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At least 109 records · Page 6Linked to original sources
PubMed1990

The benefit of colonoscopy.

In a prospective study involving 833 consecutive outpatient and open-access colonoscopies, attempts were made to characterize the benefit of colonoscopy in terms of both predicted and unpredicted findings and therapeutic procedures. The endoscopist therefore predicted the endoscopic findings before the endoscopy. The results were compared for the different indications for colonoscopy. The overall agreement between the predictions and the colonoscopic findings was 61%. Clinically significant abnormalities were found in about half the examinations. The most frequent abnormal findings were benign polyps (24%), inflammatory bowel disease (17%), and malignancy (5%). In about half the patients with a malignancy the indication for colonoscopy was rectal bleeding, and half of the malignancies were not predicted. The greatest benefit of colonoscopy was found in patients referred because of overt rectal bleeding or occult faecal blood, and abnormal barium enema or endoscopy findings. The importance of complete colonoscopy in connection with operation for colorectal carcinoma is emphasized.

Colonic Polyps↗
PubMed1995

Gastro-oesophageal reflux disease in general practice.

Symptoms of reflux-like dyspepsia and gastro-oesophageal reflux disease (GORD) are common problems in the community and in general practice. The 1-year prevalence of reflux-like dyspepsia is in the region of 30%, with many patients experiencing a range of other symptoms in addition to the principal complaint of retrosternal pain or burning. Although only a minority, about one-quarter, of these patients consult general practitioners about their problems, many of them have had symptoms for several years, and experience symptoms on a frequent, often daily, basis. The decision to consult a general practitioner often depends more upon patients' anxieties about the possibility of heart disease and cancer than on symptom severity. General practitioners need to address these issues, as well as attempting to make a safe, clinical diagnosis; this is aided by the findings that, at least in patients under the age of about 45, a reasonably confident clinical diagnosis can be made on the basis of symptoms alone, although older patients and those in whom alarm symptoms are present require timely investigation. The increasing availability of open-access endoscopy means that many of these patients can be managed entirely in general practice without the need for specialist referral. Management in general practice begins with a clear explanation of the mechanisms and significance of GORD and a direct response to patients' anxieties. Lifestyle factors may require modification before drug therapy begins.(ABSTRACT TRUNCATED AT 250 WORDS)

Family Practice↗
PubMed1997

High incidence and prevalence of adult coeliac disease. Augmented diagnostic approach.

BACKGROUND: The diagnosis of coeliac disease is easily overlooked as patients can present with mild or atypical symptoms, or the condition can even be clinically silent. Our aim was to detect coeliac disease patients with such atypical or no symptoms as well as those with typical features. METHODS: The incidence of adult coeliac disease in Tampere was calculated from 1975 to 1994 and the prevalence as of 31 December 1994. Open-access endoscopy was available for general practitioners, and small-bowel biopsy was done routinely. Serologic screening was applied to patients with an increased risk of coeliac disease. RESULTS: The incidence of coeliac disease increased tenfold, and the prevalence was 270 per 100,000 inhabitants in 1994. Twenty per cent were found by serologic screening and 10% as a result of routine biopsy; 24% had dermatitis herpetiformis. CONCLUSIONS: Our diagnostic approach gave a coeliac prevalence similar to that found in population screening studies. One-third had silent coeliac disease.

Adolescent↗
PubMed1994

Managing the termination of a hospital system from your provider network: a case study.

In 1992, a decision was reached by Medica Choice, a large open-access HMO with over 350,000 members, to terminate their contact with a large five-hospital system. In this article, the authors discuss the details of this termination, identify the organizational strategies for successfully managing the contract termination of a major hospital system from a health plan's provider network, attempt to identify the possible pitfalls in managing such a transition, and offer suggested guidelines for tactical planning for similar situations.

Contract Services↗
PubMed1997

Managed care: the next generation.

Managed care today affects most Americans. Of the 160 million Americans receiving employee coverage, 120 million are in a managed care setting. HMO development to date has been driven by the desire to reduce health benefit costs for employers. Employees, the real consumers, perceive a clash between "good care and good profits." Health plans have generated profits by reducing utilization and keeping a portion of the savings. In the future, market conditions will force plans to develop new ways of maintaining profitability. Also, plans will survive by focusing on factors that matter most to consumers-such as overall care quality and access. Care systems that combine the benefits of open-access systems with the benefits of point-of-service products represent the next generation of consumer-driven healthcare.

Community Participation↗
PubMed1998

Junior doctors. Night vision.

By establishing separate timetables for senior house officers and registrars, an obstetrics and gynaecology department has been able to reduce out-of-hours work while offering training relevant to the doctors' proposed careers. Following the establishment of a daily, open-access gynaecology clinic, extending the role of midwives has reduced the out-of-hours workload of junior doctors. Emergency admissions, a major feature of out-of-hours work, have fallen by a quarter.

Appointments and Schedules↗
PubMed1998

Specialty empowerment: a new trend in managed care.

