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  1. Teaching mental health skills to general practitioners and medical officers.

    PubMed

    Goldberg, David; Gask, Linda

    2002-01-01

    David Goldberg opened by describing the research that had led up to the present WPA teaching package. Early research had demonstrated that many psychological illnesses were not detected in primary care settings (Goldberg & Huxley 1980; ibid 1992), and these findings have been replicated in 14 centres round the world, with broadly similar results (Ustun & Sartorius 1995). We have found that in the UK the problem is not defects in factual knowledge, but not having clinical skills to assist in the management of mental disorders in general medical settings. The clinical skills needed in primary care are seldom taught in medical schools, and cannot be learned by listening to a lecture: it is necessary to practice them after they have been demonstrated. To do this it is convenient to break complex clinical skills down into their components: these are called "micro-skills", and we will deal later with the way in which these are taught. The most powerful method for improving mental health skills in this setting is to provide doctors with feedback--either video or audio--of their interview with real patients. The emphasis of such teaching must be on the interview techniques used by the doctor, rather than the clinical problems displayed by the particular patient being interviewed (Gask et al 1991). The problem with this is that video-feedback teaching of the necessary type is not always available, so we have developed videotapes that we can send out to distant locations, and which focus the attention of both local tutor and postgraduates on what should be learned. Because it is essential that most of the teaching is done by the live teacher rather than the videotape, there are always several "discussion points" so that postgraduates can ask questions, or describe their own way of dealing with particular situations. The videotapes are supplied together with teaching notes for the tutor, power points slides which can be adapted to suit local conditions, "role plays" to allow

  2. Ultrasound imaging in the general practitioner's office – a literature review

    PubMed Central

    Ryk, Małgorzata; Suwała, Magdalena; Żurakowska, Tatiana; Kosiak, Wojciech

    2016-01-01

    Ultrasound, which is a safe and non-invasive diagnostic modality that uses more and more advanced imaging techniques, has become the first-choice examination in various diseases. It is more and more often used in the general practitioner's office to supplement physical examination and interview. Aim The aim of this paper is to review the Polish medical literature pertaining to the usage of ultrasound imaging in general practice as well as to present advantages, disadvantages and utility associated with conducting ultrasound examinations by general practitioners based on selected publications. Material and methods The analysis involved 15 articles found in Polish medical literature published in 1994–2013 in 9 medical journals. These publications were obtained using various data bases, such as Polish Medical Bibliography, Google Scholar as well as websites of “Lekarz Rodzinny” and “Ultrasonografia.” Results Of 15 available publications, 5 papers present the usage of ultrasound imaging by a primary care physician for general purposes, 4 discuss the usage of abdominal scans, 3 – imaging of the neck and lymph nodes, 1 – lungs, and 2 discuss its usage for specific disease entities. In over 70% of the papers, the financial aspect associated with the usage of this modality in general practice is mentioned. More than a half of the publications draw attention to the possibility of using point-of-care ultrasound examinations. Advantages of ultrasonography most often mentioned by the authors include: good effects of screening, safety, short duration and low cost. The authors of eight publications also indicate disadvantages associated with ultrasound imaging used by a general practitioner. Conclusions In the Polish literature, there are relatively few papers on the role of ultrasonography in the office of a primary care physician. This modality is more and more often becoming a tool that helps primary care physicians to establish diagnoses, accelerates the

  3. [Insomnia in the general practitioner's office: from diagnosis to initial interventions].

    PubMed

    Sommer, Isabelle; Brühl, Annette; Delsignore, Aba; Weidt, Steffi

    2014-05-21

    Insomnia is the most frequent type of sleeping disorder and - following pain - the second most common symptom reported in the general practitioner's office. The prevalence of insomnia increases with age. Untreated, insomnia is regarded as risk factor for other comorbid somatic and mental disorders. Therefore, it is important to make a thorough diagnostic and differential diagnostic assessment. Particularly interventions aiming at improving sleep hygiene and therapy using sleep restriction can help alleviate insomnia. Pharmacologically, herbal drugs and antidepressants with sleep inducing effects can be used, for short-term treatment also benzodiazepine/gaba-ergic agonists. PMID:24846890

  4. The future role of dental therapists in the UK: a survey of District Dental Officers and General Practitioners in England and Wales.

    PubMed

    Hay, I S; Batchelor, P A

    1993-07-24

    A postal questionnaire concerning the opinion of the dental profession as to the future role of dental therapists in the UK was sent to a random sample of 30 District Dental Officers and 70 General Dental Practitioners. In total 76 questionnaires were returned, 26 from DDOs, 50 from GDPs, giving corrected response rates of 86.7% and 57.1% respectively. Returns revealed that 69.2% of District Dental Officers predicted a future role for dental therapists in the Community Dental Service. A total of 47.5% of General Dental Practitioners stated they would like to see therapists working in general dental practice, with 40% of this group willing to employ a therapist providing the current legislation was changed. The most popular predicted role in both services appears to be an equal division between the provision of clinical care and dental health education. Recently qualified General Dental Practitioners were more in favour of the employment of therapists than older members of the profession, which suggest that with time, the demand for this auxiliary in general dental practice could increase. PMID:8347412

  5. New roles for general practitioners.

    PubMed Central

    Handysides, S.

    1994-01-01

    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. Images p513-a p514-a PMID:8136671

  6. [General practitioner burnout: risk factors].

    PubMed

    Dagrada, H; Verbanck, P; Kornreich, C

    2011-09-01

    This paper aims to review current knowledge on risk factors leading to burn-out of general practitioners, who are particularly concerned by burn-out, as 50% of them are being more or less affected. This article is based on bibliographic research covering literature between 1975 and 2010, using PUB MED software, medical books and articles. 44 articles were selected as dealing well with the aspects of the burn-out reviewed here. It seems established that stress precedes burnout symptoms. Theories investigating relationships between stress and work are presented. Exogenic stress (load and organization of work, emotional interaction with the patient, constraints, lack of recognition, conflicts between private and professional life) interacts with endogenous stress (idealism, (too much) acute feeling of responsibility, mood disorder, difficulty in collaborating, character, personality). Burn-out symptoms would appear preferentially when these two stresses coexist. Despite the wealth of publications, there is still a lack of knowledge of the causes of burn-out, requiring therefore increased research efforts, in order to improve the implementation of preventive measures, beneficial to the doctors as well as to their patients. PMID:22034773

  7. Orthodontic First Aid for General Dental Practitioners.

    PubMed

    Sodipo, Ibukunoluwa; Birdsall, Joanne

    2016-06-01

    Orthodontic emergencies occasionally arise and although they can cause discomfort to the patient, they can usually be stabilized by a general dentist and then followed up by the orthodontist. CPD/Clinical Relevance: Patients undergoing orthodontic treatment may initially present to their general dental practitioner with an orthodontic emergency as opposed to their orthodontist. It is therefore important that general dental practitioners are aware of common orthodontic emergencies and their management. PMID:27529914

  8. Violence against General Practitioners in Turkey

    ERIC Educational Resources Information Center

    Aydin, Berna; Kartal, Mehtap; Midik, Ozlem; Buyukakkus, Alper

    2009-01-01

    We aimed to determine the violence against general practitioners (GPs) through their suggestions on its cause and prevention. This is a descriptive cross-sectional study based on self-administered questionnaire answered by a convenience study population consisting of 522 GPs between November and December 2006. Of the participating GPs, 82.8%…

  9. Predicting mental health problems in general practitioners.

    PubMed

    Chambers, R; Belcher, J

    1994-09-01

    A total of 704 general practitioners completed questionnaires enquiring about mental health problems (response rate = 82.0%). Excessive anxiety was reported by 31.1%, troublesome depression by 13.4%, exhaustion or stress (on three or more weekdays) by 60.7%, and sleep difficulties by 47.6%. General practitioners aged 40-49 years old were most likely to report anxiety, exhaustion or stress, sexual and sleep difficulties. Retired doctors reported mental health problems markedly less often. Predictive factors for anxiety were depression, one or more nights on-call per week, and exhaustion or stress; predictive factors for depression were anxiety, and exhaustion or stress; predictive factors for exhaustion or stress were anxiety, depression, no hobbies, paperwork on three or more evenings per week, and sleep difficulties. Gender, country of origin, being single-handed, excessive alcohol consumption, and having no coping methods were not predictive factors for mental health problems. PMID:7949065

  10. General practitioners and the independent contractor status

    PubMed Central

    Gray, D. J. Pereira

    1977-01-01

    Primary medical care can be provided either by a bureaucratic hierarchical organization or alternatively by independent contractors. Most members of the caring professions in medicine, nursing, and social work are employed in bureaucracies, whereas general medical practitioners, general dental practitioners, opticians, and pharmacists are independent contractors. The independent contractor status has recently been heavily attacked from within the medical and nursing professions, and also from outside. It has been suggested that contracting for services is an inappropriate and anomalous way of arranging medical care, which should now be stopped. However, this process of contracting for services can be analysed, using perspectives from some of the behavioural sciences, to reveal hidden depths in the independent contractor status which suggest that the provision of primary medical care is best carried out by independent contractors. PMID:616865

  11. The general practitioner as sports physician.

    PubMed Central

    Timpson, R. J.

    1977-01-01

    General practitioners must become more knowledgeable about sports medicine in order both to treat the injured athlete and to provide better rehabilitative treatment and advice on fitness and exercise to other patients. Close involvement with young amateur athletes also helps to keep the older physician "in tune" with the younger generation. Finances remain a major problem for amateur sporting events and sports medicine groups, as well as for the individual physician volunteering his time. PMID:902211

  12. Minor surgery — one general practitioner's experiences

    PubMed Central

    Wall, D. W.

    1982-01-01

    A study was made of 869 personal cases of minor surgery performed in a cottage hospital over the seven years 1974-1980 inclusive. Results showed a wide range of procedures, little waiting time for patients, low infection rates and low referral to consultants subsequently. The cost benefits to the community and hospital services and the job satisfaction for the general practitioner are discussed. PMID:7131422

  13. Attitudes of general practitioners in New Zealand to pharmaceutical representatives.

    PubMed Central

    Thomson, A N; Craig, B J; Barham, P M

    1994-01-01

    BACKGROUND. Pharmaceutical representatives are a vital component of the marketing of pharmaceutical products and an important source of prescribing information for general practitioners. AIM. A study was undertaken to explore the attitudes of New Zealand general practitioners to pharmaceutical representatives. METHOD. A questionnaire survey of 100 general practitioners was undertaken to which 67 general practitioners responded. RESULTS. The provision of practical prescribing advice by representatives and gifts relevant to medicine were seen as desirable activities by many respondents. However, gifts of value considerably greater than suggested acceptable in recent guidelines for general practitioners were also highly favoured by some practitioners. CONCLUSION. Current ethical guidelines setting out the relationship between pharmaceutical representatives and medical practitioners are inadequate and should be based on the need for the general practitioner to become an unbiased promoter of patient health. PMID:8204336

  14. General practitioners' continuing medical education within and outside their practice.

    PubMed Central

    Owen, P. A.; Allery, L. A.; Harding, K. G.; Hayes, T. M.

    1989-01-01

    To study continuing medical education 96 out of 101 general practitioners chosen at random from the list held by a family practitioner committee were interviewed. The results provided little evidence of regular attendance at local postgraduate centre meetings, though practice based educational meetings were common. Thirty one of the general practitioners worked in practices that held one or more practice based educational meetings each month at which the doctors provided the main educational content. Performance review was undertaken in the practices of 51 of the general practitioners, and 80 of the doctors recognised its value. The general practitioners considered that the most valuable educational activities occurred within the practice, the most valued being contact with partners. They asked for increased contact with hospital doctors. The development of general practitioners' continuing medical education should be based on the content of the individual general practitioner's day to day work and entail contact with his or her professional colleagues. PMID:2504381

  15. General practitioner fundholding: experience in Grampian.

    PubMed

    Wisely, I C

    1993-03-13

    Proposals for fundholding were greeted with scepticism by many general practitioners, and in Scotland the BMA persuaded the government to allow a scheme to test the arrangements as a demonstration project operating "shadow" practice funds. This allowed the six selected practices to set up administrative and computer systems without the worry of dealing with real money. The shadow fundholding scheme has since been extended to small practices and to a trial of fundholding for all services except accident and emergency. The six practices in the original pilot have all become fundholders and are beginning to effect improvements in the service to their patients. However, with more practices becoming fundholders negotiating contracts with providers is becoming increasingly complicated and more time and money needs to be put into this aspect. PMID:8471925

  16. Complementary therapies: the appeal to general practitioners.

    PubMed

    Eastwood, H L

    2000-07-17

    Pragmatism--among consumers seeking a cure and among general practitioners seeking clinical results and more patients--is not a complete explanation for the burgeoning of complementary and alternative medicine (CAM) in Western societies. Instead, this growth is substantially a result of pervasive and rapid social change, alternatively termed 'globalisation' and 'postmodernisation'. Globalisation and postmodernisation are creating a new social reality, of which a prominent characteristic is the proliferation of consumer choice. GPs are enmeshed in this social change and subject to the trend to greater choice--both their patients' and their own. On the one hand, GPs are reacting to social change as "economic pragmatists", responding to consumers' increasing demand for CAM. On the other hand, GPs themselves are acting as agents of social change by acknowledging the limitations of orthodox biomedical treatments and promoting CAM as part of their service delivery. Lack of scientific validation of CAM has not prevented GPs' use of such therapies. The phrase "clinical legitimacy" can be seen as a trump card that overrides "scientific legitimacy". It is the shibboleth of a postmodern movement among GPs towards healing and the "art" of medicine, as opposed to the "science" of medicine per se. PMID:10937039

  17. General practitioner's knowledge of when to refer deaths to a coroner.

    PubMed Central

    Start, R D; Usherwood, T P; Carter, N; Dorries, C P; Cotton

    1995-01-01

    BACKGROUND--In 1992 about 179,000 deaths were reported to coroners in England and Wales and these represented 32% of the total number of registered deaths. Many of these cases were referred to coroners by general practitioners who certify the vast majority of deaths which occur outside hospitals. The safeguards to society which are provided by the coroner system in England and Wales are undermined if doctors fail to recognize those deaths which should be reported for further investigation. AIM--A study was undertaken to assess the ability of general practitioners to recognize deaths which require referral to a coroner. METHOD-A postal questionnaire consisting of 12 fictitious case histories was sent to all 323 general practitioners in Sheffield and the senior staff of the local coroner's office (two coroner's officers and two deputy coroners). Ten of the case histories contained a clear indication for referral to the coroner. RESULTS--A total fo 196 general practitioners (61%) and all the coroner's office staff returned the questionnaire. General practitioners correctly identified whether or not referral was indicated, with reasons, in a mean of 8.5 cases (range 4-12). Only six general practitioners (3%) were correct in all 12 cases. All of the coroner's staff were correct in all cases. CONCLUSION--General practitioners may be failing to bring certain categories of cases to the attention of coroners because of misconceptions of ignorance of their medico-legal responsibilities. General practitioner education in this area, and a closer working relationship between general practitioners and coroners may improve the situation. PMID:7612320

  18. [A general practitioners' program for primary care in Chile].

    PubMed

    Bass del Campo, Germán Camilo

    2015-01-01

    The public health system in Chile does not have a comprehensive development policy for physician resources in primary care, so there is currently a significant deficit of hours for medical care. The article contains a proposal for a "General Program for Primary Care Physicians", which aims to reduce the gap of general practitioners and specialists in primary care. The program proposes to integrate newly graduated physicians to work in the public medical offices with the subsequent possibility of applying for a scholarship specialty, and consecutively a return period as a specialist in the public health network. The immediate implementation of this program is perfectly feasible given the current availability of doctors, over 1400 medical graduates from universities. PMID:25826371

  19. Stress among general practitioners and their spouses: a qualitative study.

    PubMed Central

    Rout, U

    1996-01-01

    BACKGROUND: Although research has been carried out on stress in general practitioners, little is known about the stresses experienced by their spouses. AIM: This study was undertaken to identify specific pressures at work and at home experienced by general practitioners and their spouses and to highlight their coping strategies. METHOD: In-depth interviews were conducted with 25 general practitioners and their spouses in the north-west of England. RESULTS: The doctors' increased workload and decreased interest in their family are important stressors for the entire family unit. Other stressors include time pressure, out-of-hours on-call, lack of support and amount of paperwork. General practitioners work late in the surgery, bring work home and spend time away from home at meetings. Family life is constantly interrupted by telephone calls. Role conflict was one of the major sources of stress for women general practitioners. Doctors' wives expressed concern regarding their husbands' excessive commitment to work and problems with communication. CONCLUSION: Recent changes to contractual working conditions have caused general practitioners to focus their energies on their practice instead of paying attention to the needs of their family. Male general practitioners leave the bulk of responsibility for running the family and household to their wives, but women general practitioners appear to maintain domestic responsibility while spending as much time in medical practice as their male colleagues. This is only an exploratory study based on a small sample, and so the findings cannot be generalized; however, it provides in-depth information on stress among general practitioners and their spouses. PMID:8731621

  20. Alternative medicine and general practitioners. Opinions and behaviour.

    PubMed Central

    Verhoef, M. J.; Sutherland, L. R.

    1995-01-01

    OBJECTIVE: To describe general practitioners' opinions and behaviour regarding alternative medicine. DESIGN: Cross-sectional survey of a random sample of Ontario and Alberta general practitioners. SETTING: General practices in Ontario and Alberta. PARTICIPANTS: A questionnaire was mailed to 400 general practitioners. Of the 384 eligible physicians, 200 completed the questionnaire. MAIN OUTCOME MEASURES: Reported beliefs and practices concerning alternative medicine. RESULTS: Acupuncture, chiropractic, and hypnosis were considered most useful and reflexology, naturopathy, and homeopathy least useful. Results showed 56% of general practitioners believed that alternative medicine has ideas and methods from which conventional medicine could benefit, 54% referred to alternative practitioners, and 16% practised some form of alternative medicine. Province of practice, place of graduation, training in alternative approaches, number of alternative approaches perceived useful, and attitude toward alternative medicine were clearly related to referring to alternative practitioners. Sex, age, type of practice, training in alternative medicine, referring to alternative practitioners, number of alternative approaches perceived useful, and attitude toward alternative medicine were related to practicing alternative medicine. CONCLUSION: Although acceptance and integration of alternative medicine extend only to certain approaches, alternative medicine cannot be discounted in general practice. A study encompassing all Canadian provinces could help in planning medical education and developing policies to guide physician behaviour. PMID:7780312

  1. General practitioner beds in Finland — lessons for the UK?

    PubMed Central

    Jones, Roger

    1987-01-01

    The Finnish Primary Health Care Act of 1972 aimed to provide comprehensive health care to the population. One consequence was an increase in the number of beds for the use of general practitioners, so that there are now 2.2 general practitioner beds per thousand population. Use of these beds varies with the location of the health station in which they are situated, but in rural areas approximates to that of general practitioner hospitals in the United Kingdom. Despite integration of general practitioner beds into overall planning, some potential benefits of these facilities have not been realized. For the UK, with traditions of personal general practice and continuity of care, the Finnish system offers one model of community care which may have medical and economic advantages. PMID:3668922

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

    PubMed Central

    Chambers, R; Wall, D; Campbell, I

    1996-01-01

    BACKGROUND: There is concern about the morale of general practitioner registrars. There may be stress-provoking factors that could be avoided or minimized. AIMS: The aims of the study were to assess the sources of stress and job satisfaction of general practitioner registrars, to compare registrars' job satisfaction with that of established principals using a recently published survey and to identify registrars' usual responses to stress. METHOD: A postal questionnaire survey was sent to all 143 general practitioner registrars in the West Midlands Region. The main measures were: self-rating scales of stresses associated with work and training; the Warr, Cook and Wall job satisfaction scale; and self-reported responses to stress. RESULTS: A total of 118 (83%) general practitioner registrars responded. The most potent sources of stress were family-job conflict, working for the Membership of the Royal College of General Practitioners, patients' unrealistic expectations and disruption of social life. Registrars practised good coping responses to stress. Registrars in this study had significantly greater job satisfaction than general practitioner principals in a 1993 survey for three out of 10 items measured (responsibility given, hours of work and the job as a whole) and significantly worse scores for three items (recognition for good work, rate of pay and variety of work). CONCLUSIONS: Registrars have additional stresses to those of established principals because they need to study for examinations, learn new tasks in general practice and carry out their service commitments at a stage in life when many are newly married or have a young family. Training in stress management for general practitioner registrars is recommended. PMID:8983252

  3. Travel advice: a study among Swiss and German general practitioners.

    PubMed

    Hatz, C; Krause, E; Grundmann, H

    1997-01-01

    Travelling to tropical and subtropical destinations is common among European citizens. Many of them consult their general practitioners (GPs) for pre-travel advice. Little is known about the knowledge, the sources of information and the needs of physicians. One hundred and fifty Swiss and I50 German GPs giving travel advice were interviewed using pretested telephone interviews and questionnaires to assess their knowledge about travel advice to be given for 2 frequent holiday destinations (Kenya and Thailand), and to ask which information sources were available to them. Ninety-six per cent and 89%, respectively, of GPs in 2 neighbouring areas of Switzerland and Germany gave travel advice to their clients. In telephone interviews, standard recommendations on malaria medication, as approved by the national travel advice committees, were stated by 45 and 25% of Swiss GPs, and 22 and 9% of German GPs for Kenya and Thailand. The figures for correct advice on vaccination requirements were 23 and 47% for the Swiss GPs, and 2 and 25% for the German GPs. Half of the GPs wanted to consult their documents before giving advice. The main source of information used by Swiss GPs was the monthly updated Bulletin of the Federal Office of Public Health (BFOPH). A variety of different sources was recorded among German practitioners. Regular, concise information on travel advice tops the list of requested information material in both countries. The extent of correct pre-travel advice is unsatisfactory in both study groups. Use of standardized, regularly updated and readily available sources of information on travel advice for the GP could avoid uncertainties of both the provider and the recipient of advice. PMID:9018297

  4. OPPORTUNITIES AND RESPONSIBILITIES OF THE GENERAL PRACTITIONER

    PubMed Central

    Truman, Stanley R.

    1949-01-01

    We believe in the ability of general practice to serve the greatest number of people with the best medical care, most efficiently and most economically. We believe that the physician in general practice receives the utmost in personal satisfaction for a job well done. We believe in the necessity for specialists and hold in high regard and deep admiration their fund of knowledge and fine technical skills. Who would call one branch of medicine more necessary than another? All are necessary, all must be nurtured, each commanding and deserving the respect of the others. PMID:18122336

  5. General practitioners' experience of the chronic fatigue syndrome.

    PubMed

    Ho-Yen, D O; McNamara, I

    1991-08-01

    In order to examine the prevalence of patients with symptoms fulfilling the criteria for the chronic fatigue syndrome an extensive survey was carried out of general practitioners on 10 local government lists in two health boards (91% response rate). At the same time practitioners' attitudes to the syndrome and their experience in terms of workload and the characteristics of patients affected were documented. The majority of general practitioners (71%) accepted the existence of chronic fatigue syndrome, but 22% were undecided. The doctors reported a prevalence among their patients of 1.3 per 1000 patients (range 0.3-2.7 for the 10 areas) with a peak in the 30-44 years age group. Female patients were more commonly affected than males (sex ratio 1.8:1.0), but the severity of illness and the use of general practitioner's time was the same among male and female patients. Patients in occupations where they were exposed to infection were affected (teachers and students, 22% of sample; hospital workers, 7%), but many patients were unskilled (8%) and skilled workers (9%). Patients suffering from the chronic fatigue syndrome appear to be a real and distinct group for general practitioners and may represent a substantial part of the workload of doctors in particular areas. PMID:1777276

  6. General practitioners' attitudes towards AIDS and their perceived information needs.

    PubMed Central

    Shapiro, J. A.

    1989-01-01

    A short questionnaire on general practitioners' self perceived and actual knowledge of AIDS and their attitudes to the illness was sent to 1824 general practitioners throughout the United Kingdom. The rate of response was 70%. Women doctors, those who trained overseas, and those who were married tended to have less positive attitudes towards patients with HIV and AIDS, whereas younger doctors, trainers, and members of the Royal College of General Practitioners were more understanding, better informed, and had more positive attitudes. Doctors with the least knowledge about HIV and AIDS and the most negative attitudes towards the illness would benefit from further education, which would be most effectively delivered through the professional journals, the Department of Health and the charitable AIDS organisations. PMID:2503118

  7. Formal complaints against general practitioners: a study of 1000 cases.

    PubMed Central

    Owen, C

    1991-01-01

    This study was carried out to determine the reasons given by patients in making formal complaints against general practitioners. A sample of 1000 complaints made by UK patients about general practitioner principals over the period 1982-89 was randomly selected from the computer database of the Medical Protection Society and retrospectively analysed. Thirteen categories of criticism were identified. The most common circumstance in which patients complained was when they believed there had been failure to visit. In nearly one third of cases the complaints were associated with the death of a patient. In a quarter of the letters it was clear that the patient's motive for complaining was concern to protect other patients. General practitioners should bear in mind that in declining to visit they could be inviting criticism, particularly if the patient dies. PMID:2031754

  8. General practitioners and women with urinary incontinence.

    PubMed Central

    Grealish, M; O'Dowd, T C

    1998-01-01

    BACKGROUND: Urinary incontinence is a common problem for adult women. It results in a large financial and psychosocial cost. Much urinary incontinence goes unreported. Women with urinary incontinence can be successfully assessed and treated in general practice but studies have shown that many GPs manage the condition inadequately. AIM: This study aims to examine GPs' awareness of urinary incontinence in women and their management of, and attitudes to, female urinary incontinence. METHOD: A qualitative study was conducted with 21 GPs responding to semi-structured interviews. Thematic analysis was carried out on these interviews, with recurrent views and experiences being identified and grouped. RESULTS: The interviews of 11 male and nine female GPs were suitable for analysis. GPs were aware of the prevalence and under-reporting of urinary incontinence in women. Many were unhappy with their own management of the condition and with the management options available to them. Male GPs in particular were reluctant to carry out gynaecological examinations, and few GPs expressed enthusiasm for teaching pelvic floor exercises or bladder drills. Medications were frequently used but generally considered ineffective or intolerable. The services of both public health nurses and practice nurses were under-used, largely because of lack of training in this area. Although incontinence nurses were employed in the area, many GPs did not know of their availability and, of those who did, few referred to them more than infrequently. CONCLUSION: This study demonstrates that many GPs avoid dealing with the problem of urinary incontinence in women and that they find it to be a difficult, chronic problem to treat. Specialist options seem not to be useful in general practice. The findings need to be explored in other GP settings. PMID:9624768

  9. Survey of general practitioners' advice for travellers to Turkey.

    PubMed Central

    Usherwood, V; Usherwood, T P

    1989-01-01

    Fifty general practitioners replied to a survey of the advice that they would offer to a tourist planning a package holiday in western Turkey. The range of prophylactic immunizations and other medication recommended by the respondents was wide, suggesting that some tourists travel without adequate protection, while some receive unnecessary injections. Most of the doctors would offer little other health advice to the traveller. General practitioners receive conflicting guidance on prophylactics for travellers, and it is suggested that the disagreements should be resolved. Wider availability of written advice for the traveller would also be valuable. PMID:2559989

  10. Survey of general practitioners' advice for travellers to Turkey.

    PubMed

    Usherwood, V; Usherwood, T P

    1989-04-01

    Fifty general practitioners replied to a survey of the advice that they would offer to a tourist planning a package holiday in western Turkey. The range of prophylactic immunizations and other medication recommended by the respondents was wide, suggesting that some tourists travel without adequate protection, while some receive unnecessary injections. Most of the doctors would offer little other health advice to the traveller. General practitioners receive conflicting guidance on prophylactics for travellers, and it is suggested that the disagreements should be resolved. Wider availability of written advice for the traveller would also be valuable. PMID:2559989

  11. [High-quality hospital discharge summaries - general practitioners expectations].

    PubMed

    Bally, Klaus; Lingenhel, Sabine; Tschudi, Peter

    2012-01-01

    Hospital discharge summaries ensure treatment continuity after hospital discharge. In Switzerland discharge letters are a celebrated custom and a tool for training young colleagues. The primary purpose is to guarantee high-quality care of patients treated by hospital staff and general practitioners. From the perspective of the patient's general practitioner discharge summaries should convey current and accurate medically important patient data to the physician responsible for follow-up care. In the era of highly developed electronic data transfer and introduction of diagnose related groups (DRGs), it will be necessary to transmit hospital discharge information selectively to different target groups. Nevertheless data protection and medical secret must be complied with. PMID:22198930

  12. Minimally invasive periodontal therapy for general practitioners.

    PubMed

    Ryder, Mark I; Armitage, Gary C

    2016-06-01

    There remains a high prevalence of mild-to-moderate forms of periodontal diseases in both developed and developing countries. Although many periodontal specialty practices currently place strong emphasis on implant surgery, periodontal plastic surgery and esthetics, general dentists and hygienists have often assumed more responsibility than periodontal specialty practices for the diagnosis, treatment, assessment and maintenance, and possible referral, of their patients. To address these current trends and challenges, this volume of Periodontology 2000 presents a series of topics on the basic biological principles of periodontal disease, as well as on approaches to diagnosis, treatment planning and treatment, in what is called 'conservative' or 'noninvasive' periodontal therapy. These topics include risk assessment of the periodontal condition; reduction, elimination and/or control of etiologies and risk factors, including mechanical, antimicrobial and host-modulation approaches; considerations for evaluation of clinical outcomes based on treatment approaches; and selected topics in laser therapy, halitosis and gingival recession. PMID:27045427

  13. Sigmoidoscopy/proctoscopy service with open access to general practitioners.

    PubMed Central

    Donald, I P; FitzGerald Frazer, J S; Wilkinson, S P

    1985-01-01

    Many hospitals now offer barium enema examinations to general practitioners on an open access basis, so bypassing the traditional sequence of first carrying out a sigmoidoscopy. An open access sigmoidoscopy/proctoscopy service was therefore opened with requests for a barium enema being denied unless preceded by sigmoidoscopy. During the first three and a half years 1458 patients referred direct from their general practitioners were examined using a rigid sigmoidoscope. Patients were also examined with a proctoscope if thought appropriate. After the first year of the service a subsequent examination with a fibreoptic sigmoidoscope was also carried out if the presenting symptom was bleeding for which no cause could be found with the rigid instruments. A total of 516 abnormalities were found to account for symptoms in 506 patients giving a diagnostic rate of 35%. The most common lesion was piles (307 cases). Other relatively common disorders included inflammatory bowel disease (107 cases), benign tumours (44), and malignant tumours (38). Of 41 patients subsequently undergoing fibreoptic sigmoidoscopy a cause for the bleeding was found in 32, the most common being a malignant tumour (16). Most general practitioners in the district used the service and a questionnaire survey indicated that most found it very helpful. Requests from general practitioners for a barium enema fell substantially over the period. PMID:3918744

  14. Adolescents' Suicidal Thinking and Reluctance to Consult General Medical Practitioners

    ERIC Educational Resources Information Center

    Wilson, Coralie J.; Deane, Frank P.; Marshall, Kellie L.; Dalley, Andrew

    2010-01-01

    Appropriate help-seeking is widely recognized as a protective factor, and vital for early treatment and prevention of mental health problems during adolescence. General medical practitioners (GPs), that is, family doctors, provide a vital role in the identification of adolescents with mental health problems and the provision of treatment as well…

  15. Men's Health Promotion by General Practitioners in a Workplace Setting.

    ERIC Educational Resources Information Center

    Aoun, Samar; Johnson, Lyn

    2002-01-01

    A project to promote rural men's health through diabetes education and screening in the workplace involved 446 men aged 40-65 in Western Australia. Of the 287 men identified at high risk of developing diabetes and referred to their general practitioner, 76 percent visited their physician. However, physician's advice on lifestyle changes was…

  16. Personality Factors Related to Career Satisfaction among General Practitioners.

    ERIC Educational Resources Information Center

    Schwartz, Robert H.; Shenoy, Sunil

    1994-01-01

    A survey of 150 general practice dentists examined the relationship between 6 career interests (scientific, artistic, social, enterprising, conventional, technical) and career satisfaction. Results are presented and compared with findings of other studies of dental students and practitioners. Results suggest that satisfied dentists tended to like…

  17. The Royal College of General Practitioners: Postgraduate Education in Britain

    PubMed Central

    Ayre, Burton

    1970-01-01

    The development and growth of the Royal College of General Practitioners in Britain against a background of escalating need for postgraduate courses within their society is outlined. The structuring of postgraduate medical education under government sponsorship with the inception of the National Health Service is described; and its evolution over the past 20 years. The main substance of this article grew out of tape recorded discussions between the author and Dr. John Hunt, President of the Royal College of General Practitioners; Dr. Patrick Byrne, Director, Department of General Practice, the University of Manchester, and Chief Examiner RCGP; Mr. Donald C. Bowie, FRCS, Regional Postgraduate Dean, The British Postgraduate Medical Federation, the University of London; Dr. J. S. K. Stevenson of McKenzie House, Edinburgh, Scotland. Some additional comments are based on extracts from The Royal Commission on Medical Education 1965-68 Report (Todd Report). Imagesp117-a PMID:20468491

  18. Roles of the general practitioner in different contexts.

    PubMed

    Van Dormael, M

    1995-01-01

    The word ¿general practice¿ denotes different contents of work as we look at different contexts. General practitioners may provide first line care, function as secondary care providers at hospital level, take responsibility for the management of health care systems. These different roles can be seen as results from historical processes of division of work in the field of health care, which gave general practice its present shapes. During the first half of the 20th century, western general practitioners were gradually excluded from hospitals as well as from public health activities. When they started to react in order to increase their legitimacy they strived--with variable success--to gain recognition as curative first line care providers, as this had become the only place in the health care system they could claim for. They gradually defined their specificity in terms of polyvalence enabling them to deal with unselected problems, and in terms of global view allowing for adequate priority setting. In developing countries, the organisation of medical care was and remains influenced by western models. As in western countries, emphasis has been put on specialisation and hospital technology. General practice was not exported to developing countries: general practitioners appear rather as cheap substitutes for specialists. The most typical workplace for general practitioners in developing countries remains the rural hospital. But their role model refers to the hospital based specialist: they tend to focus on patient care for hospital users rather than on dynamising health care delivery to the whole community in the district. In urban areas, the recent expansion of (mostly private) first line medical care is also not specific to general practice and tends to be in favour of specialists. What is the common denominator to these different roles, if any? A possible answer lies in the primary health care approach. It allows to define the specificity of general practitioners

  19. Modelling Nonlinearities and Reference Dependence in General Practitioners' Income Preferences.

    PubMed

    Holte, Jon Helgheim; Sivey, Peter; Abelsen, Birgit; Olsen, Jan Abel

    2016-08-01

    This paper tests for the existence of nonlinearity and reference dependence in income preferences for general practitioners. Confirming the theory of reference dependent utility within the context of a discrete choice experiment, we find that losses loom larger than gains in income for Norwegian general practitioners, i.e. they value losses from their current income level around three times higher than the equivalent gains. Our results are validated by comparison with equivalent contingent valuation values for marginal willingness to pay and marginal willingness to accept compensation for changes in job characteristics. Physicians' income preferences determine the effectiveness of 'pay for performance' and other incentive schemes. Our results may explain the relative ineffectiveness of financial incentive schemes that rely on increasing physicians' incomes. Copyright © 2015 John Wiley & Sons, Ltd. PMID:26095526

  20. Professional and social support networks of rural general practitioners.

    PubMed

    Joyce, Catherine; Veitch, Craig; Crossland, Lisa

    2003-01-01

    This study explored the nature of rural general practitioners' (GPs) professional and personal support networks. A qualitative design was employed, using in-depth interviews with a diverse sample of GPs in rural Queensland. The support network of the rural GPs in this study incorporated the domains of clinical, workforce and social support, with clinical support as the most important domain. There was a preference for face-to-face contact wherever possible. Such contact was particularly important in the process of developing the network and for personal support. Despite this, many network contacts were by telephone out of necessity. There were few notable differences between male and female rural GPs on the issues explored in the present study. General Practitioners' satisfaction with their professional interactions was varied across the sample. The findings suggest that level of satisfaction may be associated with intentions to leave or stay for this group. PMID:12603440

  1. Exploratory study of general practitioners' orientations to general practice and responses to change.

    PubMed Central

    Petchey, R

    1994-01-01

    BACKGROUND. Research into general practitioners' responses to the changes in the health service has focused on the quantifiable dimensions of workload, stress, job satisfaction and mental health. AIM. This study set out to investigate general practitioners' practice orientations and responses to change. METHOD. The study was undertaken in 1992. 'Young principals' who had attended MSD Foundation regional courses were invited by letter to reflect on recent change in general practice and to give their views on morale and recruitment. RESULTS. Forty nine young principals responded (response rate 45%). Responses were found to cluster around four orientations to practice: collectivism, pragmatism, traditionalism, and alienation. These varied in terms of four underlying values: autonomy, individualism, external referent and optimism. CONCLUSION. General practitioners' responses to change are more complex than is currently understood and are influenced by orientation to practice. In a relatively homogeneous 'enthusiastic' subgroup of general practitioners there is striking variation in practice orientation. PMID:7748665

  2. General-practitioner obstetrics: two styles of care.

    PubMed Central

    Roseveare, M P; Bull, M J

    1982-01-01

    Two systems of general-practitioner obstetric care currently in use in England are compared. In one (Oxford) a large number of doctors, working with community midwives, have autonomous responsibility for the management of patients whose condition conforms with defined booking criteria. In the other (Dulwich) two practitioners, working with hospital midwives, operate a minimal selection policy, but all their patients are reviewed at 36 weeks' gestation by a specialist obstetrician. Despite the differing selection policies which created incongruities in the groups in respect of age, social class, and birthweight distribution, the outcomes in terms of mode of delivery showed no significant differences. The perinatal mortality rates were also similar and appeared to be better than those achieved nationally. PMID:6802369

  3. 7 CFR 2.4 - General officers.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 1 2011-01-01 2011-01-01 false General officers. 2.4 Section 2.4 Agriculture Office of the Secretary of Agriculture DELEGATIONS OF AUTHORITY BY THE SECRETARY OF AGRICULTURE AND GENERAL OFFICERS OF THE DEPARTMENT General § 2.4 General officers. The work of the Department is under the supervision and control of the Secretary who...

  4. 7 CFR 2.4 - General officers.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 1 2010-01-01 2010-01-01 false General officers. 2.4 Section 2.4 Agriculture Office of the Secretary of Agriculture DELEGATIONS OF AUTHORITY BY THE SECRETARY OF AGRICULTURE AND GENERAL OFFICERS OF THE DEPARTMENT General § 2.4 General officers. The work of the Department is under the supervision and control of the Secretary who...

  5. Coeliac disease in children - an update for general dental practitioners.

    PubMed

    Paul, S P; Kirkham, E N; John, R; Staines, K; Basude, D

    2016-05-13

    Coeliac disease (CD) is an immune-mediated systemic disorder caused by ingestion of gluten found in wheat, rye and barley. It affects around 1% of children, but 90% of cases are considered to remain undiagnosed. CD classically presents with gastrointestinal manifestations including diarrhoea, bloating, weight loss and abdominal pain, but extra-intestinal features (including oral and dental manifestations) are increasingly being reported. Dental and oral manifestations such as dental enamel defects, delayed eruption of teeth, recurrent aphthous ulcers are well-recognised manifestations of CD. In patients with yet undiagnosed CD, these can sometimes be the only presenting features. Dentists have regular contact with well children, and therefore the visit to the dentist is an opportunity to suspect CD. When CD is suspected, Dental practitioners can liaise with the general medical practitioner to organise screening for coeliac disease. Positive serology will prompt onward referral to a paediatric gastroenterologist to confirm the diagnosis. The recent European Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines revised in 2012 have streamlined the diagnostic pathway for faster diagnosis of CD. Management involves strict adherence to a gluten free diet, which should lead to resolution of symptoms, recovery of intestinal mucosa and prevention of long-term complications associated with it. This article aims to describe CD, inform of recent changes to the diagnostic pathway and highlight the dental manifestations of the condition to equip dental practitioners to aid early diagnosis and initiation of treatment for children with CD. PMID:27173708

  6. Segmenting a general practitioner market to improve recruitment outcomes.

    PubMed

    Hemphill, Elizabeth; Kulik, Carol T

    2011-05-01

    Recruitment is an ongoing challenge in the health industry with general practitioner (GP) shortages in many areas beyond rural and Indigenous communities. This paper suggests a marketing solution that identifies different segments of the GP market for recruitment strategy development. In February 2008, 96 GPs in Australia responded to a mail questionnaire (of which 85 questionnaires were useable). A total of 350 GPs were sent the questionnaire. Respondents considered small sets of attributes in the decision to accept a new job at a general practice and selected the most and least important attribute from each set. We identified latent class clusters (cohorts) of GPs from the most-least important data. Three cohorts were found in the GP market, distinguishing practitioners who emphasised job, family or practice attributes in their decision to join a practice. Few significant demographic differences exist between the cohorts. A segmented GP market suggests two alternative recruitment strategies. One option is for general practices to target members of a single cohort (family-, job-, or practice-focussed GPs). The other option is for general practices to diversify their recruitment strategies to target all three cohorts (family-, job- and practice-focussed GPs). A single brand (practice) can have multiple advertising strategies with each strategy involving advertising activities targeting a particular consumer segment. PMID:21612720

  7. General practitioners and clinical practice guidelines: a reexamination.

    PubMed

    Clerc, Isabelle; Ventelou, Bruno; Guerville, Marc-André; Paraponaris, Alain; Verger, Pierre

    2011-08-01

    General practitioners' (GPs') use of clinical practice guidelines (CPGs) may be influenced by various contextual and attitudinal factors. This study examines general attitudes toward CPGs to establish profiles according to these attitudes and to determine if these profiles are associated with awareness and with use of CPGs in daily practice. The authors conducted a cross-sectional telephone survey of 1,759 French GPs and measured (a) their general attitudes toward CPGs and (b) their awareness and use in daily practice of CPGs for six specific health problems. A bivariate probit model was used with sample selection to analyze the links between GPs' general attitudes and CPG awareness/use. The authors found three GP profiles according to their opinions toward CPGs and a positive association between these profiles and CPG awareness but not use. It is important to build awareness of CPGs before GPs develop negative attitudes toward them. PMID:21536601

  8. Elder abuse and neglect: a survey of Irish general practitioners.

    PubMed

    O'Brien, James G; Riain, Ailis Ni; Collins, Claire; Long, V; O'Neill, Desmond

    2014-01-01

    The objective of this study was to survey general practitioners (GPs) in Ireland regarding their experience with elder abuse. A random sample of 800 GPs were mailed a survey in March 2010, with a reminder in May 2010, yielding a 24% response rate. The majority, 64.5%, had encountered elder abuse, with 35.5% encountering a case in the previous year. Most were detected during a home visit. Psychological abuse and self-neglect were most common. Most GPs in Ireland have encountered cases of elder abuse, most were willing to get involved beyond medical treatment, and 76% cited a need for more education. PMID:24779541

  9. Continuing medical education for general practitioners: a practice format

    PubMed Central

    VanNieuwenborg, Lena; Goossens, Martine; De Lepeleire, Jan; Schoenmakers, Birgitte

    2016-01-01

    Introduction Our current knowledge-based society and the many actualisations within the medical profession require a great responsibility of physicians to continuously develop and refine their skills. In this article, we reflect on some recent findings in the field of continuing education for professional doctors (continuing medical education, CME). Second, we describe the development of a CME from the Academic Center for General Practice (ACHG) of the KU Leuven. Methods First, we performed a literature study and we used unpublished data of a need assessment performed (2013) in a selected group of general practitioners. Second, we describe the development of a proposal to establish a CME programme for general practitioners. Results CME should go beyond the sheer acquisition of knowledge, and also seek changes in practice, attitudes and behaviours of physicians. The continuing education offerings are subject to the goals of the organising institution, but even more to the needs and desires of the end user. Conclusions Integrated education is crucial to meet the conditions for efficient and effective continuing education. The ACHG KU Leuven decided to offer a postgraduate programme consisting of a combination of teaching methods: online courses (self-study), contact courses (traditional method) and a materials database. PMID:26850504

  10. Meeting the educational needs of general practitioners for epilepsy.

    PubMed

    Chappell, B; Smithson, H

    1999-05-01

    Epilepsy care in general practice has been criticized, but what do GPs feel they deal with most and complete satisfactorily? If criticism is justified, education should be useful in improving epilepsy care, but what do general practitioners want to learn and how do they want to learn it? Questionnaires about these issues were sent to randomly chosen general practitioners throughout the United Kingdom. One hundred and twenty-four out of 200 (62%) responded. They were not biased by age, sex, type of practice or previous interest in epilepsy. Drug treatment and regular review were the two areas of care GPs said they dealt with most, but only half felt they dealt with them well. Sixty-six percent wanted to learn more about drug treatment, 46% about lifestyle advice, 45% about non-drug treatment, 44% about diagnosis and only 16% did not want to learn more about any aspect of care. Weekdays and evenings were the preferred times for study. Courses up to one full day away from practices were popular, distance learning and personal education plans were not, except for a group of younger GPs. When attending courses multi-disciplinary lectures rated highly and nearly three-quarters preferred to attend courses where epilepsy was covered in conjunction with other conditions. Future epilepsy education for GPs should recognize these findings if attendance and positive outcomes are to be maximized. PMID:10356373

  11. Nicholas Culpeper (1616-1654): London's first general practitioner?

    PubMed

    Farthing, Michael J G

    2015-08-01

    Nicholas Culpeper is often regarded as an ill-disciplined, maverick, mid-17th century herbalist and the father of contemporary alternative medicine. There are elements of this statement that have some truth but to dismiss his contribution to the development of health provision in London at the time would be a great injustice. Culpeper did not complete his apprenticeship as an apothecary and was not a formally trained physician, but he developed a clinical practice for the poor of London, indistinguishable from the role of the present day general practitioner. Observers at the time recognised his concern and compassion and his commitment to treat the whole patient and not just the disease. His enduring contribution was his translation from Latin of the physicians' Pharmacopoeia Londinensis which could be regarded as the first major step towards the demystification of medicine. Culpeper's London Dispensatory and the many other medical treatises that followed were affordable and widely available to the common man. Culpeper antagonised both apothecaries and physicians because he breached the regulations of the day by accepting patients directly. So perhaps Culpeper was, de facto, London's first general practitioner, at least 150 years before the role was formally recognised in the Apothecaries Act 1815. PMID:24585603

  12. Patient care and the general practitioner. Joint Working Party of the Welsh Council of the Royal College of General Practitioners and the Welsh General Medical Services Committee.

    PubMed

    1994-10-29

    The role of general practitioners is being redefined in the light of the emphasis on more care in the community, economic factors, and patients' expectations. The strength of general practice lies in the doctor-patient relationship; this strength must not be lost sight of. Specific tasks of the general practitioner include the responsibility for the care of individuals; the role of gatekeeper; broad knowledge of curative, preventive; and rehabilitative medicine; teamwork; management; and development of population based strategies. Future work patterns include the general practitioner first and foremost as a clinician and an integrator of health services, but they also involve audit, education and training, research, management, and relations with organisations in the public, private, and voluntary sectors. It is important to make changes only when they benefit patients and to maintain the principle of equity of access to care. PMID:7987112

  13. [Reducing problematic sickness absence: of importance to every general practitioner].

    PubMed

    Wind, H; Opstelten, W; Hendriks, A C

    2016-01-01

    Problematic sickness absence is an issue that concerns not only occupational health physicians, but all physicians. More collaboration between occupational health and treating physicians, plus improved alignment of symptom treatment and reintegration counselling, can help avoid long-term sickness absence of employees. Achieving this goal presupposes mutual knowledge of each other's professions. Medical practice guidelines are a tool par excellence to share knowledge and bring this into practice. Treating physicians should not refrain from posing work-related and return-to-work questions, even if the overall responsibility lies with the occupational health physicians in terms of reintegration efforts. The patient's interest should be the leading principle for all physicians involved. This means not only provision of good care, aimed at patient recovery, but also adequate reintegration in the labour market. Occupational health physicians, general practitioners and consultant specialists should share this common goal. PMID:27299497

  14. Do general practitioners and general psychiatrists want to look after drug misusers? Evaluation of a non-specialist treatment policy.

    PubMed Central

    Tantam, D; Donmall, M; Webster, A; Strang, J

    1993-01-01

    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) PMID:8292420

  15. Do general practitioners and general psychiatrists want to look after drug misusers? Evaluation of a non-specialist treatment policy.

    PubMed

    Tantam, D; Donmall, M; Webster, A; Strang, J

    1993-11-01

    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) PMID:8292420

  16. Physician Associate and General Practitioner Consultations: A Comparative Observational Video Study

    PubMed Central

    de Lusignan, Simon; McGovern, Andrew P.; Tahir, Mohammad Aumran; Hassan, Simon; Jones, Simon; Halter, Mary; Joly, Louise; Drennan, Vari M.

    2016-01-01

    Background Physician associates, known internationally as physician assistants, are a mid-level practitioner, well established in the United States of America but new to the United Kingdom. A small number work in primary care under the supervision of general practitioners, where they most commonly see patients requesting same day appointments for new problems. As an adjunct to larger study, we investigated the quality of the patient consultation of physician associates in comparison to that of general practitioners. Method We conducted a comparative observational study using video recordings of consultations by volunteer physician associates and general practitioners with consenting patients in single surgery sessions. Recordings were assessed by experienced general practitioners, blinded to the type of the consulting practitioner, using the Leicester Assessment Package. Assessors were asked to comment on the safety of the recorded consultations and to attempt to identify the type of practitioner. Ratings were compared across practitioner type, alongside the number of presenting complaints discussed in each consultation and the number of these which were acute, minor, or regarding a chronic condition. Results We assessed 62 consultations (41 general practitioner and 21 physician associates) from five general practitioners and four physician associates. All consultations were assessed as safe; but general practitioners were rated higher than PAs in all elements of consultation. The general practitioners were more likely than physician associates to see people with multiple presenting complaints (p<0.0001) and with chronic disease related complaints (p = 0.008). Assessors correctly identified general practitioner consultations but not physician associates. The Leicester Assessment Package had limited inter-rater and intra-rater reliability. Conclusions The physician associate consultations were with a less complex patient group. They were judged as competent and safe

  17. 49 CFR 1103.15 - The practitioner's duty to clients, generally.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false The practitioner's duty to clients, generally. 1103.15 Section 1103.15 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT OF TRANSPORTATION RULES OF PRACTICE PRACTITIONERS Canons of Ethics The Practitioner's Duties and...

