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PubMed1999

General practitioners' use of computers during the consultation.

This study documents the extent of reported computer use by general practitioners (GPs) in consultations with patients, and identifies barriers to their use. There was a 65% response rate from a random sample of 600 GPs in the South and West National Health Service (NHS) region who were sent a questionnaire. Ninety-one per cent (357) had a desktop computer terminal in their consulting rooms. Of these, 98% used the computer to look up information or prescribe medication, 75% entered details about selected problems presented by patients, and 36% entered information about the patient's presenting problem at every consultation. Only 18% used computers to access reference information. Use of the computer for anything other than looking up patient information or prescribing was positively associated with fundholding status and use of a personal computer at home, and was independent of number of years in practice. Sixty-five per cent of responders had positive attitudes to the inclusion of management guidelines on the computer software, and 45% of responders held positive views towards the idea of integrating management guidelines with the patient's personal computerized medical record. Consideration should be given to targeting training at those GPs who appear to be reluctant to use computers during the consultation.

Attitude to Computers↗
PubMed1999

The simulated surgery--an alternative to videotape submission for the consulting skills component of the MRCGP examination: the first year's experience.

BACKGROUND: The simulated surgery was developed to examine the consulting skills of general practice (GP) registrars by observing their consultations with standardized patients. It was introduced in 1997 as an alternative to videotape submission in the consulting skills component of the Membership of the Royal College of General Practitioners (MRCGP) examination for those candidates who are unable to prepare a videotape. AIM: To describe the methodology of the examination and to report on the first year's experience. METHOD: The development of the cases and the techniques of marking and standard setting in the simulated surgery are described. RESULTS: Thirty-eight GP registrars took part in pilot examinations and 37 candidates were examined for the MRCGP. The distribution of their marks and the resulting pass/fail decisions are reported. The reliability of the 20-case simulated surgery, using Cronbach's alpha coefficient, is greater than 0.85. CONCLUSION: The simulated surgery is a feasible, valid, and reliable examination of consulting skills. Cost and manpower requirements remain a problem, but these are being addressed by current plans.

Clinical Competence↗
PubMed1999

Patients' reasons for not presenting emotional problems in general practice consultations.

BACKGROUND: Patients commonly do not mention emotional problems in consultations, and this is a factor in general practitioners' (GPs') difficulty in identifying psychological morbidity. AIM: To investigate patients' self-reported reasons for not disclosing psychological problems in consultations with GPs. METHOD: From nine general practices, a sample of patients with high General Health Questionnaire scores, who planned to present only somatic symptoms to the GP, were interviewed after their consultation with the GP. The interview covered their reasons for not mentioning emotional problems. A patient satisfaction questionnaire was administered. RESULTS: A total of 83 patients were interviewed. Sixty-four patients confirmed that they had not mentioned emotional problems in the consultation; 23 (36%) of these gave primarily realistic reasons for not presenting emotional problems (e.g. able to cope with distress), 29 (45%) gave reasons related to psychological embarrassment or hesitation to trouble the GP, and 12 (19%) were mainly deterred by the doctors' interview behaviours. The latter group had significantly lower satisfaction scores than patients in the other two groups. In addition, patients in all groups commonly reported perceptions of lack of time (48%) and that there is nothing doctors can do to help (39%) as barriers to mentioning emotional problems. CONCLUSION: An understanding of patients' reasons for not disclosing emotional problems can assist in identifying subgroups of patients with different management needs.

Adolescent↗
PubMed2000

[Evaluation of the first social consultation in oncology: a series of 200 cases. Groupe de recherche de l'action médico-sociale en Aquitaine (Gramsa)].

The aim of the present study is to evaluate the clinical social work in oncology. We present a series of 137 men and 63 women treated for cancer (mean age: 57 y; 20-90) who were addressed (65%) or came spontaneously (35%) for a first social consultation; 45 consultations concerned the family at the day of death of the patient. The collected data (expressed requests, evaluated real difficulties, orientations of the social work, necessity of network) are correlated with the medical data and the time between diagnosis and social consultation. The social intervention is often brief (95%) and focused (66%). A medical and social network is used in 70% of cases. The administrative and psychosocial problems predominate with an important discordance between the requests and the evaluated difficulties. The metastatic status increases psychosocial, legal difficulties and problems of the organisation of home-care. The delay of the social consultation has great influence upon the legal difficulties. The family's difficulties, after the patient's death are administrative (93.3%), psychosocial (84.4%) and legal (68.9%). Clinical social work is part of the global management of patients and their families; its quality has direct implication on their daily life during and after treatment.

