The fresh new contract for general practitioners. General practitioners are in impossible position.
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Contract Services↗
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Variations in use of cardiac services in England: perceptions of general practitioners, general physicians and cardiologists.
OBJECTIVE: To explain why those who live some distance from tertiary cardiac centres make less use of coronary angiography and revascularisation than those who live close by, and why people living in particular wards within certain districts make less use of services than might be expected from their level of need. METHOD: Semi-structured interviews with 24 general practitioners (GPs) in two English health districts (Morecambe Bay and East Lancashire), five general physicians working in district general hospitals, and four interventional cardiologists working in tertiary centres. Transcripts of audiotape recordings were analysed using the constant comparative method. RESULTS: Those living far from tertiary centres are usually referred to general physicians before they are referred for angiography. The general physicians tend to be more conservative in their approach to treatment than interventional cardiologists. GPs working near tertiary centres are able to refer directly to interventional cardiologists. There are also logistical and economic reasons for inequitable use of services. Some GPs perceived that patients of South Asian descent undergo fewer investigations than might be expected because of communication or other difficulties. CONCLUSION: Use of cardiac services would be more equitable if there were interventional cardiologists based in district general hospitals who could perform angiograms for their own patients in the tertiary centres. Patients might also benefit in angiograms could be conducted in selected district general hospitals. Further qualitative research, involving both doctors and patients, is needed to explore other reasons for relatively low rates of investigation and revascularisation in certain groups of patients.
Attitude of Health Personnel↗
[The general practitioner teaching general practitioners. Traumatology of the locomotor system in the general practitioner's office].
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Diagnostic Imaging↗
Detection of patients with high alcohol intake by general practitioners.
General practitioners have the potential to treat patients with alcohol problems effectively. Despite the medical implications of excessive alcohol intake, it appears that general practitioners are not sufficiently aware of the drinking habits of their patients. The aim of the study was to investigate the accuracy of 56 randomly chosen general practitioners in detecting which of their patients had a high alcohol intake. Altogether, 2081 patients were recruited in general practitioners' waiting rooms, where they answered questions about their drinking habits. After the consultations general practitioners were asked to indicate the patients' levels of alcohol intake. The results showed that general practitioners correctly identified only 27.5% of patients who were classified as "high risk" drinkers, using Australian Medical Association criteria. They correctly identified only 45.2% of patients who were classified as "moderate to heavy" drinkers, defined by them as drinkers who consume four or more standard drinks a day. These findings have important implications for clinical practice since they indicate that general practitioners are failing to perform adequately in an important area of preventive medicine. This issue needs to be addressed in undergraduate and postgraduate medical education.
Adult↗
Attitudes to community psychiatry among urban and rural general practitioners.
General practitioners' requirements for community psychiatric services may differ according to the area in which they practise. A questionnaire survey of general practitioners' attitudes to community psychiatric services is reported from three contrasting areas: an inner city urban area, a new town and a rural area. General practitioners in all areas wanted more consultation with psychiatrists, and 53-68% wanted regular psychiatric outpatient clinics in their surgeries. There was enthusiasm for community psychiatric nurses and for help with psychotherapy. In the rural area general practitioners favoured surgery based psychiatric outpatient clinics and arranging emergency hospital admissions themselves; in urban areas domiciliary visits from psychiatrists to help with emergencies were favoured. These results appear to reflect the greater geographical distance between primary and hospital based secondary care in rural as opposed to urban areas. Overall, general practitioners wanted more support from community psychiatric services in carrying out their primary therapeutic role especially in rural areas far from hospital-based psychiatric services.
Attitude of Health Personnel↗
HIV infection and South-West general practitioners.
General practitioners in the Severn Faculty of the Royal College of General Practitioners were asked about their knowledge and practice in dealing with HIV infected patients. 62% responded to our anonymous questionnaire. Overall, four-fifths of the doctors expressed confidence in their ability to advise HIV antibody positive patients on sexual activity, drug abuse and domestic activities. Only 61% were confident of their ability to advise such patients on pregnancy. Differences in screening policy and measures of awareness were related to location of practice by county within the Region and to the presence of HIV infected patients on individual lists. The findings are discussed in relation to previous surveys of general practitioners in the UK.