  18. Cancer detection in primary care: insights from general practitioners

    PubMed Central

    Green, T; Atkin, K; Macleod, U

    2015-01-01

    Background: General practitioners (GPs) have a key role in cancer detection as the usual first point of contact for patients with potential cancer symptoms. Nevertheless, there is limited work that investigates their perceptions of their role in the early detection of cancer. To address this gap, we aimed to gain an in-depth understanding of cancer diagnosis from the perspective of GPs. Methods: Individual face-to-face semi-structured interviews were conducted with 55 GPs from the North and North East of England and Greater London. All interviews were recorded and professionally transcribed verbatim. Repeated reading and co-coding engendered systematic thematic analysis across the interview material. Results: Three main themes emerged from the analysis of our data. First, we identified the burden of early cancer detection in general practice, both related to the anxiety and symptoms patients bring to GPs and the need for GPs to recognise patterns of cancer symptoms and refer appropriately; second, this burden is intensified by a perceived fragmentation of services within the National Health Service (NHS); and third, it is made more complex by the interface between general practice and public health. Conclusions: GPs occupy a challenging but pivotal role in cancer detection. It is crucial that this role be supported by policy and research. PMID:25734388

  19. Ambulatory Care in Medical Residency: Integration of Private Practitioner's Office with Traditional Sites.

    ERIC Educational Resources Information Center

    Bane, Susan; Criscione, Teri

    1983-01-01

    An Albany Medical College program utilizes private internists' offices as sites for resident ambulatory education. The private practitioner is perceived as an excellent teacher and role model who provides a positive effect on the long-term career goals of residents. (MLW)

  20. General practitioners' perspectives on primary care consultations for suicidal patients.

    PubMed

    Saini, Pooja; Chantler, Khatidja; Kapur, Navneet

    2016-05-01

    Little is known about general practitioners' (GPs') perspectives, management of and interactions with suicidal patients prior to the patient's suicide. The aims of the study were to explore GPs' interpretations of patient communication and treatment in primary care leading up to suicide and to investigate the relationship between GPs and mental health services prior to a patient's suicide. Thirty-nine semi-structured interviews with GPs of people who had died by suicide were conducted as part of a retrospective study. Interviews were transcribed verbatim and analysed using a thematic approach. The following themes emerged from GP interviews: (i) GP interpretations of suicide attempts or self-harm; (ii) professional isolation; and (iii) GP responsibilities versus patient autonomy. GPs recruited for the study may have different views from GPs who have never experienced a patient suicide or who have experienced the death of a patient by suicide who was not under the care of specialist services. Our findings may not be representative of the rest of the United Kingdom, although many of the issues identified are likely to apply across services. This study highlighted the following recommendations for future suicide prevention in general practice: increasing GP awareness of suicide-related issues and improving training and risk assessment skills; removing barriers to accessing therapies and treatments needed in primary care; improving liaison and collaboration between services to provide better patient outcomes; and increasing awareness in primary care about why patients may not want treatments offered by focusing on each individual's situational context. PMID:25661202

  1. Easy Medic: an Internet application for the general practitioner.

    PubMed

    Arnone, G; Bianchi, A; Della Pietra, B; Sernicola, R; Sparacino, E; Vitolo, R

    1998-01-01

    A research project has been carried out to develop a client server application which supplies the general practitioner (GP) with a 'personal digital assistant' (hand-held mobile computer) to connect to Web servers at a hospital site through the Internet. This allows the doctor to book medical examinations, hospital admissions and manage patient data. The application used advanced object-oriented techniques, on both the client and the server side. The connection to a Web server was achieved through GSM wireless cellular telephones using standard Internet protocols (HTTP, TCP/IP and CGI). Conventional telephone lines can be used as well. Other application modules on the client side provided patients medical record supervision, GP schedule management, general information about hospitals and clinics, and pharmacy consultation. These services should help GPs in their daily work. Moreover, the quality of health-care resource management and cost supervision should improve, since each GP 'transaction' is automatically entered in realtime into a database at the server. The services are under test in the health-care system of an urban area in southern Italy. PMID:9640752

  2. [General practitioner or specialist at home or abroad?].

    PubMed

    van den Bussche, H; Kromark, K; Köhl-Hackert, N; Robra, B; Rothe, K; Schmidt, A; Stosch, C; Wagner, R; Wonneberger, C; Scherer, M; Alfermann, D; Gedrose, B

    2012-12-01

    This study investigated the career preferences of medical graduates in Germany with regard to discipline, place and position after the completion of postgraduate training. We also investigated differences in career options according to gender and region of study (former German Federal Republic vs. former German Democratic Republic).The study is based on a standardised postal survey among all last year medical students in the medical faculties of Erlangen, Giessen, Hamburg, Heidelberg, Cologne, Leipzig and Magdeburg in 2009. 2 107 persons were contacted and 1 012 (48%) participated in the survey.96% of participants stated their intention to pursue a postgraduate training in a medical discipline, and only 0.4% denied such an objective. 7% of the graduates preferred a career towards general practice, and a similar percentage preferred general internal medicine which usually also leads to a primary care activity. 84% aimed at becoming a medical specialist. In total, 28% intended to work in a specialist practice, and 10% in a general practice. Only one-fifth of the latter aimed at working in a countryside setting. 7% aimed at starting postgraduate training outside of Germany, and 8% preferred to work outside Germany after completion of the postgraduate training. In both cases, Switzerland was by far the most preferred country.The results contradict the thesis that young graduates are reluctant to enter clinical medicine. Working abroad is within the scope of less than 10% of the graduates. A dramatic difference between the demand for general practitioners and the career intentions of medical graduates is observed. Measures to increase the attractiveness of primary care, especially in the countryside, are urgently needed. PMID:22622844

  3. Incidence of pertussis in patients of general practitioners in Poland.

    PubMed

    Stefanoff, P; Paradowska-Stankiewicz, I A; Lipke, M; Karasek, E; Rastawicki, W; Zasada, A; Samuels, S; Czajka, H; Pebody, R G

    2014-04-01

    We estimated the incidence of pertussis in patients consulting general practitioners (GPs). Between July 2009 and April 2011, we conducted a prospective cohort study of patients attending 78 general practices (158 863 persons overall). We included patients aged ≥ 3 years, with cough lasting 2-15 weeks, who gave informed consent. GPs interviewed eligible patients, collected a blood specimen, and a nasopharyngeal swab. At follow-up 30-60 days after the initial visit, physicians collected a second blood specimen and conducted patient interview. Cases were confirmed by specific IgA and/or IgG antibody titre exceeding significantly the general population background level or detection of bacterial DNA by real-time PCR. During the study period, 3864 patients with prolonged cough consulted the participating GPs, of those 1852 met the inclusion criteria, 1232 were recruited, and 288 were confirmed as pertussis cases (4% by PCR, 96% by serology). The adjusted incidence rate was 201.1/100 000 person-years [95% confidence interval (CI) 133.9-302.0], ranging from 456.5 (95% CI 239.3-870.8) in the 15-19 years group to 94.0 (95% CI 33.4-264.5) in the 25-29 years group. The reporting ratio was 61, ranging from 4 in those aged 3-5 years, to 167 in those aged 65-69 years. The study confirmed high incidence of pertussis in all age groups in the general population, in particular in adults, not appropriately documented by the existing surveillance system. PMID:23870166

  4. [Diagnosis of Alzheimer's disease for general practitioners: screening instruments and early symptoms].

    PubMed

    Allegri, Ricardo F

    2010-01-01

    Despite the increasing prevalence and the potential benefits of early identification, dementias continue to be under-diagnosed. By some estimates, fewer than half of all dementia patients have been diagnosed. AD is particularly under-diagnosed in primary care settings perhaps because patients with early AD may appear entirely appropriate in the context of a brief office visit. This, coupled with increasingly abbreviated office visits and the lack of routine use of mental status exams, make identification of cognitive deficit challenging in the primary care setting. Detection of these patients must be made by the general practitioners, who must know the possibilities to detect and guide the study of them. Patients' screening must include discrimination of forgetfulness and use of mini mental examination. Once the cognitive impairment is suspected we need to continue with neuropsychological assessment for cognitive profile, ancillary studies and CT scan to exclude structural diseases. The appropriate knowledge and training of general practitioners will allow the early diagnosis of these patients and the beginning of preventive actions and adequate symptomatic treatment. PMID:21598736

  5. Leadership and management curriculum planning for Iranian general practitioners

    PubMed Central

    KHOSRAVAN, SHAHLA; KARIMI MOONAGHI, HOSSEIN; YAZDANI, SHAHRAM; AHMADI, SOLEIMAN; MANSOORIAN, MOHAMMAD REZA

    2015-01-01

    Introduction Leadership and management are two expected features and competencies for general practitioners (GPs). The purpose of this study was leadership and management curriculum planning for GPs which was performed based on Kern’s curriculum planning cycle. Methods This study was conducted in 2011- 2012 in Iran using an explanatory mixed-methods approach. It was conducted through an initial qualitative phase using two focus group discussions and 28 semi-structured interviews with key informants to capture their experiences and viewpoints about the necessity of management courses for undergraduate medical students, goals, objectives, and educational strategies according to Kern’s curriculum planning cycle. The data was used to develop a questionnaire to be used in a quantitative written survey. Results of these two phases and that of the review of medical curriculum in other countries and management curriculum of other medical disciplines in Iran were used in management and leadership curriculum planning. In the qualitative phase, purposeful sampling and content analysis with constant comparison based on Strauss and Corbin’s method were used; descriptive and analytic tests were used for quantitative data by SPSS version 14. Results In the qualitatively stage of  this research, 6 main categories including the necessity of management course, features and objectives of management curriculum, proper educational setting, educational methods and strategies, evolutionary method and feedback result were determined. In the quantitatively stage of the research, from the viewpoints of 51.6% of 126 units of research who filled out the questionnaire, ranked high necessary of management courses. The coordination of care and clinical leadership was determined as the most important role for GPs with a mean of 6.2 from sample viewpoint. Also, team working and group dynamics had the first priority related to the principles and basics of management with a mean of 3

  6. Knowledge of, and treatment strategies for, endometriosis among general practitioners.

    PubMed

    van der Zanden, Moniek; Nap, Annemiek W

    2016-05-01

    Endometriosis is the most common benign gynaecological disorder. The general practitioner (GP) plays an important role in identifying women at early stages of the disease. This study was conducted to acquire information about awareness and knowledge of endometriosis among Dutch GPs, and clinical strategies taken. A total of 101 GPs completed a questionnaire either by email or at a local education meeting. The GPs annually encounter 2.8 women they suspect of having endometriosis. The estimated time to diagnosis was 65.7 months (39.1 months patient delay and 26.6 months doctors delay); 56.7% of GPs primarily refer to a gynaecologist for consultation or diagnostic tests. The GPs answered on average 16.6 out of 28 knowledge questions correctly. Seventy-six out of 87 GPs stated that they needed further education. The results of this study indicate that if a GP considers endometriosis as a diagnosis, adequate action is undertaken. As only limited numbers of women with endometriosis are encountered in their practice, GPs do not recognize immediately the symptoms that may be caused by endometriosis, leading to diagnostic delay. Our findings may help to set up teaching programmes and awareness strategies for first-line medical professionals to enhance timely diagnosis and treatment of endometriosis. PMID:26947452

  7. General practitioners' decisions about discontinuation of medication: an explorative study.

    PubMed

    Nixon, Michael Simon; Vendelø, Morten Thanning

    2016-06-20

    Purpose - The purpose of this paper is to investigate how general practitioners' (GPs) decisions about discontinuation of medication are influenced by their institutional context. Design/methodology/approach - In total, 24 GPs were interviewed, three practices were observed and documents were collected. The Gioia methodology was used to analyse data, drawing on a theoretical framework that integrate the sensemaking perspective and institutional theory. Findings - Most GPs, who actively consider discontinuation, are reluctant to discontinue medication, because the safest course of action for GPs is to continue prescriptions, rather than discontinue them. The authors conclude that this is in part due to the ambiguity about the appropriateness of discontinuing medication, experienced by the GPs, and in part because the clinical guidelines do not encourage discontinuation of medication, as they offer GPs a weak frame for discontinuation. Three reasons for this are identified: the guidelines provide dominating triggers for prescribing, they provide weak priming for discontinuation as an option, and they underscore a cognitive constraint against discontinuation. Originality/value - The analysis offers new insights about decision making when discontinuing medication. It also offers one of the first examinations of how the institutional context embedding GPs influences their decisions about discontinuation. For policymakers interested in the discontinuation of medication, the findings suggest that de-stigmatising discontinuation on an institutional level may be beneficial, allowing GPs to better justify discontinuation in light of the ambiguity they experience. PMID:27296879

  8. Scope and nature of prescribing decisions made by general practitioners

    PubMed Central

    Denig, P; Witteman, C; Schouten, H

    2002-01-01

    Background: This study describes cognitive processes of doctors who are deciding on the treatment for a patient. This helps to uncover how prescribing decisions could benefit from (computerised) support. Methods: While thinking aloud, 61 general practitioners made prescribing decisions for five patients with urinary tract infections or stomach complaints. The resulting 305 transcripts were analysed to determine the scope and nature of the decision processes. Differences in the process were related to case or doctor characteristics, and to differences in the quality of prescribing behaviour. Results: The decision processes were not extensive, particularly for patients with a urinary tract infection. The doctors did not actively consider all possible relevant information. Considerations referring to core aspects of the treatment were made in 159 cases (52%) and to contextual aspects in 111 cases (36%). Habitual behaviour, defined as making a treatment decision without any specific contemplation, was observed in 118 cases (40%) and resulted in prescribing first choice as well as second choice drugs. For stomach complaints, second choice drugs were often prescribed after considering other treatments or in view of specific circumstances. Experience of the doctor was not related to the type of decision process. Conclusions: The processes observed deviate from the decision theoretic norm of thoroughly evaluating all possible options, but these deviations do not always result in suboptimal prescribing. Decision support is useful for bringing pertinent information and first choice treatments to the prescriber's attention. In particular, information about relevant contraindications, interactions, and costs could improve the quality of prescribing. PMID:12448805

  9. Can organizational justice help the retention of general practitioners?

    PubMed

    Heponiemi, Tarja; Manderbacka, Kristiina; Vänskä, Jukka; Elovainio, Marko

    2013-04-01

    In many countries, public sector has major difficulties in recruiting and retaining physicians to work as general practitioners (GPs). We examined the effects of taking up a public sector GP position and leaving public sector GP work on the changes of job satisfaction, job involvement and turnover intentions. In addition, we examined whether organizational justice in the new position would moderate these associations. This was a four-year prospective questionnaire study including two measurements among 1581 (948 women, 60%) Finnish physicians. A change to work as a public GP was associated with a substantial decrease in job satisfaction and job involvement when new GPs experienced that their primary care organization was unfair. However, high organizational justice was able to buffer against these negative effects. Those who changed to work as public GPs had 2.8 times and those who stayed as public GPs had 1.6 times higher likelihood of having turnover intentions compared to those who worked in other positions. Organizational justice was not able to buffer against this effect. Primary care organizations should pay more attention to their GPs - especially to newcomers - and to the fairness how management behaves towards employees, how processes are determined, and how rewards are distributed. PMID:23453045

  10. [Pharmacists' and general practitioners' views on parallel import of drugs].

    PubMed

    Gundersen, R; Torgauten, O; Olsen, H

    1999-04-30

    Since 1995, parallel import of drugs to Norway has been allowed under the European Economic Area Agreement. The health authorities have stated that there are no concerns connected with the use of parallel-imported drugs. This study is an interview survey among general practitioners, pharmacy staff and pharmacists working in pharmacies. The findings show that 91% of the pharmacies dispense parallel-imported drugs and that there is a certain amount of scepticism regarding the use of parallel-imported drugs. Most respondents feel that parallel-imported pharmaceuticals may have financial advantages for the individual patient and economic advantages for society at large, but 50% of the pharmacists and 54% of the physicians were of the opinion that parallel-imported pharmaceuticals represented an increased medical risk for the patients. Approximately 15% of doctors and pharmacy staff had knowledge of either incorrect treatment or adverse drug reactions due to the use of parallel-imported drugs. The time used for prescribing and dispensing parallel-imported drugs is longer than for directly imported preparations. The survey shows that approximately every fifth doctor will use the right of reservation in connection with the dispensing of parallel-imported drugs, whereas approximately every fourth pharmacist will disregard the right of reservation. PMID:10385799

  11. General Practitioners' Participation in a Large, Multicountry Combined General Practitioner-Patient Survey: Recruitment Procedures and Participation Rate

    PubMed Central

    Greß, Stefan; Schäfer, Willemijn

    2016-01-01

    Background. The participation of general practitioners (GPs) is essential in research on the performance of primary care. This paper describes the implementation of a large, multicountry study in primary care that combines a survey among GPs and a linked survey among patients that visited their practice (the QUALICOPC study). The aim is to describe the recruitment procedure and explore differences between countries in the participation rate of the GPs. Methods. Descriptive analyses were used to document recruitment procedures and to assess hypotheses potentially explaining variation in participation rates between countries. Results. The survey was implemented in 31 European countries. GPs were mainly selected through random sampling. The actual implementation of the study differed between countries. The median participation rate was 30%. Both material (such as the payment system of GPs in a country) and immaterial influences (such as estimated survey pressure) are related to differences between countries. Conclusion. This study shows that the participation of GPs may indeed be influenced by the context of the country. The implementation of complex data collection is difficult to realize in a completely uniform way. Procedures have to be tuned to the context of the country. PMID:27047689

  12. Challenges and Enablers of Deprescribing: A General Practitioner Perspective

    PubMed Central

    Ailabouni, Nagham J.; Nishtala, Prasad S.; Mangin, Dee; Tordoff, June M.

    2016-01-01

    Aims Deprescribing is the process of reducing or discontinuing medicines that are unnecessary or deemed to be harmful. We aimed to investigate general practitioner (GP) perceived challenges to deprescribing in residential care and the possible enablers that support GPs to implement deprescribing. Methods A qualitative study was undertaken using semi-structured, face-to-face interviews from two cities in New Zealand and a purpose-developed pilot-tested interview schedule. Interviews were recorded with permission and transcribed verbatim. Transcripts were read and re-read and themes were identified with iterative building of a coding list until all data was accounted for. Interviews continued until saturation of ideas occurred. Analysis was carried out with the assistance of a Theoretical Domains Framework (TDF) and constant comparison techniques. Several themes were identified. Challenges and enablers of deprescribing were determined based on participants’ answers. Results Ten GPs agreed to participate. Four themes were identified to define the issues around prescribing for older people, from the GPs’ perspectives. Theme 1, the ‘recognition of the problem’, discusses the difficulties involved with prescribing for older people. Theme 2 outlines the identified behaviour change factors relevant to the problem. Deprescribing challenges were drawn from these factors and summarised in Theme 3 under three major headings; ‘prescribing factors’, ‘social influences’ and ‘policy and processes’. Deprescribing enablers, based on the opinions and professional experience of GPs, were retrieved and summarised in Theme 4. Conclusion The process of deprescribing is laced with many challenges for GPs. The uncertainty of research evidence in older people and social factors such as specialists’ and nurses’ influences were among the major challenges identified. Deprescribing enablers encompassed support for GPs’ awareness and knowledge, improvement of

  13. The recognition of family and social problems by general practitioners: towards developing a taxonomy

    PubMed Central

    Metcalfe, D. H. H.

    1978-01-01

    A short feasibility study to investigate the recognition rate and precision of family problems by general practitioners is described. The need for such work in preparing a taxonomy of family and social problems, and the difficulties involved are discussed. Further support by general practitioners is invited. PMID:553169

  14. Chronic disease or physical disability? The role of the general practitioner.

    PubMed

    Memel, D

    1996-02-01

    There has been a lack of discussion and consensus as to what the role of the general practitioner should be in the care of patients with chronic diseases. Should general practitioners concentrate on the disease or should their remit include the resultant disability and handicap? General practitioners have tended to concentrate on the disease, but this may be inappropriate. For many disabled people, their general practitioner is their only source of health care and is the gatekeeper to other services. Greater knowledge among doctors of the functional and social aspects of disease would therefore improve the quality of care for patients, and should be assessed through clinical audit. Ways are described in which general practitioners, working together with their patients with chronic diseases and with other health professionals, can improve aspects of the care of these patients. PMID:8855019

  15. Chronic disease or physical disability? The role of the general practitioner.

    PubMed Central

    Memel, D

    1996-01-01

    There has been a lack of discussion and consensus as to what the role of the general practitioner should be in the care of patients with chronic diseases. Should general practitioners concentrate on the disease or should their remit include the resultant disability and handicap? General practitioners have tended to concentrate on the disease, but this may be inappropriate. For many disabled people, their general practitioner is their only source of health care and is the gatekeeper to other services. Greater knowledge among doctors of the functional and social aspects of disease would therefore improve the quality of care for patients, and should be assessed through clinical audit. Ways are described in which general practitioners, working together with their patients with chronic diseases and with other health professionals, can improve aspects of the care of these patients. PMID:8855019

  16. Clinical Decision Making among Dental Students and General Practitioners.

    ERIC Educational Resources Information Center

    Grembowski, David; And Others

    1989-01-01

    Senior dental students and family dental practitioners were surveyed concerning their choice of pairs of alternative treatments and the technical and patient factors influencing their decisions. Greater agreement in clinical decision-making was found among dentists than among students for all four pairs of alternative services. (MSE)

  17. True believers? Characteristics of general practitioners in Victorian community health centres.

    PubMed

    Montalto, M; Dunt, D; Young, D

    1994-12-01

    General practitioners have been part of multidisciplinary services in Victoria Community Health Centres (CHCs) for 20 years. This model institutionalizes a high degree of integration between general practitioners and other primary care and community service personnel. Of 51 eligible full-time general practitioners in Victorian CHCs, 46 were interviewed, using a structured questionnaire. General practitioners in CHCs were younger, less experienced and more likely to be female than other general practitioners. Nearly three-quarters were salaried. The philosophy of practice and the conditions of employment were the commonest reasons for entering CHC practice. Teamwork and the conditions of employment were felt to be the biggest advantages of CHC practice, while difficulties with management and the perceived loss of professional ownership and control were the commonest disadvantages. None reported interference from the CHC management in their clinical practice. Nearly a quarter of full-time CHC general practitioners do not undertake any formal community health promotion activities. Forty-five per cent of respondents intended to leave their CHC within the next five years. Universal health insurance has diminished the impact of CHC general practice. The philosophy of CHCs and the salaried nature of the employment continues to attract general practitioners. High staff turnover is a feature of CHC general practice, in part related to young doctors making an initial, but not long-term commitment to CHC practice. However, the loss of professional control and management difficulties should be addressed, as these may contribute to the high turnover. PMID:7718658

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

    PubMed Central

    van den Brink-Muinen, A; de Bakker, D H; Bensing, J M

    1994-01-01

    AIM. This study set out to examine the degree to which women choose to visit a woman doctor for women's health problems and the determinants of this choice. The differences between women and men doctors with regard to treating women's health problems were also studied. METHOD. Data from the Dutch national survey of general practice were used. All group practices with both women and men general practitioners were selected. Analyses were restricted to consultations among women aged 15-65 years about menstruation, the menopause, vaginal discharge, breast examination and cervical smear tests. RESULts. Given the size of their female practice population, women doctors saw considerably more women with women's health problems than did their male colleagues. Women were more likely to consult a woman general practitioner if she was more available (that is, working longer hours), and younger women were more likely than older women to choose women general practitioners. Sex differences in the treatment of women's health problems were small and mainly related to the verbal part of the consultation: counselling and providing information. The doctors' availability and their certainty about the working diagnosis explained differences in the verbal aspects of consultations. Women general practitioners had longer consultations than their male colleagues mainly because more health problems were presented per consultation. CONCLUSION. In order to increase the possibility of patients choosing women general practitioners, policy should be directed towards the education of more women general practitioners and women general practitioners should be encouraged to work more days a week. PMID:8204333

  19. Social and sexual contact between general practitioners and patients in New Zealand: attitudes and prevalence.

    PubMed Central

    Coverdale, J H; Thomson, A N; White, G E

    1995-01-01

    BACKGROUND. Doctor-patient social and sexual contact is increasingly acknowledged as an issue of importance for the medical profession. However, there is little research concerning general practitioners on this topic. AIM. A study was undertaken to obtain data on social and sexual contact between general practitioners and their patients. METHOD. An anonymous questionnaire was mailed to a nationwide randomized sample of 217 general practitioners in New Zealand. RESULTS. A response rate of 86% was obtained. Dating and sexual contact with patients was considered to be sometimes or usually acceptable to 35% and 10% of general practitioners, respectively. Of respondents, 6% reported having dated a patient, 4% reported having had sexual contact with a patient at some point during their career and 2% reported having engaged in sexual contact with a former patient. General practitioners who had personally known of a colleague who had engaged in sexual contact with a patient were more likely to believe this behaviour had negative consequences than general practitioners who themselves reported having engaged in sexual contact with a patient. CONCLUSION. The study results have implications for developing behavioural guidelines and educational interventions for general practitioners. PMID:7619570

  20. Dramaturgical study of meetings between general practitioners and representatives of pharmaceutical companies

    PubMed Central

    Somerset, Maggie; Weiss, Marjorie; Fahey, Tom

    2001-01-01

    Objectives To examine the interaction between general practitioners and pharmaceutical company representatives. Design Qualitative study of 13 consecutive meetings between general practitioner and pharmaceutical representatives. A dramaturgical model was used to inform analysis of the transcribed verbal interactions. Setting Practice in south west England. Participants 13 pharmaceutical company representatives and one general practitioner. Results The encounters were acted out in six scenes. Scene 1 was initiated by the pharmaceutical representative, who acknowledged the relative status of the two players. Scene 2 provided the opportunity for the representative to check the general practitioner's knowledge about the product. Scene 3 was used to propose clinical and cost benefits associated with the product. During scene 4, the general practitioner took centre stage and challenged aspects of this information. Scene 5 involved a recovery strategy as the representative fought to regain equilibrium. In the final scene, the representative tried to ensure future contacts. Conclusion Encounters between general practitioners and pharmaceutical representatives follow a consistent format that is implicitly understood by each player. It is naive to suppose that pharmaceutical representatives are passive resources for drug information. General practitioners might benefit from someone who can provide unbiased information about prescribing in a manner that is supportive and sympathetic to the demands of practice. What is already known on this topicPharmaceutical representatives influence physicians' prescribing in ways that are often unacknowledged by the physicians themselvesMeetings with pharmaceutical representatives are associated with increased prescribing costs and less rational prescribingWhat this study addsMeetings between pharmaceutical representatives and general practitioners follow a consistent format that is implicitly understood by each playerGeneral practitioners

  1. History of the Royal College of General Practitioners--the first 40 years.

    PubMed Central

    Gray, D P

    1992-01-01

    A steering committee met in 1952 to plan for the formation of a new college of general practitioners. An analysis of the work of the Royal College of General Practitioners over its first 40 years suggests that the published aims of the steering committee were largely fulfilled and in some ways exceeded. The unifying theme of the College's development appears to have been the wish to establish general medical practice as a scientific discipline. PMID:1586530

  2. The referral practice of general medical practitioners to the surgical specialties: implications for the future.

    PubMed

    McArdle, P J; Whitnall, M

    1996-10-01

    With increasing numbers of general medical practitioners (GMPs) becoming purchasers of health care, providers of surgical services need to understand factors influencing GMP referrals. Using an anonymous postal questionnaire, criteria used by 400 randomly selected general medical practitioners to make referral decisions were assessed. Issues regarding the importance of waiting lists, cost, distance and communication were assessed, along with previous training and fundholding status. The findings of this study reveal that waiting list times for consultation and treatment, along with communication, are the most important criteria influencing referral. Cost, travel and literature from each specialty were the least important factors. General medical practitioners are shown, in the majority, to remain unaware of the range of conditions managed by oral and maxillofacial surgeons. A series of strategies are outlined, which might be used to broaden the referral base for maxillofacial surgery. The need for active education of practitioners is emphasised and the possible effects of regionalisation of the service is discussed. PMID:8909729

  3. [The practice guideline 'Anemia' from the Dutch College of General Practitioners; a response from the perspective of general practice medicine].

    PubMed

    van den Bosch, W J

    2003-10-01

    The practice guideline 'Anaemia' from the Dutch College of General Practitioners will certainly be a support for the Dutch general practitioner. The inclusion of an algorithm to make a more precise diagnosis is an experiment that needs to be evaluated in the near future. However, many general practitioners will regard it as too complex for use in daily practice and specialists will find it to be of limited use, as it does not cover all cases. Consultation between the general practitioner and the specialist will give the best answer in complicated cases. Patients who complain about tiredness or dizziness will expect their general practitioner to take a blood sample for a haemoglobin test. The general practitioner will consider the risk of false-positive test results in interpreting the patient's haemoglobin level. A few concrete remarks: the guideline does not mention that vegetarianism and a low meat intake can increase the risk of vitamin B12 deficiency, and iron suppletion is advised in premenopausal women with profuse vaginal blood loss, whereas there are several treatable disorders that may cause menorrhagia. PMID:14574775

  4. Referral to Chinese medicine practitioners in Australian primary care: a survey of New South Wales rural and regional general practitioners

    PubMed Central

    2013-01-01

    Background Chinese medicine practitioners (CMPs) play an important part in rural and regional Australian healthcare. A survey was conducted to investigate referral practices between Chinese medicine (CM) and conventional primary health care practitioners in this region. Methods A 27-item questionnaire was sent to all 1486 general practitioners (GPs) currently practising in rural and regional Divisions of General Practice in New South Wales, Australia. This survey explored GP opinions, perceptions and practices in relation to complementary and alternative medicine or Chinese medicine specifically. Results A total of 585 GPs completed the questionnaire. Forty-nine were returned as ‘no longer at this address’, resulting in an adjusted response rate of 40.7%. One in ten GPs (9.9%) had referred their patients to CMPs at least a few times over the past 12 months, one in five GPs (17.4%) could not locate a CMP to refer to in their local area, and over one-third of GPs (37.7%) stated they would not refer to a CMP under any circumstances. GPs that had graduated from an Australian medical college (OR = 3.71; CI: 1.22, 11.23), GPs observing positive responses previously in patients using CM (OR = 2.53; 95% CI: 1.12, 8.58), GPs perceiving a lack of other options for patients (OR = 3.10; 95% CI: 1.12, 8.58), GPs reporting satisfactory or higher levels of CM knowledge (OR = 15.62; 95% CI: 5.47, 44.56), and GPs interested in increasing their complementary and alternative medicine knowledge (OR = 3.28; 95% CI: 1.17, 9.21) referred to CMPs more frequently than did other groups of GPs amongst the rural GPs included in this study. Conclusion There has been little interaction between CMPs and Australian rural and regional GPs. PMID:23566291

  5. Office of the Inspector General. Annual report

    SciTech Connect

    Wright, J.K.

    1981-03-01

    A summary of the progress and problems encountered by the Office of the Inspector General during 1980 is presented. Information on such administrative matters as the IG office organization, staffing, affirmative action, and training is reported. Planning and policy matters and expectations for the future are discussed. Important work done by the audit, inspection, and investigative staffs is summarized. Summaries of significant findings, recommendations, and actions taken in response are included. (MCW)

  6. After hours availability of general practitioners in Canterbury/Westland: a survey.

    PubMed

    Musgrove, J P; Waghorne, M S

    1977-04-27

    The results of a postal questionnaire to 185 general practitioners in the Canterbury-Westland agea are discussed. The intention was to describe the after hours provision for patients made by general practitioners. The study indicates that about one half of doctors are on call on weekdays evenings and about a third on weekends. Only a handful of doctors provide no cover. The kind of cover provided is discussed and the patient load during such hours is analysed. Figures are presented which suggest that Canterbury practitioners are marginally younger than the national average; that most doctors (100 out of 106 responding) have formal cover arrangements; that 82% are on duty no more than one weekend a month (less often for group practitioners); that about two-thirds have a regular half-day free during the week; that about two-thirds of after hours call are judged to be justified. PMID:271815

  7. General practitioners' habits and knowledge in relation to the management of H. pylori-associated dyspepsia and their views about a locally available 13-carbon urea breath test.

    PubMed Central

    Heaney, A; Collins, J S; Watson, P R; Kalin, R M

    2000-01-01

    We report the results of general practitioners' views on Helicobacter pylori-associated dyspepsia and use of screening tests in the community. The use of office serology tests in screening is of concern as independent validation in specialist units has been disappointing. PMID:10750235

  8. Study of general practice consultations and menopausal problems. Oxford General Practitioners Menopause Study Group.

    PubMed Central

    Barlow, D H; Brockie, J A; Rees, C M

    1991-01-01

    OBJECTIVE--To investigate the nature of work related to the menopause in general practice. DESIGN--Questionnaire study over six months among general practitioners after each consultation with a woman aged 40-69 at which issues related to the climacteric had been discussed. SETTING--9 General practices in the Oxford area. SUBJECTS--416 Women who had 572 consultations. MAIN OUTCOME MEASURES--Age, menopausal state, and first or subsequent consultation. Symptoms were classified together with the treatment and the outcome of the consultation. RESULTS--The consultation rate varied greatly between practices, the overall rate being 4.4%. There were many premenopausal women and women in their 60s presenting; women with hysterectomies presented more often--36% (37/103) of women with hysterectomies had more than one consultation compared with 26% (38/144) for premenopausal women and 24% (38/155) for postmenopausal women. 409 women had symptoms and 218 were prescribed oestrogen treatment. 156 of the consultations involved discussion and advice only. Only four women were referred to a local specialist clinic. CONCLUSION--There is a low overall use of hormone replacement therapy in the general postmenopausal population despite the recent media coverage of its benefits in the prevention of osteoporosis and subsequent fractures. PMID:1998795

  9. Open Access to General Practice Was Associated with Burnout among General Practitioners.

    PubMed

    Vedsted, Peter; Sokolowski, Ineta; Olesen, Frede

    2013-01-01

    Walk-in open access in general practice may influence the general practitioner's (GP's) work, but very little research has been done on the consequences. In this study from Danish general practice, we compare the prevalence of burnout between GPs with a walk-in open access and those without. In a questionnaire study (2004), we approached all 458 active GPs in the county of Aarhus, Denmark, and 376 (82.8%) GPs returned the questionnaire. Walk-in open access was defined as at least 30 minutes every weekday where patients could attend practice without an appointment. Burnout was measured by the Maslach Burnout Inventory. Analyses using logistic regression were adjusted for gender, age, marital status, job satisfaction, minutes per consultation, practice organisation, working hours, number of listed patients per GP, number of contacts per GP, continuing medical education- (CME-) activities, and clusters of GPs. In all, 8% of GPs had open access and the prevalence of burnout was 24%. GPs with walk-in open access were more likely to suffer from burnout. Having open access was associated with a 3-fold increased likelihood of burnout (OR = 3.1 (95% CI: 1.1-8.8, P = 0.035)). Although the design cannot establish causality, it is recommended to closely monitor possible negative consequences of open access in general practice. PMID:23401770

  10. Stigmatization of psychiatrists and general practitioners: results of an international survey.

    PubMed

    Gaebel, Wolfgang; Zäske, Harald; Zielasek, Jürgen; Cleveland, Helen-Rose; Samjeske, Kathrin; Stuart, Heather; Arboleda-Florez, Julio; Akiyama, Tsuyoshi; Baumann, Anja E; Gureje, Oye; Jorge, Miguel R; Kastrup, Marianne; Suzuki, Yuriko; Tasman, Allan; Fidalgo, Thiago M; Jarema, Marek; Johnson, Sarah B; Kola, Lola; Krupchanka, Dzmytry; Larach, Veronica; Matthews, Lyndy; Mellsop, Graham; Ndetei, David M; Okasha, Tarek A; Padalko, Ekaterina; Spurgeoun, Joyce A; Tyszkowska, Magdalena; Sartorius, Norman

    2015-04-01

    The stigma of mental illness affects psychiatry as a medical profession and psychiatrists. The present study aimed to compare the extent and correlation patterns of perceived stigma in psychiatrists and general practitioners. An international multicenter survey was conducted in psychiatrists and general practitioners from twelve countries. Responses were received from N = 1,893 psychiatrists and N = 1,238 general practitioners. Aspects of stigma assessed in the questionnaire included perceived stigma, self-stigma (stereotype agreement), attitudes toward the other profession, and experiences of discrimination. Psychiatrists reported significantly higher perceived stigma and discrimination experiences than general practitioners. Separate multiple regression analyses showed different predictor patterns of perceived stigma in the two groups. Hence, in the psychiatrists group, perceived stigma correlated best with discrimination experiences and self-stigma, while in the general practitioners group it correlated best with self-stigma. About 17% of the psychiatrists perceive stigma as a serious problem, with a higher rate in younger respondents. Against this background, psychiatry as a medical profession should set a high priority on improving the training of young graduates. Despite the number of existing antistigma interventions targeting mental health professionals and medical students, further measures to improve the image of psychiatry and psychiatrists are warranted, in particular improving the training of young graduates with respect to raising awareness of own stigmatizing attitudes and to develop a better profession-related self-assertiveness. PMID:25190351

  11. Video-assisted feedback in general practice internships using German general practitioner's guidelines

    PubMed Central

    Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

    2012-01-01

    Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. Teaching method: First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient – student – consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. Feasibility: The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept. The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily

  12. Practical Rehabilitation and Physical Therapy for the General Equine Practitioner.

    PubMed

    Kaneps, Andris J

    2016-04-01

    Physical treatment and rehabilitation play major roles in recovery and maintenance of the equine athlete, and many therapeutic measures are accessible by the veterinarian in general practice. An accurate diagnosis of the condition undergoing treatment is a requirement, and measurable parameters obtained at diagnosis allows for quantification of treatment outcomes. Therapeutic modalities accessible to the general practicing veterinarian are reviewed. Mechanisms of action, indications, and treatment protocols of thermal therapy, therapeutic ultrasound, extracorporeal shock wave, and laser are discussed. Manipulative therapies, including stretching and use of core strengthening exercises and equipment, are outlined. PMID:26898959

  13. General Medical Terminology for Vocational Rehabilitation Counselors. "A Guide for the Rehabilitation Practitioner." Final Report.

    ERIC Educational Resources Information Center

    Phelps, William R.

    This training guide is prepared primarily for the Vocational Rehabilitation practitioner, although academicians may also find it of value. Sixteen specific areas are covered, including common abbreviations, prefixes and suffixes, root words, general terms, operative terminology, special senses and body systems, general medical examination, medical…

  14. Factors that influence general practitioners' choice of hospital when referring patients for elective surgery.

    PubMed

    Mahon, A; Whitehouse, C; Wilkin, D; Nocon, A

    1993-07-01

    To describe the factors that influence general practitioners' choice of hospital when referring patients for elective surgery in three specialties, a postal questionnaire was distributed in January 1991 to 449 doctors who had referred patients to one of six hospitals in the North Western Regional Health Authority. Responses were received from 260 general practitioners (58%). Of the respondents 95% selected 'local and convenient' as a factor that commonly influenced their choice of hospital for at least one specialty and 65% mentioned this across all three specialties. Seventy four per cent mentioned patient preference as influencing choice for at least one specialty and 57% across all three specialties. Only 32% of doctors mentioned waiting times for appointment across the three specialties and 26% waiting times for surgery across the three specialties. When asked to select the single most important factor 'local and convenient' was selected by 33% of general practitioners for a least one specialty, the general standard of clinical care by 28% and waiting time for appointment by 23%. Patient preference was only selected by 6% of doctors as the most important factor. It is of note that 33% of general practitioners perceived there to be no choice of hospital for at least one specialty and 14% thought this to be the single most important influence on choice for at least one specialty. Approximately half the general practitioners (49%) considered it always or often appropriate to give their patients a choice. Most general practitioners received waiting time information from hospitals in their own health district but fewer received such information from hospitals outside their district.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8398242

  15. Collectivising the Kulaks? General practitioners and primary care groups in England.

    PubMed

    Clegg, K

    2000-07-01

    It has previously been suggested that the English Department of Health seems, wittingly or not, to have drawn on the experiences of Stalinist Russia in devising policies for the National Health Service. The development of general practitioner fundholding during the 1990s could be compared to the Soviet support for the Kulaks (rich peasants with capital and entrepreneurship) in 1923. Both initiatives aimed to propel innovation and enhance productivity by giving increased market freedom to an elite group of entrepeneurial workers. Writing in 1991, Hughes and Dingwall speculated about the likelihood of general practitioners sharing the same fate as the Kulaks in 1928, namely forcible collectivisation. The current creation of Primary Care Groups (collections of about 50 general practitioners) raises the question of whether they are likely to be vulnerable to the same pathologies as collective agriculture, or has the metaphor become exhausted? PMID:11183630

  16. General practitioners and family doctors in the Russian Federation.

    PubMed

    Ryan, M; Stephen, J

    1996-08-01

    This paper looks at the emergence in Russia of a strategy for delivering primary health care which differs radically from the specialist-based system of the former Soviet Union. Drawing on Russian language sources, the paper outlines previous training arrangements, the limited role of 'sector' doctors and the reasons for official endorsement of general practice during the years of perestroika. It reports that the Health Ministry asked all the country's regions to make a gradual transition to general practice in 1992, and that legislation made the choice of family doctor a universal right in 1993. The conclusion refers to factors which are likely to determine whether that right will become a reality. PMID:8949332

  17. General practitioners and family doctors in the Russian Federation.

    PubMed Central

    Ryan, M; Stephen, J

    1996-01-01

    This paper looks at the emergence in Russia of a strategy for delivering primary health care which differs radically from the specialist-based system of the former Soviet Union. Drawing on Russian language sources, the paper outlines previous training arrangements, the limited role of 'sector' doctors and the reasons for official endorsement of general practice during the years of perestroika. It reports that the Health Ministry asked all the country's regions to make a gradual transition to general practice in 1992, and that legislation made the choice of family doctor a universal right in 1993. The conclusion refers to factors which are likely to determine whether that right will become a reality. PMID:8949332

  18. General practitioner fees: the effect of an additional 10% goods and services tax.

    PubMed

    Toop, L J; Chetwynd, S J; Botting, C H

    1987-09-23

    The effects of an increase in general practitioner fees on the timing of decisions to seek certain consultations were studied at the time of the introduction of a 10% goods and services tax (GST) on 1 October 1986. Fifty-six general practitioners collected information on 4113 consecutive paediatric consultations over a four week study period. The price rise itself appeared to have little or no effect either on numbers attending, pattern of illness or on the timing of consultations. However, private medical insurance may have influenced decisions on when to seek medical attention. PMID:3452103

  19. Risk Judgment by General Dental practitioners: Rational but Uninformed

    PubMed Central

    Ellervall, Eva; Brehmer, Berndt; Knutsson, Kerstin

    2010-01-01

    Background Decisions by dentists to administer antibiotic prophylaxis to prevent infectious complications in patients involves professional risk assessment. While recommendations for rational use have been published, several studies have shown that dentists have low adherence to these recommendations. Objective To examine general dental practitioners’ (GDPs’) assessments of the risk of complications if not administering antibiotic prophylaxis in connection with dental procedures in patients with specific medical conditions. Methods Postal questionnaires in combination with telephone interviews. Risk assessments were made using visual analogue scales (VAS), where zero represented “insignificant risk” and 100 represented a “very significant risk”. Results Response rate: 51%. The mean risk assessments were higher for GDPs who administered antibiotics (mean = 54, SD = 23, range 26–72 mm on the VAS) than those who did not (mean = 14, SD = 12, range 7–31 mm) (P < 0.05). Generally, GDPs made higher risk assessments for patients with medical conditions that are included in recommendations than those with conditions that are not included. Overall, risk assessments were higher for tooth removal than for scaling or root canal treatment, even though the risk assessments should be considered equal for these interventions. Conclusions GDPs’ risk assessments were rational but uninformed. They administered antibiotics in a manner that was consistent with their risk assessments. Their risk assessments, however, were overestimated. Inaccurate judgments of risk should not be expected to disappear in the presence of new information. To achieve change, clinicians must be motivated to improve behaviour and an evidence-based implementation strategy is required.

  20. Inequalities in family practitioner use by sexual orientation: evidence from the English General Practice Patient Survey

    PubMed Central

    Urwin, Sean; Whittaker, William

    2016-01-01

    Objective To test for differences in primary care family practitioner usage by sexual orientation. Design Multivariate logistic analysis of pooled cross-sectional postal questionnaire responses to family practitioner usage. Setting Patient-reported use and experience of primary care in England, UK. Data from several waves of a postal questionnaire (General Practice Patient Survey) 2012–2014. Population 2 807 320 survey responses of adults aged 18 years and over, registered with a family practitioner. Main outcome measures Probability of a visit to a family practitioner within the past 3 months. Results Lesbian women were 0.803 times (95% CI 0.755 to 0.854) less likely to have seen a family practitioner in the past 3 months relative to heterosexual women (bisexual women OR=0.887, 95% CI 0.817 to 0.963). Gay men were 1.218 times (95% CI 1.163 to 1.276) more likely to have seen a family practitioner relative to heterosexual men (bisexual men OR=1.084, 95% CI 0.989 to 1.188). Our results are robust to the timing of the family practitioner visit (0–3, 0–6, 0–12 months). Gay men were more likely to have seen a family practitioner than heterosexual men where the proportion of women practitioners in the practice was higher (OR=1.238, 95% CI 1.041 to 1.472). Conclusions Inequalities in the use of primary care across sexual orientation in England exist having conditioned on several measures of health status, demographic and family practitioner characteristics. The findings suggest these differences may be reduced by policies targeting a reduction of differences in patient acceptability of primary care. In particular, further research is needed to understand whether lower use among heterosexual men represents unmet need or overutilisation among gay men, and the barriers to practitioner use seemingly occurring due to the gender distribution of practices. PMID:27173816

  1. Comparative Quality Indicators for Hospital Choice: Do General Practitioners Care?

    PubMed Central

    Ferrua, Marie; Sicotte, Claude; Lalloué, Benoît; Minvielle, Etienne

    2016-01-01

    Context The strategy of publicly reporting quality indicators is being widely promoted through public policies as a way to make health care delivery more efficient. Objective To assess general practitioners’ (GPs) use of the comparative hospital quality indicators made available by public services and the media, as well as GPs’ perceptions of their qualities and usefulness. Method A telephone survey of a random sample representing all self-employed GPs in private practice in France. Results A large majority (84.1%–88.5%) of respondents (n = 503; response rate of 56%) reported that they never used public comparative indicators, available in the mass media or on government and non-government Internet sites, to influence their patients’ hospital choices. The vast majority of GPs rely mostly on traditional sources of information when choosing a hospital. At the same time, this study highlights favourable opinions shared by a large proportion of GPs regarding several aspects of hospital quality indicators, such as their good qualities and usefulness for other purposes. In sum, the results show that GPs make very limited use of hospital quality indicators based on a consumer choice paradigm but, at the same time, see them as useful in ways corresponding more to the usual professional paradigms, including as a means to improve quality of care. PMID:26840429

  2. Knowledge, Attitude and Practice of Devitalizing Agents: A Survey of General Dental Practitioners

    PubMed Central

    Walimbe, Hrishikesh; Kontham, Ujjwal; Bijle, Mohammed Nadeem Ahmed; Wani, Vaibhav; Nankar, Meenakshi; Muchandi, Sneha

    2015-01-01

    Background: This study aimed to analyze knowledge, attitude and practice of general dental practitioners regarding the use of devitalizing agents in their respective practice. Materials and Methods: A total of 100 practicing general dentists were randomly chosen as per the list of practitioners available to local state association. The questionnaire was designed to cover general information of the participating dentist and concerning different aspects of devitalizing agents. The collected data was subjected to statistical analysis using SPSS (Statistical Package for Social Sciences) version 17.0 (IBM Statistics, Chicago, Illinois, USA). Descriptive statistics was drawn with respective percentages to have a comparative overview. Results: The response rate was 97%, of which the effective and complete replies received were 77% (75). 56% respondents used paraformaldehyde containing pastes. Majority of general practitioners (61%) did not observe any post-operative complication following the use of devitalising agent. 33% (25) of the respondents were not aware of the complications of devitalizing agents. Conclusion: Thus, it can be concluded that general dental practitioners in Pune and Nashik district of Maharashtra, India do use pulp devitalizing agents in spite of possessing knowledge related to the complications. PMID:25878471

  3. Knowledge, Attitude and Practice of Devitalizing Agents: A Survey of General Dental Practitioners

    PubMed Central

    Walimbe, Hrishikesh; Kontham, Ujjwal; Bijle, Mohammed Nadeem Ahmed; Wani, Vaibhav; Nankar, Meenakshi; Muchandi, Sneha

    2015-01-01

    Background: This study aimed to analyze knowledge, attitude and practice of general dental practitioners regarding the use of devitalizing agents in their respective practice. Materials and Methods: A total of 100 practicing general dentists were randomly chosen as per the list of practitioners available to local state association. The questionnaire was designed to cover general information of the participating dentist and concerning different aspects of devitalizing agents. The collected data was subjected to statistical analysis using SPSS (Statistical Package for Social Sciences) version 17.0 (IBM Statistics, Chicago, Illinois, USA). Descriptive statistics was drawn with respective percentages to have a comparative overview. Results: The response rate was 97%, of which the effective and complete replies received were 77% (75). 56% respondents used paraformaldehyde containing pastes. Majority of general practitioners (61%) did not observe any post-operative complication following the use of devitalising agent. 33% (25) of the respondents were not aware of the complications of devitalizing agents. Conclusion: Thus, it can be concluded that general dental practitioners in Pune and Nashik district of Maharashtra, India do use pulp devitalizing agents in spite of possessing knowledge related to the complications. PMID:26464546

  4. The utility of standardized advance directives: the general practitioners' perspective.

    PubMed

    Otte, Ina Carola; Elger, Bernice; Jung, Corinna; Bally, Klaus Walter

    2016-06-01

    Advance directives (AD) are written documents that give patients the opportunity to communicate their preferences regarding treatments they do or do not want to receive in case they become unable to make decisions. Commonly used pre-printed forms have different formats. Some offer space for patients to (a) appoint a surrogate decision maker, and/or (b) to determine future medical treatments and/or (c) give a statement of personal values. So far it is unknown which forms GPs preferably use and why they decide to do so. 23 semi-structured interviews with GPs were analysed using content analysis. Interviewees mainly use short templates (to appoint surrogate decision makers) and medium length templates with checkboxes to indicate patients' preferences in regards to life prolonging measures. Especially when patients faced the progression of a disease, participants use the latter version. Only then, the interviewees remarked, patients are capable to rate concrete situations reliably. GPs also realize the importance of the verbal assessment of patients' preferences; however they rarely keep a written form of the conversation. Some GPs hand out one or more templates and ask their patients to read and think about them at home with the option to talk to them about it later on, while others prefer their patients to fill them out alone at home. Regardless of template usage, most GPs emphasize that ADs require regular updates. GPs tend to see standardized advance directives mainly as a tool to start a conversation with their patients and to identify their real preferences and values. When the patient is still not facing the progression of an already existing disease it could be sufficient to only appoint a surrogate decision maker instead of creating a full AD. However, in all other situations, appointing a surrogate decision maker should be backed up by a written statement of a patient's general values. Patients and their relatives should always have the opportunity to ask

  5. Training medical students in general practice: a qualitative study among general practitioner trainers in Sri Lanka

    PubMed Central

    Ramanayake, R. P. J. C.; De Silva, A. H. W.; Perera, D. P.; Sumanasekera, R. D. N.; Athukorala, L. A. C. L.; Fernando, K. A. T.

