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PubMed2003

Computerisation in Australian general practice.

AIM: To assess the current levels of computer use in Australian general practice, and identify clinical and administrative tasks for which computers are most commonly used by general practitioners. METHODS: A telephone survey of a nationally representative sample of Australian GPs in active practice (n = 1202). RESULTS: The national response rate was 55.5%, with New South Wales, Tasmania and the Australian Capitol Territory recording lower than national rates, and Queensland, Western Australia and the Northern Territory recording higher rates. Australian general practices were highly computerised (86%). General practitioners practising in capital cities were less likely to be computerised than their rural colleagues (p < .001). There were no significant differences in general computerisation among practices in the Australian states and territories (p > .05). Three task sets for which computers were used were identified: general administrative functions, patient oriented administrative functions and clinical functions. Computers were more likely to be used for administrative than clinical tasks. Use for administrative tasks increased with the size of the practice (p < .001) and with years of computer use (p < .001). DISCUSSION: The results suggest that within two years 95% of Australian general practices will be computerised. While use of computers for clinical functions is less common than for administrative purposes, electronic script writing packages are widely employed. However, other theoretically valuable functions for improving clinical outcomes for patients, such as patient educational material and decision support systems, are the least commonly used.

Australia↗
PubMed1976

The role of practice manager--changes in attitudes promoted by the Royal College of General Practitioners.

Because of the roles traditionally required of them, and because of the insularity of ancillary staff in general medical practice, many senior ancillary staff may not have been giving their doctors the most effective support of which they are capable. This is changing as a result of the change-promoting activities of the North of England Faculty of the Royal College of General Practitioners.A survey of ancillary staff and general practitioners in the North of England has shown that the Royal College of General Practitioners has assisted ancillary staff to a greater consensus of more progressive views about the emerging role of practice manager than is the case amongst general practitioners. The results also show that differences in the size of practices have determined whether or not a need for a practice manager is perceived.The focus of interest created by this faculty of the Royal College of General Practitioners has resulted in the formation of special interest groups of senior ancillary staff in the North of England. These groups form a valuable resource for exploration and innovation to discover more effective means of organising and managing general medical practice.

Allied Health Personnel↗
PubMed2003

Sustaining quality general practice in a flawed market.

BACKGROUND: Recent years have seen an increasing corporatization of general practice. OBJECTIVE: This paper considers how divisions of general practice should respond to the corporatization of general practice. DISCUSSION: Corporate models are an economically rational outcome of structural features of Medicare funding for Australian general practice. One limitation of these structures is that they are indifferent to quality. Corporate general practice competes with divisions of general practice at some level because it provides an alternative organisational structure and service values for large numbers of general practitioners. Accepting this, the challenge for divisions becomes one of differentiating themselves from the corporate model through a focus on promoting and encouraging quality practice.

Australia↗
PubMed2003

The nature and prevalence of psychological problems in New Zealand primary healthcare: a report on Mental Health and General Practice Investigation (MaGPIe).

AIMS: This paper describes the methods used in a study of the prevalence and types of common mental disorders among patients attending New Zealand general practices, and reports some key findings from the first phase of the study. The study also aimed to determine the degree of associated disability and other factors influencing recognition, management, course and outcome of these disorders, and subsequent papers will address these issues. METHODS: General practitioners (GPs) were selected randomly. In the first phase of the study, all adult attenders at each practice on selected days were administered a short questionnaire, the General Health Questionnaire (GHQ-12), which screens for psychological symptoms. The GP recorded the reasons for each consultation, and was interviewed at the end of each day about selected patients to determine their opinion about the type of psychological problems experienced. Selected patients were then visited in their own homes and an extensive interview conducted, which included the Composite International Diagnostic Interview (CIDI) to determine mental health status, the World Health Organization's Disability Assessment Schedule (WHODAS) to determine disability, and a detailed exploration of use of health services. In the second phase of the study, patients were contacted by telephone at three, six, nine and 12 months, and both patients and GPs were re-interviewed at 12 months. RESULTS: The study achieved a very high response rate among the GPs (90%). Nearly all eligible patients (93%) completed the GHQ screening, and their response rate was 70% for the first-phase interview. GPs thought that 54% of female and 46% of male patients had experienced some level of psychological problems in the past year. GHQ screening also found that more than half of those attending their general practitioner experienced some psychological symptoms at initial screening, and the CIDI interview found that more than one in three had a diagnosable mental disorder during the past 12 months. The most common mental disorders were depressive, anxiety and substance use disorders. These disorders were more common among younger than older general practice attenders, and comorbidity was high. CONCLUSIONS: Mental health problems are very common among general practice attenders. Contrary to the prevailing view that general practitioners seldom identify psychological problems in their patients, they identified about half their patients as having some type of psychological problems in the past year, although they considered that these were moderate or severe in about only one in ten patients. Further work from this large New Zealand study will focus on the nature of the relationship between disorder and disability, and on the recognition, management and outcome of psychological problems.

