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PubMed1995

Use of blood tests in general practice: a collaborative study in eight European countries. Eurosentinel Study Group.

BACKGROUND: Laboratory tests are routine examinations in general practice and are associated with increasing costs in industrialized countries. AIM: The objective of this collaborative study was to determine the differences in general practitioners' use of blood tests in different European countries and to evaluate the relationship between these differences and organizational aspects of the health care system and also characteristics of the participating general practices. METHOD: A descriptive study was conducted by eight European sentinel networks. Voluntary participating general practitioners registered all blood tests requested for four weeks, specifying the type of test, and age group and sex of patients. Details of all face-to-face encounters with patients by age group and sex were collected for the same period. Information on the participating practices and general practitioners was collected by questionnaire. RESULTS: The request rate for blood tests varied considerably between countries. The characteristics of general practitioners and practice were only slightly or were not associated with the use of blood tests while dummy 'country' variables were strongly associated. The number of general practitioners per 1000 inhabitants was the most positively associated variable partly explaining the intercountry variation. CONCLUSION: This European study suggests that some national characteristics of the health system could determine the use of blood tests in general practice and underlines the need for further investigation in order to develop successful strategies for promoting the optimal use of diagnostic technology.

Adult↗
PubMed1994

Annual assessment of patients aged 75 years and over: general practitioners' and practice nurses' views and experiences.

BACKGROUND: The new contract for general practitioners, introduced in 1990, required them to offer an annual assessment, or 'health check', to patients aged 75 years or more. AIM: A study was undertaken to collect details of practice organization of these assessments, general practitioners' and practice nurses' experience of assessments, and their views of the value of such assessments. METHOD: A nationwide postal survey of 1000 general practitioners and interview surveys with general practitioners and practices nurses from 150 practices were carried out in 1992. RESULTS: The postal survey yielded a response rate of 69% and the interview survey a practice response rate of 76%. Organization of assessments varied enormously between, and often within, practices with a variety of methods of invitation and assessment instruments being used. Of general practitioners 13% did not use a letter of any sort to invite patients to attend, and many doctors excluded certain patients from assessment, particularly those who were seen regularly or had been seen recently. However, 70% of general practitioners estimated that they had assessed over 60% of their elderly patients in the first year (1990-91). A substantial proportion of assessments were estimated to have been conducted on an opportunistic basis and few practices were doing all the assessments of those aged 75 years and over in the patients' homes. In the majority of practices, the general practitioners and practice nurses were the only personnel carrying out assessments. Only 9% of the doctors and 34% of the nurses interviewed had been specially trained to carry out the assessment; 54% of nurses said they would like more training in this area. Both doctors and nurses reported that the assessments did detect previously unknown problems, although over half of doctors reported that they rarely picked up new mental health problems. Increased referrals to social services as a direct result of the assessments were reported by 63% of doctors. The majority of doctors and nurses reported that routine assessments were useful in providing advice and reassurance to elderly people. Two thirds of doctors said they would continue to offer at least selected groups of their elderly patients routine assessments, even if not contractually obliged to do so. CONCLUSION: The findings suggest that the experiences of the first two years of this activity had convinced some general practitioners that routine assessment of elderly patients is worthwhile. However the increased demand for other services must obviously be met by an increase in resources if the effectiveness of these assessments is not to be undermined.

Aged↗
PubMed1994

Consultations for women's health problems: factors influencing women's choice of sex of general practitioner.

AIM: This study set out to examine the degree to which women choose to visit a woman doctor for women's health problems and the determinants of this choice. The differences between women and men doctors with regard to treating women's health problems were also studied. METHOD: Data from the Dutch national survey of general practice were used. All group practices with both women and men general practitioners were selected. Analyses were restricted to consultations among women aged 15-65 years about menstruation, the menopause, vaginal discharge, breast examination and cervical smear tests. RESULts. Given the size of their female practice population, women doctors saw considerably more women with women's health problems than did their male colleagues. Women were more likely to consult a woman general practitioner if she was more available (that is, working longer hours), and younger women were more likely than older women to choose women general practitioners. Sex differences in the treatment of women's health problems were small and mainly related to the verbal part of the consultation: counselling and providing information. The doctors' availability and their certainty about the working diagnosis explained differences in the verbal aspects of consultations. Women general practitioners had longer consultations than their male colleagues mainly because more health problems were presented per consultation. CONCLUSION: In order to increase the possibility of patients choosing women general practitioners, policy should be directed towards the education of more women general practitioners and women general practitioners should be encouraged to work more days a week.