    2015-01-01

    Introduction: Worldwide Family Medicine has gained an important place in the undergraduate medical curriculum over the last few decades and general practices have become training centers for students. Exposure to patients early in the disease process, out patient management of common problems, follow up of chronic diseases and psychosocial aspects of health and disease are educational advantages of community based training but such training could have varying impact on patients, students and trainers. This study explored the views of General Practitioner (GP) trainers on their experience in training students. Methodology: This qualitative study was conducted among GP trainers of the faculty of medicine, University of Kelaniya, Sri Lanka, to explore their experience on wide range of issues related to their role as GP trainers. The interviews were recorded and transcribed verbatim. Themes expressed were identified. Results: Altruistic reasons, self-satisfaction, self-esteem and opportunity to improve their knowledge were the motivations for their involvement in teaching. Teachers were confident of their clinical and teaching skills. They perceived that patients were willing participants of the process and benefited from it. There was a positive impact on consultation dynamics. Time pressure was the major problem and ideal number of trainees per session was two. They were willing to attend teacher training workshops to update their knowledge. Conclusions: GP trainers driven by altruistic reasons were willing participants of student training process. The perceived advantages of involvement of teaching for trainers and patients were an encouragement for potential trainers. University should organize training sessions for trainers which will boost their knowledge, confidence and teaching skills which will eventually benefit students. PMID:25949960

  6. Workplace Learning among General Practitioners and Specialists: The Use of Videoconferencing as a Tool

    ERIC Educational Resources Information Center

    Nilsen, Line Lundvoll

    2011-01-01

    Purpose: Videoconferencing between general practitioners and hospitals has been developed to provide higher quality health care services in Norway by promoting interaction between levels of care. This article aims to explore the use of videoconferencing for information exchange and consultation throughout the patient trajectory and to investigate…

  7. Effects of a community mental health service on the practice and attitudes of general practitioners.

    PubMed Central

    Warner, R W; Gater, R; Jackson, M G; Goldberg, D P

    1993-01-01

    Recent years have seen closer links developing between general practitioners and mental health specialists. A study was undertaken in Manchester to determine the effects of a new community mental health service on the practice and attitudes of general practitioners. Ten doctors had access to the community based psychiatric team over a three year period while another 10 doctors continued to use hospital services. Those with access to the team were significantly more satisfied with the specialist support services, and were more likely to give high priority to community psychiatric nurses and psychiatric social workers working as part of a primary health care team than those without access to the service. Those with access were more willing than those without access to share with psychiatrists the care of patients with chronic neurotic disorders. The community mental health team was considered particularly helpful in reducing the burden posed by patients with neurotic and psychosocial problems, but this resulted in the general practitioners doing less counselling themselves. The study did not find that the new service had an effect on the general practitioners' ability to detect or manage psychiatric illness. PMID:8312022

  8. General Management Skills: Do Practitioners and Academic Faculty Agree on Their Importance?

    ERIC Educational Resources Information Center

    Levenburg, Nancy M.

    1996-01-01

    Usable responses from 165 business practitioners and 218 business faculty showed significant differences on the perceived importance of general management skills, especially oral/written communication, problem solving, and teamwork. Global awareness, diversity, and project management skills received low rankings from both groups. (SK)

  9. Do Teachers Know More about Specific Learning Difficulties than General Practitioners?

    ERIC Educational Resources Information Center

    Kirby, Amanda; Davies, Rhys; Bryant, Amy

    2005-01-01

    In this article, Dr Amanda Kirby, medical director at the Dyscovery Centre in Cardiff, Rhys Davies, a researcher for the School of Education at the University of Wales, and Amy Bryant, a psychology student at Cardiff University, report on their investigations into teachers' and general practitioners' (GPs') knowledge of six specific learning…

  10. On the Journey with the Dying: How General Practitioners Experience the Death of Their Patients

    ERIC Educational Resources Information Center

    Zambrano, Sofia C.; Barton, Christopher A.

    2011-01-01

    A grounded theory study was undertaken to understand how general practitioners (GPs) experience the death of their patients. Eleven GPs participated in semi-structured interviews. The participants explained their experience of a patient's death using the "death journey" metaphor. This journey, the Journey with the Dying, could be described from 5…

  11. Intention to Encourage Complementary and Alternative Medicine among General Practitioners and Medical Students

    ERIC Educational Resources Information Center

    Godin, Gaston; Beaulieu, Dominique; Touchette, Jean-Sebastien; Lambert, Leo-Daniel; Dodin, Sylvie

    2007-01-01

    The authors' goal was to identify factors explaining intention to encourage a patient to follow complementary and alternative medicine (CAM) treatment among general practitioners (GPs), fourth-year medical students, and residents in family medicine. They surveyed 500 GPs and 904 medical students via a self-administered mailed questionnaire that…

  12. Designing a deprivation payment for general practitioners: the UPA(8) wonderland.

    PubMed Central

    Carr-Hill, R A; Sheldon, T

    1991-01-01

    OBJECTIVE--To analyse critically the deprived area payment introduced in the new general practitioner contract. The payment formula is based on the Jarman underprivileged area index (UPA(8)) and aims at compensating general practitioners for increases in workload. DESIGN--Evaluation of the deprived area payment against the stated policy objective with a set of criteria for developing resource allocation formulas. MAIN OUTCOME MEASURES--The degree to which the components of the Jarman index predict the workload of general practitioners; whether construction of the index is sensible and comprehensible; and how the formula incorporates the index and is likely to work in practice. RESULTS--The fact that the index relies on census data and the way the weighting was derived means that the formula will not accurately reflect the workload. The use of statistical transformations obscures the original policy intent. There has been no validation to support the application of the index as part of a national policy. The payments are not linked to the quality of service provided and may have the perverse effect of increasing list size. CONCLUSION--The formula used as the basis of the deprived area payments is poorly suited to the policy objective of compensating general practitioners for increases in workload. More research is urgently needed to enable the effect of the payment to be monitored and a more empirically sound set of incentives to be developed. PMID:2004146

  13. [May the general practitioner not be concerned about the alcohol consumption of his patients?].

    PubMed

    Cnockaert, P

    2002-09-01

    Based on a literature review, the author points out the importance, in adult general medicine practice, of the prevalences in different alcohol consumption levels, alcohol induced sicknesses and dependencies. The very large frequency of these problems in general practice, the somatic repercussions of an excessive consumption and the general practitioner's possibilities of action on preventive and curative levels lead the physician to make a research about the alcohol consumption level of all his patients, to write it down on the patients files, to give at least a pronounced advice and to carry out a follow-up. The actual commitment of general practitioners and their issues are tackled. French inquiries show that if intention of research on risk patients is very frequent (85% of the practitioners), this attitude is far from being systematic for a whole practice (research by less than 50% of the practitioners and inscription in a space for less than 30% of the patients files). This relative commitment seems to be induced (french and belgian inquiries) by an underestimation of the effect of the advice given to the patient, and by a discouragement feeling in front of the impression of low treatment efficiency as well as the relapses and the attitudes of that kind of patients. PMID:12422453

  14. A Health Website Recommendation from Gold Coast General Practitioners to Their Patients: A Mixed Method Approach

    ERIC Educational Resources Information Center

    Usher, Wayne

    2011-01-01

    Introduction: To identify health website recommendation trends by Gold Coast (Australia) general practitioners (GPs) to their patients. Method: A mixed method approach to data collection and analysis was employed. Quantitative data were collected using a prepaid postal survey, consisting of 17 questions, mailed to 250 (61 per cent) of 410 GPs on…

  15. General Practitioners' Understanding Pertaining to Reliability, Interactive and Usability Components Associated with Health Websites

    ERIC Educational Resources Information Center

    Usher, Wayne

    2009-01-01

    This study was undertaken to determine the level of understanding of Gold Coast general practitioners (GPs) pertaining to such criteria as reliability, interactive and usability components associated with health websites. These are important considerations due to the increased levels of computer and World Wide Web (WWW)/Internet use and health…

  16. Checklists for General Practitioner Diagnosis of Depression in Adults with Intellectual Disability

    ERIC Educational Resources Information Center

    Torr, J.; Iacono, T.; Graham, M. J.; Galea, J.

    2008-01-01

    Background: In Australia, diagnosis and management of depression in adults with intellectual disability (ID) often occurs within the primary care setting. Few tools are available to assist general practitioners (GPs) in the diagnostic process. The study aim was to assess properties of carer and GP checklists developed to address this problem.…

  17. Knowledge and Attitude of General Practitioners regarding Autism in Karachi, Pakistan

    ERIC Educational Resources Information Center

    Rahbar, Mohammad Hossein; Ibrahim, Khalid; Assassi, Parisa

    2011-01-01

    General practitioners (GPs) could have an important role in early diagnosis of autism. There have been no studies evaluating the knowledge of GPs regarding autism in Pakistan. We aimed to fill that gap by assessing knowledge and attitude of GPs in Karachi regarding autism. We conducted a cross-sectional survey of 348 GPs; only 148 (44.6%) had…

  18. Why Some Adults with Intellectual Disability Consult Their General Practitioner More Than Others

    ERIC Educational Resources Information Center

    Turk, V.; Kerry, S.; Corney, R.; Rowlands, G.; Khattran, S.

    2010-01-01

    Background: This research identifies factors affecting why some adults with intellectual disability (AWIDs) consult their general practitioner (GP) more than others. Little is known about these factors, despite AWIDs having higher health needs and reduced longevity. Current barriers to accessing health care need to be understood and overcome to…

  19. Australian General Practitioner Uptake of a Remunerated Medicare Health Assessment for People with Intellectual Disability

    ERIC Educational Resources Information Center

    Koritsas, Stella; Iacono, Teresa; Davis, Robert

    2012-01-01

    In 2007 the Australian Commonwealth Government announced the Medicare Health Assessment for People with an Intellectual Disability as part of the Enhanced Primary Care (EPC) program (Department of Health and Ageing, 2008). The annual health assessment is a structured framework for general practitioners (GPs), which enables an annual comprehensive…

  20. Three Strategies for Delivering Continuing Medical Education in Geriatrics to General Practitioners

    ERIC Educational Resources Information Center

    Rikkert, Marcel G. M.; Rigaud, Anne-Sophie

    2004-01-01

    General practitioners (GPs) need advanced skills in geriatric assessment to be competent to treat the increasing number of elderly patients. Continuing medical education in geriatrics for GPs is heterogeneous, and not assessed for effectiveness. In this study we compared the educational effects of three geriatric post-graduate training methods on…

  1. General Practitioners Recognizing Alcohol Dependence: A Large Cross-Sectional Study in 6 European Countries

    PubMed Central

    Rehm, Jürgen; Allamani, Allaman; Vedova, Roberto Della; Elekes, Zsuzsanna; Jakubczyk, Andrzej; Landsmane, Inga; Manthey, Jakob; Moreno-España, José; Pieper, Lars; Probst, Charlotte; Snikere, Sigita; Struzzo, Pierluigi; Voller, Fabio; Wittchen, Hans-Ulrich; Gual, Antoni; Wojnar, Marcin

    2015-01-01

    PURPOSE Although alcohol dependence causes marked mortality and disease burden in Europe, the treatment rate is low. Primary care could play a key role in reducing alcohol-attributable harm by screening, brief interventions, and initiating or referral to treatment. This study investigates identification of alcohol dependence in European primary care settings. METHODS Assessments from 13,003 general practitioners, and 9,098 interviews (8,476 joint number of interviewed patients with a physician’s assessment) were collected in 6 European countries. Alcohol dependence, comorbidities, and health service utilization were assessed by the general practitioner and independently using the Composite International Diagnostic Interview (CIDI) and other structured interviews. Weighted regression analyses were used to compare the impact of influencing variables on both types of diagnoses. RESULTS The rate of patients being identified as alcohol dependent by the CIDI or a general practitioner was about equally high, but there was not a lot of overlap between cases identified. Alcohol-dependent patients identified by a physician were older, had higher rates of physicial comorbidity (liver disease, hypertension), and were socially more marginalized, whereas average consumption of alcohol and mental comorbidity were equally high in both groups. CONCLUSION General practitioners were able to identify alcohol dependence, but the cases they identified differed from cases identified using the CIDI. The role of the CIDI as the reference standard should be reexamined, as older alcohol-dependent patients with severe comorbidities seemed to be missed in this assessment. PMID:25583889

  2. "Cascades, Torrents & Drowning" in Information: Seeking Help in the Contemporary General Practitioner Practice in the UK

    ERIC Educational Resources Information Center

    Holley, Debbie; Santos, Patricia; Cook, John; Kerr, Micky

    2016-01-01

    This paper responds to the Alpine Rendez-Vous "crisis" in technology-enhanced learning. It takes a contested area of policy as well as a rapid change in the National Health Service, and documents the responses to "information overload" by a group of general practitioners practices in the North of England. Located between the…

  3. General practitioners' views on reattribution for patients with medically unexplained symptoms: a questionnaire and qualitative study

    PubMed Central

    Dowrick, Christopher; Gask, Linda; Hughes, John G; Charles-Jones, Huw; Hogg, Judith A; Peters, Sarah; Salmon, Peter; Rogers, Anne R; Morriss, Richard K

    2008-01-01

    Background The successful introduction of new methods for managing medically unexplained symptoms in primary care is dependent to a large degree on the attitudes, experiences and expectations of practitioners. As part of an exploratory randomised controlled trial of reattribution training, we sought the views of participating practitioners on patients with medically unexplained symptoms, and on the value of and barriers to the implementation of reattribution in practice. Methods A nested attitudinal survey and qualitative study in sixteen primary care teams in north-west England. All practitioners participating in the trial (n = 74) were invited to complete a structured survey. Semi-structured interviews were undertaken with a purposive sub-sample of survey respondents, using a structured topic guide. Interview transcripts were used to identify key issues, concepts and themes, which were grouped to construct a conceptual framework: this framework was applied systematically to the data. Results Seventy (95%) of study participants responded to the survey. Survey respondents often found it stressful to work with patients with medically unexplained symptoms, though those who had received reattribution training were more optimistic about their ability to help them. Interview participants trained in reattribution (n = 12) reported that reattribution increased their confidence to practice in a difficult area, with heightened awareness, altered perceptions of these patients, improved opportunities for team-building and transferable skills. However general practitioners also reported potential barriers to the implementation of reattribution in routine clinical practice, at the level of the patient, the doctor, the consultation, diagnosis and the healthcare context. Conclusion Reattribution training increases practitioners' sense of competence in managing patients with medically unexplained symptoms. However, barriers to its implementation are considerable, and frequently

  4. The factors associated to psychosocial stress among general practitioners in Lithuania. Cross-sectional study

    PubMed Central

    Vanagas, Giedrius; Bihari-Axelsson, Susanna

    2005-01-01

    Background There are number of studies showing that general practice is one of the most stressful workplace among health care workers. Since Baltic States regained independence in 1990, the reform of the health care system took place in which new role and more responsibilities were allocated to general practitioners' in Lithuania. This study aimed to explore the psychosocial stress level among Lithuanian general practitioner's and examine the relationship between psychosocial stress and work characteristics. Methods The cross-sectional study of 300 Lithuanian General practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the R. Karasek scale. The analysis included descriptive statistics; interrelationship analysis between characteristics and multivariate logistic regression to estimate odds ratios for each of the independent variables in the model. Results Response rate 66% (N = 197). Our study highlighted highest prevalence of psychosocial stress among widowed, single and female general practitioners. Lowest prevalence of psychosocial stress was among males and older age general practitioners. Psychosocial stress occurs when job demands are high and job decision latitude is low (χ2 = 18,9; p < 0,01). The multivariate analysis shows that high job demands (OR 4,128; CI 2,102–8,104; p < 0,001), patient load more than 18 patients per day (OR 5,863; CI 1,549–22,188; p < 0,01) and young age of GP's (OR 6,874; CI 1,292–36,582; p < 0,05) can be assigned as significant predictors for psychosocial stress. Conclusion One half of respondents suffering from work related psychosocial stress. High psychological workload demands combined with low decision latitude has the greatest impact to stress caseness among GP's. High job demands, high patient load and young age of GP's can be assigned as significant predictors of psychosocial stress among GP's. PMID:15946388

  5. [Survey of general dental practitioners in Abidjan on the use of the operatory field in dentistry].

    PubMed

    Avoaka-Boni, M C; Gnagne-Koffi, N D Y; Assoumou-Adou, N M; Kouakou, K F; Guinan, J C; Abouattier-Mansilla, E C

    2009-09-01

    Rubber dam is a standard operatory field in operative dentistry and endodontics. It is undoubtedly the most certain way to insure the success of therapeutics acts. Its use by Abidjan practitioners has been the subject of our study which aim is to underline the place of rubber dam in daily practice. Our investigations show that rubber dam is totally absent from practitioners acts. Generally cotton rolls constitute the most frequent mean used by practitioners to isolate the tooth in operative dentistry and endodontics. Only 23.9% of them associate saliva sucking up. Some cases of aspiration and swallowing file by accident by patients have been highlighted. Those results lead us to recommend the systematic use of rubber dam as the mean of efficiency and security which cannot be ignored in our practice. PMID:20441127

  6. Open-access echocardiography to general practitioners for suspected heart failure.

    PubMed Central

    Murphy, J J; Frain, J P; Ramesh, P; Siddiqui, R N; Bossingham, C M

    1996-01-01

    Echocardiography is now considered to be the key investigation when heart failure is suspected, and should improve clinical management. An open-access echocardiography service was piloted to 24 general practitioners and the service was audited after 250 cases. The impact on clinical management was assessed by reviewing general practice notes 2 months after the echocardiogram. Significant impairment of left ventricular function was found in 49 patients (20%). Out of these subjects, 38 had been started on an ACE inhibitor. Twenty patients were considered to have a significant valve lesion by echocritiera, of whom 14 had been referred for a cardiological opinion. The provision of an open-access echocardiography service was popular with general practitioners and the information resulted in appropriate management decisions being made. PMID:8949328

  7. 16 CFR 1000.16 - Office of the Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Office of the Inspector General. 1000.16 Section 1000.16 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.16 Office of the Inspector General. The Office of the Inspector General is...

  8. 16 CFR 1000.16 - Office of the Inspector General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Office of the Inspector General. 1000.16 Section 1000.16 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.16 Office of the Inspector General. The Office of the Inspector General is...

  9. 16 CFR 1000.16 - Office of the Inspector General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Office of the Inspector General. 1000.16 Section 1000.16 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.16 Office of the Inspector General. The Office of the Inspector General is...

  10. 16 CFR 1000.16 - Office of the Inspector General.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Office of the Inspector General. 1000.16 Section 1000.16 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.16 Office of the Inspector General. The Office of the Inspector General is...

  11. 16 CFR 1000.16 - Office of the Inspector General.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Office of the Inspector General. 1000.16 Section 1000.16 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.16 Office of the Inspector General. The Office of the Inspector General is...

  12. 39 CFR 221.3 - Office of Inspector General.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 39 Postal Service 1 2013-07-01 2013-07-01 false Office of Inspector General. 221.3 Section 221.3 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION GENERAL ORGANIZATION § 221.3 Office of Inspector General. (a) Establishment. The Office of Inspector General (OIG) was established as an independent law enforcement...

  13. 39 CFR 221.3 - Office of Inspector General.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 39 Postal Service 1 2011-07-01 2011-07-01 false Office of Inspector General. 221.3 Section 221.3 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION GENERAL ORGANIZATION § 221.3 Office of Inspector General. (a) Establishment. The Office of Inspector General (OIG) was established as an independent law enforcement...

  14. 40 CFR 1.29 - Office of Inspector General.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Office of Inspector General. 1.29 Section 1.29 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL STATEMENT OF ORGANIZATION AND GENERAL INFORMATION Headquarters § 1.29 Office of Inspector General. The Office of...

  15. Preferred Materials and Methods Employed for Endodontic Treatment by Iranian General Practitioners

    PubMed Central

    Raoof, Maryam; Zeini, Negar; Haghani, Jahangir; Sadr, Saeedeh; Mohammadalizadeh, Sakineh

    2015-01-01

    Introduction: The aim of this study was to gather information on the materials and methods employed in root canal treatment (RCT) by general dental practitioners (GDPs) in Iran. Methods and Materials: A questionnaire was distributed among 450 dentists who attended the 53th Iranian Dental Association congress. Participants were asked to consider demographic variables and answer the questions regarding the materials and methods commonly used in RCT. Descriptive statistics were given as absolute frequencies and valid percentages. The chi-square test was used to investigate the influence of gender and the years of professional activity for the employed materials and techniques. Results: The response rate was 84.88%. The results showed that 61.5% of the participants did not perform pulp sensitivity tests prior to RCT. Less than half of the general dental practitioners (47.4%) said that they would trace a sinus tract before starting the treatment. Nearly 16% of practitioners preferred the rubber dam isolation method. Over 36% of the practitioners reported using formocresol for pulpotomy. The combined approach of working length (WL) radiographs and electronic apex locators was used by 35.2% of the practitioners. Most of the respondents used K-file hand instruments for canal preparation and the technique of choice was step-back (43.5%), while 40.1% of respondents used NiTi rotary files, mostly ProTaper and RaCe. The most widely used irrigant was normal saline (61.8%). Calcium hydroxide was the most commonly used inter appointment medicament (84.6%). The most popular obturation technique was cold lateral condensation (81.7%) with 51% using zinc oxide-eugenol-based sealers. Conclusions: The majority of Iranian GDPs who participated in the present survey do not comply with quality guidelines of endodontic treatment. PMID:25834595

  16. [Acute head injuries in primary health care--internet survey conducted with general practitioners].

    PubMed

    Luoto, Teemu M; Artsola, Minna; Helminen, Mika; Liimatainen, Suvi; Kosunen, Elise; Ohman, Juha

    2013-01-01

    Patients with head injury constitute a large population treated in primary health care. It is essential to recognize patients with traumatic brain injury among this notable population to determine the need for more specific evaluation. General practitioners (n=331) in Pirkanmaa hospital district in Finland received an email link to answer the survey. The response rate was 54.1% (n=179). Mean survey score was 20.5 points (max. 25). Only acquaintance with the national traumatic brain injury practice guidelines was associated with greater survey scores. The general practitioners' level of knowledge in managing head injuries was good. Deficiencies were found in the questions dealt with post-traumatic amnesia and the definition of traumatic brain injury. PMID:23786110

  17. "We need to get you focused": general practitioners' representations of chronic low back pain patients.

    PubMed

    Macneela, Pádraig; Gibbons, Andrea; McGuire, Brian; Murphy, Andrew

    2010-07-01

    Although subject to considerable research from perspectives including general practitioners, patients, and perspective guidelines, chronic low back pain (CLBP) continues to be a common but contentious condition in primary care. We used medical consultation records, critical incident interviews, and a think-aloud problem-solving task to examine how general practitioners applied professional knowledge of the condition, especially in relation to psychosocial care. Using qualitative content analysis and thematic analysis, we identified a pragmatic, goal-focused approach to patients, a schema based on biomedical knowledge and tacit theories of motivation. The doctors' expectations for CLBP included uncertainty over symptoms and doubts over patient credibility, which helped to explain an autonomous rather than collaborative approach to managing back pain patients. The findings are discussed in light of social representations theory, self-determination, and research on the therapeutic relationship. PMID:20335499

  18. [Practice guideline 'Urinary incontinence in women' from the Dutch College of General Practitioners].

    PubMed

    Damen-van Beek, Z; Wiersma, Tj

    2016-01-01

    - The Dutch College of General Practitioners' (NHG) practice guideline 'Urinary incontinence in women' provides guidelines for diagnosis and management of stress, urgency and mixed urinary incontinence in adult women.- General practitioners (GPs) should be alert to signals for urinary incontinence in women and offer active diagnosis and treatment if necessary.- Shared decision making is central in the guideline; the GP and the patient should discuss therapeutic options and decide on treatment policy in mutual consultation.- Women with stress urinary incontinence can choose between pelvic floor exercises or a pessary as initial treatment. Placing a midurethral sling (MUS) will be discussed if initial treatment is insufficiently effective or in the case of serious symptoms.- When bladder training is ineffective in urgency incontinence, the GP will discuss the pros and cons of adding an anticholinergic agent.- Exercise therapy can take place in the GPs practice or under supervision of a pelvic physical therapist. PMID:27484432

  19. 40 CFR 1.29 - Office of Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... AND GENERAL INFORMATION Headquarters § 1.29 Office of Inspector General. The Office of Inspector... legislation and regulations to assess the impact on the administration of EPA's programs and operations....

  20. 39 CFR 3002.16 - Office of Inspector General. [Reserved

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 39 Postal Service 1 2012-07-01 2012-07-01 false Office of Inspector General. 3002.16 Section 3002.16 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL ORGANIZATION § 3002.16 Office of Inspector General....

  1. The provision of orthodontic services by general dental practitioners. 2. Factors influencing variation in service provision.

    PubMed

    Lawrence, A J; Wright, F A; D'Adamo, S P

    1995-12-01

    Previous work has shown that variations exist amongst general dental practitioners in the volume and type of orthodontic services provided, the type of orthodontic appliances used, and the objectives of the orthodontic treatment. The aims of this survey were to identify practitioner characteristics that account for variations in the level of orthodontic services provided and which distinguish providers and non-providers of orthodontic services. Multiple regression analysis revealed that four practitioner characteristics explained 41 per cent of the variance in the number of orthodontic patients treated. Dentists who treated more orthodontic patients: 1) treated more general practice patients; 2) frequently used multiple sources to keep up to date in orthodontics; 3) perceived their patient base to contain more children; and 4) were likely to have attended a Truitt course. Eleven variables best distinguished providers from non-providers of orthodontic treatment; 1, 2 and 3 above had the highest correlation with the discriminant function. The Null Hypothesis that selected characteristics of dentists providing orthodontic services were no different from those of dentists not providing orthodontic services was rejected. The provision of orthodontic services was associated with a higher level of continuing orthodontic education as well as treating more general practice patients, especially children. PMID:8615740

  2. Determining the frequency of defensive medicine among general practitioners in Southeast Iran

    PubMed Central

    Moosazadeh, Mahmood; Movahednia, Mahtab; Movahednia, Nima; Amiresmaili, Mohammadreza; Aghaei, Iraj

    2014-01-01

    Background: Defensive medicine prompts physicians not to admit high-risk patients who need intensive care. This phenomenon not only decreases the quality of healthcare services, but also wastes scarce health resources. Defensive medicine occurs in negative and positive forms. Hence, the present study aimed to determine frequency of positive and negative defensive medicine behaviors and their underlying factors among general practitioners in Southeast Iran. Methods: The present cross-sectional study was performed among general practitioners in Southeast Iran. 423 subjects participated in the study on a census basis and a questionnaire was used for data collection. Data analysis was carried out using descriptive and analytical statistics through SPSS 20. Results: The majority of participants were male (58.2%). The mean age of physicians was 40 ± 8.5. The frequency of positive and negative defensive medicine among general practitioners in Southeast Iran was 99.8% and 79.2% respectively. A significant relationship was observed between working experience, being informed of law suits against their colleagues, and committing defensive medicine behavior (P< 0.001). Conclusion: The present study indicated high frequency of defensive medicine behavior in the Southeast Iran. So, it calls policy-makers special attention to improve the status quo. PMID:24757688

  3. 16 CFR 0.13 - Office of the Inspector General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Office of the Inspector General. 0.13 Section 0.13 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ORGANIZATION § 0.13 Office of the Inspector General. The Office of Inspector General (OIG) was...

  4. 16 CFR 0.13 - Office of the Inspector General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Office of the Inspector General. 0.13 Section 0.13 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ORGANIZATION § 0.13 Office of the Inspector General. The Office of Inspector General (OIG) was...

  5. 39 CFR 3002.13 - Office of the General Counsel.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 39 Postal Service 1 2014-07-01 2014-07-01 false Office of the General Counsel. 3002.13 Section 3002.13 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL ORGANIZATION § 3002.13 Office of the General Counsel. (a) The General Counsel directs and coordinates the functions of the Office of...

  6. 39 CFR 3002.16 - Office of Inspector General.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 39 Postal Service 1 2013-07-01 2013-07-01 false Office of Inspector General. 3002.16 Section 3002.16 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL ORGANIZATION § 3002.16 Office of Inspector General. (a) The Office of Inspector General has the duty and responsibility to: (1) Provide...

  7. 39 CFR 3002.13 - Office of the General Counsel.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 39 Postal Service 1 2013-07-01 2013-07-01 false Office of the General Counsel. 3002.13 Section 3002.13 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL ORGANIZATION § 3002.13 Office of the General Counsel. (a) The General Counsel directs and coordinates the functions of the Office of...

  8. 39 CFR 3002.16 - Office of Inspector General.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 39 Postal Service 1 2014-07-01 2014-07-01 false Office of Inspector General. 3002.16 Section 3002.16 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL ORGANIZATION § 3002.16 Office of Inspector General. (a) The Office of Inspector General has the duty and responsibility to: (1) Provide...

  9. Assessment of prescribing practices among urban and rural general practitioners in Tamil Nadu

    PubMed Central

    Gopalakrishnan, Sekharan; Ganeshkumar, Parasuraman; Katta, Ajitha

    2013-01-01

    Background: Studying drug use pattern among medical practitioners is of vital importance in the present scenario where irrational drug use and development of drug resistance is becoming rampant. Objective: To assess, the pattern of prescribing practices among the general practitioners in a defined rural and urban area of Tamil Nadu. Materials and Methods: A community based descriptive study was conducted to collect 600 prescriptions from the catchment areas of rural and urban health training centers of a medical college using prescribing indicators as per the WHO “How to investigate drug use in health facilities” tool. Results: This prescription study revealed that multivitamins (19.5%), antibiotics (19.3%), drugs for gastro-intestinal tract (GIT) (18%), analgesic non-steroidal anti-inflammatory drugs/ (NSAID's) (15.1%), and antihistaminic (12.5%) were prescribed frequently. Among the antibiotics, amoxicillin (49.2%) was the most commonly prescribed followed by gentamicin (31.7%). Percentage of prescriptions with an antibiotic was 55% and nearly 62% of the practitioners prescribed drugs by their generic names. As a practice of poly-pharmacy, it was observed that the average number of drugs prescribed in urban and rural area was nearly 5 and 4, respectively. Nearly 80% of the urban and rural practitioners were prescribing at least one injection. Study of the quality of prescriptions revealed that there was poor legibility, high usage of abbreviations, inadequate details of the drugs, and absence of signature by practitioners in the prescriptions. Conclusion: This study clearly highlights the practice of poly-pharmacy, low usage of generic drugs, injudicious usage of antibiotics and injections and low usage of drugs prescribed from essential drugs list. PMID:23833368

  10. General practitioner participation in the second Australian National Blood Pressure Study (ANBP2).

    PubMed

    Reid, C M; Ryan, P; Nelson, M; Beckinsale, P; McMurchie, M; Gleave, D; DeLoozef, F; Wing, L M

    2001-08-01

    1. The second Australian National Blood Pressure Study (ANBP2) is an outcome trial of the treatment of hypertension in the elderly conducted entirely in general practices across Australia. Prior to ANBP2, no study of this size and nature had been undertaken in Australian general practice and the response of General Practitioners (GPs) to becoming involved in long-term cardiovascular research was unknown. 2. Academic departments and Divisions of General Practice were approached to support the project. General Practitioners were approached by letter of invitation and contacted by a regional medical coordinator (RMC) either at a face-to-face meeting or by telephone. 3. At the close of recruitment to ANBP2, 1938 GPs from 950 practices had registered as investigators. Sixty-two Divisions of General Practice were approached to support the study in five mainland Australian states with 39 (63%) participating, although participation by state was highly variable (range: 18-100%). Thirty divisional or promotional dinner meetings were held, with 56% (368/658) of those attending registering as investigators. Of the 8098 GPs sent a letter of invitation to participate in the study, 1357 (17%) expressed interest and eventually enrolled as investigators, ranging from 8% in Queensland to 28% in New South Wales. Ninety-six per cent of GPs who had a personal face-to-face contact (696/724) with the RMC registered in the study. 4. The GP recruitment phase of ANBP2 has been successfully completed. Peer-to-peer recruitment was the most successful strategy; however, success varied between states. General Practitioner recruitment to long-term clinical trials appears to be successful with a multifactorial approach focusing on peer-to-peer recruitment. PMID:11473534

  11. How can a postgraduate professional education and development course benefit general practitioners?: a qualitative study

    PubMed Central

    Agius, Steven; Baron, Rebecca; Lewis, Barry; Luckhurst, Stephen; Sloan, Mark; Ward, Thomas

    2015-01-01

    Purpose: The rationale for ‘professional education and development’ (PED) courses is to support general practitioners, enabling them to access a range of theoretical and practical skills within a supportive schema. It aims to identify whether and how a regional PED course has had a beneficial impact upon participants. Methods: The study comprised a qualitative investigation of participants’ assessed coursework portfolios. The content of each portfolio gives individual accounts of the impact of the course on personal and practice development. Permission to access extant portfolios was obtained from 16 recent alumni of the course. The anonymous written material was analysed by the research team for recurring discourses and themes using a thematic framework analysis. Results: Seven major thematic categories were extrapolated from the data: leadership, resilience, quality improvement, change management, development of new services, educational expertise, and patient safety. In each category, we found evidence that the course enabled development of practitioners by enhancing knowledge and skills which had a positive impact upon their self-perceived effectiveness and motivation. Conclusion: Extended specialty training is on the horizon but such courses may still serve a valuable purpose for current trainees and the existing general practitioners workforce which will be responsible for leading the shift towards community-based service delivery. PMID:26084681

  12. Controlled evaluation of brief intervention by general practitioners to reduce chronic use of benzodiazepines.

    PubMed Central

    Bashir, K; King, M; Ashworth, M

    1994-01-01

    BACKGROUND: It is recommended that long-term users of benzodiazepines in general practice be withdrawn from their medication where possible. AIM: A study was undertaken to assess the effectiveness of minimal intervention delivered by general practitioners in helping chronic users of benzodiazepines to withdraw from their medication, and to determine the psychological sequelae on patients of such intervention. METHOD: Patients taking benzodiazepines regularly for at least one year were recruited by their general practitioner and allocated either to a group receiving brief advice during one consultation supplemented by a self-help booklet or to a control group who received routine care. The patients completed the 12-item general health questionnaire and a benzodiazepine withdrawal symptom questionnaire at the outset of the study and at three and six months after this. RESULTS: Eighteen per cent of patients in the intervention group (9/50) had a reduction in benzodiazepine prescribing recorded in the notes compared with 5% of the 55 patients in the control group (P < 0.05). In the intervention group, 63% of patients had a score of two or more on the general health questionnaire at baseline compared with 52% at six months. Of the 20 intervention patients reporting benzodiazepine reduction, 60% had a score of two or more at baseline compared with 40% at six months. Intervention patients had significantly more qualitative, but not quantitative, withdrawal symptoms at six months compared with baseline. Consultation rates were not increased in the intervention group. CONCLUSION: The study indicates that some chronic users can successfully reduce their intake of benzodiazepines with simple advice from the general practitioner and a self-help booklet. This type of intervention does not lead to psychological distress or increased consultation. PMID:8790654

  13. The Office of Inspector General (OIG)

    NASA Technical Reports Server (NTRS)

    Macisco, Christopher A.

    2004-01-01

    The NASA Office of Inspector General is the Federal Law Enforcement Agency at NASA which conducts criminal and regulatory investigations in which NASA is a victim. The OIG prevents and detects crime, fiaud, waste and abuse and assists NASA management in promoting economy, efficiency, and effectiveness in its programs and operations. Investigations (OI) and the Office of Audits (OA). The investigations side deals with criminal Investigations, administrative investigations, and civil investigations. The Audits side deals with inspections and assessments as well as the Auditing of NASA Programs and Activities. Our mission at the OIG is to conduct and supervise independent and objective audits and investigations relating to agency programs and operations; to promote economy, effectiveness and efficiency within the agency; to prevent and detect crime, fraud, waste and abuse in agency programs and operations; to review and make recommendations regarding existing and proposed legislation and regulations relating to agency programs and operations. We are also responsible for keeping the agency head and the Congress fully and currently informed of problems in agency programs and operations. deal with False Claims, False Statements, Conspiracy, Theft, Computer Crime, Mail Fraud, the Procurement Integrity Act, the Anti-Kickback Act, as well as noncompliance with NASA Management Instructions, the Federal Acquisition Regulations (FAR), and the Code of Federal Regulations (CFR). Most of the casework that is dealt with in our office is generated through gum shoe work or cases that we generate on our own. These cases can come from Law Enforcement Referrals, GIDEP Reports, EPlMS (NASA Quality System), Defense Contract Audit Agency, Newspaper Articles, and Confidential Information. In many cases, confidentiality is the biggest factor to informants coming forward. We are able to maintain confidentiality because the 01 is independent of NASA Management and doesn t report to the Center

  14. [The practice guideline 'Pregnancy and puerperium' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice medicine].

    PubMed

    Giesen, P H; Slagter-Roukema, T M

    2004-01-10

    The first revision of the Dutch College of General Practitioners' practice guideline about pregnancy and puerperium does not significantly differ from the first edition. The guideline is extensive, is well-worth reading and supports daily practice. There is a greater emphasis on the importance of cooperation and differentiation in primary care (midwifes and general practitioners). During the last decade many general practitioners stopped doing home deliveries and have therefore lost their experience in obstetric care and pathology. The guideline describes the general practitioner's tasks as a preconception counsellor, a professional expert on illnesses during pregnancy and after the delivery, and as the doctor of the newborn baby. It will hopefully stimulate a revived interest of and involvement in pregnancy and post-partum care among general practitioners. PMID:14753124

  15. Experienced and novice officers' generalized communication suspicion and veracity judgments.

    PubMed

    Masip, Jaume; Alonso, Hernán; Herrero, Carmen; Garrido, Eugenio

    2016-04-01

    Deception detection research has shown that police officers are less truth-biased and make their veracity judgments with greater confidence than do nonofficers. Here we examined nonofficers, novice officers, and experienced officers' response bias, confidence, and generalized communicative suspicion. In Experiment 1, novice officers aligned with nonofficers in terms of both generalized communicative suspicion scores and confidence, with both these groups scoring lower than experienced officers. Generalized communicative suspicion scores and veracity judgments were not significantly related for either sample. However, novice officers aligned with experienced officers in terms of judgments: both police groups were lie-biased, whereas nonofficers were truth-biased. These findings suggest that unlike experienced officers, who have embraced the police culture to a greater degree, novice officers are not dispositionally suspicious (generalized communicative suspicion); however, they are able to mirror the prototypical police behavior (deception judgments) in police-related contexts. Experiment 2 supported these notions. PMID:26844912

  16. Validation of a questionnaire measuring patient satisfaction with general practitioner services

    PubMed Central

    Grogan, S; Conner, M; Norman, P; Willits, D; Porter, I

    2000-01-01

    M Conner, senior lecturer P Norman, senior lecturer D Willits, general practitioner I Porter, research and development head Background—In order that patient satisfaction may be assessed in a meaningful way, measures that are valid and reliable are required. This study was undertaken to assess the construct validity and internal reliability of the previously developed Patient Satisfaction Questionnaire (PSQ). Method—A total of 1390 patients from five practices in the North of England, the Midlands, and Scotland completed the questionnaire. Responses were checked for construct validity (including confirmatory factor analysis to check the factor structure of the scale) and internal reliability. Results—Confirmatory factor analysis showed that items loaded on the appropriate factors in a five factor model (doctors, nurses, access, appointments, and facilities). Scores on the specific subscales showed highly significant positive correlations with general satisfaction subscale scores suggesting construct validity. Also, the prediction (derived from past research) that older people would be more satisfied with the service was borne out by the results (F (4, 1312) = 57.10; p<0.0001), providing further construct validation. The five specific subscales (doctors, nurses, access, appointments, and facilities), the general satisfaction subscale, and the questionnaire as a whole were found to have high internal reliability (Cronbach's α = 0.74–0.95). Conclusion—The results suggest that the PSQ is a valid and internally reliable tool for assessing patient satisfaction with general practitioner services. (Quality in Health Care 2000;9:210–215) Key Words: patient satisfaction; general practitioner services; questionnaire construction; construct validity; reliability PMID:11101705

  17. A survey of French general practitioners on the epidemiology of wounds in family practice

    PubMed Central

    Sarazin, Marianne; Roberton, Florence; Charles, Rodolphe; Falchi, Alessandra; Chiappe, Solange Gonzales; Blanchon, Thierry; Lucht, Frédéric; Hanslik, Thomas

    2015-01-01

    Background To measure the frequency and nature of wounds in patients treated in general practice and to describe the patients’ tetanus vaccination status and the sources providing information about this status. Methods A descriptive, prospective, week-long, national electronic survey was conducted among general practitioners within the Sentinelles network. Results The participation rate was 12.6% (95% confidence interval [CI], 10.6%–14.6%; 130 general practitioners): 197 patients with wounds were reported, and 175 of them were described. Wound frequency was 1.4 (95% CI, 1.2–1.6) per 100 consultations. These wounds had an acute character in 76 (95% CI, 69.7–82.3) of cases, were mostly of traumatic origin (54.8% of cases; 95% CI, 47.5%–62.1%), were more than 24 hours old (67.1%; 95% CI, 59.1%–75.1%), and were clean, without bone and/or muscle decay (94%; 95% CI, 90.5%–97.5%). Vaccination status was known for 71 (95% CI, 64–78) patients. According to the 2013 immunization schedule, 21% (95% CI, 13.9%–28.1%) of the patients had not updated their vaccinations, mostly among the patients older than 75 years. Conclusion This survey describes in detail the wounds treated in general practice in France and the associated patients’ immunization status. It also shows how difficult it is for general practitioners to assess the risk of contracting tetanus and the disease’s development. It highlights as well the fact that the ideal solution to assess tetanus risk is an up-to-date immunization schedule. PMID:26124675

  18. General practitioners' knowledge of their patients' psychosocial problems: multipractice questionnaire survey.

    PubMed Central

    Gulbrandsen, P.; Hjortdahl, P.; Fugelli, P.

    1997-01-01

    OBJECTIVES: To evaluate general practitioners' knowledge of a range of psychosocial problems among their patients and to explore whether doctors' recognition of psychosocial problems depends on previous general knowledge about the patient or the type of problem or on certain characteristics of the doctor or the patient. DESIGN: Multipractice survey of consecutive adult patients consulting general practitioners. Doctors and patients answered written questions. SETTING: Buskerud county, Norway. SUBJECTS: 1401 adults attending 89 general practitioners during one regular working day in March 1995. MAIN OUTCOME MEASURES: Doctors' knowledge of nine predefined psychosocial problems in patients; these problems were assessed by the patients as affecting their health on the day of consultation; odds ratios for the doctor's recognition of each problem, adjusted for characteristics of patients, doctors, and practices; and the doctor's assessment of previous general knowledge about the patient. RESULTS: Doctors' knowledge of the problems ranged from 53% (108/203) of "stressful working conditions" to 19% (12/63) of a history of "violence or threats." Good previous knowledge of the patient increased the odds for the doctor's recognition of "sorrow," "violence or threats," "substance misuse in close friend or relative," and "difficult conflict with close friend or relative." Age and sex of doctor and patient, patient's educational level and living situation, and location of practice influenced the doctor's awareness. CONCLUSIONS: Variation in the patients' communication abilities, the need for confidence in the doctor-patient relationship before revealing intimate problems, and a tendency for the doctors to be entrapped by their expectations may explain these findings. PMID:9112847

  19. [Study of the follow-up by the general practitioner of the children of separated parents].

    PubMed

    Kacenelenbogen, N; Roland, M; Schetgen, M; Dusart, A F

    2006-09-01

    In Belgium, on 10 millions of inhabitants, there are more than 31.000 divorces per year and we estimate that 600.000 children are experiencing separation of their parents. The general practitioner (GP) have inevitably the responsability of the medical follow-up of some of these children. The possible professional implications related to these young patients, concerning the GP have never been the subject of a study so far. Consequently the aim of this research was to reveal what is happening in the daily practice of the family practitioner related with the children of separete parents. There were some hypothesis notably about particular working conditions for the GP in connection with possible consequences for these children and possible necessity of special professional attitudes. A qualitative research in focus group was organized with GPs in order to get an interaction between the participants and to go past the concepts supposed before the study. Therefore between September and December 04, 8 focus groups of 10-18 generalist practitioners were set up in Brussels and Mons. Each meeting was axed around couples separated for less than 3 years and children between 0 and 15 years. Finally, 120 GPs discussed about 242 cases of divorces from their practice. The debates totally typed word by word were analysed with assistance of the software QSR N5. The point of view of the GPs is: 1) A divorce affects the working conditions of the general practitioner, for example the parcelling out of the medical follow-up of the child and the fact " of being used" by the family. 2) The conflict between the parents after the separation increases the difficulties for the GP in his daily practice. 3) The parental's separation influences the choice of professional attitudes of the GP, notably vis-a-vis the conflict (for instance to try or not to try the conflict's management). 4) Mainly in conflict situation, parental divorce is a risk for the child; psychological or behavioural

  20. [General practitioners' commitment to treating excessive alcohol consumption: A question of role security in treating affected patients?].

    PubMed

    Fankhänel, Thomas; Rascher, Anja; Thiel, Carolin; Schulz, Katrin; Klement, Andreas

    2016-01-01

    Only a few general practitioners (GPs) are committed to screen their patients for alcohol consumption and, in case of excessive alcohol consumption conduct by a brief intervention according to WHO recommendations. Apart from inadequate compensation and work load, another barrier identified by the GPs was their uncertainty about how to deal with affected patients. Most German universities presently spend no more than 90minutes lecture time on addiction medicine teaching. Our research aims to investigate the question whether medical studies and advanced medical education increases the role security of medical students and physicians and their commitment to implementing alcohol screening and brief intervention. Moreover, we will explore whether lack of therapeutic commitment can be related to lack of role security. Questionnaires were administered to pre-clinical and clinical medical students as well as senior house officers. Role security and therapeutic commitment of students and senior house officers were assessed using the Alcohol and Alcohol Problems Questionnaire (SAAPPQ) subscales "Role Security" and "Therapeutic Commitment". Analysis was based on 367 questionnaires. As expected, senior house officers reported more Role Security than clinical medical students who showed a higher level of Role Security than pre-clinical medical students. No differences could be found for Therapeutic Commitment. An association between Role Security and Therapeutic Commitment was only revealed for clinical medical students. Medical studies and advanced medical education can increase students' and senior house officers' Role Security to treat patients with excessive alcohol consumption, but not Therapeutic Commitment. Moreover, no association between Role Security and Therapeutic Commitment could be found for senior house officers. Hence, it may be assumed that educational activities aiming to increase Role Security do not promote the development of motivational aspects such as

  1. A Focus Group on Dental Pain Complaints with General Medical Practitioners: Developing a Treatment Algorithm

    PubMed Central

    Carter, Geoff; Abbey, Robyn

    2016-01-01

    Objective. The differential diagnosis of pain in the mouth can be challenging for general medical practitioners (GMPs) as many different dental problems can present with similar signs and symptoms. This study aimed to create a treatment algorithm for GMPs to effectively and appropriately refer the patients and prescribe antibiotics. Design. The study design is comprised of qualitative focus group discussions. Setting and Subjects. Groups of GMPs within the Gold Coast and Brisbane urban and city regions. Outcome Measures. Content thematically analysed and treatment algorithm developed. Results. There were 5 focus groups with 8-9 participants per group. Addressing whether antibiotics should be given to patients with dental pain was considered very important to GMPs to prevent overtreatment and creating antibiotic resistance. Many practitioners were unsure of what the different forms of dental pains represent. 90% of the practitioners involved agreed that the treatment algorithm was useful to daily practice. Conclusion. Common dental complaints and infections are seldom surgical emergencies but can result in prolonged appointments for those GMPs who do not regularly deal with these issues. The treatment algorithm for referral processes and prescriptions was deemed easily downloadable and simple to interpret and detailed but succinct enough for clinical use by GMPs. PMID:27462469

  2. A Focus Group on Dental Pain Complaints with General Medical Practitioners: Developing a Treatment Algorithm.

    PubMed

    Carter, Ava Elizabeth; Carter, Geoff; Abbey, Robyn

    2016-01-01

    Objective. The differential diagnosis of pain in the mouth can be challenging for general medical practitioners (GMPs) as many different dental problems can present with similar signs and symptoms. This study aimed to create a treatment algorithm for GMPs to effectively and appropriately refer the patients and prescribe antibiotics. Design. The study design is comprised of qualitative focus group discussions. Setting and Subjects. Groups of GMPs within the Gold Coast and Brisbane urban and city regions. Outcome Measures. Content thematically analysed and treatment algorithm developed. Results. There were 5 focus groups with 8-9 participants per group. Addressing whether antibiotics should be given to patients with dental pain was considered very important to GMPs to prevent overtreatment and creating antibiotic resistance. Many practitioners were unsure of what the different forms of dental pains represent. 90% of the practitioners involved agreed that the treatment algorithm was useful to daily practice. Conclusion. Common dental complaints and infections are seldom surgical emergencies but can result in prolonged appointments for those GMPs who do not regularly deal with these issues. The treatment algorithm for referral processes and prescriptions was deemed easily downloadable and simple to interpret and detailed but succinct enough for clinical use by GMPs. PMID:27462469

  3. Should the General Practitioner Consider Mesotherapy (Intradermal Therapy) to Manage Localized Pain?

    PubMed

    Mammucari, Massimo; Maggiori, Enrica; Lazzari, Marzia; Natoli, Silvia

    2016-06-01

    Wide variations in the types of pain and response to analgesic pharmacotherapy mean that a variety of treatment strategies are needed. One approach is mesotherapy (intradermal therapy). This consists of microinjections into the skin and is ideally suited to the management of localized pain. Advantages include increasing the duration of drug activity, reduced risk of adverse events and interactions, and possible synergy with other therapies. Mesotherapy provides general practitioners with another tool for the treatment of local pain. However, it is important to provide patients with full details of the pros and cons of this approach and obtain informed patient consent. PMID:27229350

  4. [General practitioner's role in immunization practice: prevention, counseling and protection of patients at risk].