Adult↗
PubMed2000

Evaluating the impact of primary care consultations on teenage lifestyle: a pilot study.

This study piloted an evaluation of the effectiveness of inviting teenagers to UK general practice consultations with health behaviour advice and appropriate follow-up care. 132 teenagers aged 14/15 years were randomised: intervention teenagers were invited to attend a health consultation with a practice nurse, the control group received usual care. Teenagers in two practices were consulted by postal survey and in focus groups to ensure the intervention met their needs. 56% of the teenagers invited attended for a consultation. 55% of the intervention group and 45% of the controls reported some positive change in health related behaviour at one month.

Adolescent↗
PubMedDate not supplied

Coping with pressures in acute medicine--the second RCP consultant questionnaire survey.

The second questionnaire survey of consultant physicians involved in acute unselected takes in 1999 achieved a 76% response rate, and the results have been compared with those from the first survey of 1997. The proportion of consultants whose trainees worked partial shifts had increased from 42% to 61%, although these patterns of duty were adjudged to have detrimental effects on the quality and continuity of care, and on junior staff education and training. The benefits of ward-based systems were counterbalanced by their disadvantages, but introductions of admission wards and assessment units were considered a resounding success. The number of hospitals with 'physician of the week' schemes had increased from 12 to 23, but opinion of their value was sharply divided. The provision and competence of all grades of locums was identified as an increasing problem. Seventy per cent of respondents stated that they would never participate in 'hands-on' emergency care, although 86% thought that future consultants might have to do so. Seventy-nine per cent reported increases in the pressures of their posts and in their working hours, and the tensions between general and specialist duties were highlighted. Most consultants considered that the only long-term solution to the staffing crisis was a marked expansion in the numbers of all grades of medical staff.

Adult↗
PubMed2000

Prevalence of lower gastrointestinal symptoms and associated consultation behaviour in a British elderly population determined by face-to-face interview.

BACKGROUND: The incidence of organic lower gastrointestinal disease increases with age. However, the prevalence of lower gastrointestinal symptoms in a British elderly population is unclear, with previous epidemiological studies focusing on younger populations. Furthermore, there is little information about consultation behaviour associated with lower gastrointestinal symptoms. AIM: To determine the prevalence of lower gastrointestinal symptoms reported by randomly selected, elderly community subjects. METHODS: An age- and sex-stratified random sample of patients aged 65 years and over was drawn from a general practice register (n = 842). Those who had not refused to participate in an initial postal survey were invited to participate in a semi-structured physician interview at their own home to assess lower gastrointestinal symptomatology (n = 745). Non-participation bias and service use of all subjects were assessed from practice records. RESULTS: Five hundred and ninety-six (71%) patients were interviewed. Fifty-seven per cent of all participants had at least one lower gastrointestinal symptom. Individual symptoms and symptom complexes were common, affecting up to 32% of subjects. Only 24% of subjects with lower gastrointestinal symptoms consulted their general practitioner (GP) with such symptoms in the previous year. As few as 31% of subjects with new onset of the significant symptoms of rectal bleeding, abdominal pain, and a change in bowel habit consulted their GP. CONCLUSION: Lower gastrointestinal symptoms are common in a British elderly population and an important reason for GP consultation.

Abdominal Pain↗
PubMed2000

[The research of a multimedia consultative system for prosthodontics].

OBJECTIVE: To study how to develop the consultative multimedia system for prosthodontics facilitating the communication between the dentists and patients, using multimedia techniques. METHODS: The Founder Author Tools V2.1 was used to develop the consultative system in the Pwin95/98 environment. Many forms (such as the articles, pictures, sound and video) of the prosthodontic knowledge were edited in this system. RESULTS: The consultative multimedia system for prosthodontics was developed, and there were three main parts of the system: (1) the background of medical departments, (2) introductions of the medical specialists (including their photos and working time), (3) introducing the common acknowledge of prosthodontics. CONCLUSION: The visualization of the prosthodontic problems consulted by patients frequently can facilitate the communication between the dentists and patients and spare visit time. This system are welcome by the patients.

