SEARCH · Search PubMed

Results for “Questionnaire Design”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,747 records · Page 97Linked to original sources

PubMed1995

Adults with a history of child sexual abuse: evaluation of a pilot therapy service.

OBJECTIVE: To evaluate a pilot service offering therapy specifically to adults with a history of child sexual abuse. DESIGN: Questionnaire survey. SETTING: Specialised therapy unit, Breakfree, which offers care, therapy, and support. SUBJECTS: 116 clients presenting to the service who were offered therapy. MAIN OUTCOME MEASURES: Scores from three psychological questionnaires--the social activities and distress scale, the general health questionnaire, and the delusions, symptoms, and states inventory--and from questionnaires about the clients' abuse, previous use of health services, and opinion of the Breakfree service. RESULTS: Clients had received previous help from health services and other agencies without apparent effect; they were highly distressed according to their psychological scores; and they were very frequent users of the health services. The clients showed significant improvement in their psychological scores (Wilcoxon's matched pairs signed ranks test): social activities and distress scale, z = -3.3, P = 0.001; general health questionnaire, z = -5.8, P < 0.00001; delusions, symptoms, and states inventory, z = -4.8, P < 0.00001). This was most pronounced for those who had completed therapy by the end of the study. Whereas 82/88 clients had a score for the general health questionnaire that indicated clinical distress at the start, only 28/58 did so at the end of the study (only 17/35 among those who had finished therapy). CONCLUSIONS: This group of adults with a history of child sexual abuse were highly disturbed and previous high users of the health service. The specialist service Breakfree was effective in the short term and, if the benefits are sustained, would yield a net cost saving to the health service.

Adult↗

PubMed1995

Rectal bleeding: prevalence and consultation behaviour.

OBJECTIVES: To determine prevalence of rectal bleeding in the community and to examine factors that lead some patients to consult their general practitioner about rectal bleeding while others do not. DESIGN: Questionnaire survey followed by semistructured interviews of sample of respondents with rectal bleeding. SETTING: Two general practices on Tyneside. SUBJECTS: 2000 adult patients registered with the general practices were sent a validated questionnaire. Respondents with rectal bleeding were divided into consulters and non-consulters, and 30 patients from each group (matched for age, sex, and characteristics of bleeding) were interviewed. MAIN OUTCOME MEASURES: Prevalence of rectal bleeding, proportion of subjects with rectal bleeding who sought medical advice, and reasons for consulting or not consulting a doctor about rectal bleeding. RESULTS: 287 of the 1200 respondents to the questionnaire had noticed rectal bleeding at some time in their lives, and 231 had noticed it within previous 12 months. Only 118 (41%) of all respondents with rectal bleeding had ever sought medical advice for the problem. Those aged over 60 were most likely to have consulted, as were those who reported blood mixed with their stools. Main difference between those who had sought medical advice and those who had not was that consulters were more likely than non-consulters to perceive their symptoms as serious. CONCLUSIONS: Although rectal bleeding is common, only minority of patients seek medical of symptoms seems to be most important factor in deciding whether to consult a doctor for rectal bleeding.

Adult↗

PubMed2000

Association between illegal drugs and weapon carrying in young people in Scotland: schools' survey.

OBJECTIVES: To identify the type and extent of weapons being carried among young people in Scotland, and to determine the relation between use of illegal drugs and weapon carrying. DESIGN: Questionnaire school survey. SETTING: Independent schools in central Scotland and schools in Lanarkshire and Perth and Kinross. PARTICIPANTS: 3121 students aged 11 to 16 in 20 schools. MAIN OUTCOME MEASURES: Self completion questionnaire reporting history of drug use and weapon carrying. RESULTS: Overall, 34.1% of males and 8. 6% of females reported having carried a weapon (P<0.0001), ranging from 29.2% of boys aged 11-13 (classes S1 to S2) to 39.3% of boys aged 13-15 (S3 to S4). These values are higher than those in a recent survey of young people in England. Weapon carrying in Lanarkshire was 70% higher for males than in the rural area of Perth and Kinross. Both males and females who had taken drugs were more likely to carry weapons (63.5% of male drug users versus 20.5% of non-users and 22.8% of female drug users versus 3.7% of non-users; both P<0.0001). The proportions of males carrying weapons who used none, one, two, three or four, or five or more illegal drugs were 21%, 52%, 68%, 74%, and 92% respectively. A similar trend was found among females. CONCLUSIONS: Better information is needed on the nature and extent of weapon carrying by young people in the United Kingdom, and better educational campaigns are needed warning of the dangers of carrying weapons.

