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PubMed2003

[The Dutch College of General Practitioners' practice guideline 'Diagnosis of breast cancer': reaction from the field of general practice].

In the revised practice guideline on the diagnosis of breast cancer, the general practitioner has an important role when, during screening, a woman is found to have an abnormality, before, during and after treatment. Breast clinics allow the situation to be dealt with rapidly, but patients also need time to cope with it all. In young women with breast complaints, but without palpable abnormalities, the practice guideline recommends mammography to be on the safe side. However, in a group with a low prevalence, this carries primarily disadvantages; the patient does need to be properly followed. The policy for patients with a positive family history of breast cancer has been clearly worded.

Female↗
PubMedDate not supplied

Make your small practice thrive. Physicians moving from big practices to small must know the business side of medicine.

Trying to gain a measure of control over their working lives, some physicians are abandoning large group practices for smaller groups. Large groups enjoy whole teams of people performing vital business tasks. Small practices rely on one or two key physicians and managers to tackle everything from customer service to marketing, medical records to human resources. Learn valuable tips for thriving in a small environment and using that extra control to achieve job satisfaction.

Benchmarking↗
PubMed1992

Hypertension in family practice. A study of knowledge, attitudes and practices.

A study was conducted in Cape Town during 1990 to investigate the knowledge, attitudes and practices of 90 family practitioners with regard to hypertension and its management. Hypertension was regarded as an important health problem by 59% while 5% thought that it was not important. Sixty-eight per cent of family practitioners estimated that less than 15% of their patients suffered from hypertension and 78% of family practitioners estimated that more than 70% of their hypertensive patients' blood pressures were controlled. Fifty-five per cent of family practitioners thought it acceptable for a lay person to measure blood pressure and 68% felt that the use of a hypertension register in the practice would assist in the management of hypertension. The information gathered will be of great value in planning intervention strategies and developing hypertension management aids that could assist the family practitioner.

Clinical Competence↗
PubMedDate not supplied

Branding your practice: twelve practical steps to creating lifelong patient relationships.

The concept of branding is not limited to large companies. It can be successfully applied in medical practices to those individuals or groups that wish to establish a distinct identity in the marketplace. Branding a medical practice establishes a competitive advantage, ensures a more predictable flow of patients, and ultimately enhances patient satisfaction. This article conceptualizes the branding process and provides guidelines for implementation that are applicable to a variety of budgets.

Advertising↗
PubMed2005

The deltoid intramuscular injection site in the adult. Current practice among general practitioners and practice nurses.

A survey of 50 general practitioners and 50 practice nurses reviewed current practice in relation to intramuscular injections in the deltoid region of adults. The great majority of practitioners used the site for the intramuscular injection of vaccines and a wide range of other medications. The injection techniques employed by the two groups were similar. The great majority of respondents used either the middle one third or the upper half of the muscle. A significant minority of both groups used inappropriate depths of injection. Awareness of the structures which are at risk from injections in the region was poor in both groups. There is an urgent need to establish reliable protocols for the administration of safe, effective intramuscular injections at the deltoid site and to train practitioners in their use.

Humans↗
PubMed2005

[Does evidence lead to a change in clinical practice? Danish anaesthetists' and nurse anesthetists' clinical practice and knowledge of postoperative residual curarization].

BACKGROUND: Recent studies have shown a high incidence of postoperative residual curarization (PORC). The reason for this is unclear. The purpose of this study was to evaluate whether the methods used by Danish anaesthetists to exclude PORC are evidence-based and, if they are not, to determine the reasons why. METHODS: 251 anaesthetists (nurses and physicians) from eight different hospital anaesthetic departments completed a questionnaire concerning their knowledge about and clinical practice of residual curarization. RESULTS: All of the 251 participants filled in the questionnaire. 91% underestimated the incidence of PORC after the administration of intermediate-acting muscle relaxants, and 27% incorrectly believed that it is always possible to exclude PORC using clinical tests. Only 45% knew that the train-of-four ratio must exceed 0.9 to exclude residual curarization, and only 25% knew that clinically significant residual curarization cannot be excluded by tactile/visual evaluation of the response to train-of-four nerve stimulation. 91% had access to a nerve stimulator, 85% with the option of objective monitoring. 13% used a nerve stimulator seldom or never. The overall attitude toward using nerve stimulators was positive. CONCLUSION: The results indicate that Danish anaesthetists" clinical practice regarding residual curarization is often not evidence-based. The reason for this seems to be a lack of knowledge, rather than lack of resources and/or a negative attitude toward neuromuscular monitoring.

Anesthesia Recovery Period↗
PubMed1991

Sampling endocervical cells on cervical smears: a comparison of two instruments used in general practice. Cumbrian Practice Research Group.

