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At least 613 records · Page 34Linked to original sources
PubMed1997

General practitioner participation in 'Morning Report' at a major teaching hospital.

General practitioners attending 'Morning Report' have provided information on the general practice management of a wide range of conditions and have promoted the benefits of improved communication between general practitioners and hospital doctors. By collecting data on a range of problems at the community hospital interface, they are in a position to identify and act upon issues with important implications for health care. This activity is recommended to all general practitioners working in association with a major hospital.

Humans↗
PubMed2004

An investigation into general practitioners associated with high patient mortality flagged up through the Shipman inquiry: retrospective analysis of routine data.

OBJECTIVE: To identify a credible explanation for the excessively high mortality associated with general practitioners who were flagged up by the Shipman inquiry. DESIGN: Retrospective analysis of routine data. SETTING: Primary care. PARTICIPANTS: Two general practitioners in the West Midlands who were associated with an unacceptably high mortality of patients during 1993-2000. MAIN OUTCOME MEASURES: Observed and expected number of deaths and deaths in nursing homes. RESULTS: Preliminary discussions with the general practitioners highlighted deaths in nursing homes as a possible explanatory factor. No relation was found between the expected number of deaths and deaths in nursing homes in each year during 1993-2000 for either general practitioner. In contrast, the magnitude and shape of the curves of a cumulative sum plot for excess number of deaths (observed minus expected) in each year were closely mirrored by the magnitude and shape of the curves of the number of patients dying in nursing homes; and this was reflected in the high correlations (R2 = 0.87 and 0.89) between excess mortality and the number of deaths in nursing homes in each year for the general practitioners. These findings were supported by administrative data. CONCLUSIONS: The excessively high mortality associated with two general practitioners was credibly explained by a nursing home effect. General practitioners associated with high patient mortality, albeit after sophisticated statistical analysis, should not be labelled as having poor performance but instead should be considered as a signal meriting scientific investigation.

Cause of Death↗
PubMed2000

Inequitable distribution of general practitioners in Australia: analysis by state and territory using census data.

The objective of this study was to describe the distribution of general practitioners in each State and Territory, stratified by statistical division and adjusted for estimated community need. The location of general practitioners was obtained from the 1996 Census of Population and Housing. Community need was estimated from crude death rates supplied by the Australian Bureau of Statistics. On average there are 920 people per full-time general practitioner in Australia. Three States are relatively oversupplied by up to 5% (Australian Capital Territory) and the rest are relatively undersupplied by up to 12% (Western Australia). Adjusted for estimated need, the Australian Capital Territory is oversupplied by 71% compared with all of Australia, while Western Australia is undersupplied by 15%. More marked differences occur within the States, with the statistical division containing each capital city in each State that is relatively overserved. The greatest oversupply is in Sydney, where 33% fewer people share a full-time general practitioner than the whole of New South Wales (adjusted for need, oversupply in Sydney is 63%). Relative undersupply is greatest in Queensland, with 133% more people sharing each general practitioner in the north-west statistical division compared with the whole State. The distribution of general practitioners between and within States and Territories is unequal and inequitable. In each State, capital cities tend to be relatively oversupplied compared with more rural areas. While these data do not inform the absolute level of service needed in a community; they do suggest that strategies to redress the inequitable distribution are required.

Australia↗
PubMed1990

Professional relationships between general practitioners and pharmacists in health centres.

The inclusion of pharmacies in health centres has created opportunities for general practitioners to become better acquainted with the potential contribution of pharmacists to health care. A qualitative study has been made to explore the extent to which this potential has been realized. Ten health centres with an integral pharmacy were selected, one from each of the regional health authorities in England which had at least one such health centre. Interviews were conducted with 13 general practitioners and 10 pharmacists working in the health centres. Nine general practitioners working in health centres without pharmacies and 10 community pharmacists were also interviewed. General practitioners' attitudes towards health centre pharmacists appeared to differ markedly from the attitudes of colleagues working in relative isolation from pharmacists. It appears that general practitioners working closely with the pharmacist develop a collaborative approach to health care.

