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PubMedDate not supplied

Analysis of orthodontic treatment by pediatric dentists and general practitioners in Indiana.

This investigation analyzed the extent of orthodontic services currently being provided by pediatric dentists and general practitioners in Indiana. All 71 Indiana pediatric dentists primarily in private practice and 500 general practitioners were mailed a survey/questionnaire. Sixty-two percent of the pediatric dentists and 17.9 percent of the general practitioners surveyed provided comprehensive orthodontic treatment, results much higher than those of previous surveys of pediatric dentists and general practitioners. Pediatric dentists were found to provide significantly more comprehensive orthodontic treatment and spend significantly more time providing orthodontic treatment than general practitioners, especially those in communities of less than 25,000. Sixty-three percent of the practitioners surveyed had taken some type of continuing education in orthodontics. These practitioners spent significantly (p less than 0.001) more time treating orthodontic conditions, and treated more complex cases than those who had not taken such courses.

Adult↗
PubMed1976

A general practitioner in an ophthalmology accident and emergency department.

After a short period of intensive training, a general practitioner successfully replaced a senior house officer (SHO) in the accident and emergency department of an eye hospital on one morning a week for a year. An unbiased observer compared the performance of the general practitioner after one year with that of a full-time SHO who had had 17 months' experience; their performances were about equal. Although a sessional general practitioner costs about 28% more than an SHO, the real cost is much less because undue length of service as an SHO or change to another specialty (because of the SHO surplus) delays achievement of a permanent grade. Continuity is a great advantage of the general practitioner. Replacement of some SHOs by general practitioners would reduce the surplus of SHOs with poor promotion prospects. The commonest diagnoses were Meibomian cysts (18%), corneal foreign bodies (20%), corneal abrasions (12%), and conjunctivitis (8%).

Economics, Medical↗
PubMed1993

[Smoking habits of French general practitioners. Results of a representative sample of 1,012 physicians].

General practitioners are in a position to influence the behaviour of the general population, notably as regards their smoking habits. This study aims to estimate the smoking habits of general practitioners in France, taken from a representative sample of 1012 general practitioners. The overall percentage of medical smokers rose in 1987 to 37%. The smoking habits varied according to age; thus if one considers current medical non-smokers, the oldest group are often ex-smokers, while the youngest are usually those who have never smoked. Compared to information obtained in 1980 from the medical population, one notes that there has been a fall in the level of doctors who smoke, whilst the proportion of doctors who have never smoked has risen considerably during the same period, particularly amongst young doctors.

Adult↗
PubMed1993

Effect of fundholding and indicative prescribing schemes on general practitioners' prescribing costs.

OBJECTIVE: To compare general practitioners' prescribing costs in fundholding and non-fundholding practices before and after implementation of the NHS reforms in April 1991. DESIGN: Analysis of prescribing and cost information (PACT data; levels 2 and 3) over two six month periods in 1991 and 1992. SETTING: Oxford region. PARTICIPANTS: Three dispensing fundholding practices; five non-dispensing fundholding practices; and seven non-dispensing, non-fundholding practices. MAIN OUTCOME MEASURES: Percentage change in net cost of ingredients, number of items prescribed, average cost per item, and proportion of generic drugs prescribed after NHS reforms. RESULTS: Prescribing costs increased in all practices in the six months after the reforms. The net costs of ingredients increased among dispensing fundholders by 10.2%, among non-dispensing fundholders by 13.2%, and among non-fundholders by 18.7%. The number of items prescribed also increased in all three groups (by 5.2%, 7.5%, and 6.1% respectively). The increase in average cost per item was 4.8% for dispensing fundholders, 5.3% for non-dispensing fundholders, and 11.9% for non-fundholders. Dispensing fundholders increased the proportion of generic drugs prescribed from 26.9% to 34.5% and non-dispensing fundholders from 44.5% to 48.7%; non-fundholders showed no change (47%). Five of the eight fundholding practices made savings in their drugs budgets at the end of the first year of fundholding (range 2.9-10.7%; the three other practices overspent by up to 3.6%). All non-fundholding practices exceeded their indicative prescribing amounts (range 3.2-20.0%). CONCLUSIONS: Fundholding has helped to curb increases in prescribing costs, even among dispensing general practitioners, for whom the incentives are different. Indicative prescribing amounts for non-fundholding practices do not seem to have had the same effect.

Drug Costs↗
PubMed2000

How do general practitioners manage hip problems in adults?