Adolescent↗

PubMed2001

Preferences of patients for patient centred approach to consultation in primary care: observational study.

OBJECTIVE: To identify patient's preferences for patient centred consultation in general practice. DESIGN: Questionnaire study. SETTING: Consecutive patients in the waiting room of three doctors' surgeries. MAIN OUTCOME MEASURES: Key domains of patient centredness from the patient perspective. Predictors of preferences for patient centredness, a prescription, and examination. RESULTS: 865 patients participated: 824 (95%) returned the pre-consultation questionnaire and were similar in demographic characteristic to national samples. Factor analysis identified three domains of patient preferences: communication (agreed with by 88-99%), partnership (77-87%), and health promotion (85-89%). Fewer wanted an examination (63%), and only a quarter wanted a prescription. As desire for a prescription was modestly associated with desire for good communication (odds ratio 1.20; 95% confidence interval 0.85 to 1.69), partnership (1.46; 1.01 to 2.09), and health promotion (1.61; 1.12 to 2.31) this study may have underestimated preferences for patient centredness compared with populations with stronger preferences for a prescription. Patients who strongly wanted good communication were more likely to feel unwell (very, moderately, and slightly unwell; odds ratios 1, 0.56, 0.39 respectively, z trend P<0.001), be high attenders (1.70; 1.18 to 2.44), and have no paid work (1.84; 1.21 to 2.79). Strongly wanting partnership was also related to feeling unwell, worrying about the problem, high attendance, and no paid work; and health promotion to high attendance and worry. CONCLUSION: Patients in primary care strongly want a patient centred approach, with communication, partnership, and health promotion. Doctors should be sensitive to patients who have a strong preference for patient centredness-those vulnerable either psychosocially or because they are feeling unwell.

Adolescent↗

PubMed2001

Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management.

OBJECTIVES: To describe the menstrual experience of women referred for menstrual problems, in particular menorrhagia (excessive menstrual loss), and to assess associations with reasons for referral given by their general practitioners, the women's understanding of the reasons for their attendance at the hospital clinics, and clinic outcome. DESIGN: Questionnaire survey, with partial review of case notes after 8 months. SETTING: Three hospital gynaecology clinics in Glasgow and Edinburgh. PARTICIPANTS: 952 women completed the questionnaire, and the first 665 were reviewed. OUTCOME MEASURES: Reason for referral, women's reported menstrual problems and reason for clinic attendance, diagnosis, and treatment. RESULTS: Only 38% (95% confidence interval 34% to 41%) of women reported excessive menstrual loss as a severe problem. However 60% (57-63%) gave it as reason for attending a clinic, and 76% (73-79%) of general practitioners gave it as reason for referral. Reason for referral was significantly biased towards bleeding (McNemar odds ratio 4.01, 3.0 to 5.3, P<0.001) and against pain (0.54, 0.4 to 0.7, P<0.001). Dysfunctional uterine bleeding was diagnosed in 37% (31-42%) of the 259 women who gave as reason for attendance something other than bleeding. Women who were economically disadvantaged differed in prevalence of the main diagnoses and were more likely to fail to reattend. Hysterectomy was associated with referral for bleeding (relative risk 4.9, 1.6 to 15.6, P<0.001) but not with the patient stating bleeding as the reason for clinic attendance. CONCLUSIONS: Intolerance of the volume of their bleeding is not a key feature among women attending clinics for bleeding problems. Broad menstrual complaint tends to be reframed as excessive bleeding at referral and during management. This may result in women receiving inappropriate care. Conceptualisation and assessment of menorrhagia requires reconsideration.

Adult↗

PubMed2003

Teaching as therapy: cross sectional and qualitative evaluation of patients' experiences of undergraduate psychiatry teaching in the community.

OBJECTIVE: To explore the impact of participating in undergraduate teaching in general practice for patients with common mental disorders. DESIGN: Questionnaire survey and qualitative in-depth interviews. SETTING: Community based undergraduate teaching programme for fourth year students at a London medical school doing a psychiatry attachment. PARTICIPANTS: Questionnaire survey: all patients involved in the teaching programme over one academic year. In-depth interviews: 20 patients, 14 students, and 12 general practitioner tutors participating in the programme. RESULTS: The questionnaire showed high levels of satisfaction with teaching encounters for participating patients, which were corroborated in the interviews. Many patients and general practitioners reported specific therapeutic benefits for patients from contact with students, including raised self esteem and empowerment; the development of a coherent "illness narrative"; new insights into their problems; and a deeper, more balanced, and understanding doctor-patient relationship. For a few patients the teaching caused some distress, which may relate to a lack of insight into their condition or deficits in students' interviewing skills. CONCLUSIONS: Participation in teaching can have additional positive therapeutic outcomes for selected patients with common mental disorders, although a small minority report negative effects. Testing in a larger sample is needed to determine the characteristics of patients in these two subgroups and establish whether these effects persist.

