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At least 577 records · Page 32Linked to original sources
PubMed2003

Patients' accounts of being removed from their general practitioner's list: qualitative study.

OBJECTIVE: To explore patients' accounts of being removed from a general practitioner's list. DESIGN: Qualitative analysis of semistructured interviews. SETTING: Patients' homes in Leicestershire. PARTICIPANTS: 28 patients who had recently been removed from a general practitioner's list. RESULTS: The removed patients gave an account of themselves as having genuine illnesses needing medical care. In putting their case that their removal was unjustified, patients were concerned to show that they were "good" patients who complied with the rules that they understood to govern the doctor-patient relationship: they tried to cope with their illness and follow medical advice, used general practice services "appropriately," were uncomplaining, and were polite with doctors. Removed patients also used their accounts to characterise the removing general practitioner as one who broke the lay rules of the doctor-patient relationship. These "bad" general practitioners were rude, impersonal, uncaring, and clinically incompetent and lied to patients. Patients felt very threatened by being removed from their general practitioner's list; they experienced removal as an attack on their right to be an NHS patient, as deeply distressing, and as stigmatising. CONCLUSIONS: Removal is an overwhelmingly negative and distressing experience for patients. Many of the problems encountered by removed patients may be remediable through general practices having an explicit policy on removal and procedures in place to help with "difficult" patients.

Adolescent↗
PubMed1984

Prevention in practice: what Wessex general practitioners are doing.

A random sample of 214 general practitioners in the Wessex region was invited to complete a postal questionnaire about the practice of preventive medicine and 90% replied. This inquired into their attitude and behaviour towards smoking and accident prevention, promoting exercise, and controlling obesity and hypertension. The results were generally encouraging. Most recognised their key role in health promotion and health education and their shared responsibility with other professionals. Many had made progress in smoking prevention and control of obesity and hypertension. Promoting exercise and accident prevention left room for improvement. The availability of information in patients' records to identify and monitor problem areas was particularly lacking. We conclude that further progress might be achieved by better training of general practitioners, and developing information systems orientated towards promoting health. The team approach in primary care needs to be strengthened. In particular extending the role of the health visitor and practice nurse may provide the support so vital for the successful outcome of preventive initiatives. Community unit management teams need to consider carefully how they may encourage advances in health promotion in primary care.

Accident Prevention↗
PubMed1986

Findings of a national survey of the role of general practitioners in the treatment of opiate misuse: extent of contact with opiate misusers.

With the recent unprecedented growth in the spread of drug misuse in the United Kingdom the role of the general practitioner has become more and more prominent, both in response to demands for treatment and as the focus of national policy on drug misuse. Although general practitioners may be the first contact, few data are available on the extent of their contact with drug misusers. A postal survey was carried out in mid-1985 of a 5% national sample of general practitioners in England and Wales concerning their role in and views on the treatment of opiate misusers, including the extent of their contact with such patients during a four week period. Of the 1166 general practitioners surveyed, 845 replied, a response rate of 72%. The results show that roughly one in five general practitioners in England and Wales attended an opiate misuser during this four week period, seeing an estimated 6000 to 9000 patients, one third of whom were "new" to the general practitioner. A cautious estimate of between 30,000 and 44,000 new cases of opiate misuse presenting to general practitioners in a year is suggested, with some adjustment necessary because of double counting. A wide variation in the prevalence of consultations among regional health authorities was found, and several of the regions with a high prevalence are outside the London area. The scale of contact thus confirms the importance of the general practitioner in the national response to drug misuse.

Family Practice↗
PubMed2001

Challenge of culture, conscience, and contract to general practitioners' care of their own health: qualitative study.

OBJECTIVE: To explore general practitioners' perceptions of the effects of their profession and training on their attitudes to illness in themselves and colleagues. DESIGN: Qualitative study using focus groups and in depth interviews. SETTING: Primary care in Northern Ireland. PARTICIPANTS: 27 general practitioners, including six recently appointed principals and six who also practised occupational medicine part time. MAIN OUTCOME MEASURES: Participants' views about their own and colleagues' health. RESULTS: Participants were concerned about the current level of illness within the profession. They described their need to portray a healthy image to both patients and colleagues. This hindered acknowledgement of personal illness and engaging in health screening. Embarrassment in adopting the role of a patient and concerns about confidentiality also influenced their reactions to personal illness. Doctors' attitudes can impede their access to appropriate health care for themselves, their families, and their colleagues. A sense of conscience towards patients and colleagues and the working arrangements of the practice were cited as reasons for working through illness and expecting colleagues to do likewise. CONCLUSIONS: General practitioners perceive that their professional position and training adversely influence their attitudes to illness in themselves and their colleagues. Organisational changes within general practice, including revalidation, must take account of barriers experienced by general practitioners in accessing health care. Medical education and culture should strive to promote appropriate self care among doctors.