Adolescent↗
PubMed1999

Thrombolysis in peripheral general practices in Scotland: another rule of halves.

OBJECTIVE: To facilitate the adoption of thrombolysis by general practitioners in peripheral practices in Scotland. DESIGN: Survey of practice policies on the management of acute myocardial infarction before and after practice visits by a consultant physician acting as a facilitator; survey of hospital consultants' attitudes to thrombolysis by general practitioners. SETTING: One hundred and eighty-two practices, with an enlisted total of 550,000 patients, located at least 30 minutes from a district general hospital; 23 such hospitals serving these peripheral practices. MAIN OUTCOME MEASURES: Possession of electrocardiograph and defibrillator; adoption of a policy of giving thrombolytic therapy. RESULTS: The majority of practices possessed an electrocardiograph (87%) and a defibrillator (76%). At the time of the visits, 67 practices (37%) already had a policy of giving thrombolytic therapy. When contacted one year later 91 practices (50%) had such a policy. In the interval between visits and follow-up, few had received any encouragement from any source to use this treatment. Hospital consultants' attitudes to thrombolysis by general practitioners were generally negative, and support from local and national health authorities has been inadequate. CONCLUSIONS: Provision of timely thrombolytic therapy for the one tenth of the Scottish population living at least 30 minutes from a district general hospital is a major public health problem for which there is a ready solution: pre-hospital thrombolysis administered by general practitioners has been shown to be feasible, fast, safe, efficacious and cost-effective. To translate this evidence into practice requires a concerted effort from all the professionals involved, and must be directed and supported by local and national management of the National Health Service in Scotland.

Drug Utilization↗
PubMed1992

What do medical students seek to learn from general practice? A study of personal learning objectives.

With the aim of stimulating learning which is more self directed, fourth year medical students in Liverpool are encouraged to set personal learning objectives for the general practice attachment. On average, a student defines seven objectives for the three week attachment. A classification of objectives derived from the 1989 cohort of students is presented and the objectives could be seen as focusing on the practice population and its health problems, the role of the general practitioner, the work of general practice, the management of general practice, general practice as a career, and general learning. The validity and reliability of the classification are considered. Along with the advantages of this approach in motivating students to learn, the findings are considered in relation to impending changes in undergraduate medical education and the future role of general practice teaching by departments and by practice based colleagues.

Curriculum↗
PubMed1992

An analysis of funding for general practice research in Australia.

OBJECTIVE: To describe the current status of funding for general practice research in Australia. DESIGN: A descriptive survey analysing funding arrangements of research projects included in a national research database, established by the Royal Australian College of General Practitioners. SETTING AND PARTICIPANTS: Research projects involving, or directly related to, general practice that had commenced in Australia since 1 January, 1989. Responses were specifically sought from all universities, the Family Medicine Programme and the Royal Australian College of General Practitioners. MAIN OUTCOME MEASURES: Extent and source(s) of funding received or requested, or both; relationship of funding received to the following: qualification and affiliations of the principal investigator; submission of the research project towards a higher degree; subject area(s) covered by the research; study design method used; and duration of project. RESULTS: A total of 237 projects from 130 principal investigators were included in the analysis. Of these, 149 (63%) had been submitted for funding and 98 (66%) had been successful. The amount of funding ranged between $300 and $855,600. The most common source of funding was the General Practice Evaluation Programme. Research contributing towards a higher degree was associated with successfully receiving funding. Other variables, including the study design and study area, were not significantly associated with an increased success of funding. CONCLUSIONS: The total amount of funds spent on general practice research is still small, relative to the size of the workforce. However, over half of general practice research undertaken in Australia is not submitted for funding. Of the research that is submitted, the success rate of receiving funds is high.