Ambulatory Care Facilities↗
PubMed2003

General practitioners' diagnostic skills and referral practices in managing patients with drug and alcohol-related health problems: implications for medical training and education programmes.

The aim of this study was to determine the current practices of established general practitioners in managing patients with drug and alcohol-related problems and identify gaps in training. A random sample of general practitioners completed a survey assessing diagnostic skills and referral practices concerning alcohol and illicit drug use in general practices in February 1999, comprising 110 general practitioners registered with the Central Sydney Division of General Practice. The main outcome measures were competent skills and knowledge, willingness to treat. The majority (96%) of GPs provided clinically appropriate responses for at least one drug category, although none received this rating for all six. Most general practitioners reported that they were unwilling to treat heroin and cocaine problems themselves but expressed willingness to refer patients appropriately. More than a quarter of general practitioners were unaware of the safe drinking levels for men and women or the appropriate treatment for patients consuming above such levels. Age, years in practice, type of practice, willingness to obtain drug use histories and post-graduate training were all significantly associated with general practitioners' willingness to treat and competence in managing drug and alcohol-related problems. In this study, general practioners reported low levels of skills and referrals for treatment of illicit drug use and suboptimal skills in the management of alcohol problems. The results suggest that a more comprehensive approach to education and training is required to bring about a change in practice behaviour. [Fucito LM, Gomes BS, Murnion B, Haber PS. General practitioners' diagnostic skills and referral practices in managing patients with drug and alcohol-related health problems: implications for medical training and education programmes.

Adult↗
PubMed1990

[General practitioners' training in psychiatry and prescription of psychotropic drugs. 1. Education, attitudes and extent of prescribing].

The object of this investigation was to describe prescription of psychotropic drugs by general practitioners in relation to their training and attitudes to employment of psychotropic drugs in the treatment of psychosocial conflicts. The investigation was carried out as a multicentre questionnaire investigation in the County of Aarhus in which 192 (89%) out of 215 general practitioners who were invited participated. In brief and prolonged psychosocial conflicts, 58 (31%) and 149 (81%), respectively, considered that prescription of psychotropic drugs constituted poor treatment. More than half of the general practitioners found that the amounts of psychotropic drugs prescribed by themselves and other general practitioners were excessive and that they were, themselves, responsible for this. The majority of the general practitioners found that their attitudes were of great significance for their prescriptions of psychotropic drugs and 71 out of 191 practitioners (37%) found that the pressure of work usually or frequently influenced this. A total of 107 (56%) had had appointments in psychiatric departments (average duration six months) prior to establishment as general practitioners. A total of 117 (61%) had received some form of postgraduate psychiatric training after establishment as general practitioners while 29 (20%) had not received any form of psychiatric training or postgraduate psychiatric education. No connection could be demonstrated between psychiatric training and the extent of prescription of psychotropic drugs.

Attitude of Health Personnel↗
PubMed1991

General practitioner referrals to specialists.

A survey of referrals by general practitioners to medical specialists was carried out to determine current referral patterns, and to compare them with two earlier Australian studies. The mean referral rate was 6 per cent of all consultations, with the four most frequent specialty groups referred to being proceduralists. A comparison with two previous Australian surveys reveals minimal change in general practitioner referral patterns in 18 years. The need to study the appropriateness of general practitioner referrals further is stressed.

Australia↗
PubMed1998

The impact on general practitioners of the changing balance of care for elderly people living in institutions.