Adult↗

PubMed2003

What do hospital consultants value about their jobs? A discrete choice experiment.

OBJECTIVE: To examine the strength of hospital consultants' preferences for various aspects of their work. DESIGN: Questionnaire survey including a discrete choice experiment. SETTING: NHS Scotland. PARTICIPANTS: 2923 hospital consultants in Scotland. MAIN OUTCOME MEASURES: Monetary valuations or prices for each job characteristic, based on consultants' willingness to pay and willingness to accept extra income for a change in each job characteristic, calculated from regression coefficients. RESULTS: The response rate was 61% (1793 respondents). Being on call was the most important attribute, as consultants would need to be compensated up to pound 18,000 (30% of their average net income) (P < 0.001) for a high on-call workload. Compensation of up to pound 9700 (16% of their net income) (P < 0.001) would be required for consultants to forgo opportunities to undertake non-NHS work. Consultants would be willing to accept pound 7000 (12% of net income) (P < 0.001) in compensation for fair rather than good working relationships with staff, and pound 6500 (11% of net income) (P < 0.001) to compensate them for a shortage of staff. The least important characteristic was hours of work, with pound 562 per year (0.9% of their net income) (P < 0.001) required to induce consultants to work one extra hour per week. These preferences also varied among specific subgroups of consultants. CONCLUSIONS: Important information on consultants' strength of preferences for characteristics of their job should be used to help to address recruitment and retention problems. Consultants would require increased payment to cover more intensive on-call commitments. Other aspects of working conditions would require smaller increases.

Consultants↗

PubMed2004

Should surgeons take a break after an intraoperative death? Attitude survey and outcome evaluation.

OBJECTIVES: To investigate attitudes of cardiac surgeons and anaesthetists towards working immediately after an intraoperative death and to establish whether an intraoperative death affects the outcome of subsequent surgery. DESIGN: Questionnaire on attitudes to working after an intraoperative death and matched cohort study. SETTING: UK adult cardiac surgery centres and regional cardiothoracic surgical centre. PARTICIPANTS: 371 consultant cardiac surgeons and anaesthetists in the United Kingdom were asked to complete a questionnaire, and seven surgeons from one centre who continued to operate after intraoperative death. MAIN OUTCOME MEASURES: Outcome for 233 patients operated on by a surgeon who had experienced an intraoperative death within the preceding 48 hours compared with outcome of 932 matched controls. Hospital mortality and length of stay as a surrogate for hospital morbidity. RESULTS: The questionnaire response rate was 76%. Around a quarter of surgeons and anaesthetists thought they should stop work after an intraoperative death and most wanted guidelines on this subject. Overall, there was no increased mortality in patients operated on in the 48 hours after an intraoperative death. However, mortality was higher if the preceding intraoperative death was in an emergency or high risk case. Survivors operated on within 48 hours after an intraoperative death had longer stay in intensive care (odds ratio 1.64, 95% confidence interval 1.08 to 2.52, P = 0.02) and longer stay in hospital (relative change 1.15, 1.03 to 1.24, P = 0.02). CONCLUSION: Mortality is not increased in operations performed in the immediate aftermath of an intraoperative death, but survivors have longer stays in intensive care and on the hospital ward.

Anesthesiology↗

PubMed1997

Should relatives be allowed in the resuscitation room?

OBJECTIVE: To assess doctors' and nurses' views on the presence of relatives in the resuscitation room during cardiac arrest or major trauma. DESIGN: Questionnaires were sent to accident and emergency (A&E) nurses and doctors of all disciplines in a London teaching hospital. Recipients were asked if they would favour the presence of selected relatives in the resuscitation room and to give comments. RESULTS: 103 questionnaires were distributed and 81 returned, a response rate of 78.6%; 33% were senior house officers, 29% consultants, 16% senior registrars/registrars, 12% A&E nurses, and 10% house officers. Of the respondents, 63% were not in favour of relatives being present, and 37% were in favour. The likelihood of being in favour of allowing relatives to be present was high among A&E nurses; among doctors it increased with rising seniority. Most respondents felt that more resuscitation training would be necessary, in addition to counselling for staff and relatives. CONCLUSIONS: Staff with the least experience in dealing with resuscitations and distressed relatives were likely to be opposed to relatives being present in the resuscitation room. As there is evidence that the bereavement process is eased if a partner/relative witnesses the resuscitation, relatives should be offered the opportunity to witness resuscitation if staff training is geared towards the presence of relatives. ALS/ATLS training for all hospital doctors and nurses should include the management of distressed relatives observing a resuscitation.