Attitude to Health↗
PubMed1994

Knowledge of and reported asthma management among South Australian general practitioners.

AIM: This study, carried out in 1989, set out to assess general practitioners' knowledge of asthma management and their reported management practices. METHOD: Of 153 randomly selected South Australian general practitioners 127 (83%) completed a questionnaire designed to explore issues relating to the management of asthma. RESULTS: The survey revealed substantial differences between general practitioners in their knowledge and management practices including the assessment of the severity of asthma, the need for objective monitoring, that is by the use of spirometry and peak flow meters, and the use of medication. Overall, the sampled general practitioners believed that patient-related factors were the main barriers to effective treatment of asthma. CONCLUSION: The findings of this study suggest that ideal asthma management was not being attained. More research is required to ascertain why such variability among practitioners exists and how best to remedy these differences.

Adult↗
PubMed1992

[Treatment of injuries in the county of Ringkøbing. 3. Attitude and behavior of the population and general practitioners in relation to treatment of injuries].

This investigation describes the attitudes and behaviour of the population and the general practitioners in the County of Ringkøbing concerning treatment of injuries and the closed casualty department. The investigation consists of three parts. 1. In order to describe the general practitioners in the County of Ringkøbing as those who treat injuries, a questionnaire was sent to these and 88.0% replied. In general, the general practitioners had relatively great experience of work in casualty departments from their hospital appointments. Only eight (5.6%) had experience for less than six months. Practically all (93.2%) had assistance during the day but, during on-call periods, only 16.4% had assistance from doctors. Only 2.1% had access to radiographic examination in their practices. The general practitioners stated that they were able to complete treatment in 82.5% (95-50) of the patients without referral to hospital. Lack of facilities and expertise were the commonest reasons for referral to hospital. 70% considered treatment of injuries as interesting or very interesting. Only 1.4% found it boring. 2. In order to describe self referral to hospital in cases of slight injury by the population of the County of Ringkøbing a questionnaire was sent to 600 of the population aged over 17 years chosen at random. 71.6% replied. 70% stated that they would contact their general practitioner or doctor-on-call in cases of wounds and suspected fracture. The individuals who would contact the casualty department, particularly in the case of wounds, were persons who lived close to the casualty department and who did not have any advantage in contacting their own general practitioner where distance was concerned.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1995

General practitioners in hospitals.

The authors review General Practitioners in Hospitals, a report prepared by the School of Medical Education, University of New South Wales (1993) for the Australian Health Ministers' Advisory Council Medical Workforce Group on Hospital Training and Career Development. The authors acknowledge that this report represents the most comprehensive look at GP involvement in hospitals across Australia, but suggest that its conclusion 'general practitioners play a substantial role in the provision of medical care in public hospitals around Australia' may be an overstatement. They discuss shortcomings associated with the study, including: definitional issues; variation in levels of involvement according to hospital type; potential biases introduced by using self-report of hospital administrators as the source of data; insufficient emphasis being placed on the views of GPs; and the validity of extrapolations.

Australia↗
PubMed2001

Rural and remote Australian general practitioners' educational needs in radiology.