Communication↗
PubMed2002

Non-English speakers consulting with the GP in their own language: a cross-sectional survey.

The Patient Enablement Instrument (PEI) gives counterintuitive results with patients who normally speak non-English languages at home. The aim of this study was to find out more about why patients speaking languages other than English were more enabled in a shorter time than English-speaking patients. A cross-sectional consultation-based questionnaire survey was conducted of 2052 adult patients speaking languages other than English compared with 23790 English-speaking patients in four contrasting study areas in the UK Highest PEI scores in shortest consultation times were associated with South Asian language-speaking patients consulting in their own language. Multiple regression analysis showed that the language factors had an independent effect. We therefore conclude that these patients derive particular benefit from general practice consultations in their own language. Enablement may have a different meaning for patients speaking languages other than English.

Adult↗
PubMed2001

[Dementia in Belgium: prevalence in aged patients consulting in general practice].

Early detection of dementia is an important element for the efficacy of therapies currently proposed to slow down disease progression. This detection mainly relies on general practitioners. In order to estimate the impact of dementia on health services, we have estimated from the data of the NAtional Dementia Economic Study (NADES) the prevalence rate of dementia in patients aged > or = 65 years living at home and consulting in general practice. The study population was based on the sampling of consecutive patients consulting a general practitioner, irrespective of the reason and location of the consultation. The diagnosis of dementia was based on the CAMDEX performed at home in patients presenting > or = 3 warning signs of dementia. The prevalence rate of dementia among 2.234 registered patients living at home was 14.3% (CI95: 12.6-16.0). In age groups 65-74, 75-84 and > or = 85 years, it was 7.0%, 17.5% and 18.5%, respectively, in men, and 6.1%, 15.8% and 25.2%, respectively, in women. The percentage of demented with mild, mild to moderate, moderate and severe dementia was 35.0%, 38.8%, 13.1% and 13.1%, respectively. After adjusting for the age and sex distribution of the Belgian population, the prevalence rate in patients aged > or = 65 years was estimated at 11.3%. A diagnosis of dementia had already been made by a specialist in 41.5% of patients with dementia, with figures of 19.3%, 34.3%, 41.9% and 60.9% according to the severity of disease (mild, mild to moderate, moderate, severe). The onset of first symptoms had preceded the diagnosis by an average of 1 year. Our results show a high prevalence rate of dementia in the elderly living at home consulting in general practice, and less than half of the patients had previously been diagnosed. It is possible that a systematic detection will not be performed as long as specific treatments are not made widely available.

Aged↗
PubMed2002

Inequalities in morbidity and consulting behaviour for socially vulnerable groups.

BACKGROUND: The focus of health policy on improving health and reducing inequality for socially vulnerable groups. AIM: To examine self-report of condition-specific morbidity and consultation with the general practitioner (GP) for socially vulnerable groups. DESIGN OF STUDY: Cross-sectional survey using a modified version of the General Practitioner Assessment Survey (GPAS). SETTING: Ten general practices in each of six health authorities. METHOD: A random sample of 200 patients was selected from each practice. The questionnaire elicited information about experience of specific acute and chronic conditions and whether the GP had been consulted. Four sub-samples were selected from the 4493 registered patients who responded to the self-completion questionnaire. They were lone mothers (n = 160), elderly living alone (n = 417), the unemployed (n = 100), and members of ethnic minority groups (n = 316). RESULTS: Logistic regression analyses showed that, after adjustment for age, sex, smoking, and housing tenure, only lone motherhood and ethnic minority group status were consistently and independently associated with poorer health outcomes. Lone motherhood was associated with a higher likelihood of anxiety (odds ratio [OR] = 2.03, 95% confidence interval [CI] = 1.34 to 3.08) and sleep problems (OR = 1.83, 95% CI = 1.18 to 2.83) and ethnic minority group status with a higher likelihood of depression (OR = 2.02, 95% CI = 1.34 to 3.04), diabetes (OR = 4.03, 95% CI = 2.54 to 6.39, migraine (OR = 1.72, 95% CI = 1.26 to 2.35), and minor respiratory symptoms (OR = 1.75, 95% CI = 1.33 to 2.29). Ethnic minority group status was the only source of social vulnerability that was independently associated with a higher likelihood of GP consultation, particularly for episodes of illness such as backache (OR = 3.28, 95% CI = 2.06 to 5.21), indigestion (OR = 2.94, 95% CI = 1.53 to 5.65), migraine (OR = 3.22, 95% CI = 1.75 to 5.93), minor respiratory symptoms (OR = 3.53, 95% CI = 2.26 to 5.50) and sleep problems (OR = 4.72, 95% CI = 2.56 to 8.71). CONCLUSIONS: Social vulnerability can be a risk factor for poorer health, but this is dependent on the source of vulnerability and is condition-specific. No association was found between inequity in the utilisation of primary care and social vulnerability. The propensity for members of ethnic minority groups to consult more than white people, particularly for acute conditions, requires further exploration.