Adult↗
PubMed1993

[Treatment of accidents occurring in a municipality in general practice and emergency clinics].

In one Danish municipality inhabited by 9433 persons, 9119 were registered in the health security system as group 1-secured (i.e. full public health coverage). Fifteen general practitioners in seven practices participated in a one year-project by registering accidents where the general practitioner was the primary treatment contact. These general practitioners were allocated 84.5% of the group 1-secured persons in the municipality. The general practitioners were the primary contact persons in 466 accidents. The one year contact incidence rate was 61 per 1000 secured persons. During the same period the total number of inhabitants of the municipality made 1006 contacts to the local emergency rooms as a direct consequence of accidents. The one year rate of contact incidence for emergency rooms was 107 per 1000 inhabitants. The total rate of contact incidences to medical practitioners in the local health system is calculated to be 166 per 1000 inhabitants. The general practitioners saw more children and more accidents that had taken place in schools and day care-centres. Injuries caused by acute muscular overtraining led more frequently to contact with general practice. Fewer fractures and open wounds due to accidents were registered in general practice than in the emergency room. During the daytime working hours, the general practitioner was contacted more frequently than the emergency room.

Accidents↗
PubMed1993

Comparison of the health and lifestyle of general practitioners and teachers.

A total of 704 general practitioners and 588 teachers responded to a questionnaire about their health and lifestyle in 1991 (response rates 82% and 87%, respectively). The results for lifestyle measures were compared with those of a similar questionnaire completed by about half of each group two years before--there were no changes in the answers of either occupational group in the intervening two years. In 1991, 9% of general practitioners and 15% of teachers drank 22 units of alcohol per week or more; 13% of general practitioners and 23% of teachers reported troublesome depression and 31% of doctors and 37% of teachers excessive anxiety in the preceding 12 months. Teachers had more sickness absence, and significantly more experienced a need for daily alcohol and binge eating, and reported sleep difficulties, depression and anxiety than general practitioners. Self-medication among general practitioners was common and overall accounted for 83% of the medication taken by doctors. A follow-up survey of non-respondents found that only 11% of general practitioners and 11% of teachers indicated they had a health problem they wished to conceal or that they felt the questions were too intimate. General practitioners' lifestyle habits are better than those of teachers and published figures for the general population. The frequency of reported mental health problems in both professions gives cause for concern.

Adult↗
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↗
PubMedDate not supplied

Numerical analysis of steady generalized Newtonian blood flow in a 2D model of the carotid artery bifurcation.

The stationary flow of blood in a two-dimensional model of the bifurcation of the human carotid artery is simulated numerically using a finite element method. The Reynolds number is taken as equal to 300, corresponding to the value during the end-diastolic phase of the heart cycle. As constitutive equations, the Newtonian model and the non-Newtonian power-law and Casson models are used. The chosen model parameters corresponded with blood. The flow in this geometry is determined by the branching of the artery and the existence of a reversed flow area in the internal carotid artery. From the results of this problem, we conclude that the general flow structure is not influenced by the generalized (non-)Newtonian models. However, there are differences that cannot be neglected. First, the generalized Newtonian models result in axial and secondary velocity profiles that have 5-10% lower maximum values compared to the Newtonian model. Second, the pressure has higher values in the case of the generalized Newtonian models, especially in the internal carotid artery where these models give maximal 25% higher pressure values. Third, along the divider wall, the wall shear stresses are lower for the generalized Newtonian models; near the apex, this difference is maximal 40% in case of the power-law model. The generalized Newtonian models give higher wall shear stresses along the non-divider wall than the Newtonian model, the maximum difference being 5%. And fourth, in the internal carotid artery the reversed flow area is 10% reduced by the generalized Newtonian models. In general, the differences are more pronounced in the case of the power-law model.

Carotid Arteries↗
PubMed1993

Attitudes towards practice nurses--survey of a sample of general practitioners in England and Wales.