Acquired Immunodeficiency Syndrome↗
Guidelines on the management of asthma. Statement by the British Thoracic Society, the Brit. Paediatric Association, the Research Unit of the Royal College of Physicians of London, the King's Fund Centre, the National Asthma Campaign, the Royal College of General Practitioners, the General Practitioners in Asthma Group, the Brit. Assoc. of Accident and Emergency Medicine, and the Brit. Paediatric Respiratory Group.
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Acute Disease↗
Weekly Returns Service of the Royal College of General Practitioners.
General practitioners in 69 practices in England and Wales monitor the spread of epidemic diseases in the community through the Weekly Returns Service (WRS) of the Royal College of General Practitioners, which has existed for over 30 years. Participating general practitioners summarise diagnoses and consultation/episode type (new episodes/ongoing consultations) for a defined population (currently about 570,000) and data are extracted to provide the 'weekly return', which includes age specific weekly incidence of new episodes of selected illnesses. The service has been used extensively to measure the burden of influenza and total acute respiratory illness in the community and the impact of enteric infections. It also provides information about illnesses for which there are no other major data sources--for example, chickenpox, scabies, and (historically) mumps. The entire network is electronically linked. Direct links with microbiological laboratories are being forged in order to integrate clinical and microbiological data in defined populations.
Communicable Disease Control↗
Detoxification from alcohol at home managed by general practitioners.
General practitioners have an important role in identifying and responding to problem drinkers, but no study has attempted to document their use of detoxification at home. A questionnaire was mailed to all general practitioners in Exeter Health District (n = 168) that was concerned with how they managed patients who presented with problems related to alcohol. The 145 (86%) responses showed that collectively they were identifying many more cases of problem drinking than any other local treatment agency. Of the estimated 230 patients a year for whom detoxification was arranged, half were managed at home, 40% in a local psychiatric hospital, and 9% in a local general hospital. Of those who were managed at home, 38% were unsupervised, a close relative held the medication for 45%, and 17% were supervised by a nurse. Fifty six percent (81) of doctors favoured chlormethiazole (Heminevrin) treatment, and many (17%) were prepared to prescribe this for longer than 10 days. Three quarters of the respondents thought that there was a need for specialist community services, such as community alcohol teams, to support general practitioners by supervising detoxification at home.
Alcoholism↗
Older persons' definitions of good health: implications for general practitioners.
General practitioners are the major providers of health-care services for the older population in Australia. Care that is provided for older persons within the general-practice setting remains crisis-orientated. Nevertheless, many of the disabling health problems of older persons neither can be "solved" nor cured. Therefore, the older population is a unique population in which to study what constitutes good health and ways in which good health can be maintained. This article describes the perceptions of a group of older persons about their health. They define good health in a remarkably non-medical way. General practitioners need to take into account this knowledge when considering ways to improve the health of these patients.
Aged↗
New roles for general practitioners.
General practice is likely to change greatly over the next few years. Increases in care in the community and day surgery will lead to more work, and the demand for better data on practice activity will mean the development of audit and epidemiological work. To make time general practitioners will have to learn to delegate work that does not require a doctor. Fundholding has already stimulated some practices to bring services to patients rather than send patients to hospital, and this trend seems set to continue. It is important to pool resources, not only within practices but among other practices in the area--joint action will increase the ability to improve the services for patients. If general practitioners take the opportunity to gain control of the changes the morale of the profession should improve.
Career Choice↗
[General practitioners and smoking. General practitioners' knowledge, attitudes and smoking habits and the relationship between these assessed by a questionnaire study in the county of Aarhus].
The objects of the investigation were to investigate the smoking habits of general practitioners, their assessment of tobacco as a risk factor for ischaemic cardiac disease, attitudes to intervention to stop smoking and to assess whether there was a connection between these. The project was carried out as a questionnaire investigation in the County of Aarhus, where all of the general practitioners received questionnaires. A total of 313 general practitioners replied to the questionnaire which corresponds to 84% participation. 33% of the general practitioners smoked and nine were chain smokers. The majority of the general practitioners accepted that smoking was a risk factor for ischaemic heart disease and were prepared to make great efforts to combat smoking. A connection was present between smoking habits and attitudes: Non-smokers considered that smoking was of great significance as a risk factor for ischaemic heart disease and were prepared to make efforts to alter the smoking habits of their patients. General practitioners doubted the effect of their advice about stopping smoking.