BACKGROUND: The Australian College of Rural and Remote Medicine (ACRRM) was funded by the Commonwealth Department of Health and Aged Care to set up a quality assurance and continuing medical education program for rural and remote general practitioners in radiology to begin in January 2001. An extensive literature search failed to uncover any previous publications on the specific educational or quality assurance needs for rural general practitioners in radiology. Broader educational needs assessments of rural general practitioners in Australia had identified radiology as an important skill for which improvement was desired. METHOD: A national steering committee consisting of four rural general practitioners and three radiologists, with the assistance of a program manager, developed and piloted a self-administered postal questionnaire to determine the educational and quality assurance needs of rural and remote general practitioners. The questionnaire was sent to all rural and general practitioners holding a remote radiology exemption using the Health Insurance Commission database. RESULTS: A total of 287 completed questionnaires were returned from all states in the country, except the Australian Capital Territory. The information gave a comprehensive picture of the self-reported radiology education needs of these doctors, who practice in isolation from radiologists and other specialists. The three areas in which the general practitioners were least confident in radiology were chest, cervical spine, and skull radiology. Their highest priority areas of need for education were chest radiology, film interpretation, and spinal radiology. The top preferred quality assurance activity was image review with a radiologist, followed by clinical audit, image review by peers, and measuring practice against guidelines. FINDINGS: Local ownership of education is important to successful program development and evaluation. Information obtained from the educational needs assessment was used to develop the Radiology Quality Assurance and Continuing Medical Education Program for Rural and Remote General Practitioners.

Australia↗
PubMed2005

Benzodiazepine prescribing behaviour and attitudes: a survey among general practitioners practicing in northern Thailand.

BACKGROUND: Over-prescribing of benzodiazepines appears common in many countries, a better understanding of prescribing practices and attitudes may help develop strategies to reduce prescribing. This study aimed to evaluate benzodiazepine prescribing behaviour and attitudes in general practitioners practising in Chiang Mai and Lampoon, Thailand. METHODS: Questionnaire survey of general practitioners in community hospitals, to estimate: i) use of benzodiazepines for anxiety/insomnia, panic disorder, depression, essential hypertension, and uncomplicated low back pain and ii) views on the optimal duration of benzodiazepine use. RESULTS: Fifty-five of 100 general practitioners returned the completed questionnaires. They reported use of benzodiazepines for anxiety/insomnia (n = 51, 93%), panic disorder (n = 43, 78%), depression (n = 26, 43%), essential hypertension (n = 15, 27 %) and uncomplicated low back pain (n = 10, 18%). Twenty-eight general practitioners would prescribe benzodiazepines for non-psychiatric conditions, 17 for use as muscle relaxants. Seventy-five per cent, 62% and 29% of the general practitioners agreed or totally agreed with the use of benzodiazepines for insomnia, anxiety and depression, respectively. Practitioners agreed that prescribing should be less than one week (80%); or from 1 week to 1 month (47%); or 1 to 4 months (16%); or 4 to 6 months (5%) or more than 6 months (2%). Twenty-five general practitioners (45%) accepted that they used benzodiazepines excessively in the past year. CONCLUSION: A considerable proportion of general practitioners in Chiang Mai and Lampoon, Thailand inappropriately use benzodiazepines for physical illnesses, especially essential hypertension and uncomplicated low back pain. However, almost half of them thought that they overused benzodiazepines. General practitioner's lack of time, knowledge and skills should be taken into account in improving prescribing behaviour and attitudes.

Adult↗
PubMed1983

Intervention against smoking and its relationship to general practitioners' smoking habits.

A postal survey was carried out in June and July 1980 to find out if there was any relationship between smoking habits of general practitioners and their reported intervention against smoking among their patients. Responses from 342 general practitioners in London and Kent indicated that there was a relationship: general practitioners who smoked cigarettes (13 per cent of the sample) were less likely to advise or help their patients to stop smoking than general practitioners who smoked a pipe or cigars or who did not smoke at all. The survey also yielded an estimate of smoking prevalence among general practitioners which indicated that prevalence has continued to decline, and that fewer general practitioners are being recruited to smoking.

Female↗
PubMed1994

Telephone versus postal surveys of general practitioners: methodological considerations.

BACKGROUND: High response rates to surveys help to maintain the representativeness of the sample. AIM: In the course of a wider investigation into counselling services within general practice it was decided to assess the feasibility of increasing the response rate by telephone follow up of non-respondents to a postal survey. METHOD: A postal survey was undertaken of a random sample of 1732 general practitioners followed by telephone administration of the questionnaire to non-respondents. The identical questionnaire was administered by telephone to a separate random sample of 206 general practitioners. RESULTS: Of 1732 general practitioners first approached by mail, 1683 were still in post of whom 881 (52%) completed the postal questionnaire and a further 494 (29%) the telephone interview. Of 206 general practitioners first contacted by telephone, 197 were still in post of whom 167 (85%) completed interviews. Compared with doctors first approached by mail, those first approached by telephone were significantly more likely to report having a partner with a special interest in psychiatry (P < 0.01); and a general practitioner, practice nurse or health visitor who worked as a counsellor (P < 0.01 in each case). A comparison of doctors first approached by telephone with those who completed telephone interviews after failing to respond to the postal questionnaire showed that postal non-respondents were significantly less likely to report having a general practitioner, practice nurse, health visitor or community psychiatric nurse who worked as a counsellor (P < 0.01 in each case). CONCLUSION: These findings suggest that non-response to the postal survey was associated with lack of activity in the study area. Telephone administration of questionnaires to postal non-respondents increased response rates to above 80% but, as telephone administration enhanced the reporting of counsellors, a social desirability bias may have been introduced.