Attitude of Health Personnel↗

PubMed2003

A survey of current consultant practice of treatment of severe ankle sprains in emergency departments in the United Kingdom.

OBJECTIVE: To determine current consultant practice in larger UK emergency departments in the management of severe ankle sprains. DESIGN: Questionnaire study to all UK emergency departments seeing more than 50 000 new patients per year. RESULTS: 70% response rate. Most popular treatment was ice, elevation, Tubigrip, and exercise, each of which was reported as used in most cases by over 70% of respondents. Crutches, early weight bearing, and non-steroidal anti-inflammatory drugs were each reported as used in most cases at over half of responding departments. Physiotherapy was usually only used in selected cases. Rest was usually advised for one to three days (35%). Follow up was only recommended for selected patients. CONCLUSIONS: The results of this survey suggest that there is considerable variation in some aspects of the clinical approach (including drug treatment, walking aids, periods of rest) taken to the management of severe ankle sprains in the UK, although in some areas (for example, not routinely immobilising, early weight bearing as pain permits, use of physiotherapy, use of rest, ice, and elevation) there was concordance.

Ankle Injuries↗

PubMed2006

Are today's junior doctors confident in managing patients with minor injury?

OBJECTIVES: To assess the confidence of junior doctors in managing minor injuries, compared with other common acute conditions. METHOD: A questionnaire designed to elicit areas of confidence and subjective competence was distributed to junior doctors working in the emergency department in December 2004. RESULTS: Junior doctors felt most competent and confident working with medical trolley patients and least competent working with patients with minor injury. A lack of teaching and experience in handling minor injuries (which are seen by nurse practitioners in a separate unit during the day) was highlighted. CONCLUSIONS: Nurse-led minor injury units may have an effect on junior doctors' experience and confidence in minor injury care. Further effort needs to be made to increase the training of junior doctors in minor injury care.

Clinical Competence↗

PubMed2000

On telling the truth to patients with dementia.

OBJECTIVES: To discover what dementia sufferers think is wrong with them, what they have been told and by whom, and what they wish to know about their illness. BACKGROUND: Ethical guidelines regarding telling truth appear to be equivocal. Declarations of cognitively intact subjects, attitudes of family members, and current psychiatric practice all vary, but no previous research has been published concerning what patients with dementia would like to know about their diagnosis and prognosis. DESIGN: Questionnaire study of patients' opinions. SETTING: Old Age Psychiatry Service in Worcester, United Kingdom. PARTICIPANTS: Thirty consecutive patients with dementia. RESULTS: The quality of information received has been poor, and many patients have no opportunity to discuss their illness with anybody. Despite that, almost half of the participants in this study had adequate insight, and most declared that they would like to know more about their predicament. CONCLUSIONS: Although many patients would like to know the truth, the rights of those who do not want to know should also be respected. Therefore, the diagnosis of dementia should not be routinely disclosed, but just as in other disorders, health care professionals should seek to understand their patients' preferences and act appropriately according to their choice.

Alzheimer Disease↗

PubMed2002

Characterising doctor-parent communication in counselling for impending preterm delivery.

OBJECTIVE: To examine the counselling of women admitted to hospital in preterm labour. Such women and their partners are often asked to participate in difficult decisions including mode of delivery, fetal monitoring, and resuscitation. STUDY DESIGN: Questionnaire based descriptive study. STUDY SETTING: A tertiary level perinatal referral centre. PATIENTS: Forty-nine women in preterm labour at 22-30 weeks gestation, admitted in two separate periods between March 1997 and May 1999. INTERVENTION AND OUTCOME MEASURE: Within 24 hours of counselling, parents were asked to complete a questionnaire assessing recall of the management plan, desire for involvement in decision making, anxiety, and feelings of control over their health. A parallel questionnaire was completed by the clinicians. RESULTS: Parents and clinicians on recall agreed well about obstetric issues but poorly about neonatal issues. Overall 27% of parents felt: "I would prefer to have the doctors advise me, rather than asking me to decide". In 79% of cases, clinicians believed parents preferred advice rather than to make decisions, but in 45% of these, they misidentified those who wished to make their decisions. Anxiety levels for one third of the mothers were high, and associated with poorer concordance of recall between parents and clinicians. CONCLUSIONS: Serious deficiencies exist in parent-clinician encounters during extremely preterm labour. Concordance between parents and clinicians is poor and anxiety very high. A quarter of parents appear to prefer to relinquish decision making autonomy, but clinicians cannot correctly identify this subgroup. Standardised counselling in the perinatal period, using formal decision aids, should be investigated.