Attitude of Health Personnel↗
Do general practitioners and general psychiatrists want to look after drug misusers? Evaluation of a non-specialist treatment policy.
A new means of monitoring drug misuse which was developed in the north west of England, but is now widely used throughout the United Kingdom, is described and evaluated. Report forms which had been specially designed and ensured the anonymity of drug misusers were widely distributed among doctors and non-medical health workers who may have had contact with drug misusers. The forms were returned post-free to a centre where they were entered on a customized drug misuse database. There were 2127 reports from the north west of England (population 3.99 million) relating to 1792 individuals over a 15-month period. However, despite intensive promotion of the project among doctors, the number of reports from doctors remained virtually unchanged over the 15 months despite a 33% increase in the overall number of reports. When the reports from three health districts, selected so as to be representative of the region demographically (total population 658,500, population aged 15-44 years 292,200), were considered there was a substantial fall (70%) in reports from general practitioners which was considerably greater than the 2% fall in all reports. In a linked study all the psychiatrists, 30% of probation officers and a one in six sample of general practitioners from the three selected health districts were approached for interview at the beginning of the 15-month period and again a year later. This structured enquiry about caseloads, treatment, and attitudes also revealed a fall in the number of drug misusers attended by general practitioners and general psychiatrists and a reduction in the services provided for them by general practitioners.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Family therapy skills for general practitioners.
General practitioners are often the first health professionals that families turn to for help at times of stress. Figures from around the world suggest that up to 80% of general practice consultations have psychological or stress based issues as a significant aspect of the presenting problems. In this paper the place of patients in a wider context is emphasised and skills with which the GP can respond to the patient and his or her family are discussed. The value of listening to patients for both the content and the feelings without necessarily trying to solve the presenting problems is emphasised.
Adult↗
Level of occupational stress in male and female rural general practitioners.
General practitioners (GPs) in five rural divisions in New South Wales completed questionnaires designed to assess the degree to which various stressors were present in their work environment; the degree to which these stressors distressed them; their general stress; and their general health. Results published in a previous paper showed that high occupational stress in doctors was associated with high general stress and poor general health. Results reported in this paper showed that male doctors were more stressed than female doctors, GPs working on a full-time basis were more stressed than those working on a part-time basis, GPs who were also working as visiting medical officers were more stressed than those who did not work in this capacity, and younger GPs were more stressed than older GPs. High workload, governments, interference with their work, and family and leisure concerns were the major stressors for rural GPs.
Adult↗
Intervention for excessive alcohol consumption in primary health care: attitudes and practices of English general practitioners.
General practitioners' (GPs') recognition of, attitudes towards, and intervention for, excessive drinking and alcohol problems among their patients were assessed in a postal questionnaire survey. Levels of recognition of, and intervention for, excessive drinking by GPs were low. GPs did not routinely enquire about alcohol and had managed only small numbers of patients specifically for excessive drinking or alcohol problems in the previous year. Enquiry about alcohol issues was elicited mainly by physical symptoms or by new patient registrations. Although 83% of GPs felt prepared to counsel excessive drinkers, only 21% felt effective in helping patients reduce consumption. Over the past 10 years, there appears to have been an increase in numbers of GPs who feel that they should be working with alcohol issues, but fewer GPs perceive themselves as being effective in this work. The main barriers to brief alcohol intervention were given as insufficient time and training, and lack of help from government policy; the main incentives related to availability of appropriate support services and proven efficacy of brief interventions.
Alcoholism↗
Not another questionnaire!: eliciting the views of general practitioners.
General practitioners have a central role to play in relation to planning and delivery of primary and community care services. This paper reports the experience of one health board in using a postal survey to ascertain the views of local GPs concerning services for people suffering from dementia. The survey was sent out once only and had a 41% response rate. Non-responding GPs were surveyed to ascertain reasons for failure to respond initially to the survey. The commonest reason given was that GPs felt they were being swamped with questionnaires. The paper discusses the problems of accessig GP opinion when time and resources are limited, the alternative strategies that could have been employed and the way forward in the light of the experience.
Attitude of Health Personnel↗
Suicide prevention: spreading the gospel to general practitioners.
General practitioners were trained in the recognition and treatment of suicide risk either by written text alone or combined with a seminar meeting. They filled in questionnaires before and after training. In the seminar group, knowledge and attitudes changed significantly, while those doctors receiving written material only had similar results to those without training.
Adolescent↗