Practice nursing has expanded rapidly since the 1990 contract for general practitioners. In 1990, a national survey was undertaken of the attitudes of a random sample of general practitioners towards practice nurses. Responses to the postal questionnaire were received from 41.9% of the 4800 general practitioners sampled. Of the responding general practitioners, 90.0% were satisfied with the role of the practice nurse within their practice. To fulfil the requirements of the 1990 contract for general practitioners 50.7% had created a new nursing post, and 83.1% had expanded the role of nurses already employed; 89.7% wished to see further expansion of the practice nurse's role. However, lack of space was the factor most frequently reported as limiting the expansion of the practice nurse's role, mentioned by 76.0% of general practitioners. Only 43.7% of general practitioners recognized lack of opportunities for practice nurse training as a hindrance to role expansion. The key to managing the expansion of the role of the practice nurse lies in the provision of resources and in training. A pressing need exists for a national training scheme based in general practice.

Attitude of Health Personnel↗
PubMed1993

Care of diabetic patients in hospital clinics and general practice clinics: a study in Dudley.

A five year retrospective casenote review was undertaken of 452 patients attending 11 different general practice diabetic clinics, and 506 patients attending a diabetic clinic at hospital A and 210 patients attending a diabetic clinic at hospital B. The populations attending the clinics, the degree of glycaemic control achieved and the monitoring for the development of diabetic complications were investigated. Insulin dependent patients comprised 57.9% of patients attending the diabetic clinic at hospital A, 35.7% at hospital B and 25.0% of patients attending the diabetic clinics at general practices. Of these 55.6%, 37.3% and 30.1% respectively received multiple daily insulin injections. Hospital A had a higher proportion of patients under 40 years old than hospital B or the general practice clinics. The ages of diabetic patients attending the general practice diabetic clinics were broadly similar to those attending hospital B. Significantly more general practice patients, both insulin and non-insulin dependent, had a mean blood glucose level of less than 11 mmol l-1 compared with patients attending clinics at hospitals A and B (P < 0.001). Glycosylated haemoglobin levels did not differ between patients attending hospital A and the general practice clinics. More non-insulin dependent and insulin dependent diabetic patients attending the general practice clinics and hospital A had been monitored satisfactorily for diabetic retinopathy (general practice clinic 68.8% and 39.7% respectively, hospital A 61.7% and 43.5%) than at hospital B (43.0% and 19.4%). Referral rates among all groups for ophthalmological assessment were similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

How does the content of consultations affect the recognition by general practitioners of major depression in women?

BACKGROUND: Major depression is a common and disabling condition. However, for many reasons, the condition is not recognized in about half of the patients with major depression. AIM: The aim of the study was to establish whether the content of general practice consultations affected general practitioners' recognition of major depressive illness in women patients. METHOD: The 30-item general health questionnaire was used as a first stage screening instrument for psychiatric morbidity. Patients newly recognized as depressed by their general practitioner and those not recognized as depressed who scored 11 or more on the questionnaire were interviewed, usually within three days of consulting their general practitioner, using the combined psychiatric interview. Videorecordings of the consultations for these two groups of women were analysed; analyses were based on mentions of physical, psychiatric and social symptoms and on whether the first mention of a psychiatric symptom was within the first four mentions of any symptoms (early in the consultation) or after four mentions of any symptoms (late) or if psychiatric symptoms were not mentioned. RESULTS: A paired sample of 72 women with major depression was obtained from patients consulting 36 general practitioners, each general practitioner providing one patient whom he or she had correctly recognized as being depressed and one patient whose depression had not been recognized. Women with major depression were about five times more likely to have their depression recognized if they mentioned their psychiatric symptoms early in the consultation compared with those who either left it later to mention such symptoms or never mentioned them. Major depression was more likely to be recognized if no physical illness was present. After adjusting for physical illness, depression was 10 times less likely to be recognized if the first psychiatric symptom was mentioned late in the consultation, or not mentioned at all, than if it was mentioned early in the consultation. CONCLUSION: General practitioners need to remember that patients who present with symptoms of physical illness may also have depression. They also need to remember to give equal importance diagnostically to mentions of symptoms at whatever point they occur in the consultation, regardless of the presence or absence of physical illness.

Adolescent↗
PubMed1996

Use of the consultation satisfaction questionnaire to examine patients' satisfaction with general practitioners and community nurses: reliability, replicability and discriminant validity.

