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PubMed1992

Health and lifestyle of general practitioners and teachers.

General practitioners (408) and secondary teachers (385) responded to a questionnaire about their health and lifestyle with a response rate of 48 and 45 per cent respectively. Their answers were corroborated by a separate questionnaire completed by their spouse or domestic partner. A sub-group of 50 general practitioners and 50 teachers were examined to assess their physical fitness and mental health. Half of each group was below average fitness compared to the general population. General practitioners were more likely than teachers to practise disease prevention. Ten per cent of general practitioners and 13 per cent of teachers were smokers; 8 per cent of general practitioners and 14 per cent of teachers reported an alcohol consumption that exceeded recommended limits. General practitioners took remarkably little sickness absence compared to teachers. Symptoms of anxiety and depression were more common in teachers: a need for alcohol, binge eating and sleep difficulties were frequently experienced in both groups. Medication taken by the two groups was similar and self-medication was common amongst the general practitioners. Less than half the general practitioners thought they would use an occupational health service if it were established.

Absenteeism↗
PubMed1993

Working with community mental health professionals: a survey among general practitioners.

Links between general practitioners and mental health professionals, such as counsellors, psychiatrists, community psychiatric nurses, clinical psychologists and social workers, are increasing in number and type. The aim of this survey was to elicit general practitioners' attitudes to these workers, comparing those with a link with a mental health worker and those without. General practitioners in two district health authorities were surveyed and a response rate of 70% was obtained. General practitioners linked to a mental health professional were more likely to have made a referral to that service in the previous three months and, on the whole, were more satisfied with that service. The commonest problem reported by respondents was the length of waiting lists. Regarding liaison with social workers, inadequate feedback and difficulty with contact were the problems mentioned most by doctors. A number of general practitioners expressed a desire for closer contact with all these mental health services. While caution is required in ascribing causality to these relationships, it is clear that a closer working relationship between general practitioners and mental health workers is productive and is valued by general practitioners. The challenge for policy makers is to structure mental health provision in such a way that more general practitioners are able to benefit than at present.

Attitude of Health Personnel↗
PubMed1997

The general practitioner, the drug misuser, and the alcohol misuser: major differences in general practitioner activity, therapeutic commitment, and 'shared care' proposals.

BACKGROUND: The primary care setting has been regarded in government policy and the scientific literature as an ideal setting for the work needed to meet the Health of the Nation drug and alcohol targets. Although studies have pointed to the negative attitudes held by general practitioners (GPs) towards alcohol- and drug-misusing patients, there has been no direct comparison of the work and attitudes of the GP towards these patients. AIM: To compare the work and attitudes of GPs towards alcohol- and drug-misusing patients. METHOD: All GPs in an outer London area (157 doctors) were surveyed, using an eight-page postal questionnaire, collecting clinical and attitudinal data alongside demographics and practice information. A response rate of 52% was achieved. RESULTS: General practitioners reported working with only 3.5 patients drinking above recommended guidelines in the previous four working weeks, and even fewer drug-using patients (0.75). While they viewed the alcohol-misusing patients negatively, the drug misuser elicited substantially more negative attitudes. The primary care setting was seen as appropriate to work with the alcohol-misusing patient but not with drug users. Training and support from local services would encourage substantially more GPs to work with alcohol misusers but not with drug misusers. CONCLUSIONS: Our findings indicate that there are some cautious grounds for optimism that GPs are willing to work with alcohol misusers; however, with regard to drug misusers, we find a GP workforce that is only minimally involved with this group and would not be greatly encouraged by the provision of additional training, support, or incentives. The Health of the Nation targets are not being met, and GPs are not detecting adequate numbers of the patients at whom these targets are aimed. Emphasis has been placed on the role of primary care, but the real achievements that can be made require detection of the less severe drinkers and injecting drug misusers.

Adolescent↗
PubMed2000

Effect of general practitioner hospitals on district general hospital bed use in the Highlands of Scotland.