    PubMed

    Marino, Maria Giulia; Corongiu, Maria; Franco, Elisabetta

    2014-01-01

    In Italy, General Practitioner (GP) plays a key role in directing patients in immunization practice, especially those at risk, who might benefit most from vaccine protection. The numerous GP's specific activities in this field include vaccine administration, reporting of adverse reactions, check of vaccination status, counseling, identification of at-risk patients, recommendation for post-exposure prophylaxis, self and ambulatory staff immunization. GP is one the main health professionals in charge of patients care and has the task to ensure both diseases prevention and health care costs restraint. PMID:25194124

  5. Drug-specific quality indicators assessing outpatient antibiotic use among French general practitioners.

    PubMed

    Pulcini, Céline; Lions, Caroline; Ventelou, Bruno; Verger, Pierre

    2013-04-01

    Quality indicators assessing the use of antibiotics among general practitioners (GPs) would be useful to target antibiotic stewardship interventions. We adapted to an individual GP level a set of 12 drug-specific quality indicators of outpatient antibiotic use in Europe developed by the European surveillance of antimicrobial consumption project. We performed a cross-sectional study analysing reimbursement data on outpatient antibiotic prescriptions in adults in south-eastern France in 2009. Substantial heterogeneity in antibiotic prescribing among French GPs was observed, and opportunity to improve antibiotic prescribing can be identified. PMID:22843612

  6. Selected demographic, social and work characteristics of the Australian general medical practitioner workforce: comparing capital cities with regional areas.

    PubMed

    Wilkinson, D

    2000-12-01

    The aim of the present study was to compare selected characteristics of the Australian general medical practitioner workforce in capital cities and regional areas. Data were derived from the 1996 Census of Population and Housing. Characteristics included age, sex, full- or part-time work, place of birth and change in residential address. Analyses were performed for each state and territory in Australia, the statistical division containing each capital city and all other statistical divisions in each state and territory. Of the 26,359 general medical practitioners identified, 68% were male. More female than male general medical practitioners were aged < 45 years (74 vs 52%, respectively; P < 0.0001). The proportion of general medical practitioners aged < 35 years was higher in capital cities (30%) than regional areas (24%; P < 0.0001). Overall, 32% of the general medical practitioner workforce was female and almost 50% of those aged < 35 years were female. The proportion of female general medical practitioners was higher in capital cities than regional areas, by up to 30%. While 13% of male general medical practitioners reported part-time work, 42% of females also reported part-time work and these figures were similar in capital cities and regional areas. Approximately 40% of the Australian general medical practitioner workforce was born outside Australia and while fewer migrants have entered in recent years they were more likely to be living in regional areas than the capitals. The census provides useful medical workforce data. The regional workforce tends to be made up of more males and is older than in capital cities. Monitoring trends in these characteristics could help to evaluate initiatives aimed at addressing regional workforce issues. PMID:11894793

  7. How effective and acceptable is Web 2.0 Balint group participation for general practitioners and general practitioner registrars in regional Australia? A pilot study

    PubMed Central

    Koppe, Hilton; Ahern, Christine M.

    2015-01-01

    Abstract Objective General practitioners (GPs) and general practice registrars report work‐related stress. Balint groups may improve coping mechanisms. However, attendance at a face‐to‐face Balint group is difficult for rural doctors due to distance constraints. The study aim was to evaluate online Balint groups for rural doctors and determine effect size for a full‐scale trial. Design A mixed‐methods approach, including a pre–post controlled trial and thematic analysis of qualitative data. Setting Rural primary care. Participants Thirteen GPs and 8 general practice registrars completed the study. Interventions Balint groups were delivered over 8–9 fortnightly online sessions. GPs and GP registrars participated in separate groups. Data were collected on work‐related affect, psychological medicine skills and professional isolation using the Warr's Work‐Related Affect Scale, the Psychological Medicine Inventory, and a professional isolation scale. Main outcome measures Change scores on Warr's Work‐Related Affect Scale, the Psychological Medicine Inventory, and a professional isolation scale. Results Balint participants' scores were significantly higher post‐intervention on the Psychological Medicine Inventory (mean 6.49 (±0.20) versus 5.43 (±0.26); P < 0.01) and Warr's Work‐Related Affect (mean 4.09 (±0.09) versus 3.60 (±0.12); P < 0.01) scales than control group scores. Effect size on these scales ranged from 0.46 to 0.50. The greatest challenge was technical problems related to insufficient broadband speed. Conclusions Online Balint groups appear to improve rural doctors' psychological medicine skills and work‐related affect. New data on effect size will inform a full‐scale trial. Improved national broadband infrastructure may enhance online support opportunities for rural doctors. PMID:26114400

  8. What do older people value when they visit their general practitioner? A qualitative study.

    PubMed

    Marcinowicz, Ludmila; Pawlikowska, Teresa; Oleszczyk, Marek

    2014-01-01

    Older patients see their general practitioners (GPs) relatively often and so recognition of their preferences can lead to improvement of quality of care in general practice. This study aimed to identify which aspects of GPs' behaviour are the most important for older people in their assessment of the quality of their visits and to explore the application of Jung's taxonomy differentiating task and affective behaviour in this context. A qualitative approach to generating data was chosen. We conducted semi-structured interviews with a sample of 30 patients aged 65 and older using GP services in two demographically diverse big cities in Poland. Participants were interviewed in 2010 according to a pre-determined topic guide. This research showed that older people assess both 'task performance' and 'affective performance' behaviours of general practitioners. There were nearly twice as many patient comments concerning affective performance behaviour relative to task performance behaviour. Older people expect that their physicians will be demonstrably friendly, kind, able to joke and have enough time for the consultation. PMID:25431547

  9. Halitosis management by the general dental practitioner--results of an international consensus workshop.

    PubMed

    Seemann, R; Conceicao, M D; Filippi, A; Greenman, J; Lenton, P; Nachnani, S; Quirynen, M; Roldan, S; Schulze, H; Sterer, N; Tangerman, A; Winkel, E G; Yaegaki, K; Rosenberg, M

    2014-03-01

    Clinical investigations on patients suffering from halitosis clearly reveal that in the vast majority of cases the source for an offensive breath odor can be found within the oral cavity (90%). Based on these studies, the main sources for intra-oral halitosis where tongue coating, gingivitis/periodontitis or a combination of the two. Thus, it is perfectly logical that general dental practitioners (GDPs) should be able to manage intra-oral halitosis under the conditions found in a normal dental practice. However, GDPs who are interested in diagnosing and treating halitosis are challenged to incorporate scientifically based strategies for use in their clinics. Therefore, the present paper summarizes the results of a consensus workshop of international authorities held with the aim to reach a consensus on general guidelines on how to assess and diagnose patients' breath odor concerns and general guidelines on regimens for the treatment of halitosis. PMID:24566222

  10. 16 CFR 0.11 - Office of the General Counsel.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Office of the General Counsel. 0.11 Section 0.11 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ORGANIZATION § 0.11 Office of the General Counsel. The General Counsel is the Commission's chief law...

  11. 16 CFR 0.11 - Office of the General Counsel.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Office of the General Counsel. 0.11 Section 0.11 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ORGANIZATION § 0.11 Office of the General Counsel. The General Counsel is the Commission's chief law...

  12. Annual report, Office of the Inspector General

    SciTech Connect

    Mansfield, J.K.

    1980-03-01

    Activities during the period January 1, 1979 through December 31, 1979 are reported. First, an overview of the progress and problems encountered by this office during the last calendar year is given. Next, certain matters of concern relating to the independence of the office and the ability to work effectively are discussed. Then progress being made and problems being met in forward planning are reviewed. The existing office organizational and staffing patterns are described in the subsequent section. Then weaknesses of the existing DOE overall audit system are discussed. Work done by the IG audit, inspection, and investigative staffs during 1979 is reviewed. Summaries of significant IG findings and recommendations, and of departmental responses thereto, are included. Finally, follow-through activities and certain developments during 1979 that were of importance to the office are described. (RWR)

  13. Effectiveness of in-office blood pressure measurement by eye care practitioners in early detection and management of hypertension

    PubMed Central

    AlAnazi, Saud A.; Osuagwu, Uchechukwu L.; AlMubrad, Turki M.; Ahmed, Hany K.; Ogbuehi, Kelechi C.

    2015-01-01

    AIM To investigate the number of hypertensive patients, the optometrist is able to identify by routinely taking blood pressure (BP) measurements for patients in “at-risk” groups, and to sample patients' opinions regarding in-office BP measurement. Many of the optometrists in Saudi Arabia practice in optical stores. These stores are wide spread, easily accessible and seldom need appointments. The expanding role of the optometrist as a primary health care provider (PHCP) and the increasing global prevalence of hypertension, highlight the need for an integrated approach towards detecting and monitoring hypertension. METHODS Automated BP measurements were made twice (during the same session) at five selected optometry practices using a validated BP monitor (Omron M6) to assess the number of patients with high BP (HBP) -in at-risk groups-visiting the eye clinic routinely. Prior to data collection, practitioners underwent a two-day training workshop by a cardiologist on hypertension and how to obtain accurate BP readings. A protocol for BP measurement was distributed and retained in all participating clinics. The general attitude towards cardiovascular health of 480 patients aged 37.2 (±12.4)y and their opinion towards in-office BP measurement was assessed using a self-administered questionnaire. RESULTS A response rate of 83.6% was obtained for the survey. Ninety-three of the 443 patients (21.0%) tested for BP in this study had HBP. Of these, (62 subjects) 66.7% were unaware of their HBP status. Thirty of the 105 subjects (28.6%) who had previously been diagnosed with HBP, still had HBP at the time of this study, and only 22 (73.3%) of these patients were on medication. Also, only 25% of the diagnosed hypertensive patients owned a BP monitor. CONCLUSION Taking BP measurements in optometry practices, we were able to identify one previously undiagnosed patient with HBP for every 8 adults tested. We also identified 30 of 105 previously diagnosed patients whose BP was

  14. Fitzsimons General Hospital, Bachelor Officers' Quarters/Officers' Club, West Harlowe Avenue, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Fitzsimons General Hospital, Bachelor Officers' Quarters/Officers' Club, West Harlowe Avenue, South side, 200 feet West of intersection of West Harlow Avenue & South First Street, Aurora, Adams County, CO

  15. General Medical Practitioners Need to Be Aware of the Theories on Which Our Work Depend

    PubMed Central

    Thomas, Paul

    2006-01-01

    When general practitioners and family physicians listen, reflect, and diagnose, we use 3 different theories of knowledge. This essay explores these theories to highlight an approach to clinical practice, inquiry, and learning that can do justice to the complex and uncertain world we experience. The following points are made: (1) A variety of approaches to research and audit are needed to illuminate the richness of experience witnessed by general medical practitioners. (2) Evidence about the past cannot predict the future except in simple, short-term, or slowly changing situations. (3) We consciously or unconsciously weave together evidence generated through 3 fundamental theories of knowledge, termed postpositivism, critical theory, and constructivism, to make sense of everyday experience. We call it listening, reflecting, and diagnosing. (4) These 3 fundamental theories of knowledge highlight different aspects within a world that is more complex, integrated, and changing than any single theory can reveal on its own; they frame what we see and how we act in everyday situations. (5) Moving appropriately between these different theories helps us to see a fuller picture and provides a framework for improving our skills as clinicians, researchers, and learners. (6) Narrative unity offers a way to bring together different kinds of evidence to understand the overall health of patients and of communities; evidence of all kinds provides discrete snapshots of more complex stories in evolution. (7) We need to understand these issues so we can create an agenda for clinical practice, inquiry, and learning appropriate to our discipline. PMID:17003147

  16. Does "electromagnetic pollution" cause illness? An inquiry among Austrian general practitioners.

    PubMed

    Leitgeb, Norbert; Schröttner, Jörg; Böhm, Michael

    2005-05-01

    More and more self-declared electromagnetic hypersensitive patients are entering physicians' practices seeking help. To assess the prevalence of cases and the opinion of Austrian physicians regarding the potential health-relevance of environmental electromagnetic fields ("electromagnetic pollution"), a statistical investigation among general practitioners was undertaken, with surprising results. Only one-third report on never having been asked about the health impact of electromagnetic pollution by patients. An overwhelming percentage of general practitioners (up to 96%) to some degree, or totally, believe in a health-relevant role of environmental electromagnetic fields, and only 39% have never associated health symptoms with "electromagnetic pollution". Two-thirds are consulted occasionally or even frequently by self-declared electromagnetic hypersensitive patients. However, sound information seems to be lacking. Knowledge on existing electromagnetic exposure limits and on environmental field levels in relation to them is poor. It is remarkable that authorities play a marginal role in informing physicians. Only 4% mention having received information on "electromagnetic pollution" from such a source. It is rather remarkable that there is such a widespread contradiction between physicians' opinions and established national and international health risk assessment. With respect to the frequency with which doctors are confronted with this issue, the results demonstrate an urgent need for action. PMID:15999632

  17. Venereology at the Polyclinic: Postgraduate Medical Education Among General Practitioners in England, 1899–1914

    PubMed Central

    Hanley, Anne

    2015-01-01

    In 1899 the British Medical Journal enthusiastically announced that a new postgraduate teaching college was to open in London. The aim of the Medical Graduates’ College and Polyclinic (MGC) was to provide continuing education to general practitioners. It drew upon emerging specialisms and in so doing built upon the generalist training received at an undergraduate level. Courses were intended to refresh knowledge and to introduce general practitioners to new knowledge claims and clinical practices. The establishment of postgraduate institutions such as the MGC marked an important stage in the development of medical education in England. Yet these institutions, and the emergence of postgraduate medical education more broadly, have been largely overlooked by historians. Moreover the history of venereological training among medical undergraduates and postgraduates alike has been overlooked. The study of such special subjects characterised postgraduate study. This article examines the dissemination of venereological knowledge among subscribers to MGC as an important case study for the development of institutionalised postgraduate medical education in England at the turn of the twentieth century. PMID:25766540

  18. The impact of dementia on the use of general practitioners among the elderly in Norway

    PubMed Central

    Ydstebø, A.E.; Bergh, S.; Selbæk, G.; Benth, J. Šaltytė; Lurås, H.; Vossius, C.

    2015-01-01

    Objective. To assess the use of general practitioners (GPs), in elderly home-dwelling persons in Norway and explore the impact of cognitive decline, age, and living situation. Design. Prospective longitudinal study. Setting. Data were collected from municipalities in four counties in Norway in the period from January 2009 to August 2012. Subjects. Home-dwelling persons 70 years of age or older, receiving in-home care. Main outcome measures. Use of GPs over a period of 18 months related to cognitive state, functional status, neuropsychiatric symptoms, and demographics. Results. A total of 599 persons were included. The mean annual number of consultations per participant was 5.6 (SD = 5.4). People with moderate to severe dementia had fewer consultations per year compared with those with mild or no dementia (3.7 versus 5.8 per year, p = 0.004). In the multivariate model higher age predicted fewer consultations while affective neuropsychiatric symptoms were associated with an increase in frequency of consultations. The most frequent reason to consult a GP was cardiovascular diseases (36.8% of all consultations), followed by musculoskeletal complaints (12.1%) and psychiatric diagnoses (8.7%). Conclusion. Our study shows that the home-dwelling elderly with moderate to severe dementia in Norway consult their GP less often than persons with mild or no dementia. This could indicate a need for better interaction between the municipal care and social services and the general practitioners. PMID:26294095

  19. Why general practitioners and consultants change their clinical practice: a critical incident study.

    PubMed Central

    Allery, L. A.; Owen, P. A.; Robling, M. R.

    1997-01-01

    OBJECTIVE: To describe the complete range of factors which doctors recognise as changing their clinical practice and provide a measure of how often education is involved in change. DESIGN: Interviews using the critical incident technique. SETTING: Primary and secondary care. SUBJECTS: Random sample of 50 general practitioners and 50 consultants. MAIN OUTCOME MEASURES: Categories of reasons for change in clinical practice. RESULTS: Doctors described 361 changes in clinical practice, with an average of 3.0 reasons per change. The three most frequently mentioned reasons were organisational factors, education, and contact with professionals, together accounting for 47.9% of the total number of reasons for change. Education accounted for one sixth (16.9%) of the reasons for change and was involved in one third (37.1%) of the changes. Education was seldom mentioned as a reason for change in referral practice but was more often mentioned in management and prescribing changes. Consultants were influenced by medical journals and scientific conferences, while general practitioners were more influenced by medical newspapers and postgraduate meetings. CONCLUSIONS: Education is involved in about a third of changes in clinical practice. The wide range of other factors affecting changes in practice need to be taken into account in providing and evaluating education. The role of education in the numerous changes in clinical practice that currently have no educational component should also be considered. PMID:9093100

  20. Continuity of healthcare for headache patients: a problem of communication between headache specialists and general practitioners.

    PubMed

    La Pegna, Giovanni Battista; Brighina, Filippo; Saporito, Vincenzo; Aloisio, Antonina; Morreale, Calgero; D'Agati, Alfio

    2005-09-01

    The continuous care of headache patients, from headache centres to general practice, is a managerial problem that is still unsolved in Italy. In fact, if on the one hand patients do not usually go to headache centres because of poor information, on the other hand, if they do, they do not find their general practitioner (GP) sufficiently prepared to continue the management. In Sicily we have formed a dense network of headache centres that we will try to link on the Internet to deal with the problem of poor patients information and poor specialist consultation. We also have faced the problem of the continuous care, trying to overcome "the difficulties of communication between specialists, GPs and patients" and "the difficulties of GPs in diagnostic work", by simple instruments like the Italian version of ID-Migraine, a simple three-item questionnaire. PMID:16362696

  1. [Vocational training for general practitioners-comparing Switzerland with other European countries].

    PubMed

    Djalali, Sima; Frei, Anja; Rosemann, Thomas; Tandjung, Ryan

    2013-03-13

    As many other European countries, Switzerland is facing a shortage of young general practitioners (GPs). This review summarizes and compares the different characteristics of vocational training programs in Switzerland and other European countries concerning their duration, learning objectives and setting. Countries with a GP-centered healthcare system offer highly structured training programs tailored to the everyday work in general practice, whereas vocational training programs in countries where patients have unlimited access to specialized care are less differentiated. Today, the vocational training of Swiss GPs lacks topically focused learning objectives and seems to be rather underdeveloped when compared to foreign programs. Particularly with regard to the duration and funding of practice-based training periods spent in GP surgeries, Switzerland still has a great development potential. PMID:23485752

  2. General practitioners' perceptions of private health screening: too much paper, anxiety, and reassurance.

    PubMed Central

    Paynton, D; Dunleavey, J; Smith, H

    1998-01-01

    There is no evidence to support the practice of screening consultations that include general physical examinations and batteries of tests; however, many patients may choose, or be sent by their employers, to have private full health screening (FHS). General practitioners (GPs) are routinely sent the results of these screening examinations and are expected to deal with any subsequent care required. GPs recognize some positive aspects of FHS, but in our survey there was a groundswell of dislike for these examinations because of uncertainty about patient benefit (raised anxiety or false assurance) and a potential to irritate the GP. The implications for workload were minimal but resented. GPs would welcome a precise summary of significant findings and for the screening doctor to take greater responsibility for follow-up. PMID:9747551

  3. A survey of Down's syndrome under general practitioner care in Scotland

    PubMed Central

    Murdoch, J. C.

    1982-01-01

    A survey of all general practitioners in Scotland has revealed details of 1,251 individuals with Down's syndrome being cared for by their family doctor; 1,150 were living at home. Eighty-two per cent of doctors responded to the questionnaire. High prevalence rates have been noted in the Western Isles and in Shetland. The survey confirms reports of a lowering of maternal and paternal age in Down's syndrome; 72 per cent of the mothers and 56 per cent of the fathers of Down's syndrome children born since 1971 were under 35 years at the time of birth. The survey also revealed an increase in the number of Down's people living with either one parent or relatives with increasing age. It is hoped that further research will be carried out into the problems facing Down's individuals and their families through the medium of general practice. ImagesFigure 1.Figure 2.Figure 3. PMID:6214625

  4. General practitioners' knowledge of functional and social factors in patients with rheumatoid arthritis.

    PubMed

    Memel, David S.; Kirwan, John R.

    1999-11-01

    The care of people with chronic physical disease is an important part of the work of general practitioners (GPs). Knowledge of social and functional factors, and good teamwork with other health and social care professionals, are necessary to provide high quality general practice care. This study investigated functional disability, social situation and the involvement of health and social care professionals in patients with rheumatoid arthritis, and their GPs' knowledge of these factors. Questionnaires were sent to all patients aged 15-74 with rheumatoid arthritis in two general practices, and similar questionnaires were given to their GPs. Functional disability was assessed using the health assessment questionnaire (HAQ), on a scale of 0-3. The GP consultation rate for patients with rheumatoid arthritis in the previous year was 6.9 compared to 3.7 for all patients in the practices, and increased with increasing disability. Sixty-five per cent of patients had a moderate (HAQ > 1 but 2) disabiltiy. There was an average difference between patient and GP scores for functional disability on the HAQ of 0.49 (95% confidence interval 0.36-0.62), with GPs scoring lower than patients and the difference increased with increasing disability. Seventy-one per cent of patients had seen a rheumatologist or orthopaedic surgeon in the previous year, but there was little involvement by other members of the primary health care team (PHCT). General practitioners had good levels of knowledge of their patients' employment status and who they lived with, but poor knowledge of most of the welfare benefits they were receiving, and of other health and social care professionals involved. It is concluded that GPs see their patients with rheumatoid arthritis frequently, but are often lacking the knowledge about their patients to provide high quality care. They often only know about aspects of their patients' care in which they are directly involved. Ways are suggested

  5. Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study

    PubMed Central

    Montgomery, Anthony J; McGee, Hannah M; Shannon, William; Donohoe, John

    2006-01-01

    Background To understand why treatment referral rates for ESRF are lower in Ireland than in other European countries, an investigation of factors influencing general practitioner referral of patients developing ESRF was conducted. Method Randomly selected general practitioners (N = 51) were interviewed using 32 standardised written patient scenarios to elicit referral strategies. Main outcome measures: General practitioner referral levels and thresholds for patients developing end-stage renal disease; referral routes (nephrologist vs other physicians); influence of patient age, marital status and co-morbidity on referral. Results Referral levels varied widely with the full range of cases (0–32; median = 15) referred by different doctors after consideration of first laboratory results. Less than half (44%) of cases were referred to a nephrologist. Patient age (40 vs 70 years), marital status, co-morbidity (none vs rheumatoid arthritis) and general practitioner prior specialist renal training (yes or no) did not influence referral rates. Many patients were not referred to a specialist at creatinine levels of 129 μmol/l (47% not referred) or 250 μmol/l (45%). While all patients were referred at higher levels (350 and 480 μmol/l), referral to a nephrologist decreased in likelihood as scenarios became more complex; 28% at 129 μmol/l creatinine; 28% at 250 μmol/l; 18% at 350 μmol/l and 14% at 480 μmol/l. Referral levels and routes were not influenced by general practitioner age, sex or practice location. Most general practitioners had little current contact with chronic renal patients (mean number in practice = 0.7, s.d. = 1.3). Conclusion The very divergent management patterns identified highlight the need for guidance to general practitioners on appropriate management of this serious condition. PMID:16970805

  6. [Training needs and role of general practitioners for preventing measures and medical surveillance of ex-exposed to occupational carcinogens].

    PubMed

    Iavicoli, S; Della Porta, G; Natali, E; Persechino, B; Petyx, M; Rondinone, B; Pira, E

    2005-01-01

    The study was aimed at investigating in a sample of general medicine practitioners the level of epidemiologic and law knowledge as well as the degree of sensitivity to the topic of subjects formerly affected by occupational cancer. From the research, carried out on a sample of 745 practitioners from two northern Italy highly industrialized regions, come out the need for training and information on the problems associated with identification and management of subjects formerly exposed to professional cancer. PMID:16240577

  7. Queensland general practitioners' applications of the "mature minor" principle: the role of patient age and gender.

    PubMed

    Teoludzka, Anna; Bartholomew, Terence P

    2010-12-01

    Most Australian jurisdictions do not have legislation that stipulates an age by which a minor can make their own medical treatment decisions. Instead, they rely on Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112, an English common law decision that recommends individual assessments of "maturity". This study explores how medical practitioners in the State of Queensland understand and apply this legal authority when faced with a young person wishing to make a contentious medical treatment decision. Almost 200 doctors made decisions about a hypothetical patient's competence and confidentiality, and detailed their reasoning in an open-ended format. The data indicate that the vagaries of existing legal criteria allow for a range of philosophical perspectives and idiosyncratic heuristics to play a role in assessment practices, and that particular combinations of patient age and gender made these cognitive shortcuts more likely to occur. A notable proportion of such processes are not consistent with legal guidelines, and this has implications for general practitioners' vulnerability to litigation as well as young patients' treatment trajectories. PMID:21355438

  8. 39 CFR 3002.16 - Office of Inspector General. [Reserved

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Office of Inspector General. 3002.16 Section 3002.16 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL ORGANIZATION §§ 3002.16 Office of Inspector General....

  9. 39 CFR 3002.16 - Office of Inspector General. [Reserved

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 39 Postal Service 1 2011-07-01 2011-07-01 false Office of Inspector General. 3002.16 Section 3002.16 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL ORGANIZATION §§ 3002.16 Office of Inspector General....

  10. General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care

    PubMed Central

    2011-01-01

    Background Primary health care specialists have a key role in the management of obesity. Through understanding how they conceive the encounter with patients with obesity, treatment may be improved. The aim of this study was thus to explore general practitioners' and district nurses' conceptions of encountering patients with obesity in primary health care. Method Data were collected through semi-structured interviews, and analysed using a phenomenographic approach. The participants were 10 general practitioners (6 women, 4 men) and 10 district nurses (7 women, 3 men) from 19 primary health care centres within a well-defined area of Sweden. Results Five descriptive categories were identified: Adequate primary health care, Promoting lifestyle change, Need for competency, Adherence to new habits and Understanding patient attitudes. All participants, independent of gender and profession, were represented in the descriptive categories. Some profession and gender differences were, however, found in the underlying conceptions. The general staff view was that obesity had to be prioritised. However, there was also the contradictory view that obesity is not a disease and therefore not the responsibility of primary health care. Despite this, staff conceived it as important that patients were met with respect and that individual solutions were provided which could be adhered to step-by-step by the patient. Patient attitudes, such as motivation to change, evasive behaviour, too much trust in care and lack of self-confidence, were, however, conceived as major barriers to a fruitful encounter. Conclusions Findings from this study indicate that there is a need for development and organisation of weight management in primary health care. Raising awareness of staff's negative views of patient attitudes is important since it is likely that it affects the patient-staff relationship and staff's treatment efforts. More research is also needed on gender and profession differences in this

  11. [Burnout of general practitioners in Belgium: societal consequences and paths to solutions].

    PubMed

    Kacenelenbogen, N; Offermans, A M; Roland, M

    2011-09-01

    The definition of burn-out the most often cited and proposed by Maslach and Jackson, clarifies the three cardinal symptoms affecting doctors, namely, emotional exhaustion, with depersonalization of their patients and reduction of the feeling of personal accomplishment. The causes of this phenomenon are relatively well-known: individual psychological factors, stressful factors intrinsic to the medical practice and finally extrinsic factors related to the professional environment and its organization. The purpose of this review is to estimate the prevalence of burnout within the population of Belgian family physicians and to understand both individual and societal consequences. About the method. This is a literature review using databases Medline, Cochrane Library, and the American Psychological Association from 2000 to 2011 with the keywords: primary health care, family practice, burnout, emotional exhaustion, psychological stressors, distress, fatigue, depersonalization, substance and alcohol abuse, depression, well-being, quality of life, job satisfaction, professional efficiency, patient care, physician-patient relations, medical errors, quality of health care, pharmaceutical/health expenditure/statistics-numerical data, obstacles to prevention, health system assessment, medical demography. Selecting of the most relevant articles through the reading of abstracts and then full text reading of 49 selected articles. In conclusion, the exact prevalence of burn-out amongst Belgian general practitioners is not known. From some works, it is estimated that about half of them would be achieved at least in terms of emotional exhaustion. The symptoms related to burn-out are potentially serious: ea depression, alcohol and tobacco abuse and cardiovascular complications. There are also arguments demonstrating the fact that this disorder amongst general practitioners influences negatively the quality of care, their cost, but also medical demography of primary care with as a

  12. The application of foraging theory to the information searching behaviour of general practitioners

    PubMed Central

    2011-01-01

    Background General Practitioners (GPs) employ strategies to identify and retrieve medical evidence for clinical decision making which take workload and time constraints into account. Optimal Foraging Theory (OFT) initially developed to study animal foraging for food is used to explore the information searching behaviour of General Practitioners. This study is the first to apply foraging theory within this context. Study objectives were: 1. To identify the sequence and steps deployed in identifiying and retrieving evidence for clinical decision making. 2. To utilise Optimal Foraging Theory to assess the effectiveness and efficiency of General Practitioner information searching. Methods GPs from the Wellington region of New Zealand were asked to document in a pre-formatted logbook the steps and outcomes of an information search linked to their clinical decision making, and fill in a questionnaire about their personal, practice and information-searching backgrounds. Results A total of 115/155 eligible GPs returned a background questionnaire, and 71 completed their information search logbook. GPs spent an average of 17.7 minutes addressing their search for clinical information. Their preferred information sources were discussions with colleagues (38% of sources) and books (22%). These were the two most profitable information foraging sources (15.9 min and 9.5 min search time per answer, compared to 34.3 minutes in databases). GPs nearly always accessed another source when unsuccessful (95% after 1st source), and frequently when successful (43% after 2nd source). Use of multiple sources accounted for 41% of searches, and increased search success from 70% to 89%. Conclusions By consulting in foraging terms the most 'profitable' sources of information (colleagues, books), rapidly switching sources when unsuccessful, and frequently double checking, GPs achieve an efficient trade-off between maximizing search success and information reliability, and minimizing searching

  13. [Is it quality of life that patients really want? Assessment from a general practitioner's perspective].

    PubMed

    Wilm, Stefan; Leve, Verena; Santos, Sara

    2014-01-01

    The multidimensional, complex construct of 'quality of life' as a patient-reported outcome is used in medicine as a measurable indicator of health and illness. But do we know what we do when we measure 'quality of life'? Can we grasp how the patient with his individual concept of disease really feels when we use instruments that were designed, administered and analysed by professionals? Do we know the meaning of what we have measured? Is it not shortsighted to focus on health-related quality of life? And is it really quality of life that patients actually want? From a general practitioner's perspective, these questions will be asked of three patients. PMID:24780710

  14. [Health risks of long-distance air travel. Role of the general practitioner].

    PubMed

    Bazex, Jacques; Cabanis, Emmanuel Alain

    2010-06-01

    Air transport is seeing an increase in long-distance flights (12-16 hours average flight time), greater seating capacity, and a higher proportion of elderly, and hence more fragile, passengers. The French Academy of Medicine recommends that medical care be reinforced, particularly on long-distance flights, through the following measures: (i) passengers should be informed in advance of potential risks, through a Passenger's Guide, (ii) all future passengers should be encouraged to seek health advice and information from their general practitioner, (iii) flight crew members should receive training as "in-flight medical correspondents", and (iv) airlines and plane designers should reserve a "medical space" on the plane, equipped with appropriate medical materials. PMID:21513137

  15. Types of work stress and implications for the role of general practitioners.

    PubMed

    Spurgeon, P; Barwell, F; Maxwell, R

    1995-08-01

    This study investigated a wide range of job-related characteristics which had the potential of acting as stressors for General Practitioners (GPs). Three hundred and four GPs completed a detailed questionnaire which sought audit information including practice workload factors, coping approaches and attitudinal information including sources of stress and the value of management training. Ten independent factors were identified as underpinning GP stress and using multi-variate analysis, it was shown that each of these factors is predicted by a separate and distinct set of variables. This finding suggests that it is inappropriate to simply talk about GP stress since it is a multi-dimensional concept. This finding has important implications for identifying potentially successful mechanisms of coping and support. PMID:10151090

  16. Validation of the General Practitioner Clinical Research Group 11-item depression scale.

    PubMed

    Gringras, M

    1980-01-01

    In trials performed by the General Practitioner Clinical Research Group two rating scales have been employed extensively to measure depression. One includes some 17 target symptoms whilst the second is a shorter scale of 11 items. Although extensively used, neither scale has been validated against other measures of depression. An attempt was made to validate the 11-item scale, completed by the physician, against the Zung self-rating depression scale and the Wakefield Inventory, both patient-completed scales. Using thirty depressed patients the correlation between the 11-item scale and the Zung was 0.59 and between the 11-item scale and the Wakefield it was 0.5. Surprisingly, although the two scales are patient-completed and purport to measure the same thing, the correlation between the Zung and the Wakefield scales was only 0.69. All the correlations were statistically significant at the 1% level. PMID:7202817

  17. [The Dutch College of General Practitioners practice guideline on 'Sexual problems'].

    PubMed

    de Jong, Jip; Leusink, Peter; Wiersma, Tjerk

    2016-01-01

    The Dutch College of General Practitioners practice guideline on 'Sexual problems' describes the diagnostics and management of common sexual problems. An adequate sexual anamnesis is essential in order to obtain a good picture of the patient's symptoms and of any underlying causes. Additional physical or other medical examination is of limited value. The provision of information and advice are central to the treatment of sexual problems. Attention should be paid to the different aspects of sexual functioning: physical, psychological, relational and sociocultural, and to gender differences. In many cases, management is determined by the causal factor, for instance comorbidity, sexual trauma or relational problems. In other cases, a more specific problem is diagnosed, and management is based on this. PMID:27122071

  18. Psychiatry for the general practitioner: Isaac Ray's Jefferson Lectures, 1871 to 1873.

    PubMed

    Weiss, Kenneth J

    2012-12-01

    In late 19th century, psychiatry developed a seriousness of purpose beyond the mere isolation of people who were insane. Beginning in Europe and spreading to America, medical schools began to prepare students for the identification and natural history of mental illnesses. Among the pioneers in education was Dr Isaac Ray, who delivered a lecture course at Jefferson Medical College between 1871 and 1873. His remarks assumed that general practitioners would encounter patients with a range of behaviors representing both normal variations and actual insanity. Ray also assumed that physicians would be called into legal matters ranging from wills to murders. He endorsed a variety of therapeutic interventions while distancing himself from a famous Philadelphian, Dr Benjamin Rush. PMID:23183367

  19. Improving the skills of established general practitioners: the long-term benefits of group teaching.

    PubMed

    Bowman, F M; Goldberg, D P; Millar, T; Gask, L; McGrath, G

    1992-01-01

    This study set out to determine the long-term benefits of teaching psychiatric interview skills. Nine established general practitioners, eight of whom were also trainers, took part some 18 months after attending a problem-based interviewing course. Interview skills were assessed by rating behaviour during 10-minute videorecorded simulated consultations with role-players, recorded before and after training and at follow-up. The finding of an earlier study that, in terms of the course model, training successfully modified the doctor's behaviour, was largely replicated. In addition, not only were acquired skills maintained but further change took place during the follow-up period, change that can be seen as improvement in terms of the course model. PMID:1538660

  20. Psychological and social problems in HIV infection: interviews with general practitioners in London.

    PubMed

    King, M B

    1989-09-16

    A random sample of 270 general practitioners in London was interviewed to assess current practice and opinions about managing psychological and social problems related to HIV infection. Physicians caring for patients with HIV infection were asked about numbers of patients in their pratice with HIV or AIDS; consultation with third parties such as sexual partners or family; reports to employers and other third parties; terminal care; contact with HIV clinics; testing for HIV infection without consent; and the impact of patients with HIV infection on their practice. All physicians were asked about patients concerned with HIV infection; awareness of other health resources for patients with HIV infection; terminal care; "safer sex" education; confidentiality; interest in AIDS; intravenous drug users as patients; managing homosexual patients; and ethical considerations. King discusses the findings and draws conclusions about primary care of HIV-infected patients in London. PMID:2508884

  1. Perception and attitude of general practitioners regarding generic medicines in Karachi, Pakistan: A questionnaire based study

    PubMed Central

    Jamshed, Shazia Qasim; Ibrahim, Mohamed Izham Mohamed; Hassali, Mohamed Azmi Ahmad; Masood, Imran; Low, Bee Yean; Shafie, Asrul Akmal; Babar, Zaheer-ud-din

    2012-01-01

    Objectives: In developing countries out-of-pocket payments (OOP) are as high as 80% of healthcare spending. Generic medicines can be instrumental in reducing this expenditure. The current study is aimed to explore the knowledge, perception, and attitude of general practitioners towards generic medicines in Karachi, Pakistan. Methods: This exploratory, descriptive study was conducted on a sample of 289 randomly selected general practitioners who were dispensing at their private clinics in Karachi, Pakistan. The questionnaires were distributed and collected by hand. Data was entered to SPSS version 17. Fischer’s exact test was applied to see the association between variables. Results: A total of 206 questionnaires were included in the study. A response rate of 71.3% was achieved. Out of 206 respondents, 139 (67.5%) were male while 67 (32.5%) respondents were female. Close to three quaters of the respondents (n= 148; 71.8%) showed correct knowledge about generic medicines being a ‘copy of the brand name medicines’ and ‘interchangeable with brand name medicines’ (n= 148; 71.8%). In terms of safety, the majority of respondents (n=85; 41.26%) incorrectly understood that the generic medicines are less safe than brand name medicines. The total percentage of correct responses was seen in 53% of the respondents. More than half of the respondents agreed that locally manufactured medicines are of the same effectiveness as brand name medicines (n=114; 55.4%). Male practitioners with practice experience of 11-15 years showed positive perception towards the quality of multinational products. The Majority of respondents believed that their prescribing decision is influenced by medical representatives (n=117; 56.8%). More than three-quarters of the respondents expressed their wish to prescribe low cost medicines in their practice (n=157; 76.2%). More than one third of the respondents expressed their uneasiness to prescribe products from all local manufacturers (n=72; 35

  2. General practitioners and online continuing medical education – which factors influence its use?

    PubMed Central

    Ruf, Daniela; Kriston, Levente; Berner, Michael; Härter, Martin

    2009-01-01

    Introduction: Although several online continuing medical education (CME) offers exist, the utilization of these by physicians is still low. In this study, we aimed to investigate the attitude towards and use of the Internet and online CME in German general practitioners (GPs) and to identify potential starting points to increase the use of online CME. Methods: In June 2006, a standardized 6-page questionnaire with 27 questions on the topic “Internet and online continuing education” was sent to all general practitioners in 6 districts (n=1304) of South Baden and South Württemberg in Germany. Data were analyzed using descriptive statistics, and exploratory regression analyses were performed to identify predictors of online CME usage. Furthermore, selected barriers were investigated in detail. Results: A total of 351 questionnaires were sent back, of which 349 could be included in the analysis (27% response rate). The sample is representative of the population contacted with respect to gender and qualifications. Univariate analyses showed that users of online CME were two years younger than non-users on average. Users spent two hours more on the Internet per week than non-users, and had been using the Internet for one year longer. Finally, users had better Internet skills, more often had previous experiences with online CME, and assessed the effectiveness of online CME to be higher and perceived fewer problems than non-users. Discussion: Measures to implement and increase the use of online CME can be aimed at different levels. The most important starting points are likely to be offering GPs the possibility to gain experience with online CME and improving their attitudes towards online CME. But for some physician populations, e.g. elderly or physicians with less Internet experience, e-learning might be an inferior option in comparison to traditional CME. PMID:19718276

  3. A qualitative investigation of women's perceptions of premenstrual syndrome: implications for general practitioners.

    PubMed Central

    Reilly, J; Kremer, J

    1999-01-01

    BACKGROUND: Many women consult general practitioners each year, seeking treatment for premenstrual syndrome. This qualitative study presents evidence of women's own perceptions of this problem, which may assist in the provision of individualized health care. AIM: To explore women's constructions of premenstrual syndrome using grounded analysis. METHOD: A qualitative, semi-structured interview study carried out in Northern Ireland. Thirteen women were interviewed individually. Thereafter, 33 women participated in group discussions. Five health visitors then commented individually on the findings. RESULTS: Seven themes emerged from the analysis. These themes suggested that women tend to view the menstrual cycle holistically and that premenstrual syndrome is regarded as debilitating by only a small minority of women. Participants indicated an awareness of the intra- and inter-personal variability of menstrual experience. They were ambivalent about menstruation, viewing it as natural but, at the same time, unnatural in terms of day-to-day existence. Talking to other women served two functions, first by providing a yardstick against which to evaluate their own experiences, and secondly by providing support and advice. In contrast, women tended to talk about menstruation only to selected men, mainly partners, primarily in the interests of educating them. Women viewed menstruation as potentially disempowering by virtue of its uncontrollability, and felt that both a positive attitude and the use of a range of remedies were important for women wishing to become empowered with respect to this aspect of their lives. CONCLUSIONS: Women's own constructions of premenstrual syndrome differ markedly from those as presented in medical textbooks and research literature: secondary sources that have significantly impacted upon general practitioners' attitudes towards this condition. The provision of a range of treatment options, including support groups, is suggested, on the basis of

  4. Prevalent Practices of Thyroid Diseases During Pregnancy Among Endocrinologists, Internists and General Practitioners

    PubMed Central

    Azizi, Fereidoun; Mehran, Ladan; Amouzegar, Atieh; Alamdari, Shahram; Subetki, Imam; Saadat, Navid; Moini, Siamak; Sarvghadi, Farzaneh

    2015-01-01

    Background: Maternal thyroid disease in pregnancy is associated with adverse impact on both mother and fetus. Both the American thyroid association and the endocrine society have recently published guidelines for the management of thyroid disease in pregnancy. Objectives: The objective of this survey was to assess and compare the current practices of various East-Asian physicians in the screening and management of thyroid disease in pregnancy. Materials and Methods: Completed survey questionnaires were collected from 112 physicians of six East-Asian countries. The survey was based on clinical case scenarios, asking questions about the clinical practices related to diagnosis and management of thyroid disease during pregnancy. Reponses from 76 endocrinologists and 33 internists and general practitioners (generalists) were analyzed. Results: There were minor differences in treatment preferences for Graves’ disease in pregnancy and tests to monitor antithyroid drugs between endocrinologists and generalists; the major difference being targeted free thyroxin, and also thyroxin, depicted in the upper end of normal range, by the majority of endocrinologist and within the normal range, by generalists. Compared to generalists, endocrinologists perform more targeted screening and are more familiar with its risk factors. Predominantly, endocrinologists increase levothyroxine dose in hypothyroid women, upon confirmation of pregnancy and also indicate full dose in a pregnant woman, diagnosed with overt hypothyroidism, and treat thyroid peroxidase antibody positive or negative pregnant women with thyroid stimulating hormone (2.5 - 5 mU/L), as compared to generalists. Conclusions: There is wide variation in the clinical practices of screening and management of thyroid disorders during pregnancy in East-Asia, with many clinicians, in particular general practitioners, not adhering to clinical practice guidelines, unfortunately. PMID:27274337

  5. Vertical and horizontal aspects of socio-economic inequity in general practitioner contacts in Scotland.

    PubMed

    Sutton, Matthew

    2002-09-01

    Health status varies across socio-economic groups and health status is generally assumed to predict health care needs. Therefore the need for health care varies across socio-economic groups, and studies of equity in the distribution of health care between socio-economic groups must compare levels of utilisation with levels of need. Economic studies of equity in health care generally assume that health care needs can be derived from the current health-health care relationship. They therefore do not consider whether the current health-health care relationship is (vertically) equitable and the focus is restricted to horizontal inequity. This paper proposes a framework for incorporating the implications of vertical inequity for the socio-economic distribution of health care. An alternative to the current health-health care relationship is proposed using a restriction on the health-elasticity of health care. The health-elasticity of general practitioner contacts in Scotland is found to be generally negative, but positive at low levels of health status. Pro-rich estimates of horizontal inequity and vertical inequity are obtained but neither is statistically significant. Further analysis demonstrates that the magnitude of vertical inequity in health care may be larger than horizontal inequity. PMID:12203756

  6. Primary prevention in general practice – views of German general practitioners: a mixed-methods study

    PubMed Central

    2014-01-01

    Background Policy efforts focus on a reorientation of health care systems towards primary prevention. To guide such efforts, we analyzed the role of primary prevention in general practice and general practitioners’ (GPs) attitudes toward primary prevention. Methods Mixed-method study including a cross-sectional survey of all community-based GPs and focus groups in a sample of GPs who collaborated with the Institute of General Practice in Berlin, Germany in 2011. Of 1168 GPs 474 returned the mail survey. Fifteen GPs participated in focus group discussions. Survey and interview guidelines were developed and tested to assess and discuss beliefs, attitudes, and practices regarding primary prevention. Results Most respondents considered primary prevention within their realm of responsibility (70%). Primary prevention, especially physical activity, healthy eating, and smoking cessation, was part of the GPs’ health care recommendations if they thought it was indicated. Still a quarter of survey respondents discussed reduction of alcohol consumption with their patients infrequently even when they thought it was indicated. Similarly 18% claimed that they discuss smoking cessation only sometimes. The focus groups revealed that GPs were concerned about the detrimental effects an uninvited health behavior suggestion could have on patients and were hesitant to take on the role of “health policing”. GPs saw primary prevention as the responsibility of multiple actors in a network of societal and municipal institutions. Conclusions The mixed-method study showed that primary prevention approaches such as lifestyle counseling is not well established in primary care. GPs used a selective approach to offer preventive advice based upon indication. GPs had a strong sense that a universal prevention approach carried the potential to destroy a good patient-physician relationship. Other approaches to public health may be warranted such as a multisectoral approach to population

  7. Medical Information Project; A Study of an Audiovisual Device as a Technique for Continuing Education for General Practitioners. Final Report.