OBJECTIVE: To investigate the medical management, and its consistency and determinants, of hip problems in adult patients. SETTING: General practice, The Netherlands. DESIGN: Observational study based on four "paper patients" and on computerised patients records (CPRs) of 400 patients (20 per general practitioner), aged 50 years and over, with new hip problems. SUBJECTS: 20 general practitioners. MAIN OUTCOME MEASURES: Examination, diagnosis and treatment of hip patients. RESULTS: Medical history and physical examination consisted mainly of questions concerning pain localisation and onset, and examining passive hip motion. The paper patients, except for the one with alarming symptoms, and the CPRs showed high variation in management between general practitioners, particularly for medication prescription and X-ray requests. Main factors influencing medical management were patients' age, number of visits and attitude of the individual general practitioner. A specific diagnosis was registered for only 32% of the 400 patients. The diagnosis osteoarthritis varied greatly between general practitioners even after adjustment for patients' age, gender and number of visits. Patients with osteoarthritis were infrequently referred to physical therapy and received nonsteroidal anti-inflammatory drugs (NSAIDs) more often than paracetamol. CONCLUSION: Diagnosis and treatment of hip problems varies widely between general practitioners. Treatment of patients with osteoarthritis is inconsistent with published recommendations.

Aged↗
PubMed1990

Perinatal mortality rates in isolated general practitioner maternity units.

OBJECTIVE: To determine the perinatal mortality rate among normally formed, singleton babies with birth weights greater than or equal to 2500 g in Bath health district based on the intended place of delivery at the time of onset of labour or at the time of diagnosis of intrauterine death. DESIGN: The numbers of live births and stillbirths were collected monthly returns from the maternity units concerned. Deaths of infants aged less than or equal to 1 week were collected in the same returns. The intended place of delivery was confirmed at the monthly perinatal mortality meeting, during which maternal and fetal factors were discussed. SETTING: A rural health district of 400,000 population where one third of all deliveries occurred in seven isolated general practitioner maternity units, 8% in the integrated general practitioner unit, and the remainder in the consultant unit. SUBJECTS: All babies of women whose deliveries were booked in the district before the onset of labour or the diagnosis of intrauterine death, excluding twins, babies with lethal congenital malformations, and those less than 2500 g. MAIN OUTCOME MEASURES: Outcome of all deliveries and parity of mothers. RESULTS: 14,415 Deliveries were analysed. The perinatal mortality rate was 2.8/1000 births in the consultant unit (7950 deliveries), 4.8 in the isolated general practitioner units (5237 deliveries), and zero in the integrated general practitioner unit (1228 deliveries). Perinatal deaths attributable to asphyxia were more common in the isolated general practitioner units (1.5 per 1000) than the consultant unit (0.6 per 1000). The perinatal mortality rate among babies born to nulliparous women was 3.2/1000 births in the consultant unit and 5.7 in the isolated general practitioner units; for those born to multigravid women it was 2.4 and 4.2 respectively. CONCLUSIONS: The outcome of delivery was not influenced by parity. Both antenatal and intrapartum care were responsible for the higher perinatal mortality rate in the isolated general practitioner units. The integrated unit, which shared midwifery staff with the consultant unit, seemed to work well. Analysis by intended place of delivery at the time of onset of labour or diagnosis of intrauterine death suggested that the care given in isolated units needs to be improved, perhaps by better training of general practitioners and consultant supervision of antenatal care.

Birth Weight↗
PubMed1992

Workload of general practitioners before and after the new contract.

OBJECTIVE: To assess changes in general practitioners' workload associated with the new contract introduced in April 1990. DESIGN: Weekly workload diary completed during four weeks in February-March 1990 and during the same period in 1991. SETTING: Sheffield, United Kingdom. SUBJECTS: All 300 general practitioners on Sheffield Family Health Services Authority list as principals in 1990 and 1991. MAIN OUTCOME MEASURES: Mean number of hours worked per week, number of patients seen each week, and mean time spent per patient. RESULTS: 181 (60%) general practitioners responded in 1990 and 163 (54%) in 1991. Of these, 18 (10%) were not working in 1990 and 14 (7%) in 1991. General medical service work increased during a "normal working week" from a mean of 38.6 hours a week in 1990 to 40.6 hours in 1991, and non-general medical service work decreased from 5.4 hours a week to 4.5 hours. Hours spent on call were similar before and after the contract. For the 99 general practitioners who responded in both years, time spent on general medical service duties increased significantly (40.5 h in 1990 v 42.5 h [corrected] in 1991; p = 0.033), mainly due to more time being spent in clinics. Significantly more patients were being seen in clinics (9 v 14; p = 0.001); the average time spent per patient remained at about 8 1/2 minutes during surgeries and 16 minutes for a home visit, and rose from 13 to 14 minutes for patients seen in clinics. The time spent on practice administration fell but not significantly. CONCLUSION: Since the new contract there has been a significant increase in general medical services work, mainly due to more patients being seen in clinics, with no reduction in the time spent per patient.

