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PubMed2004

Intrauterine contraception: the role of general practitioners in four Dutch general practices.

The intrauterine device (IUD) use in the Netherlands and the United States is limited to a small group of women, though the risk of infection and pregnancy is small. Therefore, it was of interest to investigate the characteristics of women who choose an IUD as contraceptive method and the influence of general practitioners concerning IUD insertion. The aim of this retrospective cohort study was to assess differences between general practices and to investigate the characteristics of IUD users. Also, we wished to study changes in IUD use with time. Patients were selected from four academic general practices belonging to the continuous morbidity registration project in Nijmegen, the Netherlands. The population under study included 461 women registered in the academic practices with a code for insertion of a new IUD in the period from 1981 to 2001. More than half of the women were between 25 and 34 years old at the time of insertion. Almost one quarter were nulliparous, one quarter unmarried and the distribution of socioeconomic status was the same as the entire practice population. General practitioners have clear preferences for certain types of IUD and, in particular, for not inserting an IUD in nulliparous women. In conclusion, married or cohabiting women, around 30 years of age, with children, are in the majority in receiving an IUD as contraception. General practitioners clearly follow their own opinions about inserting IUD in nulliparous women. Currently, general practitioners are prescribing more Multiload Cu 375 IUDs and levonorgestrel-releasing IUDs.

Adolescent↗
PubMed2005

Strengthening Medicare: will increasing the bulk-billing rate and supply of general practitioners increase access to Medicare-funded general practitioner services and does rurality matter?

BACKGROUND: Recent increases in the bulk-billing rate have been taken as an indication that the Federal government's Strengthening Medicare initiative, and particularly the bulk-billing incentives, are 'working'. Given the enduring geographic differences in the supply of general practitioners (GPs) it is timely to reconsider the impact that this increase in the provision of 'free care' will have on access to Medicare-funded GP services in rural and urban areas of Australia. Utilisation has been modelled as two different stochastic processes: the decision to consult and the frequency of consultation. RESULTS: In the decision to consult model the supply of FFS GPs is a more important predictor of utilisation than the bulk-billing rate. Paradoxically the modelling predicts that ceteris paribus increases in either GP supply or the bulk-billing rate appear to have perverse effects in some areas by decreasing utilisation. In the frequency of consultation model, GP density is not a predictor and increasing the bulk-billing rate will unambiguously increase the frequency of consultation across all areas. In both models, the positive impacts associated with changes in supply and cost are constrained outside the inner metropolitan area by reduced geographic accessibility to Medicare-funded GP services. The modelling also shows that people are more likely to consult a GP in areas of high socioeconomic disadvantage, although socioeconomic status is not a predictor of frequency of consultation. CONCLUSION: Bulk-billing rates and the supply of FFS GPs are important features of the Australian health care system that are, potentially, amenable to policy manipulation. The implications of this research are that government policies designed to achieve similarity in these characteristics across geographic areas will not result in equity of access because they fail to address problems caused by geographic inaccessibility in rural and remote areas. Attempting to increase bulk-billing rates in some of these areas may, in fact, reduce access to FFS GP services.

Journal Article↗
PubMed1990

Towards a typology of general practitioners' attitudes to general practice.

Current knowledge about the origins of variations in general practitioners' (GPs') prescribing and referral behaviour is limited. Differences are as yet unexplained by demographic factors such as list size or geographic location. Drawing on social psychological theory it is suggested that attitudes towards general practice held by GPs may be predictive of GP behaviour. A classification of GP types on the basis of expressed attitudes may represent the first step towards this goal. This research demonstrates that GPs in Avon have identifiable attitudes to general practice which can be classified into separate types. Uses of such a classification and implications for further research are also discussed.

Adult↗
PubMed1995

[Mass screening against cervical cancer--what are the viewpoints of female general practitioners?].

Female general practitioners play a central role in the national programme for organized cervical mass screening. The article presents results from a study among Norwegian female general practitioners (n = 720) on their view of the benefit of the screening programme and about the recommendations they give their patients regarding routine Pap-smear. The response rate was 95%. 93% found that the national programme was of great or some benefit. 70% gave recommendations in accordance with the programme. Only 14 physicians recommended longer intervals for routine Pap-smears than those recommended in the programme. However, a considerable proportion reported that Pap-smears are taken more often than recommended by the programme, usually among young women who are considered to be at risk, or who express a wish to have a smear taken. We identify possible misunderstandings and misleading expectations which should be approached by means of strategies for quality assurance of the national programme.