    ERIC Educational Resources Information Center

    Abrahamson, Stephen; And Others

    The unique factor in the Medical Information Project is that working from ground zero, it undertook to design and put into operation a communication system for general medical practitioners using an individualized, programmed, audiovisual medium. The development of this system involved three general phases. Phase I, consisted of: (1) obtaining and…

  8. Reducing Adolescents' Perceived Barriers to Treatment and Increasing Help-Seeking Intentions: Effects of Classroom Presentations by General Practitioners

    ERIC Educational Resources Information Center

    Wilson, Coralie Joy; Deane, Frank P.; Marshall, Kellie L.; Dalley, Andrew

    2008-01-01

    The "Building Bridges to General Practice" (BBGP) program is an outreach initiative. It aims to reduce young peoples' perceived knowledge- and belief-based barriers to engaging in treatment and to increase their behavioral intentions to consult a general medical practitioner (GP) for physical and psychological problems. By increasing intentions,…

  9. Experimenting Clinical Pathways in General Practice: a Focus Group Investigation with Italian General Practitioners

    PubMed Central

    Zannini, Lucia; Cattaneo, Cesarina; Peduzzi, Paolo; Lopiccoli, Silvia; Auxilia, Francesco

    2012-01-01

    Background Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB), Italy, to develop general practitioners’ (GPs) care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs) held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results Four major themes emerged: i) clinical pathways can result in GPs working in a more efficient and effective fashion; ii) they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii) nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv) the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment. Acknowledgments the Authors thank Dr. AP. Cantù and Dr D. Cereda who participated in the two focus groups as observers. PMID:25181354

  10. How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

    PubMed Central

    2013-01-01

    Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. Methods The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. Results One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. Conclusion General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management

  11. The views of general practitioners on community carrier screening for cystic fibrosis.

    PubMed Central

    Boulton, M; Cummings, C; Williamson, R

    1996-01-01

    BACKGROUND: Recent developments in molecular genetics have made it possible to identify carriers of the cystic fibrosis (CF) mutation, regardless of family history, before they have an affected child. Using these techniques, population or 'community' carrier screening can offer informed reproductive choice to individuals and couples who would not otherwise know of their risk of having a CF child. AIM: This study set out to assess the views of general practitioners (GPs) on community carrier screening for CF and to consider the factors that influence their willingness to offer it themselves. METHOD: A self-administered questionnaires was sent to all 616 GPs in four areas of North Thames (West) Region. RESULTS: Two-thirds of respondents indicated that identifying carrier couples to offer genetic counselling before conception was a very important benefit of community carrier screening. Two-thirds felt that general practice was the most appropriate place in which to offer it, and similar proportions that the most appropriate times to do so were when a close relative was diagnosed and when seeking family planning. About half wanted to offer community carrier screening themselves; this was related to experience with CF patients and CF carrier testing, and estimates of the numbers of CF carriers in the practice. CONCLUSIONS: There is considerable support among GPs for community carrier screening for CF in general practice, particularly in the context of family planning services. Knowledge and experience of CF increase GPs' willingness to offer it themselves. PMID:8762747

  12. Development of a questionnaire to measure patients' satisfaction with general practitioners' services.

    PubMed Central

    Grogan, S; Conner, M; Willits, D; Norman, P

    1995-01-01

    BACKGROUND. It is now a requirement that patients' satisfaction with the services obtained from their general practitioner should be surveyed. AIM. The aim of the study was to produce a reliable and valid multidimensional patient satisfaction questionnaire that could be used in general practice. METHOD. Items were originally derived from patients' responses to open-ended questions. The resulting 148-item Likert-scale questionnaire was completed by 1193 patients. General satisfaction items were removed from the set, and responses to remaining items underwent factor analysis. Subscales were produced from items representing each factor. Reliability and validity of each subscale were examined. RESULTS. Five subscales with a total of 40 items resulted from the factor analysis: doctors, access, nurses, appointments and facilities. Each subscale was internally reliable (Cronbach's alpha coefficient between 0.73 and 0.95), and initial tests of validity suggested that all subscales were valid. CONCLUSION. The study has resulted in a 40-item scale that has been found to be reliable and valid after initial tests. Further work to test the reliability and validity of the final version of the patient satisfaction questionnaire is described. PMID:7492421

  13. The prevalence of proctological symptoms amongst patients who see general practitioners in France

    PubMed Central

    Benabderrahmane, Mustapha; Pospait, Dan; Philip, Julie; Laouénan, Cédric

    2014-01-01

    Background Patients do not often discuss anal symptoms, resulting in late diagnosis of proctological disorders and impacting health. Poor epidemiological knowledge is a contributing factor to this, which can be a significant problem in general medicine. Authors evaluated the role of family doctors in proctological disorders by assessing how many of these are spontaneously diagnosed and how many are diagnosed after questioning the patient. Methods Thirty-nine general practitioners completed a targeted questionnaire to assess all patients seen prospectively over 2.5 days of consultations. Results A total of 1079 questionnaires were completed, 621 (58%) for females and 458 (42%) for males with a median age of 54. Twenty-two patients (2%) were seen primarily for anal symptoms. Following questioning, an anal symptom was found in 153 patients (14%). Symptoms reported were: bleeding (32%), pain (31%), pruritus ani (22%), swelling (22%), oozing (14%), and anal discharge (14%). Physicians’ diagnoses were: haemorrhoids, anal fissure, anal discharge, dermatology disease, and functional disorder. In 35% of patients, questioning alone was used to make these diagnoses. Anal incontinence was the only factor associated with referral to a specialist (OR = 5; 95% CI: 1.4–17.8). Conclusion The role of proctology in the general population appears to be significant. In five out of six cases, patients conceal anal symptoms. The high proportion of unexamined patients with anal symptoms is probably multifactorial. Further studies are needed to identify these and put in place the improvement of diagnosis and treatment of anal disorder. PMID:24702041

  14. The ability of trainee general practitioners to identify psychological distress among their patients.

    PubMed

    Goldberg, D P; Jenkins, L; Millar, T; Faragher, E B

    1993-02-01

    It is argued that a general practitioner's ability to make accurate ratings of psychological distress is partly determined by the rate at which patients emit cues that are indicative of such distress. This study addresses the behaviours of doctors which influence the rates at which patients emit such cues. Consultations were videotaped involving six General Practice Vocational Trainees, three of them poor, and three of them able identifiers of emotional illness. Consultations were selected so that each trainee was rated interviewing 4 patients with low GHQ scores, and 4 patients with high scores. Behaviours are described which lead to increased cue emission and which are also practised more frequently by able identifiers, while other behaviours reduce cue emission and are practised less frequently by them. Another set of behaviours is no more frequent among the able identifiers, but when practised by able identifiers is associated with increased cue emission by the patients, and when practised by poor identifiers with unaltered or decreased cue emission. Interviews that are 'patient-led' are associated with increased rates of cue emission, while those that are 'doctor-led' are associated with lower rates. The implications of these findings for training doctors working in general medical settings are discussed. PMID:8475207

  15. Reasons for variations in the use of open access gastroscopy by general practitioners.

    PubMed

    Hungin, A P; Bramble, M G; O'Callaghan, H

    1995-02-01

    This study aimed to investigate the wide variation between general practitioners (GPs) in their use of open access gastroscopy by assessing (i) their partnership share, workload, and the aggregated practice request rate; (ii) correlations with their professional and practice characteristics; and (iii) a comparison with referral rates to medicine, surgery, and all specialties. All 145 GPs and their practice managers were sent a questionnaire and hospital held data on all requests for open access gastroscopy over one year were reviewed. During the year, the 145 GPs made 1210 requests for open access gastroscopy, varying from one to 44 per GP. There were 987,880 practice consultations altogether, an average of 22,451 per practice or 7127 per whole time practitioner. Requests for open access gastroscopy formed 2.4% of all referrals, an average of one per 1000 consultations, or eight per GP. Of a total of 49,123 referrals to all specialties (371 per GP) 4218 (8.5%) were to medicine, and 6444 to surgery (13.1%). The following factors did not correlate with requests: vocational training, a concurrent hospital post, length of service, or receipt of the deprivation allowance by the practice. When the open access gastroscopy referral rate was aggregated for each practice the variation between practices was narrowed to essentially twofold. Requests for open access gastroscopy form a small proportion of all referrals (2.4%). Aggregated practice request rates are relatively uniform compared with the wide variation between individual GPs, suggesting a disproportionate gastroenterology workload between partners. The open access gastroscopy service does not seem to be subject to misuse from most GPs if a variation in practice usage is used as a measure. PMID:7883213

  16. Consultations with general practitioners on patient safety measures based on routinely collected data in primary care

    PubMed Central

    Tsang, Carmen; Majeed, Azeem; Aylin, Paul

    2012-01-01

    Objectives To gauge the opinions of doctors working, or interested, in general practice on monitoring patient safety using administrative data. The findings will inform the development of routinely collected data-based patient safety indicators in general practice and elsewhere in primary care. Design Non-systematic participant recruitment, using personal contacts and colleagues’ recommendations. Setting Face-to-face consultations at participants’ places of work, between June 2010 and February 2011. Participants Four general practitioners (GPs) and a final year medical student. The four clinicians had between eight to 34 years of clinical practice experience, and held non-clinical positions in addition to their clinical roles. Main outcome measures Views on safety issues and improvement priorities, measurement methods, uses of administrative data, role of administrative data in patient safety and experiences of quality and safety initiatives. Results Medication and communication were the most commonly identified areas of patient safety concern. Perceived safety barriers included incident-reporting reluctance, inadequate medical education and low computer competency. Data access, financial constraints, policy changes and technology handicaps posed challenges to data use. Suggested safety improvements included better communication between providers and local partnerships between GPs. Conclusions The views of GPs and other primary care staff are pivotal to decisions on the future of English primary care and the health system. Broad views of general practice safety issues were shown, with possible reasons for patient harm and quality and safety improvement obstacles. There was general consensus on areas requiring urgent attention and strategies to enhance data use for safety monitoring. PMID:22461969

  17. Sleep problems in general practice: a national survey of assessment and treatment routines of general practitioners in Norway.

    PubMed

    Sivertsen, Børge; Nordhus, Inger H; Bjorvatn, Bjørn; Pallesen, Ståle

    2010-03-01

    The aim of the current national survey of all general practitioners (GPs) practising in Norway was to explore assessment, treatment practice and perceived efficacy of treatment of sleep problems in general practice. A short questionnaire, including self-report measures of the frequency and routines of treatment and assessment of sleep problems, was sent to all 4049 GPs in Norway, of whom 1465 (36.7%) provided valid responses. The prevalence of sleep problems among patients in general practice was estimated to be 11.2%, of which almost two-thirds were believed to be caused by a medical condition. Anamnestic information and blood tests were the most common assessment of sleep problems, whereas GPs rarely referred patients to all-night polysomnographic recording. Sleep hygiene advices were the most commonly used treatment strategy, whereas hypnotics were believed to have the best short-term efficacy. Antidepressives were considered to be the best option for long-term management of sleep problems. About one-third of the patients were prescribed benzodiazepines or 'Z-drugs' for more than 6 months. This study demonstrates that sleep problems are recognized by GPs, but despite evidence that non-pharmacological treatment is superior in the long-term management of insomnia, the current study shows that hypnotics are still considered by GPs to be the most successful treatment. PMID:19732316

  18. Adoption and Use of Digital Technologies among General Dental Practitioners in the Netherlands

    PubMed Central

    van der Zande, Marieke M.; Gorter, Ronald C.; Aartman, Irene H. A.; Wismeijer, Daniel

    2015-01-01

    Objectives To investigate (1) the degree of digital technology adoption among general dental practitioners, and to assess (2) which personal and practice factors are associated with technology use. Methods A questionnaire was distributed among a stratified sample of 1000 general dental practitioners in the Netherlands, to measure the use of fifteen administrative, communicative, clinical and diagnostic technologies, as well as personal factors and dental practice characteristics. Results The response rate was 31.3%; 65.1% replied to the questionnaire on paper and 34.9% online. Each specific digital technology was used by between 93.2% and 6.8% of the dentists. Administrative technologies were generally used by more dentists than clinical technologies. Dentists had adopted an average number of 6.3±2.3 technologies. 22.5% were low technology users (0 to 4 technologies), 46.2% were intermediate technology users (5 to 7 technologies) and 31.3% were high technology users (8 to12 technologies). High technology users more frequently had a specialization (p<0.001), were younger on average (p=0.024), and worked more hours per week (p=0.003) than low technology users, and invested more hours per year in professional activities (p=0.026) than intermediate technology users. High technology use was also more common for dentists working in practices with a higher average number of patients per year (p<0.001), with more dentists working in the practice (p<0.001) and with more staff (p<0.001). Conclusion With few exceptions, all dentists use some or a substantial number of digital technologies. Technology use is associated with various patterns of person-specific factors, and is higher when working in larger dental practices. The findings provide insight into the current state of digital technology adoption in dental practices. Further exploration why some dentists are more reluctant to adopt technologies than others is valuable for the dental profession’s agility in adjusting

  19. Survey based investigation into general practitioner referral patterns for spinal manipulative therapy

    PubMed Central

    2013-01-01

    Background In the UK Physiotherapy, Chiropractic and Osteopathy are all statutory regulated professions. Though guidelines have supported the use of Spinal Manipulative Therapy (SMT) for low back pain (LBP), General Practitioners (GP) referral patterns to the 3 registered professions that perform SMT are generally unknown. Method A short questionnaire was designed and piloted. Demographic information, patient referral to SMT and the GPs own personal utilisation of SMT were obtained. 385 GP’s were contacted representing approximately 20% of the GP’s in Wales Autumn 2007. Results and discussion 182 (50.8%) completed questionnaires were returned. Profile characteristics: 2/3 of respondents were male, 79% were 40 years old or older (statistically reflective of the total population of GPs in Wales at that time) and 62% had 20 years or less in practise. Personal use of SMT by GP’s: 48 respondents had sought SMT treatment and a further 56% of those that had not previously sought SMT indicated that they would consider doing so. Patient referral to SMT by GP’s: 131 respondents (72%) had referred patients to SMT and of those who had not a further 13% would consider referring. The general referral pattern and utilisation pattern was Physiotherapy: Osteopathy: Chiropractic. 21% who had never referred patients neither had, nor would consider it for themselves. A small subgroup appeared to manage personal choice differently from patient referral: 5 individuals who had not referred patients either had or would consider it for themselves and 23 of the group that would refer patients neither had nor would seek it for themselves. Conclusions This limited investigation indicates that GP’s do practise consistently with guidelines on back pain and utilise SMT as a care option. Although the main option for referral was physiotherapy, slightly over 40% of respondents who expressed a preference would refer to either osteopathy or chiropractic, or both in preference to

  20. 39 CFR 3002.13 - Office of the General Counsel.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Counsel and is directly responsible for the counseling and advisory services set forth in 39 CFR 3000.735... 39 Postal Service 1 2010-07-01 2010-07-01 false Office of the General Counsel. 3002.13 Section 3002.13 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL ORGANIZATION § 3002.13 Office of...

  1. 39 CFR 3002.13 - Office of the General Counsel.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Counsel and is directly responsible for the counseling and advisory services set forth in 39 CFR 3000.735... 39 Postal Service 1 2011-07-01 2011-07-01 false Office of the General Counsel. 3002.13 Section 3002.13 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL ORGANIZATION § 3002.13 Office of...

  2. 39 CFR 3002.13 - Office of the General Counsel.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Counsel and is directly responsible for the counseling and advisory services set forth in 39 CFR 3000.735... 39 Postal Service 1 2012-07-01 2012-07-01 false Office of the General Counsel. 3002.13 Section 3002.13 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL ORGANIZATION § 3002.13 Office of...

  3. [Summary of the Dutch College of General Practitioners' practice guideline 'Delirium in elderly people'].

    PubMed

    van der Weele, G M; Olde Rikkert, M G M; Eizenga, W H; Assendelft, W J J

    2003-05-17

    The Dutch College of General Practitioners' practice guideline 'Delirium in elderly people' contains a number of key messages. These are: Consider the diagnosis of delirium in the case of changes in consciousness and attention, incoherent thinking or disorientation, if this picture developed over a short period of time (hours to days) and if the symptoms vary over the 24-hour period. Delirium is provoked by one or more somatic disorders; investigation and treatment of these disorders is an essential part of managing delirium. It is often difficult to distinguish delirium from dementia and depression. Although delirium is generally reversible, the prognosis in the elderly is relatively poor. If delirium is accompanied by fear or agitation, haloperidol is the drug of first choice, but in delirium induced by alcohol withdrawal or benzodiazepine withdrawal, a short-acting benzodiazepine such as lorazepam or oxazepam is indicated. Part of the treatment, but also prevention of delirium is focused on inducing factors that can provoke a delirium, such as medication with an anticholinergic effect, polypharmacy, inadequate nutrition, dehydration, sleep deprivation, immobility and sensory handicaps. PMID:12784530

  4. 2. July 1988 GENERAL VIEW, EAST END OF OFFICE, WITH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. July 1988 GENERAL VIEW, EAST END OF OFFICE, WITH INTERPRETIVE LOG AND PROTECTION ASSISTANT'S HOUSE (LEFT BACKGROUND) - Glacier Ranger Station, Washington State Route 542, Glacier, Whatcom County, WA

  5. 19. GENERAL VIEW, LOOKING SOUTHWEST TO NORTHEAST, SHOWING ENCLOSED OFFICE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    19. GENERAL VIEW, LOOKING SOUTHWEST TO NORTHEAST, SHOWING ENCLOSED OFFICE UNITS FLANKING OVERHEAD PORT AT NORTHEAST END OF BUILDING - Oakland Army Base, Transit Shed, East of Dunkirk Street & South of Burma Road, Oakland, Alameda County, CA

  6. 41 CFR 105-53.131 - Office of Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... functions and established an Office of Inspector General in 11 major domestic departments and agencies... United States Attorneys on all matters relating to the detection and prevention of fraud and abuse....

  7. 3. GENERAL VIEW LOOKING NORTHWEST; CITY OF CHICAGO CENTRAL OFFICE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. GENERAL VIEW LOOKING NORTHWEST; CITY OF CHICAGO CENTRAL OFFICE BUILDING (1913) TO THE RIGHT - Chicago River Bascule Bridge, Clarke Street, Spanning Chicago River at Clarke Street, Chicago, Cook County, IL

  8. 27. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    27. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-151. MOBILIZATION BUILDINGS; STANDARD WINDOW DETAILS; TYPES SCHEDULES & DETAILS. - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  9. 33. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    33. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-190. MOBILIZATION BUILDINGS; STANDARD DETAILS; SMOKE PIPE & FLUE DETAILS. - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  10. 30. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    30. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-185. MOBILIZATION BUILDINGS; MISCELLANEOUS DETAILS; INTERIOR & EXTERIOR DETAILS. - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  11. 35. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    35. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-196. MOBILIZATION BUILDINGS; STANDARD HEATING DETAILS; WARM AIR HEATING; SMOKE PIPES & VENT HOODS FOR RANGES. - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  12. 31. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    31. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-186. MOBILIZATION BUILDINGS; MISCELLANEOUS DETAILS; INTERIOR & EXTERIOR DETAILS. - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  13. 24. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    24. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-121. MOBILIZATION BUILDINGS; 29'-6' WIDE BLDG. - BEARING PARTITIONS; TWO STORY; STRUCTURAL. - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  14. 23. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    23. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-120. MOBILIZATION BUILDINGS; 29'-6' WIDE BLDG. - BEARING PARTITIONS; TWO STORY; ARCHITECTURAL; TYPICAL PLAN, ELEVATION & SECTIONS. - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  15. Dutch general practitioners' referral of children to specialists: a comparison between 1987 and 2001

    PubMed Central

    Otters, Hanneke; van der Wouden, Johannes C; Schellevis, François G; van Suijlekom-Smit, Lisette W A; Koes, Bart W

    2004-01-01

    Background: Although children are frequently referred to specialists, detailed information on referral patterns of them is scarce. Even less information is available on how referral patterns evolve over time. Aims: To examine current referral patterns for children aged 0–17 years and compare these with referral patterns reported for 1987. Design of study: Data were analysed from two national cross-sectional surveys, performed in 2001 (91 general practices) and in 1987 (103 general practices). Setting: Dutch general practice. Method: All new referrals to specialists were assessed by age, sex, International Classification of Primary Care (ICPC) category, specialty referred to, and specific episodes of disease. Referral measures were quantified as new referrals per 1000 person–years and per 100 new episodes, a measure of likelihood of a young person with a specific diagnosis to be referred. Rates in 2001 were compared with those from 1987. Results: Referral rates decreased from 138 per 1000 person–years in 1987, to 84 per 1000 person–years in 2001. Age differences in referral rates were similar in both surveys. Compared with 1987, more boys than girls were referred to specialists. The overall likelihood of a condition being referred decreased from 8.0 per 100 episodes in 1987 to 6.5 per 100 episodes in 2001. Reasons for referral had also changed by 2001, particularly for the ear, nose, and throat (ENT) specialist and ophthalmologist. Moreover, referral rates for acute otitis media, refractive disorders, and vision problems decreased two- to fourfold in 2001. Conclusion: Presently, Dutch general practitioners tend to manage more health problems themselves and refer less young people to specialists. PMID:15527611

  16. Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) sentinel network: a cohort profile

    PubMed Central

    Correa, Ana; Hinton, William; McGovern, Andrew; van Vlymen, Jeremy; Yonova, Ivelina; Jones, Simon; de Lusignan, Simon

    2016-01-01

    Purpose The Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) is one of the longest established primary care sentinel networks. In 2015, it established a new data and analysis hub at the University of Surrey. This paper evaluates the representativeness of the RCGP RSC network against the English population. Participants and method The cohort includes 1 042 063 patients registered in 107 participating general practitioner (GP) practices. We compared the RCGP RSC data with English national data in the following areas: demographics; geographical distribution; chronic disease prevalence, management and completeness of data recording; and prescribing and vaccine uptake. We also assessed practices within the network participating in a national swabbing programme. Findings to date We found a small over-representation of people in the 25–44 age band, under-representation of white ethnicity, and of less deprived people. Geographical focus is in London, with less practices in the southwest and east of England. We found differences in the prevalence of diabetes (national: 6.4%, RCPG RSC: 5.8%), learning disabilities (national: 0.44%, RCPG RSC: 0.40%), obesity (national: 9.2%, RCPG RSC: 8.0%), pulmonary disease (national: 1.8%, RCPG RSC: 1.6%), and cardiovascular diseases (national: 1.1%, RCPG RSC: 1.2%). Data completeness in risk factors for diabetic population is high (77–99%). We found differences in prescribing rates and costs for infections (national: 5.58%, RCPG RSC: 7.12%), and for nutrition and blood conditions (national: 6.26%, RCPG RSC: 4.50%). Differences in vaccine uptake were seen in patients aged 2 years (national: 38.5%, RCPG RSC: 32.8%). Owing to large numbers, most differences were significant (p<0.00015). Future plans The RCGP RSC is a representative network, having only small differences with the national population, which have now been quantified and can be assessed for clinical relevance for specific studies. This

  17. Modification of general practitioner prescribing of antibiotics by use of a therapeutics adviser (academic detailer)

    PubMed Central

    Ilett, Kenneth F; Johnson, Sarah; Greenhill, Graham; Mullen, Lenette; Brockis, Jennifer; Golledge, Clayton L; Reid, Donald B

    2000-01-01

    Aims This was a pilot study of the use of a clinical pharmacist as a therapeutics adviser (academic detailer) to modify antibiotic prescribing by general practitioners. Methods Following a visit by the adviser (March-May), 112 general practitioners were recruited and randomised to control or active groups. A panel of experts prepared a best practice chart of recommended drugs for upper and lower respiratory tract infections, otitis media and urinary tract infections. The adviser made a 10–15 min visit to each prescriber in the active group (June–July), gave them the chart and discussed its recommendations briefly. Doctors in the control group were not visited nor given the chart. Prescription numbers for all prescribers were obtained from the Commonwealth Health Insurance Commission for the pre(March-May) and postdetailing (August–September) periods using a three month lag time for data collection. Data for total numbers of prescriptions and for selected individual antibiotics used in these two periods were analysed using nonparametric statistics. Results Prescribing patterns were similar for the control and active groups in the predetailing period. For both groups, there were significant (P < 0.03) increases (45% for control and 40% for active) in total number of antibiotic prescriptions in the post compared with the predetailing period. This trend was anticipated on the basis of the winter seasonal increase in respiratory infections. In line with the chart recommendations for first-line treatment, doctors in the active group prescribed significantly more amoxycillin (P < 0.02) and doxycycline (P < 0.001) in the post vs predetailing periods. By contrast, doctors in the control group prescribed significantly more cefaclor (P < 0.03) and roxithromycin (P < 0.03), drugs that were not recommended. The total cost of antibiotics prescribed by doctors in the control group increased by 48% ($37 150) from the preto postdetailing periods. In the same time period, the

  18. The Willingness-to-Pay for General Practitioners in Contractual Service and Influencing Factors among Empty Nesters in Chongqing, China

    PubMed Central

    Chen, Fei; Xu, Xiang-Long; Yang, Zhan; Tan, Hua-Wei; Zhang, Liang

    2015-01-01

    Background: In 2012, a pilot health policy of contractual service relations between general practitioners and patients was implemented in China. Due to the decline in body and cognitive function, as well as the lack of family care and narrow social support networks, the demand of health services among the elderly is much higher than that among the general population. This study aims to probe into the empty nesters’ willingness-to-pay for general practitioners using a contractual service policy, investigating empty nesters’ payment levels for the service, and analyze the main factors affecting the willingness of empty-nesters’ general practitioners using contractual service supply cost. Methods: This cross-sectional study adopted a multistage stratified sampling method to survey 865, city empty nesters (six communities in three districts of one city) aged 60–85 years. A condition value method was used to infer the distribution of the willingness-to-pay; Cox’s proportional hazards regression model was used to analyze the influencing factors of willingness-to-pay. Results: More than seventy percent (76.6%) of the empty nesters in this city were willing to pay general practitioners using contract service in Chongqing. The level of willingness-to-pay for the surveyed empty nesters was 34.1 yuan per year. The median value was 22.1 yuan per year, which was below the Chongqing urban and rural cooperative medical insurance individual funding level (60 yuan per year) in 2013. Cox’s proportional hazards regression model analysis showed that the higher the education level was, the worse the self-reported health status would be, accompanied by higher family per capita income, higher satisfaction of community health service, and higher willingness-to-pay empty nesters using a contract service. Women had a higher willingness-to-pay than men. Conclusions: The willingness-to-pay for general practitioners by contractual service is high among city empty nesters in

  19. It's More Than the Money: The Relationship between Social Values and Demographic Change in Sustaining a Rural General Practitioner Workforce

    ERIC Educational Resources Information Center

    Cheney, Helen; Willetts, Juliet; Wilson, Erin

    2004-01-01

    Historically, rural General Practitioners (GPs) in Australia tended to be male, Anglo, middle-class and in nuclear family structures, whereas the contemporary workforce demographic is increasingly female and of diverse ethnicity. Demographic trends and changing social values of university-educated professionals directly affect services in rural…

  20. Training Australian General Practitioners in Rural Public Health: Impact, Desirability and Adaptability of Hybrid Problem-Based Learning

    ERIC Educational Resources Information Center

    Gladman, Justin; Perkins, David

    2013-01-01

    Context and Objective: Australian rural general practitioners (GPs) require public health knowledge. This study explored the suitability of teaching complex public health issues related to Aboriginal health by way of a hybrid problem-based learning (PBL) model within an intensive training retreat for GP registrars, when numerous trainees have no…

  1. Training General Practitioners in the Identification and Management of Adolescent Depression within the Consultation: A Feasibility Study.

    ERIC Educational Resources Information Center

    Gledhill, Julia; Kramer, Tami; Iliffe, Steven; Garralda, M. Elena

    2003-01-01

    General practitioners (GPs) completed a checklist indicating recognition of psychopathology prior to and following GP training in the identification/management of adolescent depression. Psychiatric interviews with 38 adolescents with high depressive scores prior to and 44 following training identified 10 (26%) and 21 (48%), respectively, as…

  2. Knowledge and Practice of Pulp Therapy in Deciduous Teeth among General Dental Practitioners in Saudi Arabia

    PubMed Central

    Togoo, RA; Nasim, VS; Zakirulla, M; Yaseen, SM

    2012-01-01

    Background: It has been observed that the general dentists and pedodontists differ in their treatment recommendations for pulp therapy in deciduous teeth. Aim: To determine the knowledge and practice of pulp therapy in deciduous teeth by general dental practitioners (GDP) in two cities of southern Saudi Arabia. Subjects and Methods: Fifty GDP selected at random from government and private dental clinics were questioned about pulp therapy in deciduous teeth in Abha and Najran cities using a 10-item questionnaire. The data were analyzed using IBM SPSS software version 11.0 and descriptive statistics were obtained. Results: All 50 participants responded to the survey. Pulpotomy was suggested as the first line of treatment for pulp-exposed primary tooth by 32 respondents with 44 using Buckley's formocresol and 32 applying it on the pulp for 5 minutes. 43 respondents squeeze dried the cotton pellet before application on the pulp. In pulpectomy procedure 44 respondents preferred zinc oxide eugenol as obturation material with 22 using handheld reamers and 15 using slow-speed lentilospirals for obturation. 12 respondents used obturation techniques which had no scientific relevance. In order of preference Glass ionomer cement (GIC), silver amalgam, and stainless steel crowns were the materials of choice for final restoration of endodontically treated deciduous teeth. All 50 answered in the affirmative when asked if they would like to have additional information about pulp therapy in deciduous teeth. Conclusion: The study concluded that general dentists were regularly performing pulp therapy in decidous teeth and therefore need to be frequently updated about these procedures. PMID:23440030

  3. The impact of general practitioner morale on patient satisfaction with care: a cross-sectional study

    PubMed Central

    McKinstry, Brian; Walker, Jeremy; Porter, Mike; Fulton, Colette; Tait, Ashley; Hanley, Janet; Mercer, Stewart

    2007-01-01

    Background The association between stress and morale among general practitioners (GP) is well documented. However, the impact of GP stress or low morale on patient care is less clear. GPs in the UK now routinely survey patients about the quality of their care including organizational issues and consultation skills and the General Practice Assessment Questionnaire (GPAQ) is widely used for this purpose. We aimed to see if there was a relationship between doctor morale as measured by a validated instrument, the Morale Assessment in General Practice Index (MAGPI) and scores in the GPAQ. Methods All GPs in Lothian, Scotland who were collecting GPAQ data were approached and asked to complete the MAGPI. Using an anonymised linkage system, individual scores on the MAGPI were linked to the doctors' GPAQ scores. Levels of association between the scores were determined by calculating rank correlations at the level of the individual doctor. Hypothesised associations between individual MAGPI and GPAQ items were also assessed. Results 276 of 475 GPs who were approached agreed to complete a MAGPI questionnaire and successfully collected anonymous GPAQ data from an average of 49.6 patients. There was no significant correlation between the total MAGPI score and the GPAQ communication or enablement scale. There were weak correlations between "control of work" in the MAGPI scale and GPAQ items on waiting times to see doctors (r = 0.24 p < 0.01). Doctors who perceived that their patients viewed them negatively also scored lower on individual communication, accessibility and continuity of care GPAQ items. Conclusion This study showed no relationship between overall GP morale and patient perception of performance. There was a weak relationship between patients' perceptions ofquality and doctors' beliefs about their workload and whether patients value them. Further research is required to elucidate the complex relationship between workload, morale and patients' perception of care. PMID

  4. Physical Violence against General Practitioners and Nurses in Chinese Township Hospitals: A Cross-Sectional Survey

    PubMed Central

    Xing, Kai; Jiao, Mingli; Ma, Hongkun; Qiao, Hong; Hao, Yanhua; Li, Ye; Gao, Lijun; Sun, Hong; Kang, Zheng; Liang, Libo; Wu, Qunhong

    2015-01-01

    Purpose The purpose of this study is to identify risk factors of physical violence in Chinese township hospitals. Methods A cross-sectional survey was used in a sample of 442 general practitioners and 398 general nurses from 90 township hospitals located in Heilongjiang province, China (response rate = 84.8%). Results A total of 106 of the 840 (12.6%) respondents reported being physically attacked in their workplace in the previous 12 months. Most perpetrators were the patients’ relatives (62.3%), followed by the patient (22.6%); 73.6% of perpetrators were aged between 20 and 40 years. Of the physical violence incidents, about 56.6% (n = 60) resulted in a physical injury, and 45.4% of respondents took two or three days of sick leave. Reporting workplace violence in hospitals to superiors or authorities was low (9.4%). Most respondents (62.8%) did not receive training on how to avoid workplace violence. Logistic regression analyses indicated that general nurses, aged 35 years or younger, and with a higher-level professional title were more likely to experience physical violence. Healthcare workers with direct physical contact (washing, turning, lifting) with patients had a higher risk of physical violence compared to other health care workers. Procedures for reporting workplace violence were a protective factor for physical violence; when in place, reporting after psychological violence (verbal abuse, bullying/mobbing, harassment, and threats) was more protective than waiting until an instance of physical violence (beating, kicking, slapping, stabbing, etc.). Conclusions Physical violence in Chinese township hospitals is an occupational hazard of rural public health concern. Policies, procedures, and intervention strategies should be undertaken to manage this issue. PMID:26571388

  5. Units of Instruction for Vocational Office Education. Volume 1. Filing, Office Machines, and General Office Clerical Occupations. Teacher's Guide.

    ERIC Educational Resources Information Center

    East Texas State Univ., Commerce. Occupational Curriculum Lab.

    Nineteen units on filing, office machines, and general office clerical occupations are presented in this teacher's guide. The unit topics include indexing, alphabetizing, and filing (e.g., business names); labeling and positioning file folders and guides; establishing a correspondence filing system; utilizing charge-out and follow-up file systems;…

  6. The General Practitioner's Consultation Approaches to Medically Unexplained Symptoms: A Qualitative Study.

    PubMed

    Hansen, Henriette Schou; Rosendal, Marianne; Fink, Per; Risør, Mette Bech

    2013-01-01

    Background. The prevalence of medically unexplained symptoms (MUSs) in primary care is about 10-15%. The definition of MUS is descriptive and there are no specific diagnostic criteria for MUS in primary care. Furthermore, a general practitioner's (GP's) categorisation of patients with MUS shows large variation. The aim of the present study is to investigate how GPs employ the definition of MUS and how they manage patients with MUS in daily practice. Methods. With a grounded theory approach five focus group interviews with GPs were performed. The interviews addressed how GPs managed MUS and their reflections on the course and prognosis for MUS patients. Results. Consultations about MUS develop around the individual patient and usually include several appointments. We identified three different types of consultations: (1) "searching for a disease," (2) "going by the routine," and (3) "following various paths." These types of consultations spanned from a biomedical approach to an approach where multiple explanations were offered to explain the patient's problem. The choice of consultation types was influenced by the GP, the patient and contextual factors which, in turn, affected the diagnostic process. Conclusions. A diagnosis of MUS is contextually embedded and the diagnostic process is shaped by the consultation. PMID:24967320

  7. Danish Citizens and General Practitioners' Use of ICT for their Mutual Communication.

    PubMed

    Bertelsen, Pernille; Stub Petersen, Lone

    2015-01-01

    This paper reports on selected findings from a Danish national survey of citizens' perception and use of information and communication technology (ICT) for their health care [1]. Focus is on citizens' use of ICT and on communication with their General Practitioner (GP). It also focuses on citizens' experience of their GPs' ICT use and no use during medical consultations. The responsibility for medical service in Denmark is to a large extent handed over to the primary sector where the GP is the gatekeeper. Our data display that 65% of the adult citizens or their relatives have been using ICT to communicate with their GP. Twenty-two percent have experienced their GP use a computer screen to actively show them something while they have a consultation. Further, our data supports the assumption that the higher the education people have, the more likely they are to use ICT for their health care. The understanding of the use of ICT in communication with the GP is central to monitoring and developing an ICT that supports all citizens and considers new ways in which to enhance quality of care. PMID:26262075

  8. Eight challenges faced by general practitioners caring for patients after an acute coronary syndrome.

    PubMed

    Vickery, Alistair; Thompson, Peter L

    2014-11-17

    The general practitioner is essential in the management of the patient who has recently been discharged from hospital following an acute coronary syndrome (ACS), particularly as duration of hospital stay is shorter than in previous decades. GPs caring for patients after an ACS face numerous challenges. Often, the first of these is insufficient or delayed documentation from the discharging hospital, although electronic discharge summaries are alleviating this problem. Post-ACS patients often have comorbidities, and GPs play a key role in managing these. Patients taking dual antiplatelet therapy who need surgery, and post-ACS patients with atrial fibrillation, require particular care from GPs. Patients will often approach their GP for advice on the safety of other drugs, such as smoking cessation medication, and phosphodiesterase type 5 inhibitors for erectile dysfunction. For patients complaining of persistent lethargy after an ACS, GPs must consider several differential diagnoses, including depression, hypotension, hypovolaemia, and side effects of β-blockers. GPs play an important ongoing role in ensuring that target cholesterol levels are reached with statin therapy; this includes ensuring long-term adherence. They may also need to advise patients who want to stop statin therapy, usually due to perceived side effects. Many of these challenges can be met with improved and respectful communication between the hospital, the treating cardiologist and the GP. The patient needs to be closely involved in the decision-making process, particularly when balancing the risks of bleeding versus thrombosis. PMID:25390497

  9. Quality-Shaping Factors and Endodontic Treatment amongst General Dental Practitioners with a Focus on Denmark

    PubMed Central

    Demant, Sune; Markvart, Merete; Bjørndal, Lars

    2012-01-01

    There is a gap between the endodontic outcome that can be achieved and the outcome observed on the basis of worldwide general dental practitioner data. The quality of root canal treatment (RCT) is shaped by the dentist's knowledge, attitude, and skills, but it may also be influenced by the patient's demands and degree of satisfaction. The topic has only been sparsely investigated. Although dental health has increased over the years in Denmark, the number of performed root fillings has also increased, probably because the number of tooth extractions have declined and more molar teeth have been treated. Caries appears to be the main cause for performing RCT and a preventive approach by employing stepwise excavation may reduce RCT, but this strategy does not remove the gap. Factors influencing RCT quality could be the status on adoption of nickel-titanium rotary technology, more focus on infection control (rubber dam use, knowledge of factors important for prognosis), as dentists often think that they are good at doing RCT, but often perform inadequately, an alteration of clinician's awareness of their performance in the context of dental practices, seems warranted. Finally, the development of new preventive modalities for pulp and apical inflammation are crucial. PMID:22536241

  10. Factors influencing patients' contract choice with general practitioners in Shanghai: a preliminary study.

    PubMed

    Jing, Limei; Shu, Zhiqun; Sun, Xiaoming; Chiu, John F; Lou, Jiquan; Xie, Chunyan

    2015-03-01

    The general practitioner (GP) system has been widely applied around the world and experimented with in Shanghai, China. To analyze some of the influencing factors on patient-GP contracts, we developed a questionnaire and conducted site investigations in 2011 and 2012 to 1200 patients by random sampling from 6 pilot community health service (CHS) centers in Pudong, Shanghai. The t test, χ(2) test, factor analysis, and logistic regression analysis were used to analyze the data. The factors influencing patients' contract behavior were age (OR = 1.03; 95%CI = 1.02-1.04), education level (OR = 0.83; 95% CI = 0.75-0.93), social interaction of social capital (OR = 1.34; 95% CI = 1.15-1.56), acceptance of first contact in community (OR = 3.25; 95% CI = 2.07-5.12), the year of investigation (OR = 2.58; 95% CI = 1.92-3.47), and the exposure to publicity (OR = 1.60; 95% CI = 1.39-1.85). Elderly patients formed a focus group to sign contracts with GPs. To increase trust in GPs by patients, it is recommended to improve the level of CHSs, strengthen publicity, and cultivate social capital among patients. PMID:25503975

  11. Survey of general practitioner satisfaction with a district communicable disease control service.

    PubMed

    Lamden, K; Baxter, D; Weighell, J

    2003-04-01

    General practitioners (GPs) have an important role in disease surveillance and control, and are therefore a key target audience for a district communicable disease control (CDC) service. The feedback of surveillance information, and the provision of policies, guidance and specialist advice, are essential functions of a CDC service. This survey was undertaken to assess how well a CDC service was meeting the needs of GPs. Satisfaction with the service was assessed using a questionnaire survey of 166 GPs. The response rate was 42%. GPs reported a high level of overall satisfaction. The service was valued and it influenced GP practice. The service was valued more for responses to requests for information and assistance than for communicable disease control policies. The highest satisfaction was expressed for communication and for immunisation advice. Several areas of need were identified, including the need for surveillance information on antibiotic resistance and for sexually transmitted infections. The survey tool is recommended as a way of auditing standards for Good Public Health Practice, as identified by the Faculty of Public Health Medicine. PMID:12736973

  12. General Practitioners' intention to prescribe and prescribing patterns in selected European settings: The OTCSOCIOMED project.

    PubMed

    Tsiantou, Vasiliki; Moschandreas, Joanna; Bertsias, Antonis; Papadakaki, Maria; Saridaki, Aristoula; Agius, Dominic; Alper, Zuleyha; Faresjo, Tomas; Klimkova, Martina; Martinez, Luc; Samoutis, George; Vlček, Jiří; Lionis, Christos

    2015-09-01

    The aim of this paper is to explore general practitioners' (GPs) prescribing intentions and patterns across different European regions using the Theory of Planned Behavior (TPB). A cross-sectional study was undertaken in selected geographically defined Primary Health Care areas in Cyprus, Czech Republic (CZ), France, Greece, Malta, Sweden and Turkey. Face-to-face interviews were conducted using a TPB-based questionnaire. The number of GP participants ranged from 39 to 145 per country. Possible associations between TPB direct measures (attitudes, subjective norms (SN) and perceived behavioral control (PBC)) and intention to prescribe were assessed by country. On average, GPs thought positively of, and claimed to be in control of, prescribing. Correlations between TPB explanatory measures and prescribing intention were weak, with TPB direct measures explaining about 25% of the variance in intention to prescribe in Malta and CZ but only between 3% and 5% in Greece, Sweden and Turkey. SN appeared influential in GPs from Malta; attitude and PBC were statistically significant in GPs from CZ. GPs' prescribing intentions and patterns differed across participating countries, indicating that country-specific interventions are likely to be appropriate. Irrational prescribing behaviors were more apparent in the countries where an integrated primary care system has still not been fully developed and policies promoting the rational use of medicines are lacking. Demand-side measures aimed at modifying GPs prescribing behavior are deemed necessary. PMID:26188356

  13. The Use of Mobile Phone and Medical Apps among General Practitioners in Hangzhou City, Eastern China

    PubMed Central

    Liu, Ying; Ren, Wen; Qiu, Yan; Liu, Juanjuan; Yin, Pei

    2016-01-01

    Background Mobile phones and mobile phone apps have expanded new forms of health professionals’ work. There are many studies on the use of mobile phone apps for different specialists. However, there are no studies on the current use of mobile phone apps among general practitioners (GPs). Objective The objective of the study was to investigate the extent to which GPs own smartphones with apps and use them to aid their clinical activities. Methods A questionnaire survey of GPs was undertaken in Hangzhou, Eastern China. Data probing GPs’ current use of medical apps in their clinical activities and factors influencing app use were collected and analyzed Results 125 GPs participated in the survey. 90.4% of GPs owned a mobile phone, with 48.7% owning an iPhone and 47.8% owning an Android phone. Most mobile phone owners had 1-3 medical-related apps, with very few owning more than 4. There was no difference in number of apps between iPhone and Android owners (χ2=1.388, P=0.846). 36% of GPs reported using medical-related apps on a daily basis. The majority of doctors reported using apps to aid clinical activities less than 30 minutes per day. Conclusions A high level of mobile phone ownership and usage among GPs was found in this study, but few people chose medical-related apps to support their clinical practice. PMID:27220417

  14. Views of general practitioners and benzodiazepine users on benzodiazepines: a qualitative analysis.

    PubMed

    Parr, Jannette M; Kavanagh, David J; Young, Ross McD; McCafferty, Kelly

    2006-03-01

    Effectively assisting benzodiazepine users to cease use requires a greater understanding of general practitioners' (GPs) and benzodiazepine users' views on using and ceasing benzodiazepines. This paper reports the findings from a qualitative study that examined the views of 28 GPs and 23 benzodiazepine users (BUs) in Cairns, Australia. A semi-structured interview was conducted with all participants and the information gained was analysed using the Consensual Qualitative Research Approach, which allowed comparisons to be made between the views of the two groups of interviewees. There was commonality between GPs and BUs on reasons for commencing benzodiazepines, the role of dependence in continued use, and the importance of lifestyle change in its cessation. However, several differences emerged regarding commencement of use and processes of cessation. In particular, users felt there was greater need for GPs to routinely advise patients about non-pharmacological management of their problems and potential adverse consequences of long-term use before commencing benzodiazepines. Cessation could be discussed with all patients who use benzodiazepines for longer than 3 months, strategies offered to assist in management of withdrawal and anxiety, and referral to other health service providers for additional support. Lifestyle change could receive greater focus at all stages of treatment. PMID:16143440

  15. Response to open access endoscopy findings by general practitioners guidelines need education for implementation.

    PubMed

    Todd, J A; Zubir, M A; Goudie, B M; Johnston, D A

    2000-04-01

    General practitioners may gain valuable information from the use of open access endoscopy. The benefit to the individual patient depends on the interpretation of the endoscopy findings and the subsequent action. The aim of the study was to determine GPs response to open access endoscopy findings of three conditions with possible malignant complications: Barrett's oesophagus, gastric ulcer and colonic adenomatous polyps. The study took place at Ninewells Hospital, Dundee. Using the endoscopy unit's records for the year, 1 January 1995 to 31 December 1995, all patients having had an open access upper gastro-intestinal endoscopy or sigmoidoscopy were identified. Case-notes were reviewed of patients who had Barrett's oesophagus, gastric ulcer or colonic polyps diagnosed. During the year, 1158 upper gastro-intestinal endoscopies and 293 sigmoidoscopies were performed by the open access service. The referral rates for the conditions were as follows: Barrett's oesophagus 56%; Gastric ulcers 56%; Adenomatous polyps 88%; Non adenomatous polyps 12.5%. The provision of guidelines does not ensure a high referral rate, education is a vital partner. PMID:10862438

  16. A qualitative evaluation of general practitioners' perceptions regarding access to medicines in New Zealand

    PubMed Central

    Grover, Piyush; Butler, Rachael; Bye, Lynne; Sheridan, Janie

    2012-01-01

    Objective The objective of this study was to evaluate general practitioners' (GPs) perceptions regarding access to medicines in New Zealand. Design Qualitative. Setting Primary care. Participants GPs. Main outcome measures GPs' views and perceptions. Results GPs were of the view that the current range of medicines available in New Zealand was reasonable; however, it was acknowledged that there were some drugs that patients were missing out on. When considering the range of subsidised medicines available in New Zealand, some GPs felt that there had been an improvement over recent years. It was highlighted that unexpected funding changes could create financial barriers for some patients and that administrative procedures and other complexities created barriers in receiving a subsidy for restricted medicines. GPs also reported problems with the availability and sole supply of certain medicines and claimed that switching from a branded medicine to its generic counterpart could be disruptive for patients. Conclusions The research concluded that although there were some issues with the availability of certain drugs, most GPs were satisfied with the broader access to medicines situation in New Zealand. This view is to contrary to the situation presented by the pharmaceutical industry. The issues around sole supply, the use of generic medicines and the administrative barriers regarding funding of medicines could be improved with better systems. The current work provides a solid account of what GPs see as the advantages and disadvantages of the current system and how they balance these demands in practice. PMID:22457477

  17. Access to general practitioner services amongst underserved Australians: a microsimulation study

    PubMed Central

    2012-01-01

    Background One group often identified as having low socioeconomic status, those living in remote or rural areas, are often recognised as bearing an unequal burden of illness in society. This paper aims to examine equity of utilisation of general practitioner services in Australia. Methods Using the 2005 National Health Survey undertaken by the Australian Bureau of Statistics, a microsimulation model was developed to determine the distribution of GP services that would occur if all Australians had equal utilisation of health services relative to need. Results It was estimated that those who are unemployed would experience a 19% increase in GP services. Persons residing in regional areas would receive about 5.7 million additional GP visits per year if they had the same access to care as Australians residing in major cities. This would be a 18% increase. There would be a 20% increase for inner regional residents and a 14% increase for residents of more remote regional areas. Overall there would be a 5% increase in GP visits nationally if those in regional areas had the same access to care as those in major cities. Conclusion Parity is an insufficient goal and disadvantaged persons and underserved areas require greater access to health services than the well served metropolitan areas due to their greater poverty and poorer health status. Currently underserved Australians suffer a double disadvantage: poorer health and poorer access to health services. PMID:22264385

  18. [Practice guideline on 'Acute diarrhoea' from the Dutch College of General Practitioners].

    PubMed

    Loogman, Masja C M; Bouma, Margriet; Burgers, Jako S

    2014-01-01

    The revised guideline on 'Acute diarrhoea' from the Dutch College of General Practitioners covers the diagnosis and management of suspected acute infectious diarrhoea. Acute diarrhoea resulting from infectious gastroenteritis is often caused by a virus and is usually self-limiting; stool testing is rarely indicated. The main complication of acute diarrhoea is dehydration, although this is rare in the Netherlands. Children under 2 years old and patients over 70 are at an increased risk of dehydration. Dehydration is a clinical diagnosis based on a combination of patient history and physical examination. DNA diagnostic methods such as polymerase chain reaction (PCR) are now available for stool testing, in addition to stool culture and the triple faeces test (TFT). PCR is preferred for its better test properties. Treatment with oral rehydration salts (ORS) is indicated for patients with dehydration and may also be useful in patients at an increased risk of this event. Acute diarrhoea after hospitalisation or after visiting the tropics or subtropics merits special attention on account of the risk of infection with unusual pathogens and the consequences with regard to management. PMID:25690070

  19. Exploring Self-Efficacy in Australian General Practitioners Managing Patient Obesity: A Qualitative Survey Study

    PubMed Central

    Ashman, Freya; Sturgiss, Elizabeth; Haesler, Emily

    2016-01-01

    Background. Obesity is a leading cause of morbidity and mortality in the Australian community, and general practitioners (GPs) are commonly approached by patients for assistance in losing weight. Previous studies have shown that GPs have low self-efficacy and low outcome expectation when it comes to managing overweight and obese patients, which affects their willingness to initiate and continue with weight counselling. This qualitative survey study aimed to explore the factors influencing confidence and behaviour in obesity management in GPs. Method. Twelve GPs recruited to deliver a pilot of an obesity management program participated in semistructured interviews, and interpretive analysis underpinned by social cognitive theory was performed on the transcripts. Results. Analysis identified five main themes: (1) perceived knowledge and skills, (2) structure to management approach, (3) the GP-patient relationship, (4) acknowledged barriers to weight loss and lifestyle change, and (5) prior experience and outcome expectation. Conclusions. GPs are likely to welcome tools which provide a more structured approach to obesity management. Shifting away from weight and BMI as sole yardsticks for success or failure and emphasising positive lifestyle changes for their own sake may improve GP self-efficacy and allow for a more authentic GP-patient interaction. PMID:27274872

  20. [General practitioners: practices and integration of mental health care in Québec].

    PubMed

    Imboua, Armelle; Fleury, Marie-Josée

    2009-01-01

    This article examines the socio-demographic profile of general practitioners (GPs), their role in the management of (transient/moderate, severe/chronic) mental health disorders in different areas (urban, semi-urban, and rural) of Quebec as well as if their clinical practice and collaboration are oriented towards integration of mental health services. This crosswise study is based on 398 GPs representative of all Quebec GPs who answered a questionnaire. The study shows that GPs play a central role in mental health. According to territories, they have different socio-demographic and practice profiles. The types of territory and the degree of severity of mental health illnesses influence the propensity of GPs to integrate mental health care. Finally, GPs practiced mostly in silo, but they support greater integration of mental health services. The authors conclude that to improve mental health services integration, more proactive incentives should be favoured by political elites, adapted to the severity of the case and environments (urban, semi-urban or rural). However, the shortage of resources that is particularly striking in rural areas as well as inadequate mechanisms for clinical decision, reduce inter-relations and seriously limit the integration of healthcare. PMID:19475194

  1. Perceived social support in relation to work among Danish general dental practitioners in private practices.

    PubMed

    Berthelsen, Hanne; Hjalmers, Karin; Söderfeldt, Björn

    2008-04-01

    Social support is an important phenomenon in the psychosocial work environment. The aim of this study was to assess the extent to which Danish general dental practitioners perceived support from colleagues and to relate perceived support to demographic and work related background factors. A questionnaire was sent to a random sample of 300 Danish dentists. The response rate was 80% after one reminder. Factor analyses and multiple regression analyses were carried out. The results showed that clinic size was the overall most important variable explaining perceived support among dentists. Gender differences were found in perceived emotional and practical support, and women perceived more emotional support (e.g. discussing problematic patients with peers) than their male colleagues. A similar gender difference was not found for the perception of practical support, such as helping each other in the event of falling behind schedule. Dentists from small and large practices did not differ in the extent of peer contact outside the clinical environment. This study emphasized the importance of the organizational setting for a professional and personal supportive psychosocial working environment in dentistry. PMID:18353010

  2. Collaboration between general practitioners (GPs) and mental healthcare professionals within the context of reforms in Quebec

    PubMed Central

    2012-01-01

    Background In the context of the high prevalence and impact of mental disorders worldwide, and less than optimal utilisation of services and adequacy of care, strengthening primary mental healthcare should be a leading priority. This article assesses the state of collaboration among general practitioners (GPs), psychiatrists and psychosocial mental healthcare professionals, factors that enable and hinder shared care, and GPs’ perceptions of best practices in the management of mental disorders. A collaboration model is also developed. Methods The study employs a mixed-method approach, with emphasis on qualitative investigation. Drawing from a previous survey representative of the Quebec GP population, 60 GPs were selected for further investigation. Results Globally, GPs managed mental healthcare patients in solo practice in parallel or sequential follow-up with mental healthcare professionals. GPs cited psychologists and psychiatrists as their main partners. Numerous hindering factors associated with shared care were found: lack of resources (either professionals or services); long waiting times; lack of training, time and incentives for collaboration; and inappropriate GP payment modes. The ideal practice model includes GPs working in multidisciplinary group practice in their own settings. GPs recommended expanding psychosocial services and shared care to increase overall access and quality of care for these patients. Conclusion As increasing attention is devoted worldwide to the development of optimal integrated primary care, this article contributes to the discussion on mental healthcare service planning. A culture of collaboration has to be encouraged as comprehensive services and continuity of care are key recovery factors of patients with mental disorders. PMID:23730332

  3. Factors Affecting the Agreement Between Emergency Psychiatrists and General Practitioners Regarding Involuntary Psychiatric Hospitalizations.