Contract Services↗
PubMed1997

A sentinel network of general practitioners for epidemiologic surveillance in Italy.

A Computer Network of General Practitioners (GP's) has been established connecting 110 general practitioners representing a statistically selected national sample, homogeneously distributed all over Italy. The purpose of the network is to increase the epidemiologic surveillance on the health status of the Italian community, to collect useful data on the routine activity of the GP's, to promote computer use among them, and to organize some "ad hoc" investigations on specific subjects (case-control studies). To this purpose, a specific software was developed both to meet the requirements of epidemiological research and to manage general practitioners' clinical files. A working prototype of health card using micro-computer technology is also being experimented on a subset of the GP's.

Computer Communication Networks↗
PubMed1992

Continuing medical education for general practitioners--a Northern Ireland plan.

Following the introduction of the 1990 contract for general practitioners and the new postgraduate education allowance, the Northern Ireland Continuing Medical Education Group, comprising the clinical tutors from four Belfast hospitals and members of the University department of general practice, was established to provide high quality co-ordinated continuing medical education for general practitioners. A questionnaire was sent to all general practitioners in Northern Ireland to find out their needs and preferences with regard to continuing education. The responses indicate the value of small group discussion as well as the traditional lecture and the important role of local hospital consultants in providing education. Therapeutics, recent advances in medicine and learning new skills are all desirable topics. The group intends to use this information in the provision of courses for general practitioners in the province.

Education, Medical, Continuing↗
PubMed2006

Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study.

BACKGROUND: To understand why treatment referral rates for ESRF are lower in Ireland than in other European countries, an investigation of factors influencing general practitioner referral of patients developing ESRF was conducted. METHOD: Randomly selected general practitioners (N = 51) were interviewed using 32 standardised written patient scenarios to elicit referral strategies. MAIN OUTCOME MEASURES: General practitioner referral levels and thresholds for patients developing end-stage renal disease; referral routes (nephrologist vs other physicians); influence of patient age, marital status and co-morbidity on referral. RESULTS: Referral levels varied widely with the full range of cases (0-32; median = 15) referred by different doctors after consideration of first laboratory results. Less than half (44%) of cases were referred to a nephrologist. Patient age (40 vs 70 years), marital status, co-morbidity (none vs rheumatoid arthritis) and general practitioner prior specialist renal training (yes or no) did not influence referral rates. Many patients were not referred to a specialist at creatinine levels of 129 micromol/l (47% not referred) or 250 micromol/l (45%). While all patients were referred at higher levels (350 and 480 micromol/l), referral to a nephrologist decreased in likelihood as scenarios became more complex; 28% at 129 micromol/l creatinine; 28% at 250 micromol/l; 18% at 350 micromol/l and 14% at 480 micromol/l. Referral levels and routes were not influenced by general practitioner age, sex or practice location. Most general practitioners had little current contact with chronic renal patients (mean number in practice = 0.7, s.d. = 1.3). CONCLUSION: The very divergent management patterns identified highlight the need for guidance to general practitioners on appropriate management of this serious condition.

Age Factors↗
PubMed1995

General practitioner's knowledge of when to refer deaths to a coroner.

BACKGROUND: In 1992 about 179,000 deaths were reported to coroners in England and Wales and these represented 32% of the total number of registered deaths. Many of these cases were referred to coroners by general practitioners who certify the vast majority of deaths which occur outside hospitals. The safeguards to society which are provided by the coroner system in England and Wales are undermined if doctors fail to recognize those deaths which should be reported for further investigation. AIM: A study was undertaken to assess the ability of general practitioners to recognize deaths which require referral to a coroner. METHOD-A postal questionnaire consisting of 12 fictitious case histories was sent to all 323 general practitioners in Sheffield and the senior staff of the local coroner's office (two coroner's officers and two deputy coroners). Ten of the case histories contained a clear indication for referral to the coroner. RESULTS: A total fo 196 general practitioners (61%) and all the coroner's office staff returned the questionnaire. General practitioners correctly identified whether or not referral was indicated, with reasons, in a mean of 8.5 cases (range 4-12). Only six general practitioners (3%) were correct in all 12 cases. All of the coroner's staff were correct in all cases. CONCLUSION: General practitioners may be failing to bring certain categories of cases to the attention of coroners because of misconceptions of ignorance of their medico-legal responsibilities. General practitioner education in this area, and a closer working relationship between general practitioners and coroners may improve the situation.