Australia↗
PubMed2003

[Self-reported level of skills in practical procedures following internship in general practice].

BACKGROUND: Previous reports have demonstrated variable and partly insufficient skills in standard practical procedures among young doctors who have served their internship. The present study examines the development of interns' self-reported level of skills in practical procedures during internship in general practice in relation to quantity and quality of supervision, gender and the size of the community they served in. MATERIAL AND METHODS: Between 1996 and 1999, all doctors going through internships in Norway were asked to indicate their level of skills in 88 practical clinical procedures before and after internship in general practice. Of 575 interns asked, 439 replied (76 %). RESULTS: All interns reported a significant overall improvement in self-reported practical skills during internship in general practice. Supervision and feedback was also significantly better in general practice than in internships in hospital. INTERPRETATION: The quality of the general practice internship in Norway is superior to the quality of hospital training. Supervision and feedback is a standard part of the education of general practitioners and represents a valuable tradition. A combination of internship in hospitals and in general practice is necessary for acquiring adequate skills in practical procedures.

Adult↗
PubMed2004

Off-period dystonia in Parkinson's disease but not generalized dystonia is improved by high-frequency stimulation of the subthalamic nucleus.

STN-HFS is well known to improve patients with IPD. Because off-period dystonia mimics focal or generalized dystonia of other causes, we proposed bilateral STN-HFS to some patients with generalized dystonia. The aim of this study was to compare the efficacy of STN stimulation on off-period dystonia and generalized dystonia. From a larger series of patients with IPD, we selected 22 patients based on the presence of severe preoperative off-period dystonia rated > or = 3 in least one limb on a severity score ranging from 0 to 4. Four patients with generalized dystonia (Hallervorden-Spatz disease, n = 3; primary, n = 1) underwent bilateral STN-HFS. Dystonia of the four limbs was rated on video recordings in all patients before surgery and 3 months after surgery. In IPD, bilateral STN stimulation reduced the severity of off-period dystonia by 70% on the four limbs (preoperative mean severity score = 2.03 +/- 1.49; postoperative mean severity score = 0.60 +/- 0.78). In contrast, bilateral STN-HFS had no effect on generalized dystonia (preoperative mean severity score = 3.25 +/- 0.77; postoperative mean severity score = 3.12 +/- 0.62). Despite clinical similarities between off-period dystonia in Parkinson's disease and generalized dystonia in certain cases, the effect of chronic bilateral STN-HFS differs. STN stimulation is highly effective in off-period dystonia of IPD, whereas it does not improve generalized dystonia. The pathophysiologic mechanisms underlying dystonia in these two disorders are still unknown. Assuming that the mechanism of action of STN-HFS is similar regardless of the cause of dystonia, our findings suggest that the STN is not similarly involved in off-period dystonia of IPD and others dystonias.

Adult↗
PubMed1992

[Treatment of injuries in the county of Ringkøbing. 3. Attitude and behavior of the population and general practitioners in relation to treatment of injuries].

This investigation describes the attitudes and behaviour of the population and the general practitioners in the County of Ringkøbing concerning treatment of injuries and the closed casualty department. The investigation consists of three parts. 1. In order to describe the general practitioners in the County of Ringkøbing as those who treat injuries, a questionnaire was sent to these and 88.0% replied. In general, the general practitioners had relatively great experience of work in casualty departments from their hospital appointments. Only eight (5.6%) had experience for less than six months. Practically all (93.2%) had assistance during the day but, during on-call periods, only 16.4% had assistance from doctors. Only 2.1% had access to radiographic examination in their practices. The general practitioners stated that they were able to complete treatment in 82.5% (95-50) of the patients without referral to hospital. Lack of facilities and expertise were the commonest reasons for referral to hospital. 70% considered treatment of injuries as interesting or very interesting. Only 1.4% found it boring. 2. In order to describe self referral to hospital in cases of slight injury by the population of the County of Ringkøbing a questionnaire was sent to 600 of the population aged over 17 years chosen at random. 71.6% replied. 70% stated that they would contact their general practitioner or doctor-on-call in cases of wounds and suspected fracture. The individuals who would contact the casualty department, particularly in the case of wounds, were persons who lived close to the casualty department and who did not have any advantage in contacting their own general practitioner where distance was concerned.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed2003