Data Collection↗
PubMed1984

Written simulation of patient-doctor encounters. 2. Assessment of the performance of general practitioners.

Two rating procedures were used to judge the performance of 19 general practitioners confronted with a written simulation of patient-doctor encounters. The simulation comprised five patients with vague complaints. A group of three 'expert' general practitioners judged the attention that the doctors paid to somatic aspects or to causes of the complaints. A second group of 18 experts judged the extent to which the therapeutic procedures of the general practitioners might induce a risk of unnecessary harm to the patient. Both rating procedures were shown to be reliable for three of the five simulated patients. A weak correlation between these issues was established for these three patients. The problems of judging the behaviour of the practitioners with the other two patients are discussed. The performance of the general practitioners was relatively constant. Variability between individuals substantially exceeded variability within an individual with respect to the attention given to somatic aspects, but these variabilities were roughly equal with respect to the risk of causing unnecessary harm.

Adult↗
PubMed1998

Nonformulary drug requests at an academic hospital in Germany--the role of general practitioners' long-term medication.

OBJECTIVE: To determine the influence of general practitioners' outpatient medication on nonformulary drug requests in university hospitals. METHODS: During a period of 1 year every nonformulary drug request at the Göttingen University Hospital was analysed (reason for request, drug class). A second analysis examined whether the introduction of a new order form that allowed the prescribing physician to mark a box to declare that this request is due to general practitioner's outpatient therapy influenced the rate of requests. RESULTS: During 12 months a total of 6,281 nonformulary drugs were ordered from the pharmacy, 1,077 (17.1%) of them because of outpatient medication. The percentage of requests according to general practitioners' outpatient medication was about 11% in both the medical and the surgical departments. The rate was rather high in the departments of psychiatry and orthopaedic surgery (39% and 60%, respectively). With the introduction of the new order form, there was a significant increase in the general practice based rate of nonformulary requests on the general surgical wards (from 10.8% to 19.9%). Only a minority of requests (14%) represented drugs of unproven efficacy. CONCLUSION: Since nonformulary requests attributable to previous outpatient medication accounts for less than 20% and since only a minor portion of them lack scientific proof of efficacy we suggest that hospital doctors and clinical pharmacologists should avoid a drug policy, which is too restrictive, and support maintenance of chronic medication initiated by general practitioners. Especially in the department of psychiatry, nonformulary requests seem to be justified by patient needs.

Drug Prescriptions↗
PubMed1994

Stress, anxiety, and depression in hospital consultants, general practitioners, and senior health service managers.

OBJECTIVE: To study stress, anxiety, and depression in a group of senior health service staff. DESIGN: Postal survey. SUBJECTS: 81 hospital consultants, 322 general practitioners, and 121 senior hospital managers (total 524). MAIN OUTCOME MEASURES: Scores on the general health questionnaire and the hospital anxiety and depression scale. RESULTS: Sixty five (80%) consultants, 257 (80%) general practitioners, and 67 (56%) managers replied. Of all 389 subjects, 183 (47%) scored positively on the general health questionnaire, indicating high levels of stress. From scores on the hospital anxiety and depression scale only 178 (46%) would be regarded as free from anxiety, with 100 (25%) scoring as borderline cases and 111 (29%) likely to be experiencing clinically measurable symptoms. The findings for depression were also of some concern, especially for general practitioners, with 69 (27%) scoring as borderline or likely to be depressed. General practitioners were more likely to be depressed than managers (69 (27%) v 4 (6%) scored > or = 8 on hospital anxiety and depression scale-D; P = 0.004) with no significant difference between general practitioners and consultants. General practitioners were significantly more likely to show suicidal thinking than were consultants (36 (14%) v 3 (5%); P = 0.04) but not managers (9 (13%)). No significant difference could be found between the three groups on any other measure. CONCLUSIONS: The levels of stress, anxiety, and depression in senior doctors and managers in the NHS seem to be high and perhaps higher than expected.