OBJECTIVES: To describe utilisation of general practitioners by elderly people resident in communal establishments; to examine variations in general practitioner utilisation and estimate the likely impact of the "downsizing" of long stay provision in NHS hospitals. DESIGN: Secondary analyses of the survey of disability among adults in communal establishments conducted by the Office of Population Censuses and Surveys in 1986, and projection to present day. SETTING: Nationally representative sample of communal establishments in Great Britain. SUBJECTS: Disabled residents aged 65 or more without mental handicap. RESULTS: Residents with higher levels of disability, disorders of the digestive system, resident in smaller local authority homes or larger voluntary residential homes were more likely to consult a general practitioner. For those who consulted, higher levels of disability and morbidity and residence in a private nursing home or a larger private residential home were all associated with greater general practitioner utilisation. Overall, when residents' characteristics and size of home was controlled for, residents in nursing homes had greater predicted utilisation than those in residential care homes. People who would previously have been cared for in NHS hospitals and are now cared for in nursing homes have high predicted utilisation due to their greater morbidity and disability. CONCLUSION: The "downsizing" of NHS provision for elderly people has increased demand on general practitioners by 160 whole time equivalents per year in Britain.

Aged↗
PubMed2001

Determinants of general practitioner use among women in Australia.

This study investigates the use of general practitioner services by women in Australia. Although there is a universal health insurance system (Medicare) in Australia, there are variations in access to services and out of pocket costs for services. Survey data from 2350 mid-age (45-50 years) and 2102 older (70-75 years) women participating in the Australian Longitudinal Study on Women's Health were linked with Medicare data to provide a range of individual and contextual variables hypothesised to explain general practitioner use. Structural equation modelling showed that physical health was the most powerful explanatory factor of general practitioner use. However, after adjusting for self-reported health, out of pocket cost per consultation was inversely associated with use of services. The out of pocket cost was generally lower for women with low socioeconomic status but cost was also directly related to geographical remoteness. Women living in more remote areas had higher out of pocket costs and poorer access to services. Women who reported better access to care were more likely to be satisfied with their most recent general practice consultation and less likely to be sceptical of the value of medical care. These results show the need for health policies that improve the equitable use of general practitioner services in Australia.

Aged↗
PubMed1995

Information on drug use in the elderly: a comparison of pharmacy, general-practitioner and patient data.

Management of pharmacotherapy by the pharmacist and the general practitioner can be a difficult task in elderly patients in whom there is a high concomitant, long-term drug use. Adequate information on drug use is essential in managing pharmacotherapy as well as in an accurate assessment of drug exposure in pharmacoepidemiologic studies. In this study data from computerized pharmacy records, general-practitioner registries and home interviews with 100 elderly patients were compared. Pharmacy records contained 80% of all the prescriptions found at the home interviews, while in general-practitioner data 40% could be traced. Use of drugs dispensed long ago reduced the validity of pharmacy and general-practitioner data. Data on analgesics (70% was found) and respiratory drugs (68%) were less traceable compared to cardiovascular (83%) and psychotropic drugs (81%). Automated pharmacy records are an important source of longitudinal data on drug use and will improve the assessment of drug exposure in pharmacoepidemiologic studies and optimize pharmaceutical care.

Aged↗
PubMed1987

Ethics and the pharmaceutical industry: some ideas for general practitioners.

This paper summarizes a report by a working party of the Royal College of Physicians on the relationship between physicians and the pharmaceutical industry. As a member of that working party, and a general practitioner, I have taken the report's points and widened the discussion to involve general practitioners in their relationship with the pharmaceutical industry. At present there are no guidelines specifically for general practitioners. Some of the problems general practitioners have found in their relationship with the pharmaceutical industry are described and some guidelines for general practitioners are suggested, which form a framework for discussion. The College would welcome feedback about the guidelines to help in the drawing up of a code of practice for general practitioners.

Drug Industry↗
PubMed1990

Do general practitioners and health visitors like 'parent held' child health records?

The study examines the reactions of general practitioners and health visitors to parents holding the main record of their own child's health and development. From 1986 the parents in part of the Oxfordshire district were given their child's records while in the other part of the health district the records remained with the clinic. The responses to questionnaires sent out to all general practitioners and health visitors in the two areas were analysed and compared. The results show that over 90% of the general practitioners and health visitors with experience of parent held records are in favour of them, wish to continue to use them, find them to be available in the clinic and are able to use them at other times. By comparison only 59% of those general practitioners who had no experience of parent held records are in favour of such a scheme. In general this latter group show greater concern in almost all areas investigated. Thus general practitioners' and health visitors' experience of the record suggests that it is not only workable but actually desirable.