Cause of Death↗
PubMed1966

Psychiatric seminars for the general practitioner.

A program of case-centred seminars in psychiatry designed for general practitioners was begun in Ontario during 1965. It came into being as the result of the cooperative endeavour of the Ontario Chapter, College of General Practice, the Ontario Psychiatric Association and the Division of Postgraduate Medicine, University of Toronto. The program was conducted on a regional rather than on a centralized basis. No general practitioner had to travel more than 30 miles to his seminar, thus ensuring regular weekly attendance for an average of 12 weeks. The Ontario Chapter recruited the general practitioners, the Psychiatric Association selected appropriate regional psychiatrists, and the University gave a brief preliminary course for these psychiatrists. Nineteen separate groups were formed in 13 different Ontario cities, with an average total weekly attendance of 120. A review conference of participating psychiatrists and general practitioners, held in November 1965, developed plans for renewal and extension of the program for 1966. This approach seems especially appropriate for large geographic regions with scattered populations.

Education, Medical, Continuing↗
PubMed1995

Attitudes of Dutch general practitioners and nursing home physicians to active voluntary euthanasia and physician-assisted suicide.

OBJECTIVE: To gain insight into the attitudes of Dutch general practitioners and nursing home physicians to voluntary active euthanasia and physician-assisted suicide. DESIGN: Descriptive study. METHOD: Data were collected by means of anonymous postal questionnaires to be completed by a random sample of 521 general practitioners from the province of North Holland, 521 general practitioners from the rest of the Netherlands, and 713 Dutch nursing home physicians who were members of the Dutch Association of Nursing Home Physicians. RESULTS: The written responses of general practitioners and nursing home physicians to six statements about voluntary active euthanasia and physician-assisted suicide showed that a large majority had a fairly positive attitude to euthanasia and suicide. This finding also emerged from the scores obtained on a scale compiled on the basis of the statements. General practitioners and nursing home physicians were more opposed to euthanasia and physician-assisted suicide if they had never performed it, if they belonged to a religious group, or if they were older. CONCLUSION: Dutch general practitioners and nursing home physicians have a fairly positive attitude toward euthanasia and physician-assisted suicide. However, the majority of these physicians favor a policy of voluntary active euthanasia and physician-assisted suicide under strict conditions.

Age Factors↗
PubMed1994

Provision of obstetric care by general practitioners in the south western region of England.

BACKGROUND: Recent government reports have suggested changes to the organization of maternity care in the United Kingdom which may well affect the contribution of general practitioners. AIM: This study set out to document the range of obstetric care provided by general practitioners, their perceived competence at various obstetric procedures, and their beliefs about their role in maternity care. METHOD: A postal questionnaire was sent to a random one in four sample of general practitioners in the South Western Regional Health Authority of England. RESULTS: Of 424 questionnaires sent out, 333 (79%) were returned. Of 303 respondents, 98% provided both antenatal and postnatal care. Of 294 respondents, 45% provided intrapartum care and 27% booked women for home deliveries. Of 117 respondents providing hospital intrapartum care 47% booked 10 or fewer women each year, and most provided little practical intrapartum care. Compared with those providing only antenatal and postnatal care, those who provided intrapartum care believed themselves to be more competent at various obstetric procedures and their perceived competence was significantly correlated to the number of procedures that they performed. Those general practitioners providing intrapartum care made significantly more postnatal visits than those providing only antenatal/postnatal care and were significantly more likely to believe that general practitioners have an important role in labour. CONCLUSION: Many general practitioners in the south western region of England still provide a choice in maternity care for women, and believe that they have an important role in such care. Further work is required to establish what women and their general practitioners believe the latter contribute to maternity care.

Adult↗
PubMed1994

The role of the general practitioner hospital in inpatient care.

The rationale of the general practitioner hospital continues to be questioned. A study of the services and case-mix of two of the four remaining general practitioner hospitals in Northern Ireland was undertaken to determine whether the nature and cost of inpatient care in these hospitals was comparable to the available alternatives. The case-notes of all non-maternity admissions (n = 509) were reviewed. The two hospitals provide acute medical care for a wide range of patients. The majority of patients appeared to require hospitalisation. It is likely that the beds at the two hospitals were mainly a substitute for district general hospital care. The general practitioner hospitals were estimated to be less costly than alternative forms of care, although it was doubtful whether they fulfilled all the structural criteria of quality generally regarded as important for hospitals of this type.