OBJECTIVE: To examine hospital bed use by General Practices with and without access to General Practitioner beds. DESIGN: Information from the Contract Management System for General Medicine and Surgery, and from SMR returns for Geriatric Medicine and GP beds was used to compare hospital bed use in District General Hospitals (DGHs) and in General Practitioner beds for practices with and without access to GP beds. Age adjusted rates were calculated for overall use of each specialty. SETTING: All General Practices in the Highland Health Board area for December 1995-April 1997. RESULTS: Compared to practices with no access to GP beds, practices with access used 39.4% fewer bed days per 1000 patients for medical specialties; 18% fewer bed days for surgical specialties; 34.5% fewer bed days for geriatric medicine, and 4.9% fewer bed days for other DGH specialties. Taking into account GP bed day use, practices with access to GP beds used 6.1% more hospital bed days per 1000 patients than did practices with no access. CONCLUSION: These findings largely replicate work in England that found substantial decreases in General Medical and Geriatric Medicine bed use in Practices with access to GP beds, combined with an overall increase in occupied bed day use of 6-8% per 1000 patients. The lower use of surgical beds was unexpected, and may reflect more flexible use of GP beds in the Highlands for observation or rehabilitation, possibly related to the far greater distances involved than in the English studies.

Adolescent↗
PubMed1996

The computer research network of the Royal New Zealand College of General Practitioners: an approach to general practice research in New Zealand.

Computers are now in widespread use by general practitioners (GPs) in many countries. In New Zealand this development has advanced general practice research by enabling collaboration among a small population of doctors practising in geographically diverse locations. This paper reviews the establishment of the Computer Research Network of the Royal New Zealand College of General Practitioners (RNZCGP) and its development between 1990 and 1995. The Network consists of 181 general practices (approximately 450 GPs) from throughout urban and rural New Zealand. All participants use computers in their practices to record consultation notes and to generate prescriptions, investigations and referral forms. Computer programs developed in the RNZCGP Research Unit are run on commercial software in doctors' surgeries to provide anonymous, individual data. In addition to the routine analysis of utilization for feedback to participants, 13 research projects have been completed. These include investigations of access to general practice care, use of health services by individuals and families, surveillance of immunization uptake, epidemiology of common conditions, and the use of pharmaceuticals in general practice. The RNZCGP Computer Research Network is an example of a computerized general practice research network that has been productive without receiving significant financial resources or having a formal management structure.

Confidentiality↗
PubMedDate not supplied

General practitioners and mammographic screening uptake: influence of different modalities of general practitioner participation. Working Group.

AIMS AND BACKGROUND: To compare the impact of different modalities of general practitioner (GP) involvement, including the introduction of target payments, on the attendance rate of organized population-based screening programs for breast cancer in Italy. STUDY DESIGN: The study was conducted between 1994 and 1996 in four Italian cities where mammographic screening programs are active: Caltanissetta (CL), Firenze (FI), Modena (MO) and Torino (TO). The impact on attendance rate of different invitation strategies based on active GP involvement was tested in each center. The additional effect of economic incentives was also assessed. The incentives were proportional to the level of compliance attained by each GP and weighted by the size of his eligible patients' list. RESULTS: In the Firenze project, an invitation signed by the GP and the project co-ordinator attained a statistically significant higher participation (difference: 4.2%, chi2 = 7.42, P = 0.006). In Caltanissetta and Torino there was a significant increase of about 7% in the response rate to the postal reminder in the groups contacted by the GPs. No difference was observed in the Modena project between the two groups. CONCLUSIONS: The main contributions of GP involvement can be: "cleaning up" the invitation lists, especially when computerized archives with the mammographic history of the target population are not available; increasing the women's participation by signing the invitation letter, by counseling and active participation in the invitation phase; co-operating in the reminder phase by recalling women non responders at first invitation. The offer of target payment had a certain impact on the screening uptake, but not easily distinguishable from GP signature of the invitation letter; further studies of appropriate design should be planned. Organizational factors, such as availability of a list of non-responders, might be crucial in order to enhance the effect of the GPs' action.