Attitude of Health Personnel↗
PubMed1978

How much child psychiatry does a general practitioner do?

Eleven general practitioners recorded information on relevant psychological and social factors on 1,127 consecutive attendances of children and adolescents under the age of 18 years. The proportion of 'pure' psychological problems was low (3.5 per cent of all attendances), but in 25.7 per cent of attendances a psychological component to the presenting problem existed. Non-specific 'emotional' problems were the most frequent psychological symptoms noted, but management problems in infancy and early childhood were also common. There were significant differences between practitioners in the proportion of 'purely physical' diagnoses made and in action taken at the time of attendance. The findings suggest that paediatric training of general practitioners should contain a considerable child psychiatric component.

Adolescent↗
PubMed1989

[Treatment of craniomandibular dysfunction by general practitioners].

A general practitioner diagnoses--after a screening--the patient who suffers from a dysfunction. Then he has to decide whether to advise either a further treatment on the basis of basic knowledge of the most frequent TMJ-dysfunctions or to refer to other disciplines. In the treatment by the general practitioner a careful and thorough screening is of primary importance. Finally, the therapy by means of a 'splint' often yields good results.

General Practice, Dental↗
PubMed1994

[Did the distribution of trauma treatment by general practitioners and emergency departments in the county of Ringkøbing change after the introduction of the on-call coverage for general practitioners?].

The aim of the study was to investigate the changes in minor trauma treatment structure after a reduction in the number of general practitioners on call in a county, where minor trauma treatment is supposed to be carried out by general practitioners and only major trauma is supposed to be treated at the hospital Accident and Emergency Department. The design was a cross-sectional analysis of trauma treatment in Ringkøbing County before and after the reduction in the number of general practitioners on call. Over a four week period before and after the reduction in the number of general practitioners on call all trauma treatment at the Accident and Emergency Departments was registered together with trauma treatment by general practitioners. Furthermore a questionnaire was given before and after the reduction to a sample of the population regarding the population's behaviour and attitude towards minor trauma. Analysis showed that there was a minor reduction in the total number of trauma treatments after the reduction in the number of general practitioners on call was made. The percentage of patients that were treated at the Accident and Emergency Departments at hospital directly without being referred from general practitioners was reduced from 30% to 21%. The population's behaviour and attitude towards minor trauma was unchanged.

Cross-Sectional Studies↗
PubMed1997

General practitioner registrars' opinions of general practice training in ophthalmology: a questionnaire survey in the northern region.

PURPOSE: Approximately 6% of general practitioners have worked in ophthalmology but to our knowledge the relevance of this training has not previously been evaluated. METHODS: We sent an anonymous questionnaire to all doctors who had held general practitioner registrar (vocational training) posts in ophthalmology in the Northern Region during a 5-year period (1989-1994). RESULTS: Twenty-six of 48 (54%) questionnaires were returned. Twenty-five of 26 respondents (96%) thought the training was useful, with 22 (91.7%) continuing to use some ophthalmic practical skills and 17 (65.4%) said they had received adequate and relevant clinical exposure. Twenty-one (87.5%) of those in general practice felt that they were more confident with eye problems than their peers and 12 (50%) said their referral patterns differed. Eleven (46%) had provided advice for colleagues. However, 9 (34.6%) commented on the large service commitment and 5 (19%) felt that supervision had been inadequate. Only 9 (34.6%) had received relevant teaching and 18 (69%) thought more was necessary. CONCLUSION: We conclude that general practitioner registrar posts in ophthalmology are useful and rewarding but that there is scope for improvement.

Attitude of Health Personnel↗
PubMedDate not supplied

[Neurological education of general practitioners. Results of a survey carried out among 196 general practitioners].