[General medicine as an academic discipline].

The aim of the article is to show emerging changes in the health care, which will require some adaptation of curricula of medical faculties. It also considers the role of general practice in those changes and it emphasizes the potential of general practice for the undergraduate medical education and for the primary care research. Three questions are discussed: What can the subject of general practice offer to medical faculties? What can the medical faculties do for the general practice? At universities, the discipline "General practice" should become, similarly to the real health care, the first bridge between books and the live human. At higher classes, it should represent a clinical field with its position in the health care system, with its definition and characteristics. Similarly to other countries, general practice should offer all attributes of a medical branch for the full accomplishment of medicals, including their scientific work and teaching. It would require further developing of its academic basis. Society will be then awarded with higher quality of medical care offered by general practitioners.

Czech Republic↗
PubMed1992

Attitudes towards and use of general practitioner services among homosexual men with HIV infection or AIDS.

In a study of 263 homosexual men positive for the human immunodeficiency virus (HIV), it was found that 87% were registered with a general practitioner and of these, 55% said that the general practitioner knew their HIV status. Of the 104 men who had experienced symptoms, 39% had consulted the general practitioner for HIV-related advice. A total of 49% of those who were not registered used a specialist outpatient clinic for all their medical needs. Of those who were registered and whose general practitioner was aware of their HIV status but who did not consult their doctor, 72% used a specialist outpatient clinic. Reasons for not consulting the general practitioner included fears of breach of confidentiality and lack of confidence in the general practitioner's understanding of HIV. Fifteen per cent of the sample continued to see a general practitioner who was unaware of their HIV status, for non-HIV related advice. The needs of patients must be taken into account when planning more integrated hospital and community care for those with HIV infection or the acquired immune deficiency syndrome (AIDS).

Acquired Immunodeficiency Syndrome↗
PubMed2004

Implications of the increasing female participation in the general practice workforce in Ireland.

Almost one in three Irish general practitioners (GPs) are now women, a ratio that has doubled since the early 1990s. The increase in numbers of women entering general practice training looks likely to continue and will have a formative influence on the future of general practice. This study investigates the implications for Irish general practice of the increasing feminization of the workforce. Questionnaires were sent to all (200) Irish vocationally trained female General Practitioners qualifying between 1995 and 2001. Sixty eight percent of respondents were currently working in full-ltime general practice. A majority wish to remain in general practice (88%) and potentially up to 90% intend to work part-time in the future. The ideal future work practices of this cohort are part-time partnerships, and over 50% are not in a position to work out of hours. To facilitate the career and working intentions of female vocationally trained GPs and to retain their services, there needs to be increased flexibility of hours of work, increased part-time partnerships and an Irish retainer scheme that will accommodate female GPs who cannot work full-time because of family commitments.

Family Practice↗
PubMed2004

Feasibility study of hernia surgery in a general practice setting.

BACKGROUND: In the early 1990s, waiting times for some surgical procedures and opinions for such routine problems as groin hernia repair were unacceptably long. General practitioners with a special interest (GPwSIs) in general surgery may improve this, but little evidence exists as to whether such service developments may improve efficiency and effectiveness of care. AIMS: To reduce the waiting time by offering a surgical service from a general practice setting without compromising on quality and safety of patient care. DESIGN OF STUDY: Feasibility study. SETTING: One general practice and the patient population of northwest Norfolk. METHODS: A GPwSI whose special interest was in general surgery started offering a surgical service, including open hernia repair, from a purpose-built operating theatre within general practice premises. RESULTS: Four thousand, nine hundred and sixty-five surgical procedures, including 286 inguinal hernia repairs, were performed. Quality and safety of patient care were not compromised and the waiting time was reduced from 18 months to 4 months. CONCLUSION: It is feasible to perform open inguinal hernia repairs in a general practice setting.