Family Practice↗
PubMed1989

Responses by general practitioners in Avon to proposals for general practice in the white paper Working for Patients.

OBJECTIVE: To determine the views of Avon's general practitioners about the general practice proposals within the government's white paper Working for Patients. DESIGN: Postal questionnaire survey. SETTING: A county in south west England. SUBJECTS: All general practitioner principals (n = 537) under contract with Avon Family Practitioner Committee. MEASUREMENTS AND MAIN RESULTS: 492 doctors (92%) responded to the survey. More than three quarters of the respondents were opposed to the government's proposals on budgets for specific surgical procedures, prescribing, and diagnostic tests; and between 63% and 93% felt negative about advantages that might accrue from the proposals. Over three quarters of general practitioners were in favour of family practitioner committees monitoring work load, prescribing, and referrals. General practitioners in large, potentially budget holding practices held similar views to doctors in smaller practices. CONCLUSIONS: Avon's general practitioners substantially reject most of the government's proposals about general practice in the white paper Working for Patients.

Attitude of Health Personnel↗
PubMed1989

General practitioners' referrals to specialist outpatient clinics. II. Locations of specialist outpatient clinics to which general practitioners refer patients.

Although linkage by computer of hospital administration systems across all clinics in a health district is becoming a practical possibility, complete records of general practitioners' referrals to outpatient clinics will be difficult to achieve. Data from a large study of general practitioners' referrals to such clinics were used to calculate the proportion of referrals that crossed district boundaries, the proportion that were made to the private sector; and the number of locations that each practice referred patients to. Of the 17,601 referrals from practices in Oxford Regional Health Authority, 13,857 (78.7%) were made to NHS outpatient clinics within practices' own districts, 1524 (8.7%) to clinics in other districts in the same region, 420 (2.4%) to NHS clinics in other regions, and 1800 (10.2%) to the private sector; but these proportions varied considerably among the practices. The mean number of different NHS hospitals or clinics that each practice referred patients to was 15.8 (range 4-42).

Catchment Area, Health↗
PubMed1992

[The general practitioner and screening for cancer of the breast. Study of a sample of 200 general practitioners in the Bas-Rhin].

A questionnaire survey of 200 doctors who were a sample of the general practitioners of the Bas-Rhin department was carried out. This was in order to ascertain what they knew about cancer of the breast and how they practised medically in this area, what were their doubts and what motivated them to screen for this kind of cancer? The questionnaire was found on the whole to acceptable. The enquiry showed that undoubtedly doctors were in favour of screening for cancer of the breast but were less enthusiastic carrying it out routinely. They also were unaware of ways in which such screening could be carried out (mammography being considered and examination which shows where the cancer was and not as a screening method). Furthermore, there was some confusion between screening and means of diagnosis. Results of this study show that it should be possible to outline the content and means of informing general practitioners about how to screen in order to enable them to participate in the Alsatian pilot campaign for screening for breast cancer.

Attitude of Health Personnel↗
PubMed1995

Reducing systematic bias in studies of general practitioners: the use of a medical peer in the recruitment of general practitioners in research.

Reducing systematic bias in any group of study participants should be a priority of any researcher. This can be achieved by ensuring the sampling framework is adequate and by increasing response rates. Response rates in studies of general practitioners have to date tended to be low. Generalization of results to the wider population of GPs is therefore reduced. This paper systematically examines those factors which can reduce bias, recognising accurate identification of the target population, gaining good access to respondents, and maximising response rates as crucial factors. The importance of a medical peer in recruitment is examined. Applying these factors to a study situation, three different recruitment strategies were tested. As the strategy improved, there was an incremental improvement in the response rate (44%, 67%, 78%). These results indicate that by specifically addressing strategies which facilitate access to the target population, and increase the legitimacy and credibility of the study, significant improvements in response rates can be achieved.

Australia↗