Adult↗
PubMed1989

The general practitioner and human immunodeficiency virus infection: an insight into patients' attitudes.

In a study of 100 patients with the acquired immune deficiency syndrome (AIDS), 77% were registered with a general practitioner and a further 14% wished to register. Of those 77 who were registered with a general practitioner, only 47 doctors knew their diagnosis; 19 of the 77 did not want their general practitioner to know. Of this small group of 19, a proportion would visit their general practitioner with symptoms, some of which may be related to AIDS. The main difficulty for patients in telling a general practitioner about their illness was a perceived lack of confidentiality and lack of sympathy. Patients valued understanding and expertise as most important in a general practitioner. This study provides an analysis of why general practice is not seen as a significant resource for many patients with AIDS in the London area and suggests some initiatives to enhance the appropriate use of primary care services.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Measuring general practitioner referrals: patient, workload and list size effects.

Individual general practitioners are known to vary widely in the number of patients they refer to hospital outpatient departments; indeed there is increasing concern that the 'high' referrers use a disproportionate quantity of National Health Service resources. Data from a one-week survey of referrals by 122 general practitioners in one health district showed that a different age-sex mix of patients consulting individual general practitioners might account for about one quarter of his or her referrals. The results also showed that different referral rates, calculated by using either workload or list size denominators, identified markedly different groups of high referrers. These different methods of measurement are discussed, and on practical grounds a referral rate based on actual referrals divided by mean practice list size is suggested for future comparisons.

Data Collection↗
PubMed1997

General practitioner knowledge of prohibited substances in sport.

OBJECTIVES: To assess general practitioner knowledge of banned substances in sport. METHODS: Postal questionnaire sent to all general practitioners in West Sussex. RESULTS: Only 55 (35%) of those who responded (157 in total) were aware that guidelines are to be found in the British National Formulary, and 19 (12%) of respondents believed that medical practitioners are allowed to prescribe anabolic steroids for non-medical reasons. CONCLUSIONS: General practitioner knowledge of which substances are prohibited in sports is poor. There is a lack of awareness of Sports Council guidelines which are to be found in the British National Formulary. Tackling drug abuse in sport requires education of both athletes and doctors.

Doping in Sports↗
PubMed1988

Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption.

OBJECTIVE: To determine effectiveness of advice from general practitioners to heavy drinkers to reduce their excessive alcohol consumption (35 U or more a week for men, 21 U or more for women). DESIGN: Randomised, controlled double blind trial over 12 months with interim assessment at six months. SETTING: Group practices (n = 47; list size averaging 10,000) recruited from Medical Research Council's general practice research framework, mostly in rural or small urban settings. PATIENTS: Patients recruited after questionnaire survey. Of total of 2571 (61.2%) of 4203 patients invited for interview who attended, 909 (35.4%) stated that in past seven days they had drunk above the limits set for study and had not received advice; they were randomised to control and treatment groups. INTERVENTIONS: Patients in treatment group were interviewed by general practitioner (who had had a training session) and received advice and information about how to reduce consumption and also given a drinking diary. END POINT: Study aimed at detecting a reduction in proportion of men with excessive alcohol consumption of 30% in treatment group and 20% in control group (for women 40% and 20%, respectively) with a power of 90% at 5% level of significance. In addition, corroborative measures such as estimation of gamma-glutamyltransferase activity were included. MEASUREMENTS AND MAIN RESULTS: At one year a mean reduction in consumption of alcohol of 18.2 (SE 1.5) U/week had occurred in treated men compared with a reduction of 8.1 (1.6) U/week in controls (p less than 0.001). The proportion of men with excessive consumption at interview had dropped by 43.7% in the treatment group compared with 25.5% in controls (p less than 0.001). A mean reduction in weekly consumption of 11.5 (1.6) U occurred in treated women compared with 6.3 (2.0) U in controls (p less than 0.05), with proportionate reductions of excessive drinkers in treatment and control groups of 47.7% and 29.2% respectively. Reduction in consumption increased significantly with number of general practitioner interventions. At one year the mean value for gamma-glutamyltransferase activity had dropped significantly more in treated men (-2.4 (0.9)IU/l) than in controls (+1.1(1.0)IU/l; t = 2.7, p less than 0.01). Reduction in gamma-glutamyltransferase activity tended to increase with number of intervention sessions in men. Changes in gamma-glutamyltransferase activity in women and changes in other indicators in both sexes did not differ significantly between treatment and control groups. CONCLUSIONS: If the results of this study were applied to the United Kingdom intervention by general practitioners could each year reduce to moderate levels the alcohol consumption of some 250000 men and 67500 women who currently drink to excess. General practitioners and other members of the primary health care team should therefore be encouraged to include counselling about alcohol consumption in their preventive activities.