    PubMed

    Geoffroy, Pierre Alexis; Duhamel, Alain; Behal, Hélène; Zouitina-Lietaert, Nadia; Duthilleul, Julie; Marquette, Louise; Ducrocq, François; Vaiva, Guillaume; Rolland, Benjamin

    2016-01-01

    Important discrepancies exist between physicians in deciding when to perform involuntary hospitalization measures (IHMs). The factors underlying these differences are poorly known.We conducted a two-year single-center retrospective study in France on patients who were referred to the emergency department (ED) with an IHM certificate written by a private-practice General Practitioner (GP). For each consultation, the official IHM motive was categorized into four groups: Suicide; Psychosis, Mania, or Melancholia (PMM); Agitation; and Other. The alcohol status of the patient was also noted. The factors underlying the ED psychiatrists' confirmation of the use of IHMs were determined using a logistic regression model. One hundred eighty-nine cases were found (165 patients; 44.2 ± 16 years, 41.3% women). The ED psychiatrists confirmed the use of IHMs in 123 instances (65.1% agreement rate). Multivariate analyses found that IHM disagreement was significantly associated with patient alcohol status and the reason for referral. Specifically, there was an increased risk of IHM disagreement when the patient had an alcohol-positive status (OR = 15.80; 95% CI [6.45-38.67]; p < 0.0001) and when the motive for IHM was "agitation" compared with "suicide" (OR = 11.44; 95% CI[3.38-38.78]; p < 0.0001). These findings reflect significant disparities between GPs and ED psychiatrists regarding the decision to proceed to an IHM. PMID:27324574

  4. Management of orthodontic emergencies in primary care - self-reported confidence of general dental practitioners.

    PubMed

    Popat, H; Thomas, K; Farnell, D J J

    2016-07-01

    Objective To determine general dental practitioners' (GDPs) confidence in managing orthodontic emergencies.Design Cross-sectional study.Setting Primary dental care.Subjects and methods An online survey was distributed to dentists practicing in Wales. The survey collected basic demographic information and included descriptions of ten common orthodontic emergency scenarios.Main outcome measure Respondents' self-reported confidence in managing the orthodontic emergency scenarios on a 5-point Likert scale. Differences between the Likert responses and the demographic variables were investigated using chi-squared tests.Results The median number of orthodontic emergencies encountered by respondents over the previous six months was 1. Overall, the self-reported confidence of respondents was high with 7 of the 10 scenarios presented scoring a median of 4 indicating that GDPs were 'confident' in their management. Statistical analysis revealed that GDPs who saw more orthodontic emergencies in the previous six months were more confident when managing the presented scenarios. Other variables such as age, gender, geographic location of practice and number of years practising dentistry were not associated with self-reported confidence.Conclusions Despite GDPs encountering very few orthodontic emergencies in primary care, they appear to be confident in dealing with commonly arising orthodontic emergency situations. PMID:27388086

  5. General practitioners' 'lived experience' of assessing psychological distress in cancer patients: an exploratory qualitative study.

    PubMed

    Carolan, C M; Campbell, K

    2016-05-01

    While psychological distress in cancer patients is common, little is known about how general practitioners (GPs) assess distress. Using semi-structured interviews, a phenomenological study of seven GPs was conducted to explore GPs' experiences of assessing distress. Findings revealed five themes: (1) Being in the Relay Team - receiving and passing the baton: where the assessment of distress was conceptualised as a relay baton passed between a team of health care professionals, with GPs most involved at diagnosis and in the palliative phase. (2) Being in a Relationship: where the doctor-patient relationship was described as a powerful facilitator to assessment. (3) Being Skilled: where GPs perceive they are skilled at assessment adopting a patient-centred approach. (4) Being Challenged - encountering barriers: challenges with assessment were identified regarding the GPs' own emotions, patient related factors and time; the duality of family as both barrier and facilitator was voiced. (5) The Intruder in the Room: where GPs did not use validated screening tools which were viewed as an intruder in the doctor-patient relationship. Further research to objectively assess GPs' skills in distress assessment and attitudes towards the use of screening tools within the cancer care context are merited. PMID:26148909

  6. Is preparedness for CBRN incidents important to general practitioners in East London?

    PubMed

    Dabrera, Gavin; Anyaegbu, Emmanuel; Addiman, Sarah; Keeling, David; Ashton, Charlotte; Whala, Shakeel; Dunne, Adrienne; Figueroa, Jose; Lovitt, Chris; Basnett, Ian; Balasegaram, Sooria

    2012-01-01

    General practitioners (GPs) have an important role in public health response to CBRN incidents, including disseminating information to worried patients and undertaking risk assessments of patients. The authors undertook the first known UK survey of GPs' CBRN preparedness to assess knowledge and attitudes towards CBRN preparedness among GPs in East London, in the area of the Olympic Park. A questionnaire was developed, focusing on GPs' self-preparedness for, and perceived roles in CBRN incidents, and GPs' access to resources and policies for dealing with such incidents. Of 157 GPs, 56 responded, although some responded collectively for their practice. The majority of respondents recognised roles for themselves in CBRN incidents, including recognition of illness, supporting decontamination, and appropriate reporting. However, 79 per cent of GPs also felt unprepared for such incidents. The most popular topic for training to address this was clinical presentation of CBRN exposures. Most practices had no policy for dealing with suspect packages and white powder incidents. Since this survey, guidance and training has been made available to local GPs. As the UK will host more events like the 2012 Olympics, preparedness for GPs will continue to be an important consideration in the UK. PMID:22948105

  7. In with the new: the determinants of prescribing innovation by general practitioners in Ireland.

    PubMed

    Bourke, Jane; Roper, Stephen

    2012-08-01

    An important element of the process by which new drugs achieve widespread use is their adoption by GPs. In this paper, we explore the factors that shape the timing of the first prescription of six new drugs by General Practitioners in Ireland. Our analysis is based on a dataset that matches prescription data with data on GP characteristics. We then use duration analysis to explore both equilibrium and non-equilibrium determinants of prescribing innovation. Our study highlights a range of commonalities across all of the drugs considered and suggests the importance of GP and practice characteristics in shaping prescribing decisions. We also find strongly significant, and consistently signed, stock and order effects across these drugs: GPs who have a track record of early adoption tend also to be early adopters of other new drugs; and, the larger the proportion of GPs which have already adopted a new drug the slower is subsequent adoption. Epidemic and learning effects are also evident with slower adoption by rural practices and among those GPs with narrower prescribing portfolios. PMID:21503785

  8. The Relationship between Work Hours and Utilization of General Practitioners in Four Canadian Provinces

    PubMed Central

    Fell, Deshayne B; Kephart, George; Curtis, Lori J; Bower, Kelly; Muhajarine, Nazeem; Reid, Robert; Roos, Leslie

    2007-01-01

    Objective To assess whether long work hours act as a barrier to accessing general practitioner (GP) services. Data Sources Secondary data from the 1996/1997 National Population Health Survey (NPHS) and administrative health services utilization data from four Canadian provinces. Study Design This study was cross-sectional, however, employment variables and GP utilization were reflective of the 12-month period preceding the NPHS interview date. Negative binomial regression was used to model the relationship between the number of GP visits in a 1-year period and employment-related variables while adjusting for other determinants of GP utilization including education, income, and health status. Data Extraction Methods NPHS and administrative data were linked to create an analysis file. Principal Findings Subjects with long, standard work hours (>45 hours/week, with most hours during the day) had significantly lower GP utilization rates compared with full-time workers. White-collar workers with long work hours visited a GP significantly less often than white-collar workers with regular hours. Conclusions Long work hours may act as a nonfinancial barrier to accessing GP services independent of health status. PMID:17610434

  9. Is general practitioner decision making associated with patient socio-economic status?

    PubMed

    Scott, A; Shiell, A; King, M

    1996-01-01

    This paper presents a preliminary exploration into the relationship between decisions made by general practitioners (GPs) and the socio-economic status (SES) of patients. There is a large literature on the association between SES, health state and the use of health services, but relatively little has been published on the association between SES and decisions by clinicians once a patient is in the health system. The associations between GP decision making and the patient's SES, health status, gender and insurance status are examined using logit analysis. Three sets of binary choices are analysed: the decision to follow up; to prescribe; and to perform or to order a diagnostic test. Secondary data on consultations for a check up/examination were used to explore these relationships. The results suggest that SES is associated independently with the decision to test and the decision to prescribe but not with the decision to follow up. Patients of high SES are, ceteris paribus, more likely to be tested and less likely to receive a prescription compared with patients of low SES. Women are more likely to be tested and to receive a prescription than men. These findings have implications for the pursuit of equity as a goal of health services policy. PMID:8745106

  10. General practitioners role in the notification of communicable diseases - study in Malta.

    PubMed

    Gauci, C; Gilles, H; O'Brien, S; Mamo, J; Calleja, N

    2007-11-01

    General practitioners (GPs) have an essential role in notification of communicable diseases. The main aim of the study described here was to assess the GPs' awareness of and attitudes towards the notification system in Malta, with special focus on infectious intestinal disease (IID). A questionnaire collecting demographic data, information on reporting practices, opinions on the existing notification system and suggestions for improvement was sent to 256 GPs working in either private or public health sector. In all, 150 GPs took part in the survey (response rate 58.6%). The responses revealed that Maltese GPs were aware of their obligations to notify communicable diseases but often did not report them, relying on the hospitals or laboratories to do so. The Disease Surveillance Unit (DSU) website and medical school training were the main sources of information on notification. Notification forms were obtained from health centres and usually kept at the place of work. Most GPs reported filling in the forms during the patients' visits. Private GPs tended to notify earlier than GPs working in public health centers. Among IID, food-borne illness was reported more frequently than person-to-person transmitted gastroenteritis and was considered to be of a higher priority with regard to public health importance (p<0.001). The survey highlighted also some areas for improvement, including need of feedback especially by direct communication or a newsletter. PMID:18005655

  11. Nature of association between rural background and practice location: A comparison of general practitioners and specialists

    PubMed Central

    2011-01-01

    Background Rural and remote areas are characterised by a shortage of medical practitioners. Rural background has been shown to be a significant factor associated with medical graduates' intentions and decisions to practise within a rural area, though most studies have only used simple definitions of rural background and not previously looked at specialists. This paper aims to investigate in detail the nature of the association between rural background and practice location of Australian general practitioners (GPs) and specialists Methods Data for 3156 GPs and 2425 specialists were obtained from the Medicine in Australia: Balancing Employment and Life (MABEL) study. Data on the number of childhood years resident in a rural location and population size of their rural childhood location were matched against current practice location. Logistic regression modelling was used to calculate adjusted associations between doctors in rural practice and rural background, sex and age. Results GPs with at least 6 years of their childhood spent in a rural area were significantly more likely than those with 0-5 years in a rural area to be practising in a rural location (OR 2.28, 95% CI 1.69-3.08), whilst only specialists with at least 11 years rural background were significantly more likely to be practising in a rural location (OR 2.27, 95% CI 1.77-2.91). However, for doctors with a rural background, the size of the community that they grew up in was not significantly associated with the size of the community in which they currently practise. Both female GPs and female specialists are similarly much less likely to be practising in a rural location compared with males (GPs: OR 0.53, 95% CI 0.45-0.62). Conclusions This study elucidates the association between rural background and rural practice for both GPs and specialists. It follows that increased take-up of rural practice by new graduates requires an increased selection of students with strong rural backgrounds. However, given the

  12. Knowledge, Attitude and Practice of General Practitioners toward Complementary and Alternative Medicine: a Cross-Sectional Study.

    PubMed

    Barikani, Ameneh; Beheshti, Akram; Javadi, Maryam; Yasi, Marzieh

    2015-08-01

    Orientation of public and physicians to the complementary and alternative medicine (CAM) is one of the most prominent symbols of structural changes in the health service system. The aim of his study was a determination of knowledge, attitude, and practice of general practitioners in complementary and alternative medicine. This cross- sectional study was conducted in Qazvin, Iran in 2013. A self-administered questionnaire was used for collecting data including four information parts: population information, physicians' attitude and knowledge, methods of getting information and their function. A total of 228 physicians in Qazvin comprised the population of study according to the deputy of treatment's report of Qazvin University of Medical Sciences. A total of 150 physicians were selected randomly, and SPSS Statistical program was used to enter questionnaires' data. Results were analyzed as descriptive statistics and statistical analysis. Sixty percent of all responders were male. About sixty (59.4) percent of participating practitioners had worked less than 10 years.96.4 percent had a positive attitude towards complementary and alternative medicine. Knowledge of practitioners about traditional medicine in 11 percent was good, 36.3% and 52.7% had average and little information, respectively. 17.9% of practitioners offered their patients complementary and alternative medicine for treatment. Although there was little knowledge among practitioners about traditional medicine and complementary approaches, a significant percentage of them had attitude higher than the lower limit. PMID:26545995

  13. Contemporary Teaching of Neurology. Teaching Neurological Behavior to General Practitioners: A Fresh Approach

    ERIC Educational Resources Information Center

    Derouesne, C.; Salamon, R.

    1977-01-01

    Ways in which teaching neurology can be simplified for the nonspecialist practitioner are addressed in this assessment of the state-of-the-art in France. The hypothesis implies simplifying both the diagnoses and symptomatology. (LBH)

  14. Acute Gastroenteritis and Campylobacteriosis in Swiss Primary Care: The Viewpoint of General Practitioners.

    PubMed

    Bless, Philipp J; Muela Ribera, Joan; Schmutz, Claudia; Zeller, Andreas; Mäusezahl, Daniel

    2016-01-01

    Acute gastroenteritis (AG) is frequently caused by infectious intestinal diseases (IID) including food- and waterborne pathogens of public health importance. Among these pathogens, Campylobacter spp. plays a major role. Many European countries monitor selected IIDs within disease surveillance systems. In Switzerland, the information on IIDs is restricted to limited surveillance data, while no data is available for AG. We conducted a qualitative study among Swiss general practitioners (GPs) to investigate the case management of AG and campylobacteriosis patients, the associated disease burden and the determinants leading to registration in the National Notification System for Infectious Diseases (NNSID). Interviews were conducted with a semi-structured questionnaire and underwent inductive content analysis based on Grounded Theory. The questionnaire was repeatedly adapted to capture emerging themes until the point of theoretical saturation. GPs perceived AG and campylobacteriosis of little relevance to their daily work and public health in general. According to GP self-estimates each consults about two cases of AG per week and diagnoses a median of five campylobacteriosis cases per year. A large proportion of AG cases receives telephone consultations only and gets medical advice from the practice nurse. Antibiotic therapy is considered useful and stool diagnostics are performed for about a fifth of consulting AG patients. Stool diagnostics ("test") and antibiotic therapy ("treat") are interrelated and follow four strategies: "Wait & See", "Treat & See", "Treat & Test", and "Test & See". AG case management is diverse and includes different triage steps. A small proportion of AG patients have stool diagnostics performed and only positive tested patients are reported to the NNSID. As a result severe cases and cases with a history of travel abroad are overrepresented in the NNSID. The use of multiplex PCR panels in routine diagnostics likely leads to improved case

  15. Blood pressure control in treated hypertensive patients: clinical performance of general practitioners.

    PubMed Central

    Frijling, B D; Spies, T H; Lobo, C M; Hulscher, M E; van Drenth, B B; Braspenning, J C; Prins, A; van der Wouden, J C; Grol, R P

    2001-01-01

    BACKGROUND: The blood pressure of many treated hypertensive patients remains above recommended target levels. This discrepancy may be related to general practitioners' (GPs') actions. AIM: To assess clinical performance of GPs in blood pressure control in treated hypertensive patients and to explore the influence of patient and GP characteristics on clinical performance. DESIGN OF STUDY: Cross-sectional study conducted on 195 GPs with invitations to participate made via bulletins and by letter. SETTING: One hundred and thirty-two practices in the southern half of The Netherlands from November 1996 to April 1997. METHOD: Performance criteria were selected from Dutch national hypertension guidelines for general practice. GPs completed self-report forms immediately after follow-up visits of hypertensive patients treated with antihypertensive medication. RESULTS: The GPs recorded 3526 follow-up visits. In 63% of these consultations the diastolic blood pressure (DBP) was 90 mmHg or above. The median performance rates of the GPs were less than 51% for most of the recommended actions, even at a DBP of > or = 100 mmHg. Performance of non-pharmacological actions increased gradually with increasing DBP; prescribing an increase in antihypertensive medication and making a follow-up appointment scheduled within six weeks rose steeply at a DBP of > or = 100 mmHg. Patient and GP characteristics contributed little to clinical performance. Action performance rates varied considerably between GPs. CONCLUSION: GPs seem to target their actions at a DBP of below 100 mmHg, whereas guidelines recommend targeting at a DBP of below 90 mmHg. PMID:11271892

  16. [General Practitioner Sentinel Network as a Tool of [Public] Health Surveillance].

    PubMed

    Rodrigues, Ana Paula; Fonseca, Rita Carvalho; Matias-Dias, Carlos

    2016-01-01

    Current strategies of European health advocate the strengthening of the role of public health, requiring from decision-makers the ability to defend and enhance the health of individuals and populations in all policies. In the pursuit of this objective, public health should be evidence-based and so public health surveillance, seen as an important tool of public health since the nineteenth century, plays a central role in public health practice through the production and dissemination of the health information necessary for health planning and for evaluation of public health actions. Within the practice of public health estimations of disease frequency are important for outbreak control, health assessment, health needs assessment and estimation of health gains, but unfortunately these estimations are not always available for the entire population. In those cases and for diseases with high prevalence sentinel surveillance based in sentinel networks have some advantages for specific groups, namely needed of scarce resources and obtainment of quick results.The central role of family doctors in chronic disease management, their knowledge on individuals and families and their responsibilities in the management of a clear defined patients list are characteristics that make general practice an appropriate context to develop a sentinel network. In fact, in Portugal there is a general practitioner sentinel network named Rede Médicos-Sentinela working since 1989 which estimated, for the last 25 years, incidence rates of several chronic diseases, some of them targeted on national priority health programs. Thus, we consider that Rede Médicos-Sentinela can be integrated in a national surveillance system for chronic diseases in Portugal. PMID:26926891

  17. Audit of a sexual health website email link for general practitioners.

    PubMed

    Biggs, K; Lowe, P; Walsh, J; Lagios, K

    2010-01-01

    The aim of this review was to evaluate an 'Email a Clinician' link on a medically reviewed sexual health website, which was established to allow general practitioners (GPs) to communicate remotely with sexual health clinic specialists. The website was developed in consultation with GPs and extensively promoted throughout the relevant professional primary health-care networks. Despite this, the email link appeared to fail in its objective of facilitating GP access to specialist sexual health physician opinion within five working days. An audit examining use of the email link was conducted for a one-year period, during which time 324 emails were received. Results showed that the bulk of the emails (93.2%) were spam, and only 6.8% were genuine enquiries. Of the 22 genuine emails, 21 (95%) originated from the general public and there were no enquiries from the GPs, who were the target audience of the website, resulting in removal of the email link from the site. Direct survey of local GPs to evaluate reasons for non-utilization of the link was not possible. However, discomfort with the technology, time added to existing workload, lack of direct perceived benefit and lack of immediate response have been cited as contributing factors that may limit widespread adoption of other telemedicine services. As a new generation of recently graduated GPs enters the Australian workforce, who might be expected to be skilled and comfortable with electronic medical communication, the option of a direct email link to a sexual health clinic, with a faster turnaround time, may be worth re-visiting in the future. PMID:20029066

  18. Practice Leaders Programme: Entrusting and Enabling General Practitioners to Lead Change to Improve Patient Experience

    PubMed Central

    Lynch, Marion; McFetridge, Nigel

    2011-01-01

    This program focused on practice-level service change as a means of improving patient care and developing leadership skills of 19 general practitioners (GPs) and aimed to: promote and support change in leadership thinking and practice, facilitate practice-led service improvement, support career development, support continuing professional development, and contribute to the development of extended GP specialty training. Nineteen GPs, in Milton Keynes, United Kingdom, both new and experienced, volunteered to participate. Milton Keynes was selected on the basis of it being an area of relative social deprivation and underperformance in national quality indicators. New and experienced GPs took part in biweekly Action Learning Sets, individual coaching, and placements with the national and local health organizations. Each participant completed a project to improve the quality of patient care. The learning sets supported the process and 11 of the GPs chose to complete a postgraduate certificate in General Practice. Evaluation consisted of analysis of development of leadership competencies recorded through Medical Leadership Competency Framework pre- and postintervention assessment, analysis of learning recorded in participants' reflective diaries, analysis of learning process recorded through participant focus groups, and analysis of learning and project outcomes recorded in project reports. Outcomes showed statistically significant increases in leadership competencies, changes in services and care, improved confidence and changed culture. GPs expressed increased confidence to “have a go” and motivation to “make a difference.” This innovative narrative, complex, neuroleadership-based program continues to inform educational policy and practice, increasing leadership competencies, and to improve the quality of patient care. PMID:21505615

  19. Should general practitioners purchase health care for their patients? The total purchasing experiment in Britain.

    PubMed

    Wyke, Sally; Mays, Nicholas; Street, Andrew; Bevan, Gwyn; McLeod, Hugh; Goodwin, Nick

    2003-09-01

    Until relatively recently, general practitioners (GPs) have been allowed to work independently, with no requirement to consider the resource implications of their referral and prescribing decisions. In order to align the interests of GPs with the overall objectives of health systems a number of countries have introduced primary care based capitation, funds pooling and budget holding either as experiments or as an overall policy. Are these experiments and policies likely to work? This paper presents evidence from the UK total purchasing experiment, which was the first major quasi-market development in the NHS to be independently evaluated from the outset. Total purchasing gave volunteer groups of practices freedom to purchase all hospital and community health services for their patients. The evidence suggests that whilst GPs have great potential as purchasers, they also have considerable limitations. The expectation that they will be able to improve the quality of patient experience of care, or to alter the use of resources, may not be generally realised. GP-based purchasing may be more appropriate where the task is to alter the balance or location of care between hospital and extramural settings. However, budgetary incentives are not 'magic potions' which have similar effects on behaviour wherever they are introduced. Holding budgets and having independent contracts, while important pre-requisites for being taken seriously in a quasi-market, were not sufficient for effective total purchasing. The paper concludes that health systems should not only value innovation and experimentation and encourage learning from evaluative research; they should also recognise the importance of supportive circumstances for any innovation to effect real and sustained change. PMID:12941492

  20. A Qualitative Study of Prescription Contraception Use: The Perspectives of Users, General Practitioners and Pharmacists

    PubMed Central

    Sweeney, Leigh-Ann; Molloy, Gerard J.; Byrne, Molly; Murphy, Andrew W.; Morgan, Karen; Hughes, Carmel M.; Ingham, Roger

    2015-01-01

    Background The oral contraceptive pill (OCP) remains the most popular form of prescription contraception in many countries, despite adherence difficulties for many. Uptake of long acting reversible contraceptives (LARCs), which are less reliant on user adherence, remains low. The aim of this study was to explore the experiences of, and attitudes towards, prescription contraception amongst samples of contraception users, general practitioners (GPs) and pharmacists. Methodology and Findings We conducted a qualitative study using semi-structured interviews with 18 contraception users, 18 GPs and 9 pharmacists. The study took place in Galway, Republic of Ireland between June and September 2014. Thematic analysis was used to analyse the data. Overall, contraception users were more familiar with the OCP, and all the women interviewed began their prescription contraception journey using this method. All participants identified episodes of poor adherence throughout the reproductive life course. The identified barriers for use of LARCs were lack of information, misconceptions, lack of access and high cost. In contrast, GPs believed that adherence to the OCP was good and stated they were more likely to prescribe the OCP than other methods, as they were most familiar with this option. Barriers to prescribing LARCSs were time, cost to practice, training and deskilling. Pharmacists also believed that adherence to the OCP was generally good and that their role was limited to dispensing medication and providing information when asked. Discussion and Conclusion There are contrasting perspectives between contraception service providers and contraceptive users. Training for healthcare providers is required to support informed contraceptive choice and adherence. It is necessary to address the practice barriers of cost and lack of time, to promote better communication around adherence issues and prescription contraception options. There is a need for more easily-accessible public

  1. 12 CFR 905.14 - Office of General Counsel.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ....14 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOUSING FINANCE BOARD ORGANIZATION AND.... (a) General. The General Counsel is the chief legal officer of the Finance Board and is responsible for advising the Board of Directors, the chairperson and other Finance Board officials...

  2. 12 CFR 905.14 - Office of General Counsel.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ....14 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOUSING FINANCE BOARD ORGANIZATION AND.... (a) General. The General Counsel is the chief legal officer of the Finance Board and is responsible for advising the Board of Directors, the chairperson and other Finance Board officials...

  3. 12 CFR 905.14 - Office of General Counsel.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ....14 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOUSING FINANCE BOARD ORGANIZATION AND.... (a) General. The General Counsel is the chief legal officer of the Finance Board and is responsible for advising the Board of Directors, the chairperson and other Finance Board officials...

  4. 10 CFR 1.12 - Office of the Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Office of the Inspector General. 1.12 Section 1.12 Energy NUCLEAR REGULATORY COMMISSION STATEMENT OF ORGANIZATION AND GENERAL INFORMATION Headquarters Inspector... the Department of Justice; (f) Reviews existing and proposed legislation and regulations for...

  5. 16 CFR 1000.14 - Office of the General Counsel.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Office of the General Counsel. 1000.14 Section 1000.14 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION... product safety standards, rules, regulations, petition actions, and substantial hazard actions. It...

  6. 16 CFR 1000.14 - Office of the General Counsel.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Office of the General Counsel. 1000.14 Section 1000.14 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION... product safety standards, rules, regulations, petition actions, and substantial hazard actions. It...

  7. 16 CFR 1000.14 - Office of the General Counsel.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Office of the General Counsel. 1000.14 Section 1000.14 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION... product safety standards, rules, regulations, petition actions, and substantial hazard actions. It...

  8. 16 CFR 1000.14 - Office of the General Counsel.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Office of the General Counsel. 1000.14 Section 1000.14 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION... product safety standards, rules, regulations, petition actions, and substantial hazard actions. It...

  9. 16 CFR 1000.14 - Office of the General Counsel.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Office of the General Counsel. 1000.14 Section 1000.14 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION... product safety standards, rules, regulations, petition actions, and substantial hazard actions. It...

  10. 41 CFR 105-53.131 - Office of Inspector General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Office of Inspector General. 105-53.131 Section 105-53.131 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION 53-STATEMENT OF ORGANIZATION...

  11. 39 CFR 221.3 - Office of Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Office of Inspector General. 221.3 Section 221.3 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION GENERAL ORGANIZATION § 221.3... an independent law enforcement and oversight agency for the United States Postal Service under...

  12. General practitioners with a special interest in respiratory medicine: national survey of UK primary care organisations

    PubMed Central

    Pinnock, Hilary; Netuveli, Gopalakrishnan; Price, David; Sheikh, Aziz

    2005-01-01

    Background To meet the universally recognised challenge of caring for people with long-term diseases many healthcare cultures are encouraging family physicians to develop specialist skills. We aimed to determine the major factors influencing the appointment of respiratory General Practitioners with a Special Interest (GPwSI) in the UK, and to determine the priority attached to the potential roles, perceived barriers to implementation, and monitoring planned. Methods We sent a piloted semi-structured questionnaire to a random sample of 50% of English and Welsh primary care organisations (PCOs) (n = 161) during winter 2003. In addition to descriptive statistics, we used hierarchical cluster analysis to classify service priorities. Free-text responses to open-ended questions were analysed qualitatively by a multidisciplinary group to identify emerging themes. Results Of the 111 (69%) PCOs who responded, 7 (6%) already have, and a further 35 (32%) are planning, a respiratory GPwSI service. This proportion is considerably lower than in specialities linked to National Health Service clinical priorities. Local needs and pressure on hospital beds were the main described motives for developing a service. Stated service priorities were to relieve pressure on secondary care and to improve quality of care, including the strategic planning of respiratory services within PCOs. Conclusion The relatively few respiratory GPwSIs currently in post reflects the lack of government prioritisation of respiratory care. However, respiratory GPwSI services are increasingly being considered as a local strategy for reducing pressure on secondary care respiratory services and raising standards of chronic disease management in primary care. PMID:15921509

  13. Getting doctors into the bush: general practitioners' preferences for rural location.

    PubMed

    Scott, Anthony; Witt, Julia; Humphreys, John; Joyce, Catherine; Kalb, Guyonne; Jeon, Sung-Hee; McGrail, Matthew

    2013-11-01

    A key policy issue in many countries is the maldistribution of doctors across geographic areas, which has important effects on equity of access and health care costs. Many government programs and incentive schemes have been established to encourage doctors to practise in rural areas. However, there is little robust evidence of the effectiveness of such incentive schemes. The aim of this study is to examine the preferences of general practitioners (GPs) for rural location using a discrete choice experiment. This is used to estimate the probabilities of moving to a rural area, and the size of financial incentives GPs would require to move there. GPs were asked to choose between two job options or to stay at their current job as part of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of doctors. 3727 GPs completed the experiment. Sixty five per cent of GPs chose to stay where they were in all choices presented to them. Moving to an inland town with less than 5000 population and reasonable levels of other job characteristics would require incentives equivalent to 64% of current average annual personal earnings ($116,000). Moving to a town with a population between 5000 and 20,000 people would require incentives of at least 37% of current annual earnings, around $68,000. The size of incentives depends not only on the area but also on the characteristics of the job. The least attractive rural job package would require incentives of at least 130% of annual earnings, around $237,000. It is important to begin to tailor incentive packages to the characteristics of jobs and of rural areas. PMID:24034949

  14. Factors affecting collaboration between general practitioners and community pharmacists: a qualitative study

    PubMed Central

    2012-01-01

    Background Although general practitioners (GPs) and community pharmacists (CPs) are encouraged to collaborate, a true collaborative relationship does not exist between them. Our objective was to identify and analyze factors affecting GP-CP collaboration. Methods This was a descriptive-exploratory qualitative study carried out in two Spanish regions: Catalonia (Barcelona) and Balearic Islands (Mallorca). Face-to-face semi-structured interviews were conducted with GPs and CPs from Barcelona and Mallorca (January 2010-February 2011). Analysis was conducted using Colaizzi’s method. Results Thirty-seven interviews were conducted. The factors affecting the relationship were different depending on timing: 1) Before collaboration had started (prior to collaboration) and 2) Once the collaboration had been initiated (during collaboration). Prior to collaboration, four key factors were found to affect it: the perception of usefulness; the Primary Care Health Center (PCHC) manager’s interest; the professionals’ attitude; and geography and legislation. These factors were affected by economic and organizational aspects (i.e. resources or PCHC management styles) and by professionals’ opinions and beliefs (i.e. perception of the existence of a public-private conflict). During collaboration, the achievement of objectives and the changes in the PCHC management were the key factors influencing continued collaboration. The most relevant differences between regions were due to the existence of privately-managed PCHCs in Barcelona that facilitated the implementation of collaboration. In comparison with the group with experience in collaboration, some professionals without experience reported a skeptical attitude towards it, reporting that it might not be necessary. Conclusions Factors related to economic issues, management and practitioners’ attitudes and perceptions might be crucial for triggering collaboration. Interventions and strategies derived from these identified

  15. [Regional management of arterial hypertension in France. Report of a survey of general practitioners].

    PubMed

    Chamontin, B; Lang, T; Vaisse, B; Nicodeme, R; Antoine, M P; Lazorthes, M L; Gallois, H; Poggi, L

    2001-08-01

    A survey was conducted in 14 regional samples of general practitioners (GPs) included in Gallup-up poll. 2,423 GPs contributed to the study and had to include all patients > 18 years old over a period of one week. Patients were considered hypertensives if the mean of two recorded BP measurements was > or = 140/90 mmHg and/or < 140/90 mmHg if they were under antihypertensive treatment. Hypertensives were considered as controlled if there BP levels were overall < 140/90 mmHg under treatment. The risk factors associated with hypertension were collected in order to evaluate the cardiovascular risk, according to 1999 ISH-OMS recommendations. 156,470 patients recruited by 2423 GPs were included in the study representing 14 different French regions: Ile-de-France I (1), Ile-de-France II (2), Ile-de-France-Pays-de-la-Loire (3), Bretagne (4), Normandie-Picardie (5), Nord-Pas-de-Calais (6), Alsace-Lorraine (7), Bourgogne-Franche Comté (8), Rhônes-Alpes (9), Provence-Côte d'Azur (10), Languedoc-Provence (11), Limousin-Auvergne (12), Midi-Pyrénées (13), Aquitaine (14). Among 70,073 hypertensives, 23,054 had never received antihypertensive treatment, and 32,059 (47%) had a high or a very high cardiovascular risk. 67% of hypertensives (47,019) were treated, and 32.8% of treated hypertensives (15,422) had a BP < 140/90 mmHg. The study illustrated few differences in prevalence and control of hypertension in the different French regions: BP control at the 140/90 mmHg threshold vary from 28.5 to 36.6% among treated hypertensives and % of patients at high cardiovascular risk from 42.1% (South-France) to 49.7% (East-France). PMID:11575211

  16. Knowledge and Practice of General Practitioners and Internists about Helicobacter pylori infection in Guilan, Iran

    PubMed Central

    Mansour Ghanaei1, Fariborz; Joukar, Farahnaz; Soati, Fatemeh; Gharib, Syrous

    2011-01-01

    BACKGROUND This study aims to elucidate the knowledge and practice of general practitioners (GP) and internists regarding diagnosis and treatment of Helicobacter pylori (H. pylori ) infection in a high prevalent area, with the intent to assist with future educational strategies for H. pylori infection. METHODS In this cross-sectional study in Guilan, a Northern Province of Iran, all GPs and internists in the city of Rasht were included. Questionnaires consisted of questions on demographic characteristics in addition to physicians’ knowledge and practice regarding H. pylori infection. The questionnaire was verified by a panel of experts, validated by the test-retest method, and distributed among participants. Scores higher than the mean score indicated good knowledge or attitude. Those lower than the mean score indicated poor knowledge and attitude. Data were collected and analyzed by SPSS version 14 software. RESULTS The mean (SD) knowledge and practice score of physicians was 12.1±3.13 and 2.37±1.54, respectively. Overall, 67.9% of GPs and 91.7% of internists exhibited good knowledge scores, while 72.4% of GPs and 95.8% of internists showed good practice. Physicians who used books or educational programs and had working histories of less than 10 years scored significantly higher in terms of mean knowledge. The mean practice score of physicians who worked in public units and had working histories of more than 5 years and those who had used books or educational programs was significantly higher. CONCLUSION Since H. pylori infection is prevalent in Iran and GPs’ practices are directly under the influence of knowledge, it is necessary to attempt to increase the level and quality of information among GPs by educational and Continuing Medical Education programs and seminars. PMID:25197543

  17. General practitioners miss disability and anxiety as well as depression in their patients with osteoarthritis.

    PubMed Central

    Memel, D S; Kirwan, J R; Sharp, D J; Hehir, M

    2000-01-01

    BACKGROUND: General practitioners (GPs) integrate physical, psychological, and social factors when assessing patients, particularly those with chronic diseases. Recently, the emphasis has been on assessment of depression but not of other factors. AIM: To determine functional disability, psychological morbidity, social situation, and use of health and social services in patients with osteoarthritis and examine GP knowledge of these factors. METHOD: Two hundred patients completed a validated postal questionnaire about functional disability (Health Assessment Questionnaire [HAQ]), mood (Hospital Anxiety and Depression Scale [HAD]), employment status, who they lived with, welfare benefits received, and use of health and social services. A similar questionnaire was completed by the patient's GP, including a HAQ. However, a three-point scale was used to assess depression and anxiety. RESULTS: Forty-seven per cent of patients were moderately or severely disabled (HAQ > 1). GPs underestimated functional disability: mean patient HAQ = 1.04 (95% confidence interval [CI] = 0.92-1.16), mean GP HAQ = 0.74 (95% CI = 0.65-0.83), and there was low correlation between patient and GP scores (kappa = 0.24). There was moderate prevalence of depression and high prevalence of anxiety, which the GP often did not recognise: patient depression = 8.3% (95% CI = 4.1%-12.8%), GP depression = 6.0% (95% CI = 2.4%-9.6%), kappa = 0.11; patient anxiety = 24.4% (95% CI = 17.8%-31.0%), GP anxiety = 11.9% (95% CI = 6.9%-16.9%), kappa = 0.19. Only 46% of severely disabled patients (HAQ > 2) were receiving disability welfare benefits. GPs were often unaware of welfare benefits received or the involvement of other professionals. CONCLUSION: GPs frequently lack knowledge about functional disability, social factors, and anxiety as well as depression in their patients with osteoarthritis. PMID:11042917

  18. Teamwork in primary care: perspectives of general practitioners and community nurses in Lithuania

    PubMed Central

    2013-01-01

    Background A team approach in primary care has proven benefits in achieving better outcomes, reducing health care costs, satisfying patient needs, ensuring continuity of care, increasing job satisfaction among health providers and using human health care resources more efficiently. However, some research indicates constraints in collaboration within primary health care (PHC) teams in Lithuania. The aim of this study was to gain a better understanding of the phenomenon of teamwork in Lithuania by exploring the experiences of teamwork by general practitioners (GPs) and community nurses (CNs) involved in PHC. Methods Six focus groups were formed with 29 GPs and 27 CNs from the Kaunas Region of Lithuania. Discussions were recorded and transcribed verbatim. A thematic analysis of these data was then performed. Results The analysis of focus group data identified six thematic categories related to teamwork in PHC: the structure of a PHC team, synergy among PHC team members, descriptions of roles and responsibilities of team members, competencies of PHC team members, communications between PHC team members and the organisational background for teamwork. These findings provide the basis for a discussion of a thematic model of teamwork that embraces formal, individual and organisational factors. Conclusions The need for effective teamwork in PHC is an issue receiving broad consensus; however, the process of teambuilding is often taken for granted in the PHC sector in Lithuania. This study suggests that both formal and individual behavioural factors should be targeted when aiming to strengthen PHC teams. Furthermore, this study underscores the need to provide explicit formal descriptions of the roles and responsibilities of PHC team members in Lithuania, which would include establishing clear professional boundaries. The training of team members is an essential component of the teambuilding process, but not sufficient by itself. PMID:23945286

  19. How common is medical training in palliative care? A postal survey of general practitioners.

    PubMed Central

    Barclay, S; Todd, C; Grande, G; Lipscombe, J

    1997-01-01

    BACKGROUND: General practitioners (GPs) have a central role in palliative care, yet research continues to reveal room for improvement in symptom control at home. There is a need to evaluate how well-prepared GPs are for this task of caring for the dying at home. AIM: To evaluate the training in palliative care GPs have received throughout their careers. METHOD: Postal survey of 450 randomly selected East Anglian GP principals, investigating training in five areas of palliative care (pain control, control of other symptoms, communication skills, bereavement care, use of syringe driver), as clinical students, junior hospital doctors, GP trainees (registrars), and GP principals. RESULTS: A response rate of 86.7% was obtained. While GPs were clinical students, training was uncommon, (32% reported no training in pain control, and 58% no training in bereavement care), although there has been a significant increase in more recent years. Training as junior doctors was particularly uncommon (over 70% report no training in communication skills or bereavement care); there was some evidence of an increase in more recent years. During the GP trainee year, training was much more common. For GP principals, most areas had been covered, although over 20% reported no training in communication skills and bereavement care. During the community-based years as trainee and principal, training was significantly more common than during the hospital-based years of training as clinical student and junior doctor. CONCLUSIONS: There is a continuing need for medical education in palliative care. Particular attention should be paid to the basic medical education of clinical students and the training of junior doctors, especially regarding communication skills and bereavement care. PMID:9463980

  20. Fostering participation of general practitioners in integrated health services networks: incentives, barriers, and guidelines

    PubMed Central

    de Stampa, Matthieu; Vedel, Isabelle; Bergman, Howard; Novella, Jean-Luc; Lapointe, Liette

    2009-01-01

    Background While the active participation of general practitioners (GPs) in integrated health services networks (IHSNs) plays a critical role in their success, little is known about the incentives and barriers to their actual participation. Methods Data were gathered through semi-structured interviews and a mail survey with GPs enrolled in SIPA (system of integrated care for older persons) at 2 sites in Montreal. A total of 61 GPs completed the questionnaire, from which 22 were randomly selected for the qualitative study, with active and non-active participation in the IHSN. Results The key themes associated with GP participation were clinician characteristics, consequences perceived at the outset, the SIPA implementation process, relationships with the SIPA team and professional consequences. The incentive factors reported were collaborative practices, high rates of elderly and SIPA patients in their clienteles, concerns about SIPA, the selection of frail elderly patients, close relationships with the case manager, the perceived efficacy of SIPA, and improved professional practices. Barriers to GP participation included high expectations, GP recruitment, lack of information on SIPA, difficult relationships with SIPA geriatricians and deterioration of physician-patient relationships. Four profiles of participation were identified: 2 groups of participants active in SIPA and 2 groups of participants not active in SIPA. The active GPs were familiar with collaborative practices, had higher IHSN patient rates, expressed more concerns than expectations, reported satisfactory relationships with case managers and perceived the efficacy of SIPA. Both active and non-active GPs reported quality care in the IHSN and improved professional practice. Conclusion Throughout the implementation process, the participation of GPs in an IHSN depends on numerous professional (clinician characteristics) and organizational factors (GP recruitment, relationships with case managers). Our

  1. International developments in revenues and incomes of general practitioners from 2000 to 2010

    PubMed Central

    2013-01-01

    Background The remuneration system of General Practitioners (GPs) has changed in several countries in the past decade. The aim of our study was: to establish the effect of these changes on the revenues and income of GPs in the first decade of the 21st century. Methods Annual GP revenue and practice costs were collected from national institutes in the eight countries included in our study (Belgium, Denmark, Finland, France, Germany, The Netherlands, Sweden, The United Kingdom (UK)) from 2000–2010. The data were corrected for inflation and purchasing power. Data on the remuneration systems and changes herein were collected from the European Observatory Health Systems Reviews and country experts. Results Comprehensive changes in the remuneration system of GPs were associated with considerable changes in GP income. Incremental changes mainly coincided with a gradual increase in income after correction for inflation. Average GP income was higher in countries with a strong primary care structure. Conclusions The gap between the countries where GPs have a lower income (Belgium, Sweden, France and Finland) and the countries where GPs have a higher income (Netherlands, Germany and the UK) continues to exist over time and appeared to be related to dimensions of primary care, such as governance and access. New payment forms, such as integrated care payment systems, and new health care professionals that are working for GPs, increasingly blur the line between practice costs and income, making it more and more important to clearly define expenditures on GPs, to remain sight on the actual income of GPs. PMID:24152337

  2. How do general practitioners manage patients with cancer symptoms? A video-vignette study

    PubMed Central

    Jiwa, Moyez; Meng, Xingqiong; O'Shea, Carolyn; Magin, Parker; Dadich, Ann; Pillai, Vinita

    2015-01-01

    Objectives Determine how general practitioners (GPs) manage patients with cancer symptoms. Design GPs reviewed 24 video-vignettes and case notes on patients with cancer symptoms and indicated whether they would refer the patient and/or prescribe medication, and/or undertake further investigation. According to available guidelines, all cases warranted a referral to a specialist or further investigations. Setting Australian primary care sector. Participants 102 practising GPs participated in this study, including trainees. Interventions The research was part of a larger randomised controlled trial testing a referral pro forma; however, this paper reports on management decisions made throughout the study. Primary and secondary outcome measures This paper reports on how the participants would manage the patients depicted in each vignette. Results In more than one-in-eight cases, the patient was not investigated or referred. Patient management varied significantly by cancer type (p<0.001). For two key reasons, colorectal cancer was the chosen referent category. First, it represents a prevalent type of cancer. Second, in this study, colorectal cancer symptoms were managed in a similar proportion of options—that is, prescription, referral or investigation. Compared with vignettes featuring colorectal cancer participants were less likely to manage breast, bladder, endometrial, and lung cancers with a ‘prescription only’ or ‘referral only’ option. They were less likely to manage prostate cancer with a ‘prescription only’, yet more likely to manage it with a ‘referral with investigation’. With regard to pancreatic and cervical cancers, participants were more likely to manage these with a ‘referral only’ or a ‘referral with investigation’. Conclusions Some patients may receive a delayed cancer diagnosis, even when they present with typical cancer symptoms to a GP who can access relevant diagnostic tests. Trial registration number ACTRN12611000760976

  3. Factors Affecting the Agreement Between Emergency Psychiatrists and General Practitioners Regarding Involuntary Psychiatric Hospitalizations

    PubMed Central

    Geoffroy, Pierre Alexis; Duhamel, Alain; Behal, Hélène; Zouitina-Lietaert, Nadia; Duthilleul, Julie; Marquette, Louise; Ducrocq, François; Vaiva, Guillaume; Rolland, Benjamin

    2016-01-01

    Important discrepancies exist between physicians in deciding when to perform involuntary hospitalization measures (IHMs). The factors underlying these differences are poorly known. We conducted a two-year single-center retrospective study in France on patients who were referred to the emergency department (ED) with an IHM certificate written by a private-practice General Practitioner (GP). For each consultation, the official IHM motive was categorized into four groups: Suicide; Psychosis, Mania, or Melancholia (PMM); Agitation; and Other. The alcohol status of the patient was also noted. The factors underlying the ED psychiatrists’ confirmation of the use of IHMs were determined using a logistic regression model. One hundred eighty-nine cases were found (165 patients; 44.2 ± 16 years, 41.3% women). The ED psychiatrists confirmed the use of IHMs in 123 instances (65.1% agreement rate). Multivariate analyses found that IHM disagreement was significantly associated with patient alcohol status and the reason for referral. Specifically, there was an increased risk of IHM disagreement when the patient had an alcohol-positive status (OR = 15.80; 95% CI [6.45–38.67]; p < 0.0001) and when the motive for IHM was “agitation” compared with “suicide” (OR = 11.44; 95% CI[3.38–38.78]; p < 0.0001). These findings reflect significant disparities between GPs and ED psychiatrists regarding the decision to proceed to an IHM. PMID:27324574

  4. The age profile of the location decision of Australian general practitioners.

    PubMed

    Mu, Chunzhou

    2015-10-01

    The unbalanced distribution of general practitioners (GPs) across geographic areas has been acknowledged as a problem in many countries around the world. Quantitative information regarding GPs' location decision over their lifecycle is essential in developing effective initiatives to address the unbalanced distribution and retention of GPs. This paper describes the age profile of GPs' location decision and relates it to individual characteristics. I use the Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors (2008-2012) with a sample size of 5810 male and 5797 female GPs. I employ a mixed logit model to estimate GPs' location decision. The results suggest that younger GPs are more prepared to go to rural and remote areas but they tend to migrate back to urban areas as they age. Coming from a rural background increases the likelihood of choosing rural areas, but with heterogeneity: While male GPs from a rural background tend to stay in rural and remote areas regardless of age, female GPs from a rural background are willing to migrate to urban areas as they age. GPs who obtain basic medical degrees overseas are likely to move back to urban areas in the later stage of their careers. Completing a basic medical degree at an older age increases the likelihood of working outside major cities. I also examine factors influencing GPs' location transition patterns and the results further confirm the association of individual characteristics and GPs' location-age profile. The findings can help target GPs who are most likely to practise and remain in rural and remote areas, and tailor policy initiatives to address the undesirable distribution and movement of GPs according to the identified heterogeneous age profile of their location decisions. PMID:26310594

  5. Pediatric Oncology Palliative Care: Experiences of General Practitioners and Bereaved Parents

    PubMed Central

    Neilson, Sue J.; Gibson, Faith; Greenfield, Sheila M

    2016-01-01

    Objective This qualitative study set in the West Midlands region of the United Kingdom, aimed to examine the role of the general practitioner (GP) in children’s oncology palliative care from the perspective of GPs who had cared for a child with cancer receiving palliative care at home and bereaved parents. Methods One-to-one semi-structured interviews were undertaken with 18 GPs and 11 bereaved parents following the death. A grounded theory data analysis was undertaken; identifying generated themes through chronological comparative data analysis. Results Similarity in GP and parent viewpoints was found, the GPs role seen as one of providing medication and support. Time pressures GPs faced influenced their level of engagement with the family during palliative and bereavement care and their ability to address their identified learning deficits. Lack of familiarity with the family, coupled with an acknowledgment that it was a rare and could be a frightening experience, also influenced their level of interaction. There was no consistency in GP practice nor evidence of practice being guided by local or national policies. Parents lack of clarity of their GPs role resulted in missed opportunities for support. Conclusions Time pressures influence GP working practices. Enhanced communication and collaboration between the GP and regional childhood cancer centre may help address identified GP challenges, such as learning deficits, and promote more time-efficient working practices through role clarity. Parents need greater awareness of their GP’s wide-ranging role; one that transcends palliative care incorporating bereavement support and on-going medical care for family members PMID:26925307

  6. The drive for universal healthcare in South Africa: views from private general practitioners.

    PubMed

    Surender, Rebecca; Van Niekerk, Robert; Hannah, Bridget; Allan, Lucie; Shung-King, Maylene

    2015-07-01

    To address problems of inadequate public health services, escalating private healthcare costs and widening health inequalities, the South Africa (SA) Government has launched a bold new proposal to introduce a universal, comprehensive and integrated system for all SAs; National Health Insurance. Though attention has been devoted to the economics of universal coverage less attention has been paid to other potential challenges, in particular the important role played by the clinicians tasked with implementing the reforms. However, historical and comparative analysis reveals that whenever health systems undergo radical reform, the medical profession is instrumental in determining its nature and outcomes. Moreover, early indications suggest many SA private general practitioners (GPs) are opposed to the measures--and it is not yet known whether they will comply with the proposals. This study therefore analyses the dynamics and potential success of the reforms by directly examining the perceptions of the SA medical profession, in particular private-sector GPs. It draws on a conceptual framework which argues that understanding human motivation and behaviour is essential for the successful design of social policy. Seventy-six interviews were conducted with clinicians in the Eastern Cape Province in 2012. The findings suggest that the SA government will face significant challenges in garnering the support of private GPs. Concerns revolved around remuneration, state control, increased workload, clinical autonomy and diminished quality of care and working conditions. Although there were as yet few signs of mobilization or agency by private clinicians in the policy process, the findings suggests that it will be important for the government to directly address their concerns in order to ensure a stable transition and successful implementation of the reforms. PMID:24966292

  7. Statistical process control for referrals by general practitioner at Health Insurance Organization clinics in Alexandria.