Communication↗

PubMed1993

Employment and insurance for young adults with congenital heart disease.

OBJECTIVE: To determine the life and health insurability and employability of young adults with congenital heart disease. DESIGN: Questionnaire study. SETTING: Cardiac department of a tertiary referral hospital for children. PATIENTS: Young adults 18-30 years old with a variety of congenital heart defects, both simple and complex, including postoperative patients. MAIN OUTCOME MEASURES: Availability of insurance at normal or high rates, with or without special conditions or exclusions. Prospects for employment. RESULTS: Questionnaires were sent to eight large life insurance companies, five health insurance companies and, 15 employers, and 26 replies were received (93%). The consensus for life insurability was that young adults with mitral valve prolapse without regurgitation, postoperative ductus arteriosus, and aortic coarctation were insurable at standard rates. Those with any of the other heart defects listed were either insurable at high rates, or in the case of many lesions, not insurable at all. The consensus for health insurance was that insurance was available, but with complete exclusion of benefit for the cardiac disorder. Employment prospects were good for those with simple defects, but poorer for those with complex lesions. CONCLUSIONS: Prospects for insurance and employment for young adults with complex congenital heart lesions are poor. Inconsistencies found in insurance and job policies may be due to lack of appropriate guidelines for the outcome of young adults with corrected and uncorrected congenital heart disease.

Adolescent↗

PubMed1996

Physician variation in the management of patients with atrial fibrillation.

OBJECTIVE: To investigate variations in the management of patients with atrial fibrillation among consultant physicians. DESIGN: Questionnaire survey. SUBJECTS: Consultant physicians in England, Wales, and Scotland. RESULTS: 214 consultant physicians (88 cardiologists and 126 non-cardiologists) were surveyed between May and July 1994. Most physicians (47.7%) reported that they saw one to five patients with atrial fibrillation weekly. Some 52% of cardiologists and 40% of non-cardiologists considered that the main factor influencing their decision of whether or not to anticoagulate was the clinical history--that is, heart failure, valve disease, or stroke. When encountering a patient admitted acutely with new onset atrial fibrillation, significantly more cardiologists (66% v 52%, chi 2 = 6.89, P = 0.03) would immediately start anticoagulant treatment, most favouring intravenous heparin. Most physicians would also introduce antiarrhythmic treatment or digoxin, but more cardiologists would attempt immediate pharmacological (39% v 18% of non-cardiologists, P < 0.001) or later electrical (86% v 69%, chi 2 = 11.7, P = 0.003) cardioversion to sinus rhythm, while non-cardiologists tended to prefer "rate control" with digoxin. Although many physicians would not continue antiarrhythmic treatment post-cardioversion, more cardiologists than non-cardiologists would do so (the commonest choice being class III agents) (31% v 17%, P = 0.04). Fewer non-cardiologists would continue anticoagulant treatment post-cardioversion (27% v 69% of cardiologists, chi 2 = 39.8, P < 0.0001). When treating patients with atrial fibrillation, decisions about anticoagulation were usually related to the perceived relative risk of thromboembolism versus haemorrhage derived for each of six case management scenarios in the questionnaire. There was, however, general agreement between cardiologists and non-cardiologists in the use of antithrombotic treatment in the management of lone atrial fibrillation, paroxysmal atrial fibrillation, and patients with atrial fibrillation and mitral valve disease or thyrotoxicosis. CONCLUSION: There is considerable variation in the management of atrial fibrillation, with more cardiologists than non-cardiologists considering cardioversion to sinus rhythm (and the use of antiarrhythmic and anticoagulant treatment post-cardioversion) and thrombo-prophylaxis with anticoagulation. Guidelines on the management of this common arrhythmia are clearly required.

Acute Disease↗

PubMed1996

Family planning requirements in the adult congenital heart disease clinic.