BACKGROUND: Primary health care services are the most frequently used in the health care system. Consumer feedback on these services is important. Research in this area relates mainly to doctor-patient relationships which fails to reflect the multidisciplinary nature of primary health care. AIM: A pilot study aimed to examine the feasibility of using a patient satisfaction questionnaire designed for use with general practitioner consultations as an instrument for measuring patient satisfaction with community nurses. METHOD: The questionnaire measuring patient satisfaction with general practitioner consultations was adapted for measuring satisfaction with contacts with a nurse practitioner, district nurses, practice nurses and health visitors. A total of 1575 patients in three practices consulting general practitioners or community nurses were invited to complete a questionnaire. Data were subjected to principal components analysis and the dimensions identified were tested for internal reliability and replicability. To establish discriminant validity, patients' mean satisfaction scores for consultations with general practitioners, the nurse practitioner, health visitors and nurses (district and practice nurses) were compared. RESULTS: Questionnaires were returned relating to 400 general practitioner, 54 nurse practitioner, 191 district/practice nurse and 83 health visitor consultations (overall response rate 46%). Principal components analysis demonstrated a factor structure similar to that found in an earlier study of the consultation satisfaction questionnaire. Three dimensions of patient satisfaction were identified: professional care, depth of relationship and perceived time spent with the health professional. The dimensions were found to have acceptable levels of reliability. Factor structures obtained from data relating to general practitioner and community nurse consultations were found to correlate significantly. Comparison between health professionals showed that patients rated satisfaction with professional care significantly more highly for nurses than for general practitioners and health visitors. Patients' rating of satisfaction with the depth of relationships with health visitors was significantly lower than their ratings of this relationship with the other groups of health professionals. There were so significant differences between health professional groups regarding patients' ratings of satisfaction with the perceived amount of time spent with health professionals. CONCLUSION: The pilot study showed that it is possible to use the consultation satisfaction questionnaire for both general practitioners and community nurses. Comparison between health professional groups should be undertaken with caution as data were available for only a small number of consultations with some of the groups of health professionals studied.

Community Health Nursing↗
PubMed1995

Investigation of benefits and costs of an ophthalmic outreach clinic in general practice.

BACKGROUND: With the advent of general practitioner fundholding, there has been growth in outreach clinics covering many specialties. The benefits and costs of this model of service provision are unclear. AIM: A pilot study aimed to evaluate an outreach model of ophthalmic care in terms of its impact on general practitioners, their use of secondary ophthalmology services, patients' views, and costs. METHOD: A prospective study, from April 1992 to March 1993, of the introduction of an ophthalmic outreach service in 17 general practices in London was undertaken. An ophthalmic outreach team, comprising an ophthalmic medical practitioner and an ophthalmic nurse, held clinics in the practices once a month. Referral rates to Edgware General Hospital ophthalmology outpatient department over one year from the study practices were compared with those from 17 control practices. General practitioners' assessments of the scheme and its impact on their knowledge and practice of ophthalmology were sought through a postal survey of all partners and interviews with one partner in each practice. Patient surveys were conducted using self-administered structured questionnaires. A costings exercise compared the outreach model with the conventional hospital ophthalmology outpatient clinic. RESULTS: Of 1309 patients seen by the outreach team in the study practices, 480 (37%) were referred to the ophthalmology outpatient department. The annual referral rate to this department from control practices was 9.5 per 10,000 registered patients compared with 3.8 per 10,000 registered patients from study practices. A total of 1187 patients were referred to the outpatient department from control practices. An increase in knowledge of ophthalmology was reported by 18 of 47 general practitioners (38%). Nineteen (40%) of 47 general practitioners took advantage of the opportunity for inservice training with the outreach team; they were more likely to change their routine practice for ophthalmic care or referral criteria for patients with cataracts or diabetes than those who did not attend for inservice training. The outreach scheme was popular with patients, for whom ease of access and familiarity of surroundings were major advantages. The cost per patient seen in the outreach clinics (48.09 pounds) was about three times the cost per patient seen in the outpatient department (15.71 pounds). CONCLUSION: The model of ophthalmic outreach care in this pilot study was popular with patients and general practitioners and appeared to act as an effective filter of demand for care in the hospital setting. However, the educational impact of the scheme was limited. Although the unit costs (per patient) of the outreach scheme compared unfavourably with those of conventional outpatient treatment, potential health gains from this more accessible model of care require further exploration.