The Aylesbury spatula and a newer plastic device, the Cervex sampler (Steriseal), have been compared in a prospective study, to assess their ability to obtain endocervical cells on cervical smears taken in general practice. Twelve general practitioners in Cumbria took part in the study each taking equal numbers of smears from women with the Aylesbury spatula and the Cervex sampler. On average each practice took 20 smears with each instrument. All women attending for cervical smears for whatever reason were included in the study. Endocervical cells were reported in 62.8% of smears taken with the Aylesbury spatula and in 78.2% taken with the Cervex sampler (odds ratio 1.24, 95% confidence interval 1.10 to 1.41). Increasing the percentage of smears which contain endocervical cells by using the Cervex sampler would reduce the number of repeat tests needed. This would cut down anxiety and inconvenience for the patient, and reduce costs for the health service.

Cervix Uteri↗
PubMed1991

[Coworkers in focus. An analysis of video recordings from receptions in general practice--a method of self evaluation of the coworker and for future development of cooperative forms in general practice].

The article describes a simple method for self-assessment and group-assessment of video recordings from the reception area in a general practice. In a group setting, the method was found to increase the receptionists' confidence in their own professional skills and revealed the need to pay more attention to communication between patients and receptionists. The layout of the reception area was rearranged and changes in the daily routines in the practice were suggested.

Communication↗
PubMed1989

[Diagnostic activity in general practice. 1. Patients' contact patterns in rural and urban general practices].

Contact with patients was described retrospectively for a period of five years by means of careful notes from the case records in five general practices in urban and rural areas chosen at random as a representative spot test. A total of 968 persons in group 1 of the Danish National Health Insurance (98-99% of the population), 485 men and 483 women or 9.7% of the group 1 insured persons over the age of 30 years had 10,410 consultations. This corresponds to 2.15 consultations per annum for persons in group 1 insurance. 91% of the patients visited the consultation. 17% of all the patient, twice as many women as men, were responsible for 50% of all the consultations. Women had 45% more consultations than men. Women in the age group 35-54 years constituted the group where most persons of the group visited general practice and this group had also the greatest total number of consultations, viz 30% of the total. Significantly more women than men had many consultations in this age group while significantly more men than women had only few consultations in the age group between 35-44 years. Expressed in percentages, the age group 55-64 years showed greatest similarity between men and women. Half of the men and slightly more than one third of all the women consulted their practitioners once per annum or more rarely. Patients of 75 years or over consulted their general practitioners most frequently.

Adult↗
PubMed1983

Clinical practice plans in family practice residency programs.

This paper examines clinical practice plans (CPPs), systems for remunerating physician faculty based on their clinical productivity, in family practice residency programs. A stratified random sample of residency directors responded to a CPP survey. CPPs were found significantly more frequently in residencies (usually operated by universities) either with CPPs in their parent institutions or with high patient volume. Residencies operated by community hospitals were more likely to distribute CPP benefits to faculty based on individual clinical activity, whereas residencies operated by universities were more likely to distribute equal benefits to all faculty or to include academic as well as clinical activities in the benefit determination. While most residency directors felt that CPPs brought financial benefits to a residency and to individual faculty, many directors who did not have CPPs feared that such a plan would create conflicts between patient care and teaching. A case report tracing the evolution of a CPP in one university-administered residency is presented.

Faculty, Medical↗
PubMed1980

Research policies and practices in family practice residencies.

A questionnaire survey of all US family practice residency programs was undertaken to gather information pertaining to the policies and practices of resident research projects. Eight-one percent of the programs responded. The majority of the programs which responded require or encourage research by their residents. Cross-tabulations of the data relate several characteristics of residency programs to their positions on resident research. University based or affiliated/administered programs, programs with fewer residents and larger faculties, and programs in the faculty are engaged in research tend to encourage or require research by residents although these findings are not consistent. Information is also presented pertaining to financing resident research, preparing residents for conducting research, and disseminating the results of residents' projects.

Faculty, Medical↗
PubMed1995

General practice training in the Oxford region. Ideas for community teaching practices.

Vocational training for general practice in Great Britain developed in local medical communities, often separate from undergraduate teaching associated with universities. Courses for skill development in teaching, support in the form of local trainers' groups, and peer assessment through practice assessment visits have contributed to the success of this model. The experience in the Oxford region can contribute to successful development of community teaching in Canada.

Community Medicine↗
PubMed1994

Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Standards of Practice Committee of the American Sleep Disorders Association.

The general public and the medical community have become increasingly aware of the prevalence of, and morbidity and mortality associated with, obstructive sleep apnea (OSA). This knowledge, recent technologic advances, and other issues have led to an increase in the use of portable recording devices intended to diagnose OSA. The American Sleep Disorders Association's Standards of Practice Committee has developed these practice parameters to guide the clinician in the appropriate use of these portable recording devices.

Adult↗
PubMed1994

[Information for quality assurance and self-evaluation in general practice. Use of data from the EDP medical records in general practice].