We have carried out a survey among professional general practitioners in our province with the aim of getting to know their opinion concerning their own training in Neurology. The survey included questions about the adequacy of training, the nature of any deficiency therein (be it theoretical and/or practical) and ability to analyse and attend a neurological patient. The percentage of replies was 78% out of a total of 196 surveys. 78.8% of those questioned consider that their neurological training has not been sufficient either for clinical or general practice; while 43.8% believe that this insufficiency is due to a lack of practical training, 1.8% think the fault lies in a lack of theoretical training, and 54.32% consider that it is due to a lack of both practical and theorectical training. 61.2% of those questioned claim to have difficulties with neurological explorations, and 55.6% claim they have greater difficulties attending a neurological patient than other patients classified within other internal medical specialties. 76% consider that it is either partially or totally false to claim that these difficulties are unimportant due to the lack of treatment for neurological illnesses, although 69.4% consider it to be partially or totally true that they will never be able to achieve diagnosis of a neurological patient due to a lack of the required complementary investigations. 43.9% consider that continued training in Neurology is not useful because it is a repetition of training received at university. As a consequence, there is an imbalance between neurological training and the need to attend the patient at the level of general practice, which should be set right by making the theoretical training given during graduation more suitable, and by increasing and improving practical credits.

Data Collection↗
PubMed1993

Quality of general practitioner referrals to outpatient departments: assessment by specialists and a general practitioner.

Thirty eight specialists in one district health authority were asked to take part in a questionnaire survey to assess the appropriateness of referral and the quality of the referral letter for 20 consecutive new patients each. A total of 705 new patient referrals to 13 specialties were included in the study. Twelve of the 38 specialists were randomly selected and their 234 new patient referral letters were independently assessed by a general practitioner for the appropriateness of the referral decision. The study revealed errors and omissions in between 5% and 28% of referral letters according to the category of information. Thirteen per cent of the new patient referrals were assessed by specialists to be inappropriate and 4% of patients had been referred to an inappropriate specialty. Significantly more of the referrals to medical specialties were inappropriate (20%) than to surgical specialties (9%) (P < 0.01). There were more than three times the number of errors and omissions in the referral letters of referrals assessed as inappropriate than in the referral letters of referrals assessed as appropriate (P < 0.01). The referral letters of referrals assessed as inappropriate were more than nine times as likely to omit the reasons for or objectives of the referral compared with letters for those referrals assessed as appropriate (P < 0.01). There was a good overall agreement between the specialists and general practitioner in their assessment of the appropriateness of the clinical referrals (kappa = 0.614, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMed2004

[General practitioners' health care for disabled patients: a survey among a panel of general practitioners in Southeastern France, in 2002].

OBJECTIVES: This article presents a study on General Practitioners' (GPs) knowledge, attitudes and practice towards disabled patients. MATERIAL: A sample of 600 private general practitioners practising in Southeastern France was selected in 2002 with a random sampling approach stratified according to age, sex, and size of the urban unit. METHOD: A standardised questionnaire was used to collect data by telephone. Results are presented as percentages. Comparisons used Pearson's chi2 test. RESULTS: Ninety percent of the GPs reported that they had to provide social assistance to their disabled patients (protecting their rights, administrative assistance, family counselor, etc.) as well as coordinating care by various other professionals. GPs frequently reported the presence of barriers that compromised the health care of disabled patients: lack of information (62.8%), time (50.2%), co-ordination between health professionals (37.7%), and training (37.7%), as well as communication problems (20.7%) and the need for assistance in clinical examinations (16.2%). More than 25% of the GPs suggested breast cancer screening (27.6%), contraceptive prevention (29.5%) or hepatitis B vaccination (29,3%) less often to their disabled than non disabled patients and 25.8% reported they had not evaluated the patients' dependency levels. CONCLUSION: This study suggests that GPs face several barriers in caring for disabled persons. A lack of knowledge may explain inappropriate care for this population. GPs need more support and guidance in dealing with disabled patients, and coordination with other health professionals must be encouraged.

Adult↗
PubMed2002

[The Dutch College of General Practitioners' "Gout" Standard: a response from general practitioners].

Although gout has a long nosological history, there are still many uncertainties regarding its pathophysiology, causative factors and most common therapies. Therefore, composing an evidence-based guideline on gout is a challenge. There is a lack of good clinical research, especially in primary care populations where most gout patients are diagnosed and treated. Far more insight is required into the mechanisms which underlie increasing and decreasing serum uric acid levels which, via the blood-synovium barrier, should increase or decrease urate crystals with inflammatory potency. In view of this lack of information, it would have been more appropriate for the Standard not to contain unproven facts and therapeutic recommendations. Guidelines should be kept simple until good clinical research proves the opposite.

Evidence-Based Medicine↗