Adolescent↗
PubMed2002

Peri-operative fluid and electrolyte management: a survey of consultant surgeons in the UK.

BACKGROUND: Current peri-operative fluid and electrolyte management in the UK may be suboptimal. We assessed the attitudes of consultant surgeons to fluid and electrolyte prescribing and gathered suggestions for improvement in education on the subject. METHODS: A postal questionnaire survey was sent to 1091 Fellows of the Association of Surgeons of Great Britain and Ireland. Of the 730 (67%) replies, 20 were invalid or incomplete, and 710 (65%) questionnaires were analysed. Outcome measures included provision of guidelines and teaching to junior staff on fluid and electrolyte prescribing, appropriateness of fluid management and suggestions to improve standards. RESULTS: Junior staff were given written guidelines in 22% of instances. Only 16% of respondents felt that their preregistration house officers (PRHOs) were adequately trained in the subject before joining the firm; 15% also stated that PRHOs did not receive much training on their firm. 65% felt that fluid balance charts were accurately maintained, nursing shortages being the commonest reason for inaccuracies. Only 30% felt that postoperative patients were receiving appropriate amounts of water, sodium and potassium. Respondents who had been consultants for > 5 years were more likely to prefer erring on the side of under-replacement of fluid than those who were consultants for 5 years (63% versus 47%, P < 0.0005). Suggestions for improvement in education included problem-oriented ward rounds, written guidelines, and discussion of patient scenarios. CONCLUSIONS: Consultant surgeons feel that present practice in peri-operative fluid management is unsatisfactory. Higher standards within clinical governance and risk management may be achieved by focused practical training combined with formal written guidelines.

Attitude of Health Personnel↗
PubMed2002

Consultation rates from the general practice research database.

An analysis was undertaken of consultation rates in 226 UK general practices contributing to the General Practice Research Database. Over the period 1992-1998 the mean age-standard-ised consultation rate per person year at risk was 3.85 (3.01 for males and 4.71 for females). In contrast with younger ages, consultation rates among those aged 65years and over showed an upward trend over the seven-year period. Consultation rates were higher in areas of low population density as compared with higher density areas.

Adolescent↗
PubMed2002

Measuring consultation skills in primary care in England: evaluation and development of content of the MAAS scale.

BACKGROUND: Consultation skills are essential for general practice. Tools for measuring consultation skills in everyday practice are not well developed AIM: To examine and develop the content validity of the MAAS History-taking and Advice Checklist GP (MAAS-GP) tool which is used in The Netherlands for testing consultation skills, with simulated patients in United Kingdom general practice from the perspectives of both general practitioners and patients. DESIGN OF STUDY: Qualitative research using semi-structured interviews. SETTING: Alternate patients attending seven general practices in the north west of England. METHOD: Thematic analysis of the contents of patient and GP interviews, and of focus groups, mapping key themes to the MAAS-GP. RESULTS: There was strong agreement between patients and GPs on issues mapping to 46 out of 68 items of the MAAS-GP. Eight further MAAS-GP items were linked to issues only raised by patients and four to issues raised only by GPs. The remaining 10 items could not be related to issues raised by either. All of the issues raised by GPs could be mapped but 27 patient items could not. These were included in a revised checklist, the Liverpool MAAS (LIV-MAAS). CONCLUSION: the revised tool seems to have content validity in measuring consultation skills. Measurement of its relability is now required.