    PubMed

    Abdel Wahab, Moataza M; Nofal, Laila M; Guirguis, Wafaa W; Mahdy, Nehad H

    2004-01-01

    Quality control is the application of statistical techniques to a process in an effort to identify and minimize both random and non-random sources of variation. The present study aimed at the application of Statistical Process Control (SPC) to analyze the referrals by General Practitioners (GP) at Health Insurance Organization (HIO) clinics in Alexandria. Retrospective analysis of records and cross sectional interview to 180 GPs were done. Using the control charts (p chart), the present study confirmed the presence of substantial variation in referral rates from GPs to specialists; more than 60% of variation was of the special cause, which revealed that the process of referral in Alexandria (HIO) was completely out of statistical control. Control charts for referrals by GPs classified by different GP characteristics or organizational factors revealed much variation, which suggested that the variation was at the level of individual GPs. Furthermore, the p chart for each GP separately; which yielded a fewer number of points out of control (outliers), with an average of 4 points. For 26 GPs, there was no points out of control, those GPs were slightly older than those having points out of control. Otherwise, there was no significant difference between them. The revised p chart for those 26 GPs together yielded a centerline of 9.7%, upper control limit of 12.0% and lower control limit of 7.4%. Those limits were in good agreement with the limits specified by HIO; they can be suggested to be the new specification limits after some training programs. PMID:17265609

  8. Pain, power and patience - A narrative study of general practitioners' relations with chronic pain patients

    PubMed Central

    2011-01-01

    Background Chronic pain patients are common in general practice. In this study "chronic pain" is defined as diffuse musculoskeletal pain not due to inflammatory diseases or cancer. Effective patient-physician relations improve treatment results. The relationship between doctors and chronic pain patients is often dysfunctional. Consultation training for physicians and medical students can improve the professional ability to build effective relations, but this demands a thorough understanding of the problems in the relation. Several studies have defined the issues that frequently cause problems, but few have described the process. The aim of this study was to understand and illustrate what GPs' experience in contact with chronic pain patients and what works and does not work in these consultations. Methods Our theoretical perspective is constructivist, based upon the relativist view that individuals construct realities to understand and navigate the world. Five Swedish General Practitioners (GPs), two male and three female, were interviewed and asked to tell a story about a difficult encounter with a chronic pain patient. Tapes of the interviews were transcribed and analysed using narrative analysis. Three GPs told narratives suited for our analytic tools and these were included in the final results. Results Each narrative highlights a certain dilemma and a strategy. The dilemmas were: power game; good intentions that fail when a patient is persuaded against her own conviction; persuasion of the unwilling; transferred tiredness; distrust and dissociation from the patient. Professional strategies of listening, encouraging and teamwork were central to handling difficult situations. Conclusions The narratives show that GP's consultations with chronic pain patients sometimes are characterized by conflicts and difficult situations. They are facilitated by methods such as active listening and teamwork, but still may remain hard to handle. This has not before been studied

  9. Effectiveness of the palliative care ‘Availability, Current issues and Anticipation’ (ACA) communication training programme for general practitioners on patient outcomes: A controlled trial

    PubMed Central

    Blankenstein, Annette H; Schweitzer, Bart PM; Knol, Dirk L; van der Horst, Henriëtte E; Aaronson, Neil K; Deliens, Luc

    2014-01-01

    Background: Although communicating effectively with patients receiving palliative care can be difficult, it may contribute to maintaining or enhancing patients’ quality of life. Little is known about the effect of training general practitioners in palliative care–specific communication. We hypothesized that palliative care patients of general practitioners exposed to the ‘Availability, Current issues and Anticipation’ communication training programme would report better outcomes than patients of control general practitioners. Aim: To evaluate the effectiveness of the Availability, Current issues and Anticipation training programme for general practitioners on patient-reported outcomes. Design: In a controlled trial, general practitioners followed the Availability, Current issues and Anticipation programme or were part of the control group. Patients receiving palliative care of participating general practitioners completed the Palliative Care Outcome Scale, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative, the Rest & Peace Scale, the Patient Satisfaction Questionnaire–III and the Availability, Current issues and Anticipation Scale, at baseline and 12 months follow-up. We analysed differences between groups using linear mixed models. Trial registration: ISRCTN56722368. Setting/participants: General practitioners who attended a 2-year Palliative Care Training Course in the Netherlands. Results: Questionnaire data were available for 145 patients (89 in intervention and 56 in control group). We found no significant differences over time between the intervention and control groups in any of the five outcome measures. Ceiling effects were observed for the Rest & Peace Scale, Patient Satisfaction Questionnaire–III and Availability, Current issues and Anticipation Scale. Conclusion: General practitioner participation in the Availability, Current issues and Anticipation training programme did not have

  10. Barriers among Danish women and general practitioners to raising the issue of intimate partner violence in general practice: a qualitative study

    PubMed Central

    2014-01-01

    Background Thirty-five percent of Danish women experience sexual or physical violence in their lifetime. However, health care professionals are not in the practice of asking about intimate partner violence (IPV) in Denmark. It is currently unknown what hinders general practitioners from asking about partner violence and how Danish women would perceive such an inquiry. This aspect has not previously been explored in Denmark. An exploratory study was conducted to examine what hinders general practitioners (GPs) from asking and what Danish women’s views and attitudes are regarding being asked about IPV. Methods Data were collected through individual and group interviews with a sample of three GPs and a diverse sample of 13 women, including both survivors of partner violence and those without any history of partner violence. An interpretative analysis was performed with the data. Results This study provides important knowledge regarding the barriers and attitudes towards inquiry about IPV in primary care in Denmark. Results indicate that Denmark is facing the same challenges when responding to survivors of IPV as other similar countries, including Sweden, Norway, the UK, USA, and Australia. Danish women want general practitioners to ask about violence in a respectful and non-judgemental manner. However, general practitioners are resistant towards such an inquiry and would benefit from training regarding how to respond to women who have been exposed to IPV. Conclusions It is acceptable to inquire about IPV with women in Denmark in a non-judgemental and respectful way. Informing about IPV prevalence is important prior to the inquiry. However, general practitioners require more awareness and training before a favourable environment for this change in procedure can be created. Further large-scale research is needed to support the evidence generated by this small study. PMID:24893567

  11. 14 CFR 221.101 - Inspection at stations, offices, or locations other than principal or general office.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Inspection at stations, offices, or locations other than principal or general office. 221.101 Section 221.101 Aeronautics and Space OFFICE OF... locations other than principal or general office. (a) Each carrier shall make available for...

  12. 14 CFR 221.101 - Inspection at stations, offices, or locations other than principal or general office.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Inspection at stations, offices, or locations other than principal or general office. 221.101 Section 221.101 Aeronautics and Space OFFICE OF... locations other than principal or general office. (a) Each carrier shall make available for...

  13. 14 CFR 221.101 - Inspection at stations, offices, or locations other than principal or general office.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Inspection at stations, offices, or locations other than principal or general office. 221.101 Section 221.101 Aeronautics and Space OFFICE OF... locations other than principal or general office. (a) Each carrier shall make available for...

  14. Current opinion concerning the treatment of heart disease. Report of a postal survey among Tayside general practitioners.

    PubMed

    Mason, C; Murdoch, J C

    1983-02-01

    Using a postal questionnaire method of investigation, the views of Tayside general practitioners were examined with respect to the management of three hypothetical patients with ischaemic heart disease. In the case of a man showing symptoms suggestive of infarction, hospital care was preferred by the majority of doctors. Of three categories of employment, the person in a manual occupation would be advised by most doctors to change his job after a second serious infarction. The advice given to patients was orientated towards the risk factors associated with ischaemic heart disease. Such advice was general rather than specific and emphasized restriction of activities rather than return to normal life. Commonly held social stereotypes appeared to affect the advice which practitioners said they would offer. The implications of these findings are discussed. PMID:6864640

  15. 5 CFR 8301.106 - Additional rules for employees of the Office of Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... rules for employees of the Office of Inspector General. Any employee of the Office of Inspector General... (d) Employment involving personnel, procurement, budget, computer, or equal employment...

  16. Interior view, hallway outside of the attorney general's office (note ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Interior view, hallway outside of the attorney general's office (note murals by Henry Varnuum Poor illustrate themes associated with crime and the deliverance of justice) - United States Department of Justice, Constitution Avenue between Ninth & Tenth Streets, Northwest, Washington, District of Columbia, DC

  17. 1. GENERAL OFFICE BUILDING FOR THE HOMESTEAD WORKS, DESIGNED BY ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. GENERAL OFFICE BUILDING FOR THE HOMESTEAD WORKS, DESIGNED BY HOFFMAN & CRUMPTON OF PITTSBURGH. THE BUILDING WAS DESIGNED TO SHOWCASE THE ARCHITECTURAL POSSIBILITIES OF STEEL. - U.S. Steel Homestead Works, Auxiliary Buildings & Shops, Along Monongahela River, Homestead, Allegheny County, PA

  18. 12 CFR 905.11 - Office of Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Office of Inspector General. 905.11 Section 905.11 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOUSING FINANCE BOARD ORGANIZATION AND... relating to the programs and operations of the Finance Board; (2) Providing leadership and...

  19. 22. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    22. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-447. MOBILIZATION BUILDINGS; 74 & 63 MAN BARRACKS, TYPES BKS-74 & BKS-63; PRISON BARRACKS - GUARDS, TYPES PBG-74 & PBG-63; 29'-6' WIDE BUILDING; HEATING. (modified at Fort McCoy). - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  20. 18. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    18. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-443. MOBILIZATION BUILDINGS; 74 & 63 MAN BARRACKS TYPES BKS-74 & BKS-63; PRISON BARRACKS - GUARDS TYPES PBG-74 & PBG-63; 29'-6' WIDE BUILDING; PLANS. (modified at Fort McCoy). - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  1. 26. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    26. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-135. MOBILIZATION BUILDINGS; 29'-6' WIDE BUILDING WITH TWO ROWS OF POSTS 9'-10' O.C; TWO STORY - STRUCTURAL. - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  2. 25. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    25. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-134. MOBILIZATION BUILDINGS; 29'-6' WIDE BUILDING WITH TWO ROWS OF POSTS 9'-10' O.C; TWO STORY - ARCHITECTURAL; TYPICAL PLAN, ELEV. & SECTIONS. - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  3. 21. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    21. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-446. MOBILIZATION BUILDINGS; 74 & 63 MAN BARRACKS, TYPES BKS-74 & BKS-63; PRISON BARRACKS - GUARDS, TYPES PBG-74 & PBG-63; 29'-6' WIDE BUILDING; ELECTRICAL & PLUMBING. (modified at Fort McCoy). - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  4. 20. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    20. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-445. MOBILIZATION BUILDINGS; 74 & 63 MAN BARRACKS, TYPES BKS-74 & BKS-63; PRISON BARRACKS - GUARDS, TYPES PBG-74 & PBG-63; 29'-6' WIDE BUILDING; MISC. DETAILS. (modified at Fort McCoy). - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  5. 19. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    19. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-444. MOBILIZATION BUILDINGS; 74 & 63 MAN BARRACKS, TYPES BKS-74 & BKS-63; PRISON BARRACKS - GUARDS, TYPES PBG-74 & PBG-63; 29'-6' WIDE BUILDING; FRAMING ELEVATIONS. (modified at Fort McCoy). - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  6. 37. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    37. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-142. MOBILIZATION BUILDINGS; ALTERNATE PLATFORM CONSTRUCTION; 25'-0' & 29'-6' WIDE BLDG. - TWO STORY; POSTS AND BEARING PARTITIONS; SECTIONS & DETAILS. - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  7. 28. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    28. OFFICE OF THE QUARTERMASTER GENERAL; CONSTRUCTION DIVISION; PLAN NUMBER 800-154. MOBILIZATION BUILDINGS; STANDARD DOOR DETAILS; TYPES SCHEDULES & DETAILS. (This photograph was copied from a drawing at Fort McCoy. There is no negative of this drawing in the Military Construction 105mm. Negative Collection at Fort Belvoir.) - Fort McCoy, Building T-1129, Sparta, Monroe County, WI

  8. BUILDING 122 CONTAINS THREE GENERAL AREAS: OFFICE AREAS, INTERNAL DOSIMETRY, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    BUILDING 122 CONTAINS THREE GENERAL AREAS: OFFICE AREAS, INTERNAL DOSIMETRY, AND MEDICAL/HEALTH. BUILDING 122 SHARES A COMMON WALL WITH BUILDING 121, THE PLANT SECURITY BUILDING. THE TWO-STORY BUILDING IN THE BACKGROUND IS BUILDING 111. (9/26/52) - Rocky Flats Plant, Emergency Medical Services Facility, Southwest corner of Central & Third Avenues, Golden, Jefferson County, CO

  9. General Office/Typist: Task List Competency Record.

    ERIC Educational Resources Information Center

    Minnesota Instructional Materials Center, White Bear Lake.

    One of 12 in the secretarial/clerical area, this booklet for the vocational instructor contains a job description for the general office typist, a task list of areas of competency, an occupational tasks competency record (suggested as replacement for the traditional report card), a list of industry representatives and educators involved in…

  10. Student Guide for Documenting Experiential Learning: General Office Practice.

    ERIC Educational Resources Information Center

    Coastline Community Coll., Fountain Valley, CA.

    Coastline Community College has developed a series of guides to assist adults who wish to obtain college credit or advanced standing in evaluating and verifying their non-college learning experiences. This guide lists the competency requirements of four courses within the General Office Practice program: Filing, Business Correspondence,…

  11. A Prescription for Resistance: Management of Staphylococcal Skin Abscesses by General Practitioners in Australia

    PubMed Central

    Parrott, Christine; Wood, Gillian; Bogatyreva, Ekaterina; Coombs, Geoffrey W.; Johnson, Paul D. R.; Bennett, Catherine M.

    2016-01-01

    Objectives: We investigated the management of staphylococcal abscesses (boils) by general practitioners (GPs) in the context of rising antibiotic resistance in community strains of Staphylococcus aureus. Design, Setting, Participants: We analyzed patient-reported management of 66 cases of uncomplicated skin abscesses from the frequency matched methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) Community-Onset Staphylococcus aureus Household Cohort (COSAHC) study (Melbourne, Australia, 2008–2012). Susceptibilities in all cases were known: 50/66 abscesses were caused by MRSA. In order to investigate GP-reported management of staphylococcal abscesses, we surveyed a random subset of GPs, from the COSAHC study (41), and of GPs (39) who used the same community-based pathology service (December 2011–May 2012). Main outcome measures: Patient outcomes, antibiotics prescribed, antibiotic resistance profiles of infecting strains, rates of incision and drainage (I&D), and attitudes to ordering microbiological cultures. Results: MRSA was three times more likely to be cultured from an abscess than MSSA. Patient-reported management revealed 100% were prescribed antibiotics and only 60.6% had I&D. Of those 85% who remembered their prescription(s), 81% of MRSA cases and 23% of MSSA cases initially received inactive antibiotics. Repeat GP visits where antibiotics were changed occurred in 45 MRSA and 7 MSSA cases, although at least 33% of subsequent prescriptions were inactive for the MRSA infections. Patients treated with I&D and antibiotics did no better than those treated with only I&D, regardless of the antibiotic activity. In the GP surveys, 89% reported I&D, with or without antibiotics, to be their preferred management. Only 29.9% of GPs would routinely swab abscesses. Conclusion: The recommended management of uncomplicated Staphylococcus abscesses is I&D without antibiotics to reduce exposure to unnecessary antibiotics. In our study, I&D was

  12. Variation in Direct Access to Tests to Investigate Cancer: A Survey of English General Practitioners

    PubMed Central

    Nicholson, Brian D.; Oke, Jason L.; Rose, Peter W.; Mant, David

    2016-01-01

    Background The 2015 NICE guidelines for suspected cancer recommend that English General Practitioners have direct access to diagnostic tests to investigate symptoms of cancer that do not meet the criteria for urgent referral. We aimed to identify the proportion of GPs in England with direct access to these tests. Methods We recruited 533 English GPs through a national clinical research network to complete an online survey about direct access to laboratory, radiology, and endoscopy tests in the three months leading up to the release of the 2015 NICE guidance. If they had direct access to a diagnostic test, GPs were asked about the time necessary to arrange a test and receive a report. Results are reported by NHS sub-region and, adjusting for sampling, for England as a whole. Results Almost all GPs reported direct access to x-ray and laboratory investigations except faecal occult blood testing (54%, 95% CI 49–59%) and urine protein electrophoresis (89%, 95% CI 84–92%). Fewer GPs had direct access to CT scans (54%, 95% CI 49–59%) or endoscopy (colonoscopy 32%, 95% CI 28–37%; gastroscopy 72%, 95% CI 67–77%). There was significant variation in direct access between NHS regions for the majority of imaging tests—for example, from 20 to 85% to MRI. Apart from x-ray, very few GPs (1–22%) could access radiology and endoscopy within the timescales recommended by NICE. The modal request to test time was 2–4 weeks for routine radiology and 4–6 weeks for routine endoscopy with results taking another 1–2 weeks. Conclusion At the time that the 2015 NICE guideline was released, local investment was required to not only provide direct access but also reduce the interval between request and test and speed up reporting. Further research using our data as a benchmark is now required to identify whether local improvements in direct access have been achieved in response to the NICE targets. If alternative approaches to test access are to be proposed they must be

  13. 'Personal Care' and General Practice Medicine in the UK: A qualitative interview study with patients and General Practitioners

    PubMed Central

    Adam, Rachel

    2007-01-01

    Background Recent policy and organisational changes within UK primary care have emphasised graduated access to care, speed of access to the first available general practitioner (GP) and care being provided by a range of healthcare professionals. These trends have been strengthened by the current GP contract and Quality and Outcomes Framework (QOF). Concern has been expressed that the potential for personal care is being diminished as a result and that this will reduce quality standards. This paper presents data from a study that explored with patients and GPs what personal care means and whether it has continuing importance to them. Methods A semi-structured questionnaire was used to interview participants and Framework Analysis supported analysis of emerging themes. Twenty-nine patients, mainly women with young children, and twenty-three GPs were interviewed from seven practices in Lothian, Scotland, ranged by practice size and relative deprivation score. Results and Discussion Personal care was defined mainly, though not exclusively, as care given within the context of a continuing relationship in which there is an interpersonal connection and the doctor adopts a particular consultation style. Defined in this way, it was reported to have benefits for both health outcomes and patients' experience of care. In particular, such care was thought to be beneficial in attending to the emotions that can be elicited when seeking and receiving health care and in enabling patients to be known by doctors as legitimate seekers of care from the health service. Its importance was described as being dependent upon the nature of the health problem and patients' wider familial and social circumstances. In particular, it was found to provide support to patients in their parenting and other familial caring roles. Conclusion Personal care has continuing salience to patients and GPs in modern primary care in the UK. Patients equate the experience of care, not just outcomes, with high

  14. 75 FR 82042 - Office of Inspector General; Privacy Act of 1974; Notification of the Office of Inspector General...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ...Pursuant to the Privacy Act of 1974 (5 U.S.C. 552a), notice is hereby given that HUD's Office of Inspector General (OIG) proposes to consolidate, update and delete Systems of Records (SORs) within its existing repository of SORs, and establish a new SORs to be maintained by the 13 Regional Special Agents in Charge nationwide and the Deputy Assistant Inspector General for Investigations in......

  15. Evaluation of specialists' outreach clinics in general practice in England: process and acceptability to patients, specialists, and general practitioners.

    PubMed Central

    Bowling, A; Stramer, K; Dickinson, E; Windsor, J; Bond, M

    1997-01-01

    OBJECTIVES: The wider study aimed to evaluate specialists' outreach clinics in relation to their costs, processes, and effectiveness, including patients' and professionals' attitudes. The data on processes and attitudes are presented here. DESIGN: Self administered questionnaires were drawn up for patients, their general practitioners (GPs) and specialists, and managers in the practice. Information was sought from hospital trusts. The study formed a pilot phase prior to a wider evaluation. SETTING: Nine outreach clinics in general practices in England, each with a hospital outpatient department as a control clinic were studied. SUBJECTS: The specialties included were ear, nose, and throat surgery; rheumatology; and gynaecology. The subjects were the patients who attended either the outreach clinics or hospital outpatients clinics during the study period, the outreach patients' GPs, the outreach patients' and outpatients' specialists, the managers in the practices, and the NHS trusts which employed the specialists. MAIN OUTCOME MEASURES: Process items included waiting lists, waiting times in clinics, number of follow up visits, investigations and procedures performed, treatment, health status, patients' and specialists' travelling times, and patients' and doctors' attitudes to, and satisfaction with, the clinic. RESULTS: There was no difference in the health status of patients in relation to the clinic site (ie, outreach and hospital outpatients' clinics) at baseline, and all but one of the specialists said there were no differences in casemix between their outreach and outpatients' clinics. Patients preferred, and were more satisfied with, care in specialists' outreach clinics in general practice, in comparison with outpatients' clinics. The outreach clinics were rated as more convenient than outpatients' clinics in relation to journey times; those outreach patients in work lost less time away from work than outpatients' clinic patients due to the clinic attendance

  16. Experiences of Parents and General Practitioners with End-of-Life Care in Adolescents and Young Adults with Cancer.

    PubMed

    Kaal, Suzanne E J; Kuijken, Noortje M J; Verhagen, Constant A H H V M; Jansen, Rosemarie; Servaes, Petra; van der Graaf, Winette T A

    2016-03-01

    This study aims to analyze the experiences of Dutch bereaved parents and general practitioners (GPs) with palliative care of AYAs (18-35 years) in the terminal stage. Fifteen parents and nine GPs involved with nine deceased AYAs filled out questionnaires and were interviewed by telephone, respectively. In general, the parents were satisfied with the emotional care they themselves received and the medical care that their child received. The GPs were very satisfied with the cooperation with the palliative team. Gaps are present in the areas of symptom control, communication between hospital professionals and parents, aftercare, and transition between hospital and GP. PMID:26812457

  17. Effect of Comprehensive Oncogenetics Training Interventions for General Practitioners, Evaluated at Multiple Performance Levels

    PubMed Central

    Houwink, Elisa J. F.; Muijtjens, Arno M. M.; van Teeffelen, Sarah R.; Henneman, Lidewij; Rethans, Jan Joost; Jacobi, Florijn; van der Jagt, Liesbeth; Stirbu, Irina; van Luijk, Scheltus J.; Stumpel, Connie T. R. M.; Meijers-Heijboer, Hanne E.; van der Vleuten, Cees; Cornel, Martina C.; Dinant, Geert Jan

    2015-01-01

    General practitioners (GPs) are increasingly called upon to identify patients at risk for hereditary cancers, and their genetic competencies need to be enhanced. This article gives an overview of a research project on how to build effective educational modules on genetics, assessed by randomized controlled trials (RCTs), reflecting the prioritized educational needs of primary care physicians. It also reports on an ongoing study to investigate long-term increase in genetic consultation skills (1-year follow-up) and interest in and satisfaction with a supportive website on genetics among GPs. Three oncogenetics modules were developed: an online Continuing Professional Development (G-eCPD) module, a live genetic CPD module, and a “GP and genetics” website (huisartsengenetica.nl) providing further genetics information applicable in daily practice. Three assessments to evaluate the effectiveness (1-year follow-up) of the oncogenetic modules were designed: 1.An online questionnaire on self-reported genetic competencies and changes in referral behaviour, 2.Referral rates from GPs to clinical genetics centres and 3.Satisfaction questionnaire and visitor count analytics of supportive genetics website. The setting was Primary care in the Netherlands and three groups of study participants were included in the reported studies:. Assessment 1. 168 GPs responded to an email invitation and were randomly assigned to an intervention or control group, evaluating the G-eCPD module (n = 80) or the live module (n = 88). Assessment 2. Referral rates by GPs were requested from the clinical genetics centres, in the northern and southern parts of the Netherlands (Amsterdam and Maastricht), for the two years before (2010 [n = 2510] and 2011 [n = 2940]) and the year after (2012 [n = 2875]) launch of the oncogenetics CPD modules and the website. Assessment 3. Participants of the website evaluation were all recruited online. When they visited the website during the month of February 2013

  18. Information resource preferences by general pediatricians in office settings: a qualitative study

    PubMed Central

    Kim, George R; Bartlett, Edward L; Lehmann, Harold P

    2005-01-01

    , general pediatric texts, Web search engines and colleagues as information sources. For Infectious Diseases (ID) vignettes, participants identified questions about patients' clinical status at presentation and questions about disease classification, diagnosis/therapy/referral guidelines and sources of patient education. For ID vignettes, they identified history, laboratory results, colleagues, specialists and personal experience as information sources. Conclusion Content analysis of office-based general pediatricians' responses to clinical vignettes provided a qualitative description of their perceptions of information needs and preferences for information resource for cases in Genetics and Infectious Diseases. This approach may provide complementary information for discovering practitioner's information needs and resource preferences in different contexts. PMID:16225686

  19. Diagnoses, demographics, and utilization of care as encountered by three U.S. Navy general medical officers.

    PubMed

    Poggi, M M; Smith, G J; Campbell, R S

    2000-09-01

    U.S. Navy general medical officers (GMOs) are physicians serving as general practitioners. Although exceptions exist, most GMOs are not board-certified in a specialty. They are post-graduate year 1 (PGY-1)-trained, state-licensed physicians analogous to civilian general practitioners. We conducted a retrospective study using data generated from patient visits with active duty males and females from June 1 to 30, 1998, to describe diagnoses, demographics, and utilization of care patterns encountered by three PGY-1-trained GMOs at an ambulatory clinic. A total of 781 patient encounters with 123 diagnoses from a patient population of 3,178 were recorded. This is an average of 260 patient encounters per GMO, at a rate of 2.52 patients seen per patient-care hour. Fifty-seven consultations/referrals were requested (7.3% of encounters, 1.8% of the patient population). Personnel assigned to the clinic accounted for 4.2% of visits (2% of the patient population). Patient satisfaction was rated as "excellent" to "satisfactory," and no significant morbidity was observed at 1.5-year follow-up. With PGY-1 training, GMOs provide primary care to a substantial volume of prescreened patients and treat patients with a majority of diagnoses without referral or unacceptable complications. The role of GMOs, and perhaps other physicians without specialty training (i.e., general practitioners), in selected settings seems valid and may have advantageous medicoeconomic implications for military and civilian managed care systems. PMID:11011539

  20. 39 CFR 4.5 - Assistant Postmasters General, General Counsel, Judicial Officer, Chief Postal Inspector.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 39 Postal Service 1 2012-07-01 2012-07-01 false Assistant Postmasters General, General Counsel, Judicial Officer, Chief Postal Inspector. 4.5 Section 4.5 Postal Service UNITED STATES POSTAL SERVICE THE BOARD OF GOVERNORS OF THE U.S. POSTAL SERVICE OFFICIALS (ARTICLE IV) § 4.5 Assistant Postmasters...

  1. 39 CFR 4.5 - Assistant Postmasters General, General Counsel, Judicial Officer, Chief Postal Inspector.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Assistant Postmasters General, General Counsel, Judicial Officer, Chief Postal Inspector. 4.5 Section 4.5 Postal Service UNITED STATES POSTAL SERVICE THE BOARD OF GOVERNORS OF THE U.S. POSTAL SERVICE OFFICIALS (ARTICLE IV) § 4.5 Assistant Postmasters...

  2. 39 CFR 4.5 - Assistant Postmasters General, General Counsel, Judicial Officer, Chief Postal Inspector.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 39 Postal Service 1 2014-07-01 2014-07-01 false Assistant Postmasters General, General Counsel, Judicial Officer, Chief Postal Inspector. 4.5 Section 4.5 Postal Service UNITED STATES POSTAL SERVICE THE BOARD OF GOVERNORS OF THE U.S. POSTAL SERVICE OFFICIALS (ARTICLE IV) § 4.5 Assistant Postmasters...

  3. 39 CFR 4.5 - Assistant Postmasters General, General Counsel, Judicial Officer, Chief Postal Inspector.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 39 Postal Service 1 2011-07-01 2011-07-01 false Assistant Postmasters General, General Counsel, Judicial Officer, Chief Postal Inspector. 4.5 Section 4.5 Postal Service UNITED STATES POSTAL SERVICE THE BOARD OF GOVERNORS OF THE U.S. POSTAL SERVICE OFFICIALS (ARTICLE IV) § 4.5 Assistant Postmasters...

  4. 39 CFR 4.5 - Assistant Postmasters General, General Counsel, Judicial Officer, Chief Postal Inspector.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 39 Postal Service 1 2013-07-01 2013-07-01 false Assistant Postmasters General, General Counsel, Judicial Officer, Chief Postal Inspector. 4.5 Section 4.5 Postal Service UNITED STATES POSTAL SERVICE THE BOARD OF GOVERNORS OF THE U.S. POSTAL SERVICE OFFICIALS (ARTICLE IV) § 4.5 Assistant Postmasters...

  5. Qualitative Evaluation of General Practitioner Training Program as Viewed by Graduates from Shiraz, Fasa and Jahrom Medical Universities

    PubMed Central

    SHAHIDI, FATEMEH; SAQEB, MOHAMMAD MEHDI; AMINI, MITRA; AVAND, ABOLGHASEM; DOWLATKHAH, HAMID REZA

    2015-01-01

    Introduction The majority of countries have brought the quality of higher education into focus in the past few years. They have tried to improve the quality of their own higher education. The studies show that Iranian Universities are not at an accepted level in terms of quality. They have encountered several problems which have diminished their quality level. This study aimed at assessing the quality of medical education program as viewed by general practitioners graduated from Shiraz, Fasa and Jahrom Medical Universities. Methods This is a cross-sectional study. 215 subjects were selected based on a census of all the general practitioners graduated from Shiraz, Fasa and Jahrom Universities during 2011-2013. The questionnaire used for collecting the data was that of the Association of Graduates from American Medical Colleges. The collected data were then analyzed using SPSS 14 through which such descriptive and bivariate statistics as percentage, means, Standard Deviation and ANOVA were used. The level of significance was set to 0.05. Results The questionnaire return rate was 97%. As to the graduates' preclinical experiences, five indices were studied which were assessed as "average" in graduates' views. However, with respect to their clinical experiences five indices were equally studied, among which such indices as "Communication skills" and "The quality of medical apprenticeship" were evaluated as "desirable" in view of the graduates from the very three universities. On the contrary, the quality of clinical experiences and technological skills was evaluated as "almost weak"; furthermore, the integration of basic science with required clinical experience was also considered "weak". Conclusion It seems essential to set up an annual assessment of general practitioner education program and a review of the medical education program in Iran based on the global medical advancement and international standards. PMID:26269791

  6. Knowledge and Attitude among General Dental Practitioners towards Minimally Invasive Dentistry in Riyadh and AlKharj

    PubMed Central

    Sheddi, Faisal Mohammed; Alharqan, Mesfer Saad; Khawja, Shabnam Gulzar; Vohra, Fahim; Akram, Zohaib; Faden, Asmaa Ahmed; Khalil, Hesham Saleh

    2016-01-01

    Introduction Minimally Invasive Dentistry (MID) emphasizes conservative caries management strategies resulting in less destruction of tooth structure, a deviation of the traditional GV Black’s restorative principles. However, there seems to be either deficiency in knowledge or little intention by general dental practitioners to adopt these principles. Aim The aim of this study was to assess the knowledge and attitude among general dental practitioners towards minimally invasive dentistry in Riyadh and AlKharj cities of Saudi Arabia. Materials and Methods Self-administered structured questionnaires were handed to general dental practitioners (GDPs) in the cities of Riyadh and AlKharj in Saudi Arabia. Several questions, including Likert-type scale response categories (1–5), were used. The questions assessed the respondents’ levels of agreement regarding diagnostic, preventive and restorative techniques such as use of caries risk assessment, use of high fluoride tooth paste, Atraumatic Restorative Treatment and tunnel preparations. Results Out of 200 respondents, 161 GDPs with overall response rate of 80.5% completed the questionnaires. The GDPs showed significantly different approach with regards to the use of sharp explorer for caries detection (p = 0.014). Almost 60% of the participants had received no special education regarding minimally invasive procedures. Moreover, GDPs who had received MID training showed significantly better knowledge and attitude in adopting minimally invasive techniques for both diagnosis and treatment of dental caries. Conclusion Although GDPs possess knowledge about the benefits of MID; however, study showed deficiencies in their attitudes towards caries detection methods and application of minimally invasive dentistry procedures.

  7. Impact of the CSM advice on thioridazine on general practitioner prescribing behaviour in Leeds: time series analysis

    PubMed Central

    Wright, Nat M J; Roberts, Alison J; Allgar, Victoria L; Tompkins, Charlotte N E; Greenwood, Darren C; Laurence, Gillian

    2004-01-01

    In December 2000, the Committee for Safety of Medicines (CSM) advised that thioridazine may prolong QT intervals risking arrhythmias. We investigated the impact on general practitioner prescribing of thioridazine using a time series analysis. Numbers of items and costs of antipsychotics and benzodiazepines prescribed in Leeds from May 1999 until April 2002 were collated. Post-advice, thioridazine prescriptions dropped by 810 items per month (95% confidence interval = 420 to 1200, P<0.001) but others increased slightly in response. Costs mimicked these changes. Fresh criteria are proposed for appraising the quality of evidence needed to inform future urgent facsimile transmissions. PMID:15113522

  8. Health care professionals’ perceptions towards lifelong learning in palliative care for general practitioners: a focus group study

    PubMed Central

    2014-01-01

    Background There is a growing need for palliative care. The majority of palliative patients prefer their general practitioner (GP) to organize their palliative home care. General practitioners need a range of competences to perform this task. However, there has been no general description so far of how GPs keep these competences up-to-date. The present study explores current experiences, views and preferences towards training and education in palliative care among GPs, palliative home-care professionals and professionals from organizations who provide training and education. Methods Five focus groups were brought together in Belgium, with a total of 29 participants, including members of the three categories mentioned above. They were analysed using a constant comparison method. Results The analysis revealed that undergraduate education and continuing medical education (CME) while in practice, is insufficient to prepare GPs for their palliative work. Workplace learning (WPL) through collaboration with specialized palliative home-care nurses seems to be a valuable alternative. Conclusions The effectiveness of undergraduate education might be enhanced by adding practical experience. Providers of continuing medical education should look to organize interactive, practice-based and interprofessional sessions. Therefore, teachers need to be trained to run small group discussions. In order to optimize workplace learning, health care professionals should be trained to monitor each other’s practice and to provide effective feedback. Further research is needed to clarify which aspects of interprofessional teamwork (e.g. professional hierarchy, agreements on tasks and responsibilities) influence the effectiveness of workplace learning. PMID:24552145

  9. Rheumatology at the general practitioner/hospital interface: a study of prevalence and access to specialist care.

    PubMed Central

    Sullivan, F M; Barber, J H; Sturrock, R D

    1990-01-01

    Four general practices with a combined population of 23,300 in the west of Scotland participated in a record research and questionnaire assessment of 551 patients with rheumatic diseases. The study describes the prevalence, levels of disability found, and the types of service used. Even with this number of patients it was not possible to detect any significant differences in disability levels, use of second line drugs, or aids/appliances when comparing practices with adequate or inadequate access to rheumatological facilities (general practitioner perception). General practice is an appropriate setting in which to investigate the effect of service provision, but larger studies will be needed to reach more definite conclusions. PMID:2270971

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

    PubMed Central

    Poulton, B C

    1996-01-01

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

  11. The use of aspirin and opiates by Dumfries and Galloway general practitioners in the management of acute myocardial infarction.

    PubMed

    Strachan, D A; Robertson, S

    1995-10-01

    In March 1994 a study in the British Medical Journal indicated a low rate of administration of aspirin and opiates by general practitioners in cases of suspected myocardial infarction. A retrospective analysis was made of 120 consecutive admissions to the medical intensive care unit of Dumfries and Galloway Royal Infirmary, by general practitioners, with a primary diagnosis of acute myocardial infarction. Of these 120 cases, 24% were given aspirin by their G.P. prior to admission and 64% were given opiate (IV or IM). Thirty-three percent were already on regular aspirin and of these 18% received further aspirin prior to admission. These figures were considerably better than those previously quoted and they showed that prior regular aspirin therapy did influence the GPs' decision on further administration of aspirin in the acute event. A questionnaire sent to all GPs in Dumfries and Galloway revealed that 100% carried aspirin in their medical bags, 62% claimed to give aspirin to patients with suspected MI, 95% used a British Heart Foundation approved dose of aspirin and 83.3% administered the aspirin using one of the approved methods. PMID:8578305

  12. Current Practice in the Referral of Individuals with Suspected Dementia for Neuroimaging by General Practitioners in Ireland and Wales

    PubMed Central

    Ciblis, Aurelia S.; Butler, Marie-Louise; Quinn, Catherine; Clare, Linda; Bokde, Arun L. W.; Mullins, Paul G.; McNulty, Jonathan P.

    2016-01-01

    Objectives While early diagnosis of dementia is important, the question arises whether general practitioners (GPs) should engage in direct referrals. The current study investigated current referral practices for neuroimaging in dementia, access to imaging modalities and investigated related GP training in Ireland and North Wales. Methods A questionnaire was distributed to GPs in the programme regions which included approximately two thirds of all GPs in the Republic of Ireland and all general practitioners in North Wales. A total of 2,093 questionnaires were issued. Results 48.6% of Irish respondents and 24.3% of Welsh respondents directly referred patients with suspected dementia for neuroimaging. Irish GPs reported greater direct access to neuroimaging than their Welsh counterparts. A very small percentage of Irish and Welsh GPs (4.7% and 10% respectively) had received training in neuroimaging and the majority who referred patients for neuroimaging were not aware of any dementia-specific protocols for referrals (93.1% and 95% respectively). Conclusions The benefits of direct GP access to neuroimaging investigations for dementia have yet to be established. Our findings suggest that current GP speciality training in Ireland and Wales is deficient in dementia-specific and neuroimaging training with the concern being that inadequate training will lead to inadequate referrals. Further training would complement guidelines and provide a greater understanding of the role and appropriateness of neuroimaging techniques in the diagnosis of dementia. PMID:27007435

  13. From the Office of the General Counsel. Advance medical directives.

    PubMed

    Orentlicher, D

    1990-05-01

    The American Medical Association's Board of Trustees recently issued a report on advance medical directives, Living Wills, Durable Powers of Attorney, and Durable Powers of Attorney for Health Care (AMA; 1989). Here Orentlicher, writing under the auspices of the AMA's Office of the General Counsel, offers an expanded version of that report. Orentlicher's article discusses the advantages and drawbacks of living wills, the appointment of a proxy decision maker through a living will, a durable power of attorney, or a durable power of attorney for health care, and the physician's role in implementing treatment preferences. PMID:2325236

  14. Diffusion of an e-learning programme among Danish General Practitioners: A nation-wide prospective survey

    PubMed Central

    Waldorff, Frans Boch; Steenstrup, Annette Plesner; Nielsen, Bente; Rubak, Jens; Bro, Flemming

    2008-01-01

    Background We were unable to identify studies that have considered the diffusion of an e-learning programme among a large population of general practitioners. The aim of this study was to investigate the uptake of an e-learning programme introduced to General Practitioners as part of a nation-wide disseminated dementia guideline. Methods A prospective study among all 3632 Danish GPs. The GPs were followed from the launching of the e-learning programme in November 2006 and 6 months forward. Main outcome measures: Use of the e-learning programme. A logistic regression model (GEE) was used to identify predictors for use of the e-learning programme. Results In the study period, a total of 192 different GPs (5.3%) were identified as users, and 17% (32) had at least one re-logon. Among responders at first login most have learnt about the e-learning programme from written material (41%) or from the internet (44%). A total of 94% of the users described their ability of conducting a diagnostic evaluation as good or excellent. Most of the respondents used the e-learning programme due to general interest (90%). Predictors for using the e-learning programme were Males (OR = 1.4, 95% CI 1.1; 2.0) and members of Danish College of General Practice (OR = 2.2, 95% CI 1.5; 3.1), whereas age, experience and working place did not seem to be influential. Conclusion Only few Danish GPs used the e-learning programme in the first 6 months after the launching. Those using it were more often males and members of Danish College of General Practice. Based on this study we conclude, that an active implementation is needed, also when considering electronic formats of CME like e-learning. Trial Registration ClinicalTrials.gov Identifier: NCT00392483. PMID:18439279

  15. Experiences of General Practitioners and Practice Assistants during the Influenza A(H1N1) Pandemic in the Netherlands: A Cross-Sectional Survey

    PubMed Central

    van Dijk, Christel E.; Hooiveld, Mariette; Jentink, Anne; Isken, Leslie D.; Timen, Aura; Yzermans, C. Joris

    2015-01-01

    Objectives Since few pandemics have occurred since the Spanish influenza pandemic, we should learn from every (mild) pandemic that occurs. The objective of this study was to report on general practitioners’ and practice assistants’ acceptance of the chosen national policy, and experiences in the Netherlands during the influenza A(H1N1)pdm09 pandemic. Methods Data on experience and acceptance of the chosen national policy were obtained by structured questionnaires for general practitioners (n = 372) and practice assistants (n = 503) in April 2010. Results The primary policy chosen for general practice was not always accepted and complied with by general practitioners, although the communication (of changes) and collaboration with involved organisations were rated as positive. In particular, the advised personal protective measures were difficult to implement in daily work and thus not executed by 44% of general practitioners. Half of the general practitioners were not satisfied with the patient information provided by the government. The influenza A(H1N1) pandemic highly impacted on general practitioners’ and practice assistants’ workloads, which was not always deemed to be adequately compensated. Discussion Involvement of general practitioners in future infectious disease outbreaks is essential. This study addresses issues in the pandemic policy which might be critical in a more severe pandemic. PMID:26313147

  16. Perceptions of collaboration between general practitioners and community pharmacists: findings from a qualitative study based in Spain.

    PubMed

    Jové, Anna Maria; Fernández, Ana; Hughes, Carmel; Guillén-Solà, Mireia; Rovira, Marta; Rubio-Valera, Maria

    2014-07-01

    According to the theory of reasoned action (TRA), collaboration is only possible when it is perceived as useful by the participants involved. This paper describes a qualitative study using semi-structured interviews to explore the preceived usefulness of general practitioner (GPs)-community pharmacists (CPs)' collaboration from these professionals' perspectives based in two Spanish regions. Thirty-seven interviews were conducted with GPs and CPs with and without previous experience of collaborating with the other groups of professionals. Analysis of the data indicated that the GPs and CPs considered that collaboration between practitioners and pharmacists to have different forms of usefulness, ranging from positive to negative perceptions of usefulness. Negative and neutral opinions (collaboration generates conflict and/or is not benefitial) could prevent practitioners from initiating collaboration with the other group of professionals, which is explained by the TRA. These perceptions were only found among those participants without experience in collaboration. When collaboration was perceived as advantageous, it could be beneficial on three levels: health system (i.e. provision of integrated care, increased efficiency of the system), GPs and CPs (i.e. increased job satisfaction and patient loyalty) and patients (i.e. improved patient safety). Although GPs and CPs with experience identified benefits using a range of examples, GPs and CPs who had never collaborated also believed that if collaboration was undertaken there would be benefits for the health system, patients and health professionals. These results should be considered when developing strategies to encourage and improve the implementation of collaborative working relationships between GPs and pharmacists in primary care. PMID:24625196

  17. Under-representation of women on governing bodies: women general practitioners on Clinical Commissioning Groups in England.

    PubMed

    Segar, Julia

    2015-10-01

    Recently formed Clinical Commissioning Groups in the English National Health Service have important responsibility for commissioning local health and care services. Women are under-represented on the governing bodies of these significant primary care based organizations despite the fact that they constitute almost half of the general practitioner workforce in England. This essay examines some of the reasons for this under-representation including the predominance of women in the salaried and part-time sector of general practice and gendered management styles within the National Health Service. It is argued that the under-representation of women on Clinical Commissioning Group governing bodies matters in terms of social justice, representation of the broader community and role models. PMID:25589088

  18. 14 CFR 221.101 - Inspection at stations, offices, or locations other than principal or general office.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Inspection at stations, offices, or locations other than principal or general office. 221.101 Section 221.101 Aeronautics and Space OFFICE OF... another person, all tariffs applicable to passenger traffic from or to the point where such...

  19. Home care by general practitioners for cancer patients in the last 3 months of life: An epidemiological study of quality and associated factors

    PubMed Central

    Pivodic, Lara; Harding, Richard; Calanzani, Natalia; McCrone, Paul; Hall, Sue; Deliens, Luc; Higginson, Irene J; Gomes, Barbara

    2016-01-01

    Background: Stronger generalist end-of-life care at home for people with cancer is called for but the quality of end-of-life care delivered by general practitioners has been questioned. Aim: To determine the degree of and factors associated with bereaved relatives’ satisfaction with home end-of-life care delivered by general practitioners to cancer patients. Design: Population-based mortality followback survey. Setting/participants: Bereaved relatives of people who died of cancer in London, United Kingdom (identified from death registrations in 2009–2010), were invited to complete a postal questionnaire surveying the deceased’s final 3 months of life. Results: Questionnaires were completed for 596 decedents of whom 548 spent at least 1 day at home in the last 3 months of life. Of the respondents, 55% (95% confidence interval: 51%–59%) reported excellent/very good home care by general practitioners, compared with 78% (95% confidence interval: 74%–82%) for specialist palliative care providers and 68% (95% confidence interval: 64%–73%) for district/community/private nurses. The odds of high satisfaction (excellent/very good) with end-of-life care by general practitioners doubled if general practitioners made three or more compared with one or no home visits in the patient’s last 3 months of life (adjusted odds ratio: 2.54 (95% confidence interval: 1.52–4.24)) and halved if the patient died at hospital rather than at home (adjusted odds ratio: 0.55 (95% confidence interval: 0.31–0.998)). Conclusion: There is considerable room for improvement in the satisfaction with home care provided by general practitioners to terminally ill cancer patients. Ensuring an adequate offer of home visits by general practitioners may help to achieve this goal. PMID:26036688

  20. 5 CFR 179.205 - Waiver requests and claims to the General Accounting Office.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Accounting Office. 179.205 Section 179.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL... General Accounting Office. These regulations do not preclude an employee from requesting waiver of an... validity of a debt by submitting a subsequent claim to the General Accounting Office in accordance with...

  1. 5 CFR 179.205 - Waiver requests and claims to the General Accounting Office.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Accounting Office. 179.205 Section 179.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL... General Accounting Office. These regulations do not preclude an employee from requesting waiver of an... validity of a debt by submitting a subsequent claim to the General Accounting Office in accordance with...

  2. 5 CFR 179.205 - Waiver requests and claims to the General Accounting Office.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Accounting Office. 179.205 Section 179.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL... General Accounting Office. These regulations do not preclude an employee from requesting waiver of an... validity of a debt by submitting a subsequent claim to the General Accounting Office in accordance with...

  3. 5 CFR 179.205 - Waiver requests and claims to the General Accounting Office.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Accounting Office. 179.205 Section 179.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL... General Accounting Office. These regulations do not preclude an employee from requesting waiver of an... validity of a debt by submitting a subsequent claim to the General Accounting Office in accordance with...

  4. 46 CFR 11.201 - Eligibility for officer endorsements and STCW endorsements, general.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Eligibility for officer endorsements and STCW endorsements, general. 11.201 Section 11.201 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY MERCHANT MARINE OFFICERS AND SEAMEN REQUIREMENTS FOR OFFICER ENDORSEMENTS General Requirements for Officer Endorsements § 11.201 Eligibility for...

  5. Office of Inspector General audit report on small disadvantaged business program at the Chicago Operations Office

    SciTech Connect

    1999-01-01

    The Office of Inspector General performed audits of the Small Disadvantaged Business Program at five management and operating contractors in FY 1994. The audits disclosed that none of the contractors fully met the intent of the Act and implementing regulations. The contractors awarded some subcontracts to firms of questionable program eligibility. Also, two of the contractors concentrated awards among a limited number of small disadvantaged businesses, and used procurement practices that precluded opportunities for many small disadvantaged businesses to participate. The objective of this audit was to determine whether Chicago was providing the maximum practicable opportunity for small disadvantaged businesses to participate in contract awards.

  6. Two-Year Longitudinal Analysis of a Cluster Randomized Trial of Physical Activity Promotion by General Practitioners

    PubMed Central

    Grandes, Gonzalo; Sanchez, Alvaro; Montoya, Imanol; Ortega Sanchez-Pinilla, Ricardo; Torcal, Jesús

    2011-01-01

    Background We evaluate the effectiveness of a physical activity promotion programme carried out by general practitioners with inactive patients in routine care. Methods and Findings Pragmatic, cluster randomised clinical trial conducted in eleven public primary care centres in Spain. Fifty-six general practitioners (GPs) were randomly assigned to intervention (29) or standard care (27) groups. They assessed the physical activity level of a systematic sample of patients in routine practice and recruited 4317 individuals (2248 intervention and 2069 control) who did not meet minimum physical activity recommendations. Intervention GPs provided advice to all patients and a physical activity prescription to the subgroup attending an additional appointment (30%). A third of these prescriptions were opportunistically repeated. Control GPs provided standard care. Primary outcome measure was the change in self-reported physical activity from baseline to six, 12 and 24 months. Secondary outcomes included cardiorespiratory fitness and health-related quality of life. A total of 3691 patients (85%) were included in the longitudinal analysis and overall trends over the whole 24 month follow-up were significantly better in the intervention group (p<0.01). The greatest differences with the control group were observed at six months (adjusted difference 1.7 MET*hr/wk [95% CI, 0.8 to 2.6], 25 min/wk [95% CI, 11.3 to 38.4], and a 5.3% higher percentage of patients meeting minimum recommendations [95% CI: 2.1% to 8.8%] NNT = 19). These differences were not statistically significant at 12 and 24 months. No differences were found in secondary outcomes. A significant difference was maintained until 24 months in the proportion of patients achieving minimum recommendation in the subgroup that received a repeat prescription (adjusted difference 10.2%, 95% CI 1.5% to 19.4%). Conclusions General practitioners are effective at increasing the level of physical activity among their inactive

  7. A generalized window energy rating system for typical office buildings

    SciTech Connect

    Tian, Cheng; Chen, Tingyao; Yang, Hongxing; Chung, Tse-ming

    2010-07-15

    Detailed computer simulation programs require lengthy inputs, and cannot directly provide an insight to relationship between the window energy performance and the key window design parameters. Hence, several window energy rating systems (WERS) for residential houses and small buildings have been developed in different countries. Many studies showed that utilization of daylight through elaborate design and operation of windows leads to significant energy savings in both cooling and lighting in office buildings. However, the current WERSs do not consider daylighting effect, while most of daylighting analyses do not take into account the influence of convective and infiltration heat gains. Therefore, a generalized WERS for typical office buildings has been presented, which takes all primary influence factors into account. The model includes embodied and operation energy uses and savings by a window to fully reflect interactions among the influence parameters. Reference locations selected for artificial lighting and glare control in the current common simulation practice may cause uncompromised conflicts, which could result in over- or under-estimated energy performance. Widely used computer programs, DOE2 and ADELINE, for hourly daylighting and cooling simulations have their own weaknesses, which may result in unrealistic or inaccurate results. An approach is also presented for taking the advantages of the both programs and avoiding their weaknesses. The model and approach have been applied to a typical office building of Hong Kong as an example to demonstrate how a WERS in a particular location can be established and how well the model can work. The energy effect of window properties, window-to-wall ratio (WWR), building orientation and lighting control strategies have been analyzed, and can be indicated by the localized WERS. An application example also demonstrates that the algebraic WERS derived from simulation results can be easily used for the optimal design of

  8. An Overview of Diabetes Management in Schizophrenia Patients: Office Based Strategies for Primary Care Practitioners and Endocrinologists

    PubMed Central

    Annamalai, Aniyizhai; Tek, Cenk

    2015-01-01

    Diabetes is common and seen in one in five patients with schizophrenia. It is more prevalent than in the general population and contributes to the increased morbidity and shortened lifespan seen in this population. However, screening and treatment for diabetes and other metabolic conditions remain poor for these patients. Multiple factors including genetic risk, neurobiologic mechanisms, psychotropic medications, and environmental factors contribute to the increased prevalence of diabetes. Primary care physicians should be aware of adverse effects of psychotropic medications that can cause or exacerbate diabetes and its complications. Management of diabetes requires physicians to tailor treatment recommendations to address special needs of this population. In addition to behavioral interventions, medications such as metformin have shown promise in attenuating weight loss and preventing hyperglycemia in those patients being treated with antipsychotic medications. Targeted diabetes prevention and treatment is critical in patients with schizophrenia and evidence-based interventions should be considered early in the course of treatment. This paper reviews the prevalence, etiology, and treatment of diabetes in schizophrenia and outlines office based interventions for physicians treating this vulnerable population. PMID:25878665

  9. Double vision: an exploration of radiologists' and general practitioners' views on using picture archiving and communication systems (PACS).