The rise of the open-access managed care model has brought the concept of specialist empowerment to the forefront. Specialists are being asked to assume the gatekeeper role for specialty services throughout individual provider networks. A growing number of specialty practices are structuring to assume this role and manage the accompanying risk and capitation dollars. Many specialist practices are using this new structure to gain a competitive edge in the market.

Capitation Fee↗
PubMed1998

Alternatives to traditional capitation in managed care agreements.

Risk arrangements typically fall into one of three categories: primary care capitation, professional services capitation, and global, or full-risk, capitation. Yet, in light of various disadvantages associated with these three methods, such as high administrative costs and inappropriate levels of risk assumed by providers, many healthcare payers and providers are experimenting with alternative payment plans. These alternatives include contact capitation arrangements, under which specialists receive a capitation payment on a per referral basis; open-access arrangements, under which patients do not need a gatekeeper referral to see specialists; and capitation arrangements with quality and hospital utilization bonuses, under which specialists and primary care physicians receive a capitation payment plus the potential for bonuses based on quality and utilization criteria.

Capitation Fee↗
PubMed1975

Community electrocardiography.

The report of the Joint Working Party on General Medical Services (1973) considered in detail the provision of electrocardiographic services for general practitioners. These are based either on primary health care teams using their own apparatus, or on hospitals offering open-access to their cardiac departments.In this survey I attempted to compare the proportions of general practitioners using their own electrocardiographs with those using hospital-based apparatus, and with those without direct access to any electrocardiograph facilities, and to evaluate the use made of such services, when available.

Electrocardiography↗
PubMedDate not supplied

Computerized health information networks: house calls of the future?

The Cleveland Free-Net is the nation's first free open-access computer system providing health information to the public. An online survey was developed for the family medicine clinic housed within the Free-Net to study the characteristics of the users of the system and the reason they selected the Free-Net as a source of health information. Three areas were addressed: 1) user demographics; 2) content analysis of questions; and 3) reasons Free-Net was used instead of the person's own health care provider. An analysis of the initial system done in 1985 revealed that early users of the system were known to be predominantly white male professionals, generally in the 25-35 age range. In comparison to that profile, more of the users in this study were women, but the majority of users continued to be white male professionals. Questions asked can be classified in six categories: diagnosis, symptoms, treatment, medications, laboratory tests, and prevention. The main categories of medical concerns were cardiovascular, gastrointestinal, obstetrical, and gynecologic problems. Users tended to use the Free-Net for health information rather than their physician because the traditional means was not always appropriate for the life-style of this population.

Adult↗
PubMed1986

Upper gastrointestinal endoscopy--a view from general practice.

An open-access upper gastrointestinal endoscopy service for general practitioners is described. Between July 1981 and May 1985, 391 endoscopies were performed on 354 patients. In contrast to the results of other studies, demand for endoscopy and the pick-up rate for major lesions has remained steady, and the number of requests for barium meals has fallen by almost a quarter. Major lesions - cancer, gastric and duodenal ulcers and severe oesophagitis - were found in 33% of patients. Oesophagitis accounted for 28% of positive endoscopies and 18% of positive endoscopies in patients with barium negative dyspepsia. With scarce resources there may, however, be a case for ;selective' access to upper gastrointestinal endoscopy in the future.

Adult↗
PubMed1974

An appointment system in a teaching practice.

Some patients have difficulty in achieving an appointment to see a doctor in a university teaching practice. Only five per cent of patients indicated serious difficulty. Patients who discriminate in favour of seeing a particular doctor have greater difficulty. It is suggested also that some patients have the same difficulty if they are making an appointment to see a particular doctor.Clearly there is a need to explore the problem further to determine the nature of the difficulties which patients experience. It might then be expected that improvements can be made which will help patients to achieve appointments more easily. At the same time it has to be recognised that there may be some patients who will continue to have difficulty in achieving an appointment however much they are helped. Such patients may need access to community health care services in a manner entirely different from the appointment system.Most patients prefer to see their general practitioner by appointment. Both open-access surgeries and appointment systems cause difficulties for patients. The former is associated with the difficulty of long waiting periods and the second with difficulties in achieving an appointment. As some form of appointment system is likely to be continued, particularly for group practices and health centres, it is probably timely to audit patients' experience of achieving appointments.University teaching practices present general practitioners with unusual additional stresses on an appointment system. The full-time teacher's day is divided between service to patients and teaching or research. Any reduction in the availability of a particular doctor in a group may result in patients having difficulty in making an appointment. This argument could equally apply to any group of practitioners who have commitments other than to general medical services.

Appointments and Schedules↗
PubMed1984

Breast cancer: views of general practitioners on its detection and treatment.

A considerable proportion of women with breast cancer in this country present for treatment in late stages of the disease; Britain's primary health-care system means that in most cases the possible diagnosis of breast cancer is first made in general practice. This offers ample opportunity for early diagnosis and a better understanding about the way the general practitioners perceive the problems associated with the disease. With that specific aim, the present article reports on a survey conducted simultaneously in Oxford and in Edinburgh. Results show that general practitioners in the survey are deeply concerned about breast cancer and see a definite role for themselves in its early detection and long-term management. They also see a need for more health education that includes the encourgement of breast self-examination programmes. Most are in favour of open-access breast clinics for women and, in general, they feel positive about self-education programmes.