A project was carried out to study the usefulness of ordinary data from computer-based journals for comparing practices. 20 general practitioners from four municipalities participated for four months in 1992. The computer-based journal provides accurate information on the number and kind of contacts with patients, and on who visits the general practitioner. It also tells what is done at each contact, such as a referral, prescription or laboratory tests. Using the International Classification of Primary Care (ICPC) even the most common diagnoses do not account for more than 3% of the consultations. The practice of the different doctors varies considerably as regards classifying consultations on a symptom level (ICPC 1-29) or a diagnosis level (ICPC 70-99). The results brought to light marked differences with regard to what general practitioners do, and what kind of problems their patients present. The patient populations differed to a lesser degree with respect to sex, age and social status. The findings provided an interesting and useful platform for group discussions among the participating doctors.

Drug Utilization↗
PubMed1993

Does family practice at residency teaching sites reflect community practice?

BACKGROUND: Family medicine has aspired to train residents and conduct research in settings that closely resemble community practice. The purpose of this study was to compare the patient characteristics of the ambulatory teaching centers of a consortium of seven community-based university-affiliated family practice residency programs in northeast Ohio with the National Ambulatory Medical Care Survey (NAMCS) results for family physicians (FPs) and general practitioners (GPs). METHODS: Ninety-eight faculty and resident physicians at the residency training site of the Northeastern Ohio Universities College of Medicine collected data on all ambulatory patient visits (N = 1498) for one randomly chosen week between July 1, 1991, and June 30, 1992. We compared these data with patient visits reported in the 1990 NAMCS for FPs and GPs. RESULTS: The residency training sites saw slightly more children, women, blacks, and Medicare and Medicaid patients. The most common reason for an office visit in both populations was an undifferentiated symptom. Fifteen of the top 20 "reason for visit" codes were identical, as were 14 of the top 20 diagnoses. More preventive and therapeutic services were offered or performed at our residency training sites but fewer diagnostic services were performed. There were fewer consultations requested at our residency training sites but similar hospitalization rates for patients. The mean duration of visit differed by only 1 minute. CONCLUSIONS: The residency training sites of the Northeastern Ohio Universities College of Medicine provide patient care opportunities similar to those found in a national survey of family and general practitioners.

Adolescent↗
PubMed1993

Dementia in general practice: the practical consequences of a more positive approach to diagnosis.

General practitioners are often reluctant to administer brief cognitive tests, and to question the relatives of patients who appear to be demented, for fear of causing distress. Diagnoses of dementia are therefore often based on guesswork, and non-demented patients may be rated as cognitively impaired in error. A randomly selected sample of 174 general practice patients aged 80 years and over were asked to complete a simple test of orientation and information in order to assess the usefulness and acceptability of such a procedure. If patients scored 10 points or less out of 12, a relative or other knowledgeable informant was questioned about their changes in mental state and behaviour. Assessments proved acceptable to patients, relatives and doctors; diagnoses were revised in 29 cases; and practical initiatives were proposed in 15 cases. Open discussions with patients and their families proved innocuous and have much to commend them.

Aged↗
PubMed1996

[Patients' attitudes towards and satisfaction with interns in general practice. Practicing interns and patient satisfaction].

The aim of this study was to evaluate the Danish vocational training scheme from a patient's point of view. This was especially interesting as all young doctors have six months vocational training in general practice after finishing university. During April 1993 junior doctors in twelve general practices in the county of Aarhus, Denmark, distributed a total of 574 questionnaires to consecutive patients after a consultation. The questionnaire was anonymously returned to the research unit. Four hundred and five patients answered the questionnaire. Ninety-three percent were fairly or very satisfied with the consultation, and 87% were sure or fairly sure that they would attend a trainee again. Eighty-five percent said that the trainee was as easy to communicate with as their own doctor. However, 36% said that attending a trainee was their only chance of seeing a doctor on the day preferred, and 47% did not feel fully informed about the trainee system. The data was analyzed with respect to sex, age, and disease related factors, and only minor differences were found. The survey shows that Danish patients were very positive about the GP trainee system, especially compared to previous investigations from other countries. However patients were not sufficiently informed about the aim and contents of the trainee system.

Attitude↗
PubMed1997

Clinical and psychopharmacologic practice patterns of psychiatrists in routine practice.

As part of the American Psychiatric Association's national Practice Research Network (PRN), this pilot study tested a data collection instrument designed to systematically characterize the sociodemographic and diagnostic characteristics of psychiatric patients and the specific treatments they received, including specific psychopharmacologic medications. Ninety-five percent of the PRN members (148 of 156 psychiatrists), who practice in a broad range of settings, completed a 21-page data collection instrument that generated detailed diagnostic, clinical, and treatment data on 290 psychiatric patients. Mood disorders constituted the most common principal DSM-IV diagnostic category, affecting 53 percent of the patients in this pilot study. The majority of patients had significant psychiatric and general medical co-occurring conditions; 20 percent of the patients had at least three DSM-IV Axis I mental disorders. Ninety percent of all patients in the sample received at least one psychopharmacologic medication, with each patient, on average, receiving 1.8 (SD = 1.2). After adjustment for patients' diagnostic and clinical characteristics, the mean number of medications prescribed per patient in this pilot study sample did not vary by health plan type or payment source. However, the combinations of treatments provided by psychiatrists (i.e., psychotherapy and medications) did vary by health plan type and payment source.

Adult↗