Family Practice↗
PubMed1996

Screening for colorectal cancer: a survey of New Zealand general practitioners.

AIM: To determine the attitudes and reported behaviours of New Zealand general practitioners concerning colorectal cancer screening and diagnosis with special consideration of the use of faecal occult blood tests. METHOD: A postal survey of a random sample of 400 New Zealand general practitioners. RESULTS: The response rate to the survey was 63%. Most of the respondents did not support a screening programme for average risk patients but did support screening in high risk groups. General practitioners favoured a screening programme offered by themselves rather than a centrally organised screening programme. A majority of respondents agreed that there was a lack of clear guidelines and a need for education regarding screening for bowel cancer. CONCLUSION: Guidelines for colorectal cancer screening are required for New Zealand general practitioners. There appears to be a need for medical education concerning screening for colorectal cancer in particular and screening and prevention in general.

Adult↗
PubMed1996

Randomised controlled trial of general practitioner versus usual medical care in an urban accident and emergency department: process, outcome, and comparative cost.

OBJECTIVE: To see whether care provided by general practitioners to non-emergency patients in an accident and emergency department differs significantly from care by usual accident and emergency staff in terms of process, outcome, and comparative cost. DESIGN: A randomised controlled trial. SETTING: A busy inner city hospital's accident and emergency department which employed three local general practitioners on a sessional basis. PATIENTS: All new attenders categorised by the triage system as "semiurgent" or "delay acceptable." 66% of all attenders were eligible for inclusion. MAIN OUTCOME MEASURES: Numbers of patients undergoing investigation, referral, or prescription; types of disposal; consultation satisfaction scores; reattendance to accident and emergency department within 30 days of index visit; health status at one month; comparative cost differences. RESULTS: 4684 patients participated. For semiurgent patients, by comparison with usual accident and emergency staff, general practitioners investigated fewer patients (relative difference 20%; 95% confidence interval 16% to 25%), referred to other hospital services less often (39%; 28% to 47%), admitted fewer patients (45%; 32% to 56%), and prescribed more often (41%; 30% to 54%). A similar trend was found for patients categorised as delay acceptable and (in a separate analysis) by presenting complaint category. 393 (17%) patients who had been seen by general practitioner staff reattended the department within 30 days of the index visit; 418 patients (18%) seen by accident and emergency staff similarly reattended, 435 patients (72% of those eligible) completed the consultation satisfaction questionnaire and 258 (59% of those eligible) provided health status information one month after consultation. There were no differences between patients managed by general practitioners and those managed by usual staff regarding consultation satisfaction questionnaire scores or health status. For all patients seen by general practitioners during the study, estimated marginal and total savings were Ir1427 pounds and Ir117,005 pounds respectively. CONCLUSION: General practitioners working as an integral part of an accident and emergency department manage non-emergency accident and emergency attenders safely and use fewer resources than do usual accident and emergency staff.

Adult↗
PubMed1992

Communication between general practitioners and consultants: what should their letters contain?

OBJECTIVE: To canvass the views of all general practitioners and consultants working in Newcastle upon Tyne on the content of referral letters and replies, the feasibility of standardising certain aspects of referral letters, and the use of communications data for audit purposes. DESIGN: A postal questionnaire was sent to all general practitioners and consultants in Newcastle upon Tyne in May 1991. Questions were asked about the clinical and administrative content of letters, the utility of standard categories to state the reason for referral, the idea of using letters for feedback purposes, and communications as a potential topic for professionally led audit. SETTING: Area served by Newcastle upon Tyne Family Health Services Authority and District Health Authority. RESULTS: Replies were received from 274 (77%) doctors (115 general practitioners and 159 consultants). A majority (225; 82%) were in favour of items defined as "always important" forming a minimum requirement for referral letters and for consultants' replies. Using standardised categories to state the reason for referral was not endorsed: 102 (89%) general practitioners and 132 (83%) consultants preferred referrers to use their own words. Using referral communications to provide feedback was less popular with consultants (54; 34%) than general practitioners (72; 63%). Finally, a majority of doctors (179; 65%) were in favour of using written communications as a topic for professionally led audit. CONCLUSIONS: A high degree of consensus exists among clinicians about the content of referral communications. Although doctors may still reject the concept of standardised communications, they have unambiguously endorsed a standard for communication that they can aspire to, and they are prepared to use it as a yardstick for their actual performance.

Communication↗