Ambulatory Care Facilities↗
PubMed1995

What type of general practice do patients prefer? Exploration of practice characteristics influencing patient satisfaction.

BACKGROUND: General practice is currently experiencing a large number of developments. Studies of patient satisfaction are required to guide the changes that many general practitioners are introducing. AIM: A study set out to examine the characteristics of general practices that influence patient satisfaction. METHOD: In 1991-92, a surgery satisfaction questionnaire of demonstrated reliability and validity was administered to 220 patients in each of 89 general practices. A further questionnaire completed by a member of practice staff collected information about practice characteristics including total list size, number, age and sex of practice partners, training status, fundholding status, presence of a practice manager and whether there was a personal list system. Stepwise multiple regression analyses were undertaken to identify those practice characteristics that influenced patient satisfaction. RESULTS: The mean of the response rates of patients completing questionnaires in each practice was 82%. An increasing total list size of patients registered with practices was associated with decreasing levels of general satisfaction and decreased satisfaction with accessibility, availability, continuity of care, medical care and premises. The presence of a personal list system was associated with increased levels of general satisfaction and increased satisfaction with accessibility, availability, continuity of care and medical care. Training practices were associated with decreased levels of general satisfaction and decreased satisfaction with availability and continuity of care. CONCLUSION: The patients of practices in this study preferred smaller practices, non-training practices and practices that had personal list systems. Practice organization should be reviewed in order to ensure that the trend towards larger practices that provide a wider range of services does not lead to a decline in patient satisfaction. General practitioners should have personal list systems and consider the creation of several personal teams within the practice consisting of small numbers of doctors, receptionists and practice nurses.

Adolescent↗
PubMed1995

Who should give lifestyle advice in general practice and what factors influence attendance at health promotion clinics? Survey of patients' views.

BACKGROUND: Health promotion activity in general practice has increased greatly since 1990. A large proportion of this work is undertaken by practice nurses. Little is known about patients' views about the providers of health promotion or their views about general practice health promotion clinics. AIM: A study was carried out in 1992 to determine patients' views about the provision of health promotion advice by general practitioners and practice nurses and their views about attending health promotion clinics. METHOD: A postal questionnaire was sent to a random sample of 1750 patients aged 16 years and over from five general practices in south Tyneside. The questionnaire explored patients' preferences regarding health promotion advice from the general practitioner or practice nurse in relation to four areas of lifestyle advice and factors that might encourage patients to attend a health promotion clinic. RESULTS: A response rate of 75% was obtained from 1639 eligible patients. Receiving health promotion advice from either the general practitioner or the practice nurse was the most commonly preferred option expressed by patients overall. The ability of health promotion clinic staff to deal with patients' concerns about their illness and short waiting times were more likely to influence patients' attendance at health promotion clinics than the presence of a general practitioner or practice nurse. CONCLUSION: In the present study, many patients found health advice received from practice nurses and general practitioners equally acceptable. However, it was the ability of health professionals to respond to patients' health concerns in the health promotion clinic rather than the type of health professional running the clinic that was important for patients.

Adolescent↗
PubMed1996

Detecting psychological distress: can general practitioners improve their own performance?

BACKGROUND: Many studies have suggested that general practitioners fail to detect a substantial minority of their patients who are psychologically distressed, and there is concern about the possible sequelae of this. Individual patients may suffer unresolved problems, and there are potential costs to the health service in consequent recurrent consultations, inappropriate referrals or treatment. Educational interventions based on small groups led by facilitators have been shown to alter the consultation behaviours of general practitioners that are known to be related to accurate detection of psychological distress. AIM: This controlled study aimed to show that, by utilizing a brief self-directed educational intervention focusing on detection of psychological distress, general practitioners can improve their performance significantly. For this purpose, a new educational intervention was designed: the second aim of the study was thus to assess the effectiveness of this specific intervention. METHOD: An educational intervention was designed which focused on skills relevant to detecting psychological distress, using the principles of reflection on general practitioner performance and consultation skill work. It was designed to be used by individual general practitioners without outside support, using a combination of written background material, feedback on performance and analysis of video material. The effectiveness of the intervention was tested by comparing a trial and control cohort of general practitioners, using detection rates as an outcome measure. RESULTS: The detection rate of the general practitioners who underwent the intervention improved significantly compared with their performance before intervention and with that of the control group. CONCLUSION: General practitioners can improve their ability to detect psychological distress in their patients utilizing this self-directed educational approach.