Adult↗
PubMed2003

The general practitioner-patient consultation pattern as a tool for cancer diagnosis in general practice.

A case-control study design was used to examine consultation patterns during the three years leading up to the diagnosis of an internal malignancy, within the context of the registered patient list of a single large general practice at Winterton, North Lincolnshire. Using a combination of matching, consultation subclassification, and conditional logistic regression, account was taken of the major confounders affecting consultation rates. Generally, the odds of cancer rose in tandem with increases in the average time between new consultations. This trend was significant for all breast cancers (at the 5% level) and persisted after adjustment for occupation, smoking, and marital status (P = 0.03), as well as after the exclusion of patients identified by routine screening (P = 0.05).

Case-Control Studies↗
PubMed2003

A survey of Irish consultants regarding awareness of sperm freezing and assisted reproduction.

Chemotherapy and radiotherapy decrease male fertility. Pretreatment semen cryopreservation offers a chance for future fatherhood. However many eligible patients are not referred. One potential reason for the reduced uptake is lack of awareness by referring consultants. We sent a questionnaire to all 41 consultant oncologists, haematologists and urologists listed in the Irish Medical Directory. The questionnaire surveyed the current knowledge, opinions and clinical practices of this key group regarding semen cryopreservation for male cancer patients. 63% responded. 73% routinely discuss semen freezing with their male cancer patients (mostly testicular carcinomas and lymphomas). 100% believe semen cryopreservation helps the patient psychologically. 12% do not know where facilities exist. 92% will only refer men aged between 20 and 40 years. 92% are unaware that semen freezing does not delay cancer treatment. 54% have heard of intracytoplasmic sperm injection (ICSI) but 88% are unaware of its benefits for patients with low sperm counts. Consultants dealing with male cancer patients do not prioritise future fertility. Most of the consultants surveyed were unaware of the advances in reproductive technology and this may be contributing to underutilization of sperm cryopreservation by male cancer patients. Units offering this service need to increase awareness of its potential benefits.

Awareness↗
PubMedDate not supplied

[Nursing consultation: analysis of actions in programs for arterial hypertension, in Fortaleza].

The nurses' performance in a hypertension and diabetes programs has been important, once its approach is not only directed to illness, but also to the patient as a whole. Therefore, the nursing consultation is a unique moment of this approach. This is a descriptive study aiming at searching the activities performed in the nursing consultations that are performed within Hypertension Programs in the city of Fortaleza, State of Ceará, Brazil. The data were gathered from March to May 1999, with 14 nurses, who work in these services. Data were analyzed according to Bardin's content analysis as well as the categorical analysis. The results showed that the nursing consultation is still based on the traditional curative medical model. The activities performed by nurses are restricted to anamnesis, brief physical examination and diet orientations, medications, walks and use of infusions. In the consultations, individual care prevails, without considering family and group approaches.

Brazil↗
PubMedDate not supplied

[Pattern-profile of emergency consultations of children in acute asthmatic crisis].

BACKGROUND: Asthma is one of the most frequent illnesses in the pediatric age, the exacerbations account for one of the main consult causes to the emergency services. OBJECTIVE: To determine the frequency of the consultation demand and the recurrence of patients with acute crisis of asthma. MATERIAL AND METHOD: A transverse study, performed at the service of pediatric emergencies, included pediatric patients with acute crisis of asthma from January to December, 2000. RESULTS: In this study 20.3% of the consultations were due to acute crisis of asthma, 54.29% needed handling in the service of pediatric emergencies with inhalotherapy; 94.3% responded to the treatment. The gender masculine-feminine relationship was of 1.7:1. The predominant ages were from 3 to 5 years. The consultation increased in September, October and November. CONCLUSIONS: When asthma is mistreated may present exacerbations.

Adolescent↗