Adult↗
PubMedDate not supplied

"Céad Míle Fáilte"--an assessment of the screening of 178 Bosnian refugees to Ireland.

The number of refugees in Western Europe has risen dramatically. Such an increase poses unique challenges for all health personnel. This paper describes how the Republic of Ireland, a country with little experience of refugees, initially coped with 178 Bosnian refugees. An open-access general practitioner service was combined with a general screening protocol. Patients with significant problems tended to visit GP's, for appropriate treatment, soon after arrival. Of a total of 92 problems diagnosed at screening, general medical (14%), psychiatric (14%) and gynaecological (11%) were the most frequently encountered. Of the 30 problems referred, 80% were referred by a GP. Deficiencies in immunisation and drug history are highlighted. We make recommendations to improve the quality of future initial refugee assessment procedures.

Adolescent↗
PubMedDate not supplied

Audit of patients' experiences after endoscopy of the upper alimentary tract.

This study comprises an audit of the experiences of upper alimentary endoscopy by 400 patients examined in 15 hospitals. The patients were asked to complete a 19-section questionnaire regarding their experience of the endoscopy before, during and after the procedure. The audit was carried out in order to evaluate the patients' understanding of the investigation and to determine the impact of the findings on the patients' level of anxiety. Of the 400 patients, 304 (76.0%) returned the questionnaire; overall satisfaction was revealed with the decision to proceed with endoscopy and with the procedure itself, as well as the reassurance provided by the investigation. The study thus supports the role of open-access endoscopy.

Adolescent↗
PubMed1994

Discriminant value of symptoms in patients with dyspepsia.

BACKGROUND: Family physicians encounter many pitfalls in managing and treating dyspeptic patients, most of whom are treated in family practice based solely on their signs and symptoms. METHODS: A computer literature search followed by a systematic methodological appraisal was performed to identify studies that evaluated clinical symptomatology in dyspeptic patients. RESULTS: Ten studies, none of which took place in a family practice, fulfilled our inclusion criteria. The main conclusion drawn from outpatient populations and patients referred for open-access endoscopy was that certain clusters of symptoms have a negative predictive value for organic causes of dyspepsia. Higher age, male sex, pain at night, relief by antacids or food, and previous history of peptic ulcer disease were identified as predictors of organic causes for abdominal symptoms. CONCLUSIONS: These findings can be helpful to family physicians in determining the need for endoscopy referral. However, since the diagnostic values of tests in family practice may differ from those in referred populations, there is a need for prospective studies in primary care.

Dyspepsia↗
PubMed1997

Usefulness of anti-Helicobacter pylori and anti-CagA antibodies in the selection of patients for gastroscopy.

OBJECTIVES: Screening of dyspeptic patients with serological tests for Helicobacter pylori before open-access gastroscopy has been suggested to be worthwhile. CagA-positive H. pylori strains may be associated with major pathology more often than CagA-negative strains. The usefulness of anti-H. pylori and anti-CagA antibodies in screening for gastroscopy was evaluated in unselected dyspeptic patients. METHODS: Four hundred consecutive, unselected dyspeptic patients (mean age, 56.8 yr) in primary care were investigated with gastroscopy, ultrasonography of the upper abdomen, laboratory tests (including serological tests for H. pylori and CagA), and other examinations if needed. The patients were followed for 1 yr. RESULTS: Results of serological tests were positive for H. pylori in 56.2% of patients, of whom 64.4% also had results positive for CagA. Use of H. pylori and CagA serology-based screening combined with a history of nonsteroidal anti-inflammatory drug use would have detected only 80 and 70% of the major pathologies (peptic ulcer, moderate or severe esophagitis, celiac disease, or malignancy), respectively, in these patients. Gastroscopy would have been avoided in 30 and 41%, respectively, if only patients who had positive results on serological tests or who were nonsteroidal anti-inflammatory drug users would have been referred. In patients younger than 45 yr of age (n = 87), 60-74% of gastroscopies would have been avoided, but 50-60% of major pathologies would have been missed, by using the screening strategy studied. One of the nine malignancies (all in patients >45 yr of age) was H. pylori-negative, and two were CagA-negative. CONCLUSIONS: Anti-CagA antibodies do not offer advantages compared with anti-H. pylori antibodies in screening patients for gastroscopy. A remarkable share of major pathologies are missed by both of these screening methods. Therefore, the results of these screening tests are not recommended as selective criteria for gastroscopy.

Adolescent↗
PubMed1998

Choice words on open access.

Drawn by rates only slightly higher than traditional HMOs, consumers have hurried to sign up for open-access plans. Yet what works for patients may work against doctors who assume the financial risks.

Health Services Accessibility↗