OBJECTIVE: To determine whether women with congenital heart disease were receiving appropriate advice on contraception. SETTING: Adult congenital heart disease clinic in a tertiary cardiac referral centre. DESIGN: Questionnaire administered to 35 consecutive female patients attending the adult congenital clinic. The cardiologist assessed what the risk would be if each patient used an oestrogen containing contraceptive pill (OCP). RESULTS: Of the 33 patients admitted to the study 6 patients thought their heart condition precluded them from taking an OCP when in fact it did not and 3 incorrectly said that an OCP would be suitable for them. Three women with relatively minor lesions had been incorrectly denied the OCP and 2 further patients were using inappropriate methods. There had been 6 unwanted pregnancies in the total group. CONCLUSIONS: Many women with congenital heart disease do not know the most appropriate method of contraception for them or have received incorrect advice. It is often patients with less severe lesions who receive the most inappropriate advice. It is clear that the family planning needs of this population are currently poorly catered for. Each unit must ensure that the information necessary in making informed decisions on contraception is available to the doctor advising on family planning.

Adolescent↗

PubMed1997

Health related quality of life and psychological wellbeing in patients with hypertrophic cardiomyopathy.

OBJECTIVE: To assess the health related quality of life and psychological wellbeing of patients with hypertrophic cardiomyopathy, to correlate these with symptoms, clinical, and psychosocial factors. DESIGN: Questionnaire distributed to 171 hypertrophic cardiomyopathy patients aged at least 14 years, selected at random from a dataset of 480 patients. Assessments included the Short Form 36 (SF-36) Health Survey, the Hospital Anxiety and Depression questionnaire, and measures of adjustment, worry, and patient satisfaction. RESULTS: There was an 80.1% response rate to the questionnaire. Patients had severe limitations in all eight dimensions of quality of life assessed by the SF-36: physical functioning, role limitations owing to physical problems, role limitations owing to emotional problems, social functioning, mental health, general health perceptions, vitality, and bodily pain. Levels of anxiety and depression were also high compared with population norms. Quality of life was particularly impaired in patients with chest pain and dyspnoea, but was less consistently related to clinical cardiological measures. Adjustment to the condition and patient satisfaction were generally good. In multivariate analysis, quality of life was associated with a combination of symptom patterns and psychosocial factors. No differences in quality of life, anxiety or depression were observed between patients with no known family history, those with familial cardiomyopathy, and patients with a family history of premature sudden death. CONCLUSIONS: Hypertrophic cardiomyopathy is associated with substantial restrictions in health related quality of life. Symptoms, adjustment, and quality of interactions with clinical staff contribute to these limitations. Recognition of the problems confronted by patients with hypertrophic cardiomyopathy requires continued efforts at education both of the public and health professionals.

Adaptation, Psychological↗

PubMed1999

Technician run open access exercise electrocardiography.

OBJECTIVE: To evaluate the safety, efficacy, and feasibility of the technician run open access exercise electrocardiography service at Freeman Hospital. DESIGN: Questionnaire analysis of the responses of the general practitioners of randomly selected patients who used the service. SETTING: A tertiary care cardiac centre, providing an open access service to general practitioners in the community. PATIENTS: 269 patients randomly selected from 552 who underwent open access exercise electrocardiography over a 2.5 year period. OUTCOME MEASURES: Utilisation of service: the reasons for referral, whether the service was optimally used by the general practitioners, and its effect on their management practice; effect on number of cardiology referrals; benefit to the patients; safety, efficacy, and feasibility of a technician run service; general practitioners' assessment of the service. RESULTS: 147 of 178 general practitioners (82.6%) responded to the questionnaire, on 247 of 269 patients (91. 8%). General practitioners used the service for diagnosing ischaemic heart disease in 72.5% of cases, for prognostic purposes in 17.8%, or both in 5.3%. In 197 cases (79.8%), the general practitioners felt that the service had changed the way they managed their patients. The exercise test was positive in 90 patients (36.5%) and identified 38 as at high risk. The service was effective in optimising the cardiology service by reducing referrals by 47%. CONCLUSIONS: The service was used by general practitioners primarily for diagnosing ischaemic heart disease and not so often for prognosis. The utilisation of the service was optimal as assessed by the high positivity rate. The service meets its primary objective of assisting general practitioners in the management of patients with suspected ischaemic heart disease, and may have helped to optimise resources by reducing the number of referrals to cardiologists. It has helped prioritize patient management and may have benefited high risk patients by facilitating rapid identification and referral. It can be run safely and effectively by trained technicians.

Adult↗