Ambulatory Surgical Procedures↗
PubMed2004

Do age, gender and marital status influence job strain development for general practitioner?

BACKGROUND: General practice is one of the most stressful workplaces among health care workers and is characterized by higher rates of job strain than in reference population. We need to take into account that respondents are influenced by quite similar working conditions and health status differently. Thus this article aimed to review the subjective processes, which make general practitioners more vulnerable to the job strain. METHODS: Computerized database Medline was searched. Search included data for 1983-2003. In this review data form many comparative cross-sectional studies found in this database were included. A data collection form was developed, prepared and filled up on reading each article. RESULTS: Collected studies highlighted that age, gender and marital status influence job strain development for general practitioner but were very controversial on how and whom they influence. We found that outcomes of job strain have higher impact for females than for males. We also found data that males have also high rates of job strain working in general practice. The age impact on job strain between females and males increases in older age groups. The rate of job strain is the highest among middle-aged general practitioners and depends on marital status. Married females have the worst health and are most vulnerable to job strain. CONCLUSIONS: Magnitude of job strain varies depending on age, gender and marital status of general practitioner. The highest rates of job strain are mostly observed in married females, younger or older general practitioners. Sociodemographic factors contribute to this. The development of job strain, in some extent, can be explained within social context.

Adult↗
PubMed2004

Quality of diagnostic coding and information flow from hospital to general practice.

AIMS: To describe the transfer of patient information from hospital to general practice and compare the quality of coding of patient diagnoses in hospital and general practice systems. METHOD SETTING: Wellington Hospital and patients registered with 12 general practitioners (GPs) from two local computerised general practices. Discharge and outpatient letters for the period June to August 2003 were analysed and diagnostic coding compared between letters and electronic health records (EHR) in hospital and general practice. A questionnaire was sent to 167 consultants and 112 GPs from Wellington city region with a 71% response rate. RESULTS: GPs received 55% of 284 discharge letters and 97% of 612 outpatient letters with a mean time of 9.4 days (range 0-70 days) and 14 days (range 0-120 days). The mean number of diagnostic codes recorded in discharge letters was 2.9 per letter, in the GPs' EHR 0.9 per letter, and in the hospital EHR 3.5 per letter. GPs were sent new diagnostic information in 30% of discharge and 36% of outpatient letters. There was more coding agreement between GPs' EHR and discharge letters than between the hospital EHR and discharge letters (65% versus 35%). GPs duplicated coding for 71% of all letters, and 74% of diagnoses were coded within the classification section of the GPs' EHR. More GPs than hospital doctors coded patient diagnoses (85% versus 15%), had any formal training in coding (25% versus 2%), and thought coding improved patient care (75% versus 50%). Most doctors in both groups experienced considerable delay of information flow and favoured an electronic transfer of information. CONCLUSIONS: There is delay in information flow from hospital to general practice and poor comparison of diagnostic coding across the two systems. Attitudinal differences and inefficient coding practices will need to be addressed to produce an integrated information system between hospital and general practice.

Adolescent↗
PubMedDate not supplied

Awareness and knowledge of fibromyalgia among French rheumatologists and general practitioners.