Adolescent↗
PubMed2002

Heart failure in primary care: qualitative study of current management and perceived obstacles to evidence-based diagnosis and management by general practitioners.

BACKGROUND: Chronic heart failure is a common clinical condition with high morbidity and mortality. Despite the evidence that appropriate treatment with angiotensin-converting enzyme inhibitors can improve morbidity, primary care studies show that patients with heart failure are incorrectly diagnosed and inadequately treated. AIM: To explore general practitioners' accounts of their management of patients with heart failure and identify the perceived obstacles to diagnosis and management. METHODS: We conducted this qualitative study using semi-structured interviews in 18 general practices. The practices were stratified on the basis of size, location, and the level of practice development. The interviews were based on a schedule of open questions based on the literature on diagnosis and management of patients with heart failure. Transcriptions of the audiotaped interviews were independently analysed by two researchers and analysis was based on open coding using a constant comparative approach. Categories were reduced to major themes. RESULTS: General practitioners suspect heart failure when patients present with breathlessness or ankle oedema. Many general practitioners reported that they would diagnose heart failure after respiratory examination and a positive finding of basal crepitations. Many general practitioners arrange a chest X-ray to establish the diagnosis and some arrange an electrocardiogram. A few general practitioners mentioned that they diagnosed heart failure with a trial of diuretics. Obstacles to diagnosis were mentioned by most general practitioners and included lack of facilities for appropriate investigations (especially echocardiography) and lack of time and expertise. Obstacles to management included lack of time, high cost of drugs, difficulty with diagnosis, selection bias towards younger patients and not having the confidence to initiate angiotensin-converting enzyme inhibitors. Many general practitioners were unaware of the impact angiotensin-converting enzyme inhibitors can have on morbidity and mortality. CONCLUSIONS: Although symptoms of heart failure are not sufficiently specific for diagnosing patients with heart failure, many general practitioners in European countries treat people with suspected heart failure on the basis of symptoms and signs alone. This study has identified many obstacles to the diagnosis and management of heart failure that may explain why patients are inadequately managed in primary care. Specific implementation strategies need to be tailored to overcome these obstacles.

Aged↗
PubMed1995

Social and sexual contact between general practitioners and patients in New Zealand: attitudes and prevalence.

BACKGROUND: Doctor-patient social and sexual contact is increasingly acknowledged as an issue of importance for the medical profession. However, there is little research concerning general practitioners on this topic. AIM: A study was undertaken to obtain data on social and sexual contact between general practitioners and their patients. METHOD: An anonymous questionnaire was mailed to a nationwide randomized sample of 217 general practitioners in New Zealand. RESULTS: A response rate of 86% was obtained. Dating and sexual contact with patients was considered to be sometimes or usually acceptable to 35% and 10% of general practitioners, respectively. Of respondents, 6% reported having dated a patient, 4% reported having had sexual contact with a patient at some point during their career and 2% reported having engaged in sexual contact with a former patient. General practitioners who had personally known of a colleague who had engaged in sexual contact with a patient were more likely to believe this behaviour had negative consequences than general practitioners who themselves reported having engaged in sexual contact with a patient. CONCLUSION: The study results have implications for developing behavioural guidelines and educational interventions for general practitioners.

Adult↗