Anxiety↗
PubMed1997

How general practitioners manage acute asthma attacks.

BACKGROUND: The management of asthma attacks by general practitioners in 1992/93 was compared with 1991/92 in relation to recommended guidelines. METHODS: The findings from a postal survey of 299 UK general practitioners who managed 2332 patients with an asthma attack in 1992/93 were compared with those from 218 practitioners who managed 1805 attacks in 1991/92. Management by a subgroup of practitioners from a special interest group was analysed separately. RESULTS: In 1992/93 2031 (87%) of attacks were managed entirely by general practitioners, 251 (11%) were referred for admission to hospital, and 50 (2%) were managed by an accident and emergency department. There was no change in the pattern of management relative to 1991/92. Compared with recommended guidelines there was underuse of systemic steroids and nebulised bronchodilators. Between 1991/92 and 1992/93 use of systemic steroids in acute attacks increased from 56% to 71%, nebulised bronchodilators from 31% to 32%, and an increase in prophylactic medication after an acute attack from 41% to 49%. Contrary to guidelines, antibiotic use increased from 32% to 40% of attacks. Practitioners from a special interest asthma group gave more of their patients systemic steroids and nebulised bronchodilators both in 1991/92 and 1992/93. CONCLUSIONS: Some aspects of the management of asthma attacks by general practitioners has changed in line with guidelines, but there is still a large gap between actual and recommended management.

Acute Disease↗
PubMed1985

[General practitioners and mental disorders].

This article presents the results of a mail survey about mental illness in general practice carried out in France in 1981 on a sample of 353 general practitioners. The research had two main objectives: The first was to understand the general practitioners perceptions of the manner in which they dealt with their patients suffering from psychiatric or psychologic disorders. The second was to test several hypothesis concerning the relationship between the frequency of diagnoses of mental disorders by the general practitioner and her or his links with the field of psychopathology and with the mental patients. The findings of the survey confirm the main hypothesis: the way general practitioners diagnose mental illness is significantly related to their interest in the subject of psychopathology and in their mental patients. Moreover, these results show how general practitioners claim that psychological problems are part of their field and that they do not feel at all uneasy when confronted with patients suffering from mental disorders. They frequently deal with these patients with mental disorders and believe that they are qualified to practice psychotherapy.

Attitude of Health Personnel↗
PubMed1990

Outcome of referrals by optometrists to general practitioners: an 18 month study in one practice.

All general ophthalmic services forms (GOS18) received by one practice over an 18 month period were analysed and the patient outcome after two years noted from the practice records. Sixty one forms were collected. Fifty patients (82%) were referred by the general practitioners to the local eye hospital. Among the 45 patients that have so far been seen by an ophthalmologist, 22 (49%) were diagnosed as having cataracts, eight (18%) macular degeneration and two (4%) glaucoma. Thirteen patients (29%) were found to have normal eyes. Nine of the 61 patients (15%) were not referred to an ophthalmologist and two patients (3%) were already under review at the eye hospital. It is concluded that some referrals to ophthalmologists might be avoided if general practitioners received improved training in ophthalmology, However, general practitioners remain an effective filter in the referral system between optometrists and ophthalmologists.

Adolescent↗
PubMed1987

Improving communication between general practitioners and specialists.

An investigation was carried out in the Almelo district in the Netherlands to study referral problems and to improve communication and cooperation between general practitioners and specialists in the area. During September and October 1984 seven general practitioners referred 30 patients to internists. There appeared to be considerable disagreement between general practitioners and internists about the necessity of the referrals from a biomedical view point and less so about the objective of the referrals. Twelve referrals were labelled as 'problem referrals'. Each of these was reviewed by the general practitioner and the internist who were involved in the referral in the presence of the author. In these meetings agreement was reached on the objective and the necessity of each of the 12 referrals. The evaluation, however, showed marked differences between general practitioners and internists with respect to the effect of the project: most general practitioners said that participation in the study influenced their conduct in referring patients to specialists, while most internists replied negatively.

Communication↗