.

Previous surveys of general practitioners (GPs) have shown stereotypic attitudes and management of persons with epilepsy (PWE). We mailed a questionnaire to 107 GPs in the Sydney and Illawarra regions of Australia to evaluate changes in knowledge and management of epilepsy and attitudes of GPs toward PWE as compared with results of a similar study made 10 years previously. Most GPs referred patients with epilepsy to a neurologist for initial management in preference to initiating investigation and treatment themselves. GPs were very satisfied with their sharing of care with neurologists, but indicated their high level of dissatisfaction with other health care therapists because of impractical advice and lack of empathy. The GPs' objectives of continuing management were mainly to prevent seizures, monitor of medication and its effects, and reduce the impact of patients' epilepsy on their daily life. Although many GPs believed that PWE were more likely to have emotional and relationship problems, most also believed that such persons contribute equally to society and can have normal quality of life (QOL). Although the GPs prefer to use a neurologist for initial management of PWE, they see themselves as having a role in continuing care and providing psychosocial support. The stereotyped perceptions of GPs indicated in the previous study have improved, although in some respects they remain negative. This study offers an audit of the outcome of a decade of educational promotion regarding epilepsy.

Activities of Daily Living↗

PubMedDate not supplied

Cognitive dementia and memory service clinics: opinions of general practitioners.

This study examined general practitioners' (GPs) satisfaction with services provided by memory clinics and the extent to which the clinics were seen as assisting with the management of their patients with dementia. Thirty-five GPs, who had recently referred patients to the Cognitive Dementia and Memory Service (CDAMS) in Victoria, Australia, were interviewed about their experiences. Overall, most were satisfied with the service the clinic provided. They were most positive about the completeness and utility of the assessment and diagnostic information provided, but relatively less satisfied with advice regarding the family's coping and community support services for the patient. It was concluded that the CDAMS is enhancing the capacity of GPs to provide ongoing care to people with dementia. However, the establishment of firmer communication and collaborative protocols between the clinics and GPs would improve their usefulness.

Ambulatory Care↗

PubMed2006

Psychiatric services in primary care settings: a survey of general practitioners in Thailand.

BACKGROUND: General Practitioners (GPs) in Thailand play an important role in treating psychiatric disorders since there is a shortage of psychiatrists in the country. Our aim was to examine GP's perception of psychiatric problems, drug treatment and service problems encountered in primary care settings. METHODS: We distributed 1,193 postal questionnaires inquiring about psychiatric practices and service problems to doctors in primary care settings throughout Thailand. RESULTS: Four hundred and thirty-four questionnaires (36.4%) were returned. Sixty-seven of the respondents (15.4%) who had taken further special training in various fields were excluded from the analysis, giving a total of 367 GPs in this study. Fifty-six per cent of respondents were males and they had worked for 4.6 years on average (median = 3 years). 65.6% (SD = 19.3) of the total patients examined had physical problems, 10.7% (SD = 7.9) had psychiatric problems and 23.9% (SD = 16.0) had both problems. The most common psychiatric diagnoses were anxiety disorders (37.5%), alcohol and drugs abuse (28.1%), and depressive disorders (29.2%). Commonly prescribed psychotropic drugs were anxiolytics and antidepressants. The psychotropic drugs most frequently prescribed were diazepam among anti-anxiety drugs, amitriptyline among antidepressant drugs, and haloperidol among antipsychotic drugs. CONCLUSION: Most drugs available through primary care were the same as what existed 3 decades ago. There should be adequate supply of new and appropriate psychotropic drugs in primary care. Case-finding instruments for common mental disorders might be helpful for GPs whose quality of practice was limited by large numbers of patients. However, the service delivery system should be modified in order to maintain successful care for a large number of psychiatric patients.

Adult↗

PubMed1988

Fitness to drive and the general practitioner.

This study investigates general practitioners' (GPs') knowledge and opinions on fitness to drive after stroke. Questionnaires were sent to 650 GPs. Despite a low response rate (24%) results suggest that most GPs rarely see stroke patients regarding driving fitness. There appears to be some confusion over terms used in the handbook issued to medical practitioners. Only a quarter of GPs knew of any driving assessment facilities and very few had ever referred a patient to a clinical psychologist for cognitive assessment. Almost all responding GPs (98%) wanted the opportunity to refer patients for assessment based on research findings. The current approach to assessment of driving fitness after stroke appears inconsistent. It is hoped that new assessment methods being developed will help to improve on the present system.

Automobile Driving↗

PubMed1977

Evaluation of automated multiphasic health testing of referred patients by general practitioners.

Seventy-eight general practitioners provided clinical follow-up reports on 752 patients whom they had referred to the Shepherd Foundation, Melbourne, for automated multiphasic health tests (AMHT). One or more new diagnoses were reported in 270 cases (36%). The yield of new diagnoses made as a result of AMHT was a function of sex, but not of age or pre-referral status. Additional useful information relevant to a previously known diagnosis was reported in 234 cases (31%) and other benefits in 185 cases (25%). Patients were significantly reassured in 623 cases (83%) while disadvantages were reported in 41 cases (5%).

Adult↗

PubMed1996

Diabetic retinopathy: examination practices and referral patterns of general practitioners.

OBJECTIVE: To investigate general practitioners' (GPs') examination and referral practices for diabetic retinopathy. METHODS: A questionnaire survey of a random stratified sample of 500 Victorian GPs. RESULTS: The response rate was 88%. 53% of GPs examined none or less than half of their patients with diabetes for diabetic retinopathy. Those who did examine for retinopathy rarely performed funduscopy through a dilated pupil and 65% reported that they never did. Only 37% had dilating drops in their surgery. Only 45% often or always tested visual acuity. 88% often or always referred patients at the recommended frequency to an ophthalmologist. CONCLUSIONS: Although most GPs do not perform dilated fundus examinations, they report referring their patients with diabetes for assessment by an ophthalmologist at an early stage to prevent vision loss. Referral chain breakdown may explain the discrepancy between GPs' reported referral rates and the lower rates of ophthalmic examination reported in the Melbourne Visual Impairment Project.

Clinical Competence↗

PubMed2001

Implementation of evidence based cardiovascular risk treatments by general practitioners.

AIM: To review general practitioner (GP) implementation of evidence based cardiovascular risk reducing strategies in subjects with coronary heart disease (CHD). METHODS: Audit of patient records of randomly selected GPs. RESULTS: There were 326 subjects with CHD under the care of 21 doctors. Except for smoking, details of lifestyle measures were rarely found in the notes. Advice on diet and exercise was mentioned in 51% and 23.3% of records respectively. Aspirin and beta-blockers were widely used. Of patients with drug untreated values of total cholesterol (TC) and/or TC/HDL exceeding National Heart Foundation (NHF) guidelines, 71% were prescribed lipid-modifying drugs. NHF targets for TC (< or = 5.0 mmol/l) were achieved by 37% and for TC/HDL (< or = 4.5) by 60%. TC remained above 5.5 mmol/L in 120 cases. Lipid results from tests within the last 12 months were found in 60% of cases. CONCLUSIONS: Recording of lifestyle treatments in subjects with CHD appears to be assigned low priority. Cardioprotective treatments were widely used. Cholesterol levels were recorded frequently and of those with values exceeding NHF guidelines, nearly 3/4 were on medication. Recommended targets for lipid parameters were being achieved by <50% of patients. More frequent monitoring could improve this outcome

Adrenergic beta-Antagonists↗