OBJECTIVES: Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain and fatigue. Its prevalence is estimated to be at 3.4% in women and 0.5% in men. It is a major cause of morbidity. Our objective was to evaluate, using a self-questionnaire sent by mail, the level of knowledge of French physicians, general practitioners, and rheumatologists on fibromyalgia and to analyse their therapeutic approach. METHODS: The demographic characteristics of a sample of general practitioners and rheumatologists were compared to those of the overall data available. This comparison demonstrated the good representativeness of our sample. RESULTS: Fibromyalgia was considered as a disease by 23% of rheumatologists and 33% of general practitioners. While on average, each rheumatologist followed 30 fibromyalgia patients, each general practitioner followed 6.1 patients (i.e., 2 to 5% of their practice's patient base). Among rheumatologists, 6.4% made no distinction between this disease and depression vs. 13.1% of general practitioners. The diagnosis of fibromyalgia was made based on tenderness that occurs in precise, localized areas of the body (trigger points) by 94% of rheumatologists and 79.1% of general practitioners. Of general practitioners and rheumatologists, 93.7% and 73.7% respectively, have not received any medical school training on fibromyalgia or chronic fatigue syndrome. CONCLUSION: Given the lack of medical school training and continuing professional education concerning fibromyalgia (rare use of pain rating scales, confusion in the classification of rheumatic diseases), there is an urgent need to initiate an explicit teaching effort on chronic pain, and on fibromyalgia in particular.

Clinical Competence↗
PubMed2006

Consultations in general practice and at an Aboriginal community controlled health service: do they differ?

INTRODUCTION: Despite the widely acknowledged health disparities between Indigenous and non-Indigenous Australians, little is known about consultations in primary care with Indigenous people. In particular, the nature of consultations in the Aboriginal Community Controlled Health Service (ACCHS) sector has been rarely studied. Data collection about consultations in primary care has been steadily improving, with good quality data now available on an ongoing basis about patient demographics, risk factors and consultation content in private general practice. This study aimed to characterise consultations at Townsville Aboriginal and Islander Health Service (TAIHS) in terms of patient demographics and consultation content. These could then be compared with existing datasets for local consultations in mainstream general practice and from a geographically distant ACCHS. METHODS: We conducted a prospective questionnaire audit of all consultations at Townsville Aboriginal and Islander Health Service (TAIHS) over two fortnights, 6 months apart in 2000 and 2001. The questionnaire was adapted from one used in previous general practice surveys, and was completed by the treating clinician at the end of each consultation. The questionnaire described consultations using the following variables: date of consultation; patient age; ethnicity and gender; postcode and whether or not they were new to the practice; where they were seen; the provider of the service (doctor, nurse, health worker etc); Medicare level of consultation; patient reasons for encounter; problems managed; treatment and medications given; investigations; admissions; follow up; and referral. Proportions with 95% confidence intervals were calculated to facilitate comparisons with other datasets. Comparison was made with previously reported data from mainstream Townsville general practice (via the local BEACH study report) and from Darwin ACCHS (Danila Dilba). RESULTS: Of 1211 consultations studied, 1994 problems managed were recorded. TAIHS patients had a significantly younger age distribution than patients in mainstream general practice (as did patients at Danila Dilba). TAIHS consultations involved the management of more problems (1.65 problems per consultation; 95%CI [1.60, 1.70]), when compared with mainstream general practice (Townsville BEACH study 1.45 problems per consultation [1.37, 1.52]; 1.48 for Indigenous patients). Danila Dilba recorded an average of 1.58 problems managed per consultation (95% CI [1.51, 1.65]). The most frequently managed problems differed between all three datasets, and at TAIHS the most common problems managed were type 2 diabetes mellitus (11.3 times per 100 consultations), upper respiratory tract infections (9.6) and hypertension (7.9). Aboriginal Health Workers (AHW) saw the patient at TAIHS in 224/1213 (18.5%) of consultations, nurses (two Indigenous) participated in 513 (42.3%) of consultations, and a (non-Indigenous) medical officer saw the patient in 1070 (88.2%) of consultations. The Danila Dilba study found that 42.6% of their consultations involved an Aboriginal health worker only, and a health worker and a doctor managed 53.5%; only 3.9% were managed by a doctor alone without input from a health worker. CONCLUSIONS: The greater number of problems managed per consultation in ACCHS, compared with Indigenous patients in mainstream general practice, supports the assertion that ACCHS fill an important role in the health system by providing care for their largely Indigenous patients with complex care needs. The Medicare system as it was structured at the time did not encourage involvement of Indigenous health workers in provision of primary medical care. It remains to be seen whether introduction of the new enhanced primary care Medicare numbers will assist in this process. These findings have implications for ACCHS in other areas of the country and for other providers of primary health care for Indigenous Australians.

Adolescent↗