Adult↗
PubMed1996

Stresses, coping mechanisms and job satisfaction in general practitioner registrars.

BACKGROUND: There is concern about the morale of general practitioner registrars. There may be stress-provoking factors that could be avoided or minimized. AIMS: The aims of the study were to assess the sources of stress and job satisfaction of general practitioner registrars, to compare registrars' job satisfaction with that of established principals using a recently published survey and to identify registrars' usual responses to stress. METHOD: A postal questionnaire survey was sent to all 143 general practitioner registrars in the West Midlands Region. The main measures were: self-rating scales of stresses associated with work and training; the Warr, Cook and Wall job satisfaction scale; and self-reported responses to stress. RESULTS: A total of 118 (83%) general practitioner registrars responded. The most potent sources of stress were family-job conflict, working for the Membership of the Royal College of General Practitioners, patients' unrealistic expectations and disruption of social life. Registrars practised good coping responses to stress. Registrars in this study had significantly greater job satisfaction than general practitioner principals in a 1993 survey for three out of 10 items measured (responsibility given, hours of work and the job as a whole) and significantly worse scores for three items (recognition for good work, rate of pay and variety of work). CONCLUSIONS: Registrars have additional stresses to those of established principals because they need to study for examinations, learn new tasks in general practice and carry out their service commitments at a stage in life when many are newly married or have a young family. Training in stress management for general practitioner registrars is recommended.

Adaptation, Psychological↗
PubMed1996

Prescription of antidepressants by general practitioners: recommendations by FHSAs and health boards.

BACKGROUND: In order to cut costs of prescribing by general practitioners family health service authorities (FHSAs) and health boards in the UK have been instructed to improve the quality and cost-effectiveness of prescribing by general practitioners in their area by tailoring advice to individual general practices. AIM: As over 95% of patients suffering from depression are treated by their general practitioner, a study was set up to investigate the effectiveness of the advice given by FHSAs and health boards to general practitioners on treatment of depression and prescription of antidepressant drugs. METHOD: The recommendations on prescription of antidepressants of professional advisors from all 117.FHSAs and health boards in the UK were elicited by telephone. Those who had produced written information for the general practitioners in their area regarding depression and antidepressants prescribing during the study period were asked to send a copy to the researchers. RESULTS: An excellent response rate (100%) was obtained to the telephone survey, and all of the bodies that provided their general practitioners with written information on depression and prescription of antidepressants sent in copies. Most of the documents received were informative and accurate; however, others provided information that was incorrect. CONCLUSION: Bulletins and newsletters from FHSAs and health boards are capable of influencing the prescribing patterns of general practitioners in their area, and must contain accurate and up-to-date information if they are to improve the management of depressed patients in the community.

Antidepressive Agents↗
PubMed1997

[The health project Ebeltoft: health check ups and discussions in general practice. Basic data from a 5-year, prospective, randomized, controlled population study].

A study was carried out to investigate people's interest in participating in health check-up and in discussions about health with their own general practitioner, participants' health status, the proportion who received health advice following health check-up, and the lifestyle goals they set following discussion with their general practitioner. This study reports the baseline data from a five-year randomized, controlled, prospective, population-based study in general practices in Ebeltoft, Denmark. All general practitioners from the four practices in Ebeltoft and a random sample of 2,000 people aged between 30 and 50 years were invited to participate. Participants were randomly divided into three groups-one control group and two intervention groups. One intervention group was given a health check-up which included a range og tests (Table 2 and 3); this group received written feedback from the general practitioner. The other intervention group was also given a health check-up and written feedback, in addition, they were given the opportunity to attend their general practitioner to discuss health-promoting measures. A total of 1370 people participated in the study (69% response rate). Health advice was given to 76% of 905 participants following health check-up. Almost all of the 456 participants (96%) who were offered the opportunity of discussing their health with their general practitioner took up the offer: 64% of the 456 participants reported that they had decided to undertake lifestyle changes. Eleven of those who discussed their health with the doctor were referred to a specialist (2%). There was considerable interest in participating in health promotion. Three out of four of those who had a health check-up were given health advice. Two out of three of those who were offered a health talk with the general practitioner appeared willing to make relevant lifestyle changes. Longterm follow up is needed to determine effects and side effects of health check-up and health talks.

Adult↗