    PubMed

    Carlin, Leslie; Smith, Helen; Henwood, Flis; Flowers, Steve; Jones, Andrea; Prentice, Rebecca; Miles, Ken

    2010-06-01

    This article explores the perspectives of two user groups, general practitioners (GPs) and consultant radiologists (CRs), on the rollout of picture archiving and communications systems (PACS) within acute trusts and eventually to primary care as part of the electronic patient record. Qualitative interviews were conducted with 16 CRs and 31 GPs. Analysis was carried out using a grounded theory approach. Radiologists expressed positive views about the implementation of PACS in secondary care, but were wary of GPs accessing radiological images. GPs expressed concerns about the added burdens that PACS might bring to primary care, but most felt that sharing images with patients could benefit doctor-patient communication and increase patient satisfaction. This study highlights both impediments and pathways to the implementation of PACS in primary care, and illustrates the importance of regarding PACS as socially embedded and users as culturally disparate. PMID:20573641

  10. 39 CFR 230.3 - Cooperation with the Office of Inspector General.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 39 Postal Service 1 2012-07-01 2012-07-01 false Cooperation with the Office of Inspector General. 230.3 Section 230.3 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION OFFICE OF INSPECTOR GENERAL General Policy and Authority § 230.3 Cooperation with the Office of...

  11. 39 CFR 230.3 - Cooperation with the Office of Inspector General.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 39 Postal Service 1 2014-07-01 2014-07-01 false Cooperation with the Office of Inspector General. 230.3 Section 230.3 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION OFFICE OF INSPECTOR GENERAL General Policy and Authority § 230.3 Cooperation with the Office of...

  12. 39 CFR 230.3 - Cooperation with the Office of Inspector General.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 39 Postal Service 1 2011-07-01 2011-07-01 false Cooperation with the Office of Inspector General. 230.3 Section 230.3 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION OFFICE OF INSPECTOR GENERAL General Policy and Authority § 230.3 Cooperation with the Office of...

  13. 39 CFR 230.3 - Cooperation with the Office of Inspector General.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 39 Postal Service 1 2013-07-01 2013-07-01 false Cooperation with the Office of Inspector General. 230.3 Section 230.3 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION OFFICE OF INSPECTOR GENERAL General Policy and Authority § 230.3 Cooperation with the Office of...

  14. 39 CFR 230.3 - Cooperation with the Office of Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Cooperation with the Office of Inspector General. 230.3 Section 230.3 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION OFFICE OF INSPECTOR GENERAL General Policy and Authority § 230.3 Cooperation with the Office of...

  15. 22 CFR 23.5 - Claims for settlement by Department of State or General Accounting Office.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... General Accounting Office. 23.5 Section 23.5 Foreign Relations DEPARTMENT OF STATE FEES AND FUNDS FINANCE AND ACCOUNTING § 23.5 Claims for settlement by Department of State or General Accounting Office. Claims for settlement by the Department of State or by the General Accounting Office shall be...

  16. 22 CFR 23.5 - Claims for settlement by Department of State or General Accounting Office.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... General Accounting Office. 23.5 Section 23.5 Foreign Relations DEPARTMENT OF STATE FEES AND FUNDS FINANCE AND ACCOUNTING § 23.5 Claims for settlement by Department of State or General Accounting Office. Claims for settlement by the Department of State or by the General Accounting Office shall be...

  17. [The benefits prevail – why electronic immunization records are advantageous to the general practitioner and his patients].

    PubMed

    Burkhardt, Tobias

    2016-01-01

    Immunization coverage throughout the Swiss population is still not optimal and therefore preventable diseases such as measles have not been eliminated in Switzerland yet. In addition, new vaccination protocols are available and official recommendations are becoming increasingly complex. The website www.myvaccines.ch has been in use since 2011 with the primary goal to increase immunization coverage. This service was established by Vaccinologist Professor Claire-Anne Siegrist from the University of Geneva and is free of charge for all Swiss doctors and pharmacists. It enables general practitioners and pediatricians to document the vaccination history of their patients in a new electronic immunization record. After a simple and quick process, the web-based software proposes up-to-date recommendations of new or follow-up vaccinations following the current Swiss Immunization Plan by the Federal Department of Health. Within this single practice, 1446 files have been recorded within the past three years. As a consequence, a total of 4378 immunizations have been administered, leading to a mean of 3.03 immunizations per patient. After introducing the electronic immunization record, the rates of immunizations have increased dramatically for all antigens (factor 2.1 to 41.5). Overall, patient acceptance was high – the doctor’s investment was positively recognized and his approach to patient care was perceived as modern. As a result, the practice has become competent in immunization. In summary, the positive outcome of using the electronic record highly supports the free program www.myvaccines.ch to all general practitioners and pediatricians in Switzerland. PMID:27268455

  18. Feasibility, safety, and efficacy of domiciliary thrombolysis by general practitioners: Grampian region early anistreplase trial. GREAT Group.

    PubMed Central

    1992-01-01

    OBJECTIVE--To assess the feasibility, safety, and efficacy of domiciliary thrombolysis by general practitioners. DESIGN--Randomised double blind parallel group trial of anistreplase 30 units intravenously and placebo given either at home or in hospital. SETTING--29 rural practices in Grampian admitting patients to teaching hospitals in Aberdeen (average distance 36 (range 16-62) miles). PATIENTS--311 patients with suspected acute myocardial infarction and no contraindications to thrombolytic therapy seen at home within four hours of onset of symptoms. MAIN OUTCOME MEASURES--Time saving, adverse events, Q wave infarction, left ventricular function. RESULTS--Anistreplase was administered at home 101 minutes after onset of symptoms, while anistreplase was given in hospital 240 minutes after onset of symptoms (median times). Adverse events after thrombolysis were infrequent and, apart from cardiac arrest, not a serious problem when they occurred in the community: seven of 13 patients were resuscitated after cardiac arrest out of hospital. By three months after trial entry the relative reduction of deaths from all causes in patients given thrombolytic therapy at home was 49% (13/163 (8.0%) v 23/148 (15.5%); difference -7.6% (95% confidence interval -14.7% to -0.4%), p = 0.04). Full thickness Q wave infarction was less common in patients with confirmed infarction receiving treatment at home (65/122 (53.3%) v 76/112 (67.9%); difference -14.6% (95% confidence interval -27.0% to -2.2%), p = 0.02). CONCLUSIONS--General practitioners provided rapid pre-hospital coronary care of a high standard. Compared with later administration in hospital, giving anistreplase at home resulted in reduction in mortality, fewer cardiac arrests, fewer Q wave infarcts, and better left ventricular function. Benefits were most marked where thrombolytic therapy was administered within two hours of the onset of symptoms. PMID:1393033

  19. Management of somatic presentations of psychiatric illness in general medical settings: evaluation of a new training course for general practitioners.

    PubMed

    Kaaya, S; Goldberg, D; Gask, L

    1992-03-01

    An improved teaching package is described which aims to help general practice trainees manage somatized presentations of psychological distress. The package comprises a training videotape in which a reattribution model is demonstrated, with material for role-play of new skills and small-group video feedback of consultations. Eighteen general practice trainees attending an 8-week course in psychiatry participated fully in the somatization management teaching programme. The teaching package was evaluated by blind rating of general interview skills and model specific skills demonstrated by trainees during 10 to 15-minute clinical interviews with professional role-players. Ratings were made on pre-training and post-training videotaped interviews. A significant improvement was demonstrated in general interview skills. Improvements were also noted in specific reattribution skills post-training. The evaluation revealed that skills in the model can be effectively learned, and that improvements in the package have resulted in its improved efficacy. PMID:1565030

  20. Conversations with Practitioners: Supporting State-Level Collaboration among General and Special Educators

    ERIC Educational Resources Information Center

    Mohammed, Sarojani S.; Murray, Christy S.; Coleman, Meghan A.; Roberts, Greg; Grim, Catherine N.

    2011-01-01

    Many states have identified collaboration between general education and special education departments as crucial to the successful implementation of a Response to Intervention (RTI) framework. Equally, the joint ownership of the RTI framework by all involved contributes to successful implementation. Regional Comprehensive Centers (RCCs) are…

  1. 8 CFR 1003.103 - Immediate suspension and summary disciplinary proceedings; duty of practitioner to notify EOIR of...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 1003.103 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE GENERAL PROVISIONS EXECUTIVE OFFICE FOR IMMIGRATION REVIEW Professional Conduct for Practitioners-Rules and... Immigration Courts any practitioner who has been found guilty of, or pleaded guilty or nolo contendere to,...

  2. Knowledge and Awareness among Parents and General Dental Practitioners regarding Rehabilitation with Full Coverage Restoration in Children: A Multi-centric Trial

    PubMed Central

    Saroj, Gyanendra; Sharma, Swati; Gupta, Basant

    2016-01-01

    ABSTRACT Aims: The aim of this study was to evaluate the knowledge and awareness among parents and general dental practitioners regarding rehabilitation with full coverage restoration in children following pulp therapy. Materials and methods: A multiple choice questionnaire was given to 1,000 parents and 400 general practitioners in this multicentric trial. The questionnaire assessed their beliefs, knowledge regarding care of primary teeth, assessment of treating children, and knowledge regarding importance of primary teeth. All the questionnaires were then compiled and statistically analyzed using Statistical Package for Social Sciences (SPSS) software. Results and discussion: 53% parents did not know the importance of primary teeth and 73% parents also thought that no treatment is possible for pulpally involved primary teeth. 20% parents believed that root canal treatment can be possible for children and only 10% knew about full coverage restorations. 40% of the general dentists felt that the best treatment in the case of primary necrotic teeth is extraction and only 13% knew about stainless steel crowns. 62% of general dental practitioners pointed out patients’ noninterest in providing crowns whereas 68% parents reported non-information by dentists. Conclusion: Both parents and general dental practitioners have incomplete and inadequate knowledge regarding full coverage restorations, and we need to improve the knowledge and dental awareness of the parents and the general dental practitioners. How to cite this article: Moda A, Saroj G, Sharma S, Gupta B. Knowledge and Awareness among Parents and General Dental Practitioners regarding Rehabilitation with Full Coverage Restoration in Children: A Multi-centric Trial. Int J Clin Pediatr Dent 2016;9(2):177-180. PMID:27365944

  3. Patient choice in a practice with men and women general practitioners.

    PubMed

    Graffy, J

    1990-01-01

    This study investigated the distribution of workload between men and women doctors in a south London practice. Of 909 attending patients aged 15 years and over, 611 were women and 48% of these consulted a woman doctor. In comparison, only 27% of the 298 men consulted a woman doctor. Twenty nine per cent of the 105 women who gave a reason for choosing a woman doctor said they had done so because of her sex. Multiple logistic regression was used to assess the relative importance of having a general preference for a woman doctor or of consulting about a problem related to sex in predicting the likelihood of a woman consulting a woman doctor. This showed that preference was 2.3 times as important as problem type in predicting this. This suggests that woman's demand for women doctors in general practice extends beyond family planning and well woman clinics. The implications of this for practice organization are discussed. PMID:2107832

  4. The grieving adult and the general practitioner: a literature review in two parts (Part 2).

    PubMed

    Woof, W R; Carter, Y H

    1997-08-01

    In part 1 of this review, published last month, literature exploring the psychological bereavement theories and the health consequences of bereavement are summarized. The second part builds on this to outline the debate surrounding the characteristics of abnormal bereavement, while also focusing on risk factors for this morbidity. This leads on to a summary of the literature on bereavement care, particularly from a general practice point of view. Finally, areas for further research are highlighted. PMID:9302794

  5. Coping with Workplace Violence against General Practitioners and Nurses in Heilongjiang Province, China: Social Supports and Prevention Strategies

    PubMed Central

    Liu, He; Gao, Lijun; Jiao, Mingli; Liu, Jinghua; Liang, Libo; Zhao, Yanming; Wu, Qunhong

    2016-01-01

    The study’s objectives were to: 1) use social support theory to examine factors influencing healthcare workers’ opinions about workplace violence (WPV) prevention strategies, and 2) to determine the types of support that general practitioners (GPs) and general nurses sought and expected to use after WPV exposure. A cross-sectional survey was used to assess a sample of 448 GPs and 412 general nurses from 90 township hospitals located in Heilongjiang province, China. Results revealed that workers exposed to physical, psychological or both WPV types had a strong opinion about the necessity of improving diagnosis/treatment competence, developing violence prevention guidelines and plans, using protective equipment, and reinforcing staff by providing back-up support. The last two strategies were also selected by tertiary hospital workers in our previous study. In addition, workers with high anxiety selected the following prevention strategies as most effective: improving doctor-patient communication skills; installing cameras on wards; keeping work areas bright; improvements in violence reporting, statistics, and interventions; security patrols in the key departments; reinforcing staff; and correcting inaccurate media perspectives and reports. The last four strategies were also selected by tertiary hospital workers. All respondents expected to receive organisational and social support. In conclusion, these prevention strategies should be tailored to the different requirements of specific populations. Furthermore, it is necessary for organisations, the public, and policymakers to provide powerful support in WPV prevention. PMID:27326460

  6. Coping with Workplace Violence against General Practitioners and Nurses in Heilongjiang Province, China: Social Supports and Prevention Strategies.

    PubMed

    Zhao, Siqi; Qu, Lijun; Liu, He; Gao, Lijun; Jiao, Mingli; Liu, Jinghua; Liang, Libo; Zhao, Yanming; Wu, Qunhong

    2016-01-01

    The study's objectives were to: 1) use social support theory to examine factors influencing healthcare workers' opinions about workplace violence (WPV) prevention strategies, and 2) to determine the types of support that general practitioners (GPs) and general nurses sought and expected to use after WPV exposure. A cross-sectional survey was used to assess a sample of 448 GPs and 412 general nurses from 90 township hospitals located in Heilongjiang province, China. Results revealed that workers exposed to physical, psychological or both WPV types had a strong opinion about the necessity of improving diagnosis/treatment competence, developing violence prevention guidelines and plans, using protective equipment, and reinforcing staff by providing back-up support. The last two strategies were also selected by tertiary hospital workers in our previous study. In addition, workers with high anxiety selected the following prevention strategies as most effective: improving doctor-patient communication skills; installing cameras on wards; keeping work areas bright; improvements in violence reporting, statistics, and interventions; security patrols in the key departments; reinforcing staff; and correcting inaccurate media perspectives and reports. The last four strategies were also selected by tertiary hospital workers. All respondents expected to receive organisational and social support. In conclusion, these prevention strategies should be tailored to the different requirements of specific populations. Furthermore, it is necessary for organisations, the public, and policymakers to provide powerful support in WPV prevention. PMID:27326460

  7. Stressed and overworked? A cross-sectional study of the working situation of urban and rural general practitioners in Austria in the framework of the QUALICOPC project

    PubMed Central

    Hoffmann, Kathryn; Wojczewski, Silvia; George, Aaron; Schäfer, Willemijn L. A.; Maier, Manfred

    2015-01-01

    Aim To assess the workload of general practitioners (GPs) in Austria, with a focus on identifying the differences between GPs working in urban and rural areas. Methods Within the framework of the Quality and Costs of Primary Care in Europe (QUALICOPC) study, data were collected from a stratified sample of GPs using a standardized questionnaire between November 2011 and May 2012. Data analysis included descriptive statistics and regression analysis. Results The analysis included data from 173 GPs. GPs in rural areas reported an average of 49.3 working hours per week, plus 23.7 on-call duties per 3 months and 26.2 out-of-office care services per week. Compared to GPs working in urban areas, even in the fully adjusted regression model, rural GPs had significantly more working hours (B 7.00; P = 0.002) and on-call duties (B 18.91; P < 0.001). 65.8% of all GPs perceived their level of stress as high and 84.6% felt they were required to do unnecessary administrative work. Conclusion Our findings show a high workload among Austrian GPs, particularly those working in rural areas. Since physicians show a diminishing interest to work as GPs, there is an imperative to improve this situation. PMID:26321030

  8. Evaluation of a computer-assisted learning programme on the oro-facial signs of child physical abuse (non-accidental injury) by general dental practitioners.

    PubMed

    Welbury, R R; Hobson, R S; Stephenson, J J; Jepson, N J

    2001-06-23

    A computer-assisted learning programme with tutorials and self assessment multiple choice questions has been developed. One hundred and two general dental practitioners were asked to evaluate the programme. Over 80% of respondents felt that the programme was easy to use, contained an appropriate level of supporting information, and had improved their knowledge of non-accidental injury. All users of the programme felt that it was a better way of learning than video, audio tapes, and journals or books on the subject. It is concluded that CAL programmes are worthwhile for providing continuing professional education for general dental practitioners. PMID:11453157

  9. A cluster randomized controlled trial aimed at implementation of local quality improvement collaboratives to improve prescribing and test ordering performance of general practitioners: Study Protocol

    PubMed Central

    Trietsch, Jasper; van der Weijden, Trudy; Verstappen, Wim; Janknegt, Rob; Muijrers, Paul; Winkens, Ron; van Steenkiste, Ben; Grol, Richard; Metsemakers, Job

    2009-01-01

    Background The use of guidelines in general practice is not optimal. Although evidence-based methods to improve guideline adherence are available, variation in physician adherence to general practice guidelines remains relatively high. The objective for this study is to transfer a quality improvement strategy based on audit, feedback, educational materials, and peer group discussion moderated by local opinion leaders to the field. The research questions are: is the multifaceted strategy implemented on a large scale as planned?; what is the effect on general practitioners' (GPs) test ordering and prescribing behaviour?; and what are the costs of implementing the strategy? Methods In order to evaluate the effects, costs and feasibility of this new strategy we plan a multi-centre cluster randomized controlled trial (RCT) with a balanced incomplete block design. Local GP groups in the south of the Netherlands already taking part in pharmacotherapeutic audit meeting groups, will be recruited by regional health officers. Approximately 50 groups of GPs will be randomly allocated to two arms. These GPs will be offered two different balanced sets of clinical topics. Each GP within a group will receive comparative feedback on test ordering and prescribing performance. The feedback will be discussed in the group and working agreements will be created after discussion of the guidelines and barriers to change. The data for the feedback will be collected from existing and newly formed databases, both at baseline and after one year. Discussion We are not aware of published studies on successes and failures of attempts to transfer to the stakeholders in the field a multifaceted strategy aimed at GPs' test ordering and prescribing behaviour. This pragmatic study will focus on compatibility with existing infrastructure, while permitting a certain degree of adaptation to local needs and routines. Trial registration Nederlands Trial Register ISRCTN40008171 PMID:19222840

  10. Contemporary management of metastatic bone disease: tips and tools of the trade for general practitioners.

    PubMed

    Quinn, Robert H; Randall, R Lor; Benevenia, Joseph; Berven, Sigurd H; Raskin, Kevin A

    2014-01-01

    Metastatic bone disease has a significant effect on a patient's mortality and health-related quality of life. An aging US population and improved survival rates of patients with cancer have led to an increase in the incidence of symptomatic bony metastatic lesions that may require orthopaedic care. Skeletal-related events in neoplastic disease include pain, pathologic fracture, hypercalcemia, and neural compression, including spinal cord compression. The clinical evaluation and diagnostic study of a patient with a skeletal lesion of unknown etiology should be approached carefully. In patients with widespread metastatic disease, the treatment of a skeletal-related event may be limited to stabilization of the pathologic fracture or local disease control. The treatment of metastatic bone disease is guided by the nature of the skeletal-related event, the responsiveness of the lesion to adjuvant care, and the overall condition and survival expectations of the patient. Impending pathologic fractures are often more easily treated, with less morbidity and easier recovery for patients, than completed fractures. Quality of life is the most important outcome measure in these patients. When surgery is indicated, the approach, choice of fixation, and use of adjuvant should allow for immediate and unrestricted weight bearing. Because metastatic lesions to the skeleton have a limited capacity for spontaneous healing, surgical fixation should be durable for the life expectancy of the patient. In the epiphyseal region of long bones, replacement arthroplasty is generally preferred over internal fixation. Metaphyseal and diaphyseal regions can generally be addressed with intramedullary nailing or plate fixation with adjuvant. The specific treatment of acetabular lesions is dictated by the anatomy and the degree of bone loss. Spinal stability and neural compromise are important considerations in choosing a strategy for managing spine tumors. Effective surgical approaches to metastatic

  11. Association between air pollution and daily consultations with general practitioners for allergic rhinitis in London, United Kingdom.

    PubMed

    Hajat, S; Haines, A; Atkinson, R W; Bremner, S A; Anderson, H R; Emberlin, J

    2001-04-01

    Few published studies have looked at the health effects of air pollution in the primary care setting, and most have concentrated on lower rather than upper respiratory diseases. The authors investigated the association of daily consultations with general practitioners for allergic rhinitis with air pollution in London, United Kingdom. Generalized additive models were used to regress time series of daily numbers of patients consulting for allergic rhinitis against 1992--1994 measures of air pollution, after control for possible confounders and adjustment for overdispersion and serial correlation. In children, a 10th--90th percentile increase in sulfur dioxide (SO(2)) levels 4 days prior to consultation (13-31 microg/m(3)) was associated with a 24.5% increase in consultations (95% confidence interval: 14.6, 35.2; p < 0.00001); a 10th--90th percentile increase in averaged ozone (O(3)) concentrations on the day of consultation and the preceding 3 days (6--29 parts per billion) was associated with a 37.6% rise (95% confidence interval: 23.3, 53.5; p < 0.00001). For adults, smaller effect sizes were observed for SO(2) and O(3). The association with SO(2) remained highly significant in the presence of other pollutants. This study suggests that air pollution worsens allergic rhinitis symptoms, leading to substantial increases in consultations. SO(2) and O(3) seem particularly responsible, and both seem to contribute independently. PMID:11282799

  12. Lifestyle changes as a treatment of gastroesophageal reflux disease: a survey of general practitioners in North Queensland, Australia

    PubMed Central

    Nowak, Madeleine; Büttner, Petra; Raasch, Beverly; Daniell, Kym; McCutchan, Cindy; Harrison, Simone

    2005-01-01

    Background Gastroesophageal reflux disease (GERD) is a common disorder in developed countries, with the usual treatment being medication. Previously, lifestyle modification was the only treatment for GERD; however, its effectiveness has not been assessed. Methods All practicing general practitioner (GP) members of two Divisions of General Practice (n = 193) in North Queensland, Australia, were surveyed in 2001 using a postal questionnaire to determine their views and practices relating to such treatment among adults with GERD. Results The response rate was 70.5%. Of those who responded, 17.6% recommended diet and postural advice as a first line of treatment, with postural advice (89.7%), avoid known precipitants (86.0%), reduce weight if overweight (79.4%), eat a low fat diet (45.6%), and stop smoking (17.6%) being the most common recommendations. Of the nine possible changes, the median number recommended was 3, interquartile range (IQR; 3, 4). Eighty-nine percent of GPs thought ≥ 10% of patients with GERD would benefit from lifestyle changes, but almost half thought ≤ 10% of patients would be prepared to change. Conclusion Most GPs thought lifestyle changes would be beneficial when treating GERD, but did not believe their patients would change. Most GPs recommended fewer than half the lifestyle changes their peers believed effective in treating GERD. PMID:18360562

  13. 5 CFR 179.205 - Waiver requests and claims to the General Accounting Office.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Waiver requests and claims to the General Accounting Office. 179.205 Section 179.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS CLAIMS COLLECTION STANDARDS Salary Offset § 179.205 Waiver requests and claims to the General Accounting Office....

  14. 7 CFR 2.12 - Secretary and general officers not precluded from exercising delegated powers.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... exercising delegated powers. 2.12 Section 2.12 Agriculture Office of the Secretary of Agriculture DELEGATIONS... from exercising delegated powers. No delegation of authority by the Secretary or a general officer contained in this part shall preclude the Secretary or general officer from exercising any of the...

  15. 7 CFR 2.12 - Secretary and general officers not precluded from exercising delegated powers.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... exercising delegated powers. 2.12 Section 2.12 Agriculture Office of the Secretary of Agriculture DELEGATIONS... from exercising delegated powers. No delegation of authority by the Secretary or a general officer contained in this part shall preclude the Secretary or general officer from exercising any of the...

  16. 29 CFR 2550.408b-2 - General statutory exemption for services or office space.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false General statutory exemption for services or office space... exemption for services or office space. (a) In general. Section 408(b)(2) of the Employee Retirement Income... to a party in interest, including a fiduciary, for office space or any service (or a combination...

  17. Late HIV diagnosis in Europe: a call for increased testing and awareness among general practitioners.

    PubMed

    Kall, Meaghan M; Smith, Ruth D; Delpech, Valerie C

    2012-09-01

    Major advancements in the treatment of HIV infection mean near normal life expectancy of persons diagnosed at an early stage of infection. Nevertheless, a significant proportion of HIV infected persons remain undiagnosed and are diagnosed at a late stage of infection, putting them at higher risk for preventable HIV-related morbidity and mortality and risking onward transmission to others. In Europe, half of people diagnosed with HIV in 2010 were diagnosed late with a CD4<350 cells/ul, at a point after which treatment should have begun. The causes of late diagnosis are manifold, and comprise barriers to testing at the patient, healthcare provider, and institutional level. Strategies to address barriers to HIV testing are essential to ensure prompt diagnosis. Routine universal HIV testing in general practice consisting of informed consent and a pre-test discussion is feasible and acceptable and should be considered in high prevalence areas to normalize HIV testing, reduce stigma, and reduce the number of infected individuals who are diagnosed late. PMID:22568402

  18. Barriers and facilitators for general practitioners to engage in advance care planning: A systematic review

    PubMed Central

    2013-01-01

    Abstract Objective The aim of this systematic review is to identify the perceived factors hindering or facilitating GPs in engaging in advance care planning (ACP) with their patients about care at the end of life. Design Studies from 1990 to 2011 were found in four electronic databases (PubMed, CINAHL, EMBASE, PsycINFO); by contacting first authors of included studies and key experts; and searching through relevant journals and reference lists. Studies were screened, graded for quality, and analysed independently by two authors; those reporting the perception by GPs of barriers and facilitators to engagement in ACP were included. Results Eight qualitative studies and seven cross-sectional studies were included for data extraction. All barriers and facilitators identified were categorized as GP characteristics, perceived patient factors, or health care system characteristics. Stronger evidence was found for the following barriers: lack of skills to deal with patients’ vague requests, difficulties with defining the right moment, the attitude that it is the patient who should initiate ACP, and fear of depriving patients of hope. Stronger evidence was found for the following facilitators: accumulated skills, the ability to foresee health problems in the future, skills to respond to a patient's initiation of ACP, personal convictions about who to involve in ACP, and a longstanding patient–GP relationship and the home setting. Conclusion Initiation of ACP in general practice may be improved by targeting the GPs’ skills, attitudes, and beliefs but changes in health care organization and financing could also contribute. PMID:24299046

  19. 76 FR 45599 - Order of Succession for Office of General Counsel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-29

    ... Succession for the General Counsel published on December 1, 2009 (74 FR 62805). Authority: Section 7(d... December 1, 2009 (74 FR 62805). Accordingly, the General Counsel designates the following Order of... URBAN DEVELOPMENT Order of Succession for Office of General Counsel AGENCY: Office of General...

  20. Office of Inspector General fiscal year 1996 annual work plan

    SciTech Connect

    1995-10-01

    This FY 1996 Office of Inspector General (OIG) Annual Work Plan is a summary and distillation of information contained in annual work plans, and includes audits and inspections that are carried over from FY 1995 as well as audits and inspections scheduled to start during FY 1996. Audits and inspections included in this consolidated OIG Annual Work Plan will be performed by OIG staff. Specialized expertise available through a Certified Public Accounting firm will be used to assist in auditing the Department`s financial statements. As part of the OIG Cooperative Audit Strategy, additional audit coverage of the Department`s programs is provided by internal auditors of the Department`s integrated contractors. Through the Cooperative Audit Strategy, the OIG ensures that the internal auditors satisfy audit standards, provides planning guidance to the internal auditors, coordinates work to avoid duplication, and tracks the work of internal auditors to ensure that needed audits are performed. Applicable portions of the four annual work plans issued for Fiscal Year 1996 by the Deputy/Assistant Inspectors General have been combined to form a major part of this overall OIG Annual Work Plan. Also included are portions of the most recent OIG Semiannual Reports to Congress to give an overview of the OIG`s mission/organization, resource status, and the environment in which the OIG currently operates. The OIG Annual Work Plan also lists ongoing and planned audits and inspections, and it presents investigative statistics which have been previously reported in the two OIG Semiannual Reports to Congress which cover Fiscal Year 1995. Furthermore, included in this work plan are descriptions of several innovations developed by the OIG to streamline its operations and to conserve as much efficiency and economy as possible in a time of resource reductions.

  1. 77 FR 71711 - Commission's Rules Regarding the Office of Managing Director and the Office of Inspector General

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-04

    ...In this document, the Federal Communications Commission (Commission) amends its rules to reassign to the Office of Managing Director (OMD) certain audit activities formerly assigned to the Office of Inspector General (OIG). The activities concern oversight of the annual audit of the Universal Service Administrative Corporation (USAC) required by the Commission's rules. In addition, the......

  2. Barriers to guideline implementation and educational needs of general practitioners regarding heart failure: a qualitative study

    PubMed Central

    Peters-Klimm, Frank; Natanzon, Iris; Müller-Tasch, Thomas; Ludt, Sabine; Nikendei, Christoph; Lossnitzer, Nicole; Szecsenyi, Joachim; Herzog, Wolfgang; Jünger, Jana

    2012-01-01

    Objectives: A clinical practice guideline (CPG) contains specifically developed recommendations that can serve physicians as a decision aid in evidence-based practice. The implementation of heart failure (HF) CPGs represents a challenge in general practice. As part of the development of a tailored curriculum, aim of this study was to identify barriers of guideline adherence and needs for medical education (CME) in HF care. Methods: We conducted a modified focus group with elements of a workshop of three hours duration. Thirteen GPs collected and discussed together and parallel in smaller groups barriers of guideline implementation. Afterwards they performed a needs assessment for a tailored CME curriculum for chronic HF. The content of the discussions was analysed qualitatively according to Mayring and categorised thematically. Results: Barriers of guideline adherence were found in the following areas: doctor: procedural knowledge (knowledge gaps), communicative and organisational skills (e.g. time management) and attitude (dissatisfaction with time-money-relation). Patients: individual case-related problems (multimorbidity, psychiatric comorbidity, expectations and beliefs). Doctor and patient: Adherence and barriers of communication. Main measures for improvement of care concerned the areas of the identified barriers of guideline adherence with the focus on application-oriented training of the abovementioned procedural knowledge and skills, but also the supply of tools (like patient information leaflets) and patient education. Conclusion: For a CME-curriculum for HF tailored to the needs of GPs, a comprehensive educational approach seems necessary. It should be broad-based and include elements of knowledge and skills to be addressed and trained case-related. Additional elements should include support in the implementation of organisational processes in the practice and patient education. PMID:22737201

  3. Building Clean. The Control of Crime, Corruption, and Racketeering in the Public Construction Markets of New York City. A Preliminary Assessment of Efforts Made by the Office of the Inspector General, New York City School Construction Authority.

    ERIC Educational Resources Information Center

    Moore, Mark H.; Tumin, R. Zachary

    The Office of the Inspector General of the New York City School Construction Authority (SCA) is attempting to secure the School Construction Authority and its building program from crime, corruption, and racketeering. This report is a preliminary assessment of this effort. It sets forth for practitioners and theorists the strategy that guided the…

  4. Roles of General Practitioners in the Provision of Health Care Services for People with Intellectual Disabilities: A National Census in Taiwan

    ERIC Educational Resources Information Center

    Lin, Jin-Ding; Hsu, Shang-Wei; Yen, Chia-Feng; Chou, Ying-Ting; Wu, Chia-Ling; Chu, Cordia M.; Loh, Ching-Hui

    2009-01-01

    Aims: The aims of the present study were to explore the perceptions of general practitioners (GPs) in the provision of health care services for people with intellectual disabilities and to analyse GPs' priorities in the delivery of health care services to this group of people in Taiwan. Methods: The study employed a cross-sectional design and was…

  5. Qualitative study to conceptualise a model of interprofessional collaboration between pharmacists and general practitioners to support patients' adherence to medication

    PubMed Central

    Rathbone, Adam P; Mansoor, Sarab M; Krass, Ines; Hamrosi, Kim; Aslani, Parisa

    2016-01-01

    Objectives Pharmacists and general practitioners (GPs) face an increasing expectation to collaborate interprofessionally on a number of healthcare issues, including medication non-adherence. This study aimed to propose a model of interprofessional collaboration within the context of identifying and improving medication non-adherence in primary care. Setting Primary care; Sydney, Australia. Participants 3 focus groups were conducted with pharmacists (n=23) and 3 with GPs (n=22) working in primary care. Primary and secondary outcome measures Qualitative investigation of GP and pharmacist interactions with each other, and specifically around supporting their patients’ medication adherence. Audio-recordings were transcribed verbatim and transcripts thematically analysed using a combination of manual and computer coding. Results 3 themes pertaining to interprofessional collaboration were identified (1) frequency, (2) co-collaborators and (3) nature of communication which included 2 subthemes (method of communication and type of communication). While the frequency of interactions was low, the majority were conducted by telephone. Interactions, especially those conducted face-to-face, were positive. Only a few related to patient non-adherence. The findings are positioned within contemporary collaborative theory and provide an accessible introduction to models of interprofessional collaboration. Conclusions This work highlighted that successful collaboration to improve medication adherence was underpinned by shared paradigmatic perspectives and trust, constructed through regular, face-to-face interactions between pharmacists and GPs. PMID:26983948

  6. HIV generations? Generational discourse in interviews with Australian general practitioners and their HIV positive gay male patients.

    PubMed

    Newman, Christy; Mao, Limin; Canavan, Peter G; Kidd, Michael R; Saltman, Deborah C; Kippax, Susan C

    2010-06-01

    The introduction of highly active antiretroviral therapy (HAART) is typically represented as a turning point in the social and medical history of HIV/AIDS, leading to a conceptual division into pre- and post-HAART eras. This paper explores how generational discourse is produced in interviews with general practitioners (GPs) and their HIV positive gay male patients in making sense of this moment and related changes in the Australian HIV epidemic. A theme of 'HIV generations' was identified in in-depth interviews with GPs who have HIV medication prescribing rights (based in Sydney, Adelaide and rural-coastal New South Wales) and the HIV positive gay men who attend their practices. In a closer analysis, generational discourse was identified across the interviews with GPs, characterising pre- and post-HAART HIV generations through three main features: treatment histories, socioeconomic status, and modes of survivorship. While generational discourse was less common in the accounts of HIV positive gay men, many of their examples wove together two narrative forms - 'a different time' and 'difference today' - suggesting that concepts of time and inequity are deeply embedded in these men's understandings of the HIV experience. Our analysis indicates that generational concepts play a significant role in shaping both professional and 'lay' understandings of changes and patterns in the HIV epidemic. PMID:20347197

  7. Effect of the Iranian hospital grading system on patients' and general practitioners' behaviour: an examination of awareness, belief and choice.

    PubMed

    Aryankhesal, Aidin; Sheldon, Trevor

    2010-08-01

    There is considerable international interest in the use of performance measurement and their public release in order to improve the quality of care. However, few studies have assessed stakeholders' awareness and use of performance data. Iranian hospitals have been graded annually since 1998 and hospital hotel charges vary by grade, but this system has never been evaluated. We conducted a cross-sectional survey of 104 outpatients at eight Teheran hospitals and 103 general practitioners (GPs) to assess the awareness of and attitudes towards hospital grading system. Only 5.8% of patients (95% CI: 1.3-10.3%) and 11.7% of GPs (95% CI: 5.5-17.9%) were aware of grading results. Patients' awareness was positively associated with their education level (P = 0.016). No patient used the grading results for choosing a hospital and only one GP (1%, 95% CI: 0-2%) reported using hospital grade to influence referral decisions. Patients were more influenced by hospitals' public reputation and that of their specialists. GPs believed that the grading system did not reflect the quality of care in hospitals. When developing performance measurement systems, public release of data should be accompanied by evaluation of its impact on awareness and health-care choices. PMID:20702891

  8. General practitioner attitudes towards referral of eating-disordered patients: a vignette study based on the theory of planned behaviour

    PubMed Central

    2008-01-01

    Objective The study examined individual differences between general practitioners (GPs) to determine their impact on variations in intention to refer a hypothetical patient with disordered eating to specialist eating disorder services. The study also examined the impact of patient weight on intention to refer. Method GPs within three primary care trusts (PCTs) were posted a vignette depicting a patient with disordered eating, described as either normal weight or underweight. A questionnaire was developed from the theory of planned behaviour to assess the GPs' attitudes, perception of subjective norms, perceived behavioural control, and intention to refer the patient. Demographic details were also collected. Results Responses were received from 88 GPs (33%). Intention to refer the patient was significantly related to subjective norms and cognitive attitudes. Together these predictors explained 86% of the variance in the intention to refer. GP or practice characteristics did not have a significant effect on the GPs' intention to refer, and nor did the patient's weight. Conclusion Despite National Institute for Health and Clinical Excellence current guidance, patient weight did not influence GPs' decisions to refer. Much of the variance in actual referral behaviour may be explained by cognitive attitudes and subjective norms. Interventions to reduce this variation should be focused on informing GPs about actual norms, and best practice guidelines. PMID:22477872

  9. 'A necessary evil that does not "really" cure disease': The domestication of biomedicine by Dutch holistic general practitioners.

    PubMed

    Raaphorst, Nadine; Houtman, Dick

    2016-05-01

    Against the background of studies about the domestication of complementary and alternative medicine into biomedical settings, this article studies how biomedicine is integrated into holistic settings. Data from 19 in-depth interviews with Dutch holistic general practitioners who combine complementary and alternative medicine with conventional treatments demonstrate that they do not believe that conventional biomedicine 'really' cures patients. They feel that it merely suppresses the physical symptoms of a disease, leaving the more fundamental and non-physical causes intact. As a consequence, they use conventional biomedicine for strictly practical and instrumental reasons. This is the case in life-threatening or acute situations, understood as non-physical causes of disease having been left untreated with complementary and alternative medicine for too long. More mundane reasons for its use are the need to take patients' demands for biomedical treatment seriously or to obey authoritative rules, regulations and protocols. The integration of biomedicine into complementary and alternative medicine, then, follows the same logic of domestication of complementary and alternative medicine into biomedicine: it is made subordinate to the prevailing model of health and illness and treated as a practical add-on that does not 'really' cure people. PMID:25944912

  10. The general practitioner's role in promoting physical activity to older adults: a review based on program theory.

    PubMed

    Hinrichs, Timo; Brach, Michael

    2012-02-01

    Positive influences of physical activity both on many chronic diseases and on preservation of mobility are well documented. But chronically ill or mobility restricted elderly living in their own homes are difficult to reach for interventions. The general practitioner's (GP) surgery offers one of the few opportunities to give advice for physical activity to those people. We used program theory to sound out knowledge on GP-centered physical activity counseling. The "conceptual theory" (evidence for training effects in old age) and the "implementation theory" (unique position of the GP) were reviewed narratively. The "action theory" (effects of GP counseling) was reviewed systematically. According to program theory, appropriate MeSH (Medical subject headings) concepts were Aged OR Aged, 80 and over (Target group), Physicians, Family OR Primary Health Care (Implementation/Setting), Counseling OR Patient Education as Topic OR Disease Management OR Health promotion (Intervention), Exercise OR Motor Activity OR Physical Fitness OR Sports (Determinants). The resulting six review papers (Pubmed, 2000-2009) were presented using the STARLITE mnemonic. Authors agree, that the GP plays a central role in the promotion of physical activity to elderly people, but there is conflicting evidence concerning counseling effectiveness. Utilizing behavioral change strategies and the collaboration between GPs and specialised professions are recommended and currently under research. PMID:21762090

  11. Cow’s Milk Protein Allergy from Diagnosis to Management: A Very Different Journey for General Practitioners and Parents

    PubMed Central

    Lozinsky, Adriana C.; Meyer, Rosan; Anagnostou, Katherine; Dziubak, Robert; Reeve, Kate; Godwin, Heather; Fox, Adam T.; Shah, Neil

    2015-01-01

    Cow’s milk protein allergy (CMPA) is the most common food allergy in infants and can affect a family’s quality of life. The purpose of this paper is to evaluate the knowledge and experience of general practitioners (GPs) in terms of CMPA diagnosis and management and to explore the views of parents on the current diagnostic process. Two surveys were conducted in June 2014, which collected data from GPs and parents of infants diagnosed with CMPA in the United Kingdom. The questionnaires included quantitative and qualitative questions, which measured self-reported knowledge, management and perceived treatment progression, and the educational needs of GPs. We also explored parents’ experiences of local healthcare support in relation to CMPA. A total of 403 GPs and 300 parents completed the surveys. The main symptoms of CMPA and diagnosis period differed between GPs and parents. Other key points include different perceptions on symptom presentation and improvement, lack of awareness from GPs about current guidelines, and the significant burden on both families and GPs. This is the first study attempting to establish GP and parental experience in diagnosing CMPA. It isnotable that the difference can be improved through training, appropriate diagnostic tools and improved communication between physicians and parents.

  12. From patient deference towards negotiated and precarious informality: An Eliasian analysis of English general practitioners' understandings of changing patient relations.

    PubMed

    Brown, Patrick; Elston, Mary Ann; Gabe, Jonathan

    2015-12-01

    This article contributes to sociological debates about trends in the power and status of medical professionals, focussing on claims that deferent patient relations are giving way to a more challenging consumerism. Analysing data from a mixed methods study involving general practitioners in England, we found some support for the idea that an apparent 'golden age' of patient deference is receding. Although not necessarily expressing nostalgia for such doctor-patient relationships, most GPs described experiencing disruptive or verbally abusive interactions at least occasionally and suggested that these were becoming more common. Younger doctors tended to rate patients as less respectful than their older colleagues but were also more likely to be egalitarian in attitude. Our data suggest that GPs, especially younger ones, tend towards a more informal yet limited engagement with their patients and with the communities in which they work. These new relations might be a basis for mutual respect between professionals and patients in the consulting room, but may also generate uncertainty and misunderstanding. Such shifts are understood through an Eliasian framework as the functional-democratisation of patient-doctor relations via civilising processes, but with this shift existing alongside decivilising tendencies involving growing social distance across broader social figurations. PMID:26517293

  13. Knowledge of Community General Practitioners and Nurses on Pre-Hospital Stroke Prevention and Treatment in Chongqing, China

    PubMed Central

    Yang, Juan; Zhang, Jie; Ou, Shu; Wang, Ni; Wang, Jian

    2015-01-01

    Background and Purpose This study aimed to investigate the knowledge of community general practitioners (GPs) and nurses about pre-hospital stroke recognition, treatment and management and secondary stroke prevention; to identify the sociodemographic and educational factors influencing knowledge. Methods A self-designed test questionnaire was applied in a self-administered close-exam setting among 480 GPs and nurses working in community health centers (stations) in eight urban districts of Chongqing. Results A total of 331 (69%) valid test questionnaires were returned. Of the 331 participants, 39% were aware of the clinical guidelines for cerebrovascular diseases, whereas 48% considered themselves to have stroke management capabilities. The correct rate of answering questions of pre-hospital recognition and management knowledge was as low as 24%, the correct rate of secondary stroke prevention knowledge was only 38%. In terms of the total score for stroke prevention and treatment knowledge, there were significant differences between the medical staff with different specialties before engaging in community health services and whether they have received GP training (P <0.05). Conclusion The community GPs and nurses in the urban districts of Chongqing clearly lack knowledge of stroke, and the levels of stroke prevention and treatment urgently need to be improved. PMID:26384330

  14. Vaccine Hesitancy Among General Practitioners and Its Determinants During Controversies: A National Cross-sectional Survey in France

    PubMed Central

    Verger, Pierre; Fressard, Lisa; Collange, Fanny; Gautier, Arnaud; Jestin, Christine; Launay, Odile; Raude, Jocelyn; Pulcini, Céline; Peretti-Watel, Patrick

    2015-01-01

    Background This study aimed to assess: 1) vaccine hesitancy (VH) prevalence among French general practitioners (GPs) through the frequency of their vaccine recommendations, and 2) the determinants of these recommendations. Methods Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France. We constructed a score of self-reported recommendation frequency for 6 specific vaccines to target populations. Results 16% to 43% of GPs sometimes or never recommended at least one specific vaccine to their target patients. Multivariable logistic regressions of the dichotomized score showed that GPs recommended vaccines frequently when they felt comfortable explaining their benefits and risks to patients (OR = 1.87; 1.35–2.59), or trusted official sources of information highly (OR = 1.40; 1.01–1.93). They recommended vaccines infrequently when they considered that adverse effects were likely (OR = 0.71; 0.52–0.96) or doubted the vaccine's utility (OR = 0.21; 0.15–0.29). Interpretation Our findings show that after repeated vaccine controversies in France, some VH exists among French GPs, whose recommendation behaviors depend on their trust in authorities, their perception of the utility and risks of vaccines, and their comfort in explaining them. Further research is needed to confirm these results among health care workers in other countries. PMID:26425696

  15. Insights of private general practitioners in group practice on the introduction of National Health Insurance in South Africa

    PubMed Central

    Luiz, John; Carmichael, Teresa; Peersman, Wim; Derese, Anselme

    2016-01-01

    Background The South African government intends to contract with ‘accredited provider groups’ for capitated primary care under National Health Insurance (NHI). South African solo general practitioners (GPs) are unhappy with group practice. There is no clarity on the views of GPs in group practice on contracting to the NHI. Objectives To describe the demographic and practice profile of GPs in group practice in South Africa, and evaluate their views on NHI, compared to solo GPs. Methods This was a descriptive survey. The population of 8721 private GPs in South Africa with emails available were emailed an online questionnaire. Descriptive statistical analyses and thematic content analysis were conducted. Results In all, 819 GPs responded (568 solo GPs and 251 GPs in groups). The results are focused on group GPs. GPs in groups have a different demographic practice profile compared to solo GPs. GPs in groups expected R4.86 million ($0.41 million) for a hypothetical NHI proposal of comprehensive primary healthcare (excluding medicines and investigations) to a practice population of 10 000 people. GPs planned a clinical team of 8 to 12 (including nurses) and 4 to 6 administrative staff. GPs in group practices saw three major risks: patient, organisational and government, with three related risk management strategies. Conclusions GPs can competitively contract with NHI, although there are concerns. NHI contracting should not be limited to groups. All GPs embraced strong teamwork, including using nurses more effectively. This aligns well with the emergence of family medicine in Africa. PMID:27380785

  16. Holter monitoring to detect silent atrial fibrillation in high-risk subjects: the Perugia General Practitioner Study.

    PubMed

    Salvatori, Valentina; Becattini, Cecilia; Laureti, Stefano; Baglioni, Gregorio; Germini, Fabrizio; Grilli, Piero; Guercini, Francesco; Filippucci, Esmeralda; Agnelli, Giancarlo

    2015-08-01

    Atrial fibrillation (AF) is diagnosed for the first time in about 5 % of patients admitted for acute ischemic stroke. Advanced aged and arterial hypertension are risk factors for AF. We evaluated the prevalence of silent AF in subjects with advanced age and systemic arterial hypertension. Subjects of both gender, aged 65 years or more with systemic arterial hypertension were randomly identified from the patient lists of the participating general practitioners in the Perugia area, in Italy. Study subjects underwent baseline 12-lead ECG and, if this did not show AF, 48-h Holter monitoring was performed. AF was known and confirmed by 12-lead ECG in 4 out of the 308 evaluated subjects (1.3 %). Baseline 12-lead ECG showed no cases of silent AF. Holter monitoring was performed in 300 subjects, mean age 70 ± 4. Twenty-six recordings were not evaluable for the presence of artifacts; therefore, 274 subjects were included in the analysis. Holter monitoring showed AF in 27 out of 274 subjects (10 %; 95 % confidence interval 6.4-13.5 %); AF was longer than 30 s in four of the subjects. In 56 additional subjects, Holter monitoring revealed excessive supraventricular ectopic activity (20 %; 95 % confidence interval 15.3-24.7 %). Holter monitoring was able to detect silent AF in about 10 % of subjects aged 65 or above with systemic arterial hypertension. The risk of stroke associated with screened silent AF should be carefully evaluated. PMID:25944128

  17. Factors associated with vaccination for hepatitis B, pertussis, seasonal and pandemic influenza among French general practitioners: a 2010 survey.

    PubMed

    Pulcini, Céline; Massin, Sophie; Launay, Odile; Verger, Pierre

    2013-08-20

    Our objectives were to describe the vaccine coverage (VC(1)) for some occupational vaccines (hepatitis B, pertussis, seasonal and pandemic influenza) among French General Practitioners (GPs(2)) and to study the factors associated with being vaccinated for each of these four diseases. We surveyed a representative national sample of 1431 self-employed GPs in France. Self-reported VC was 76.9% for 2009/10 seasonal influenza, 73.0% for hepatitis B, 63.9% for pertussis and 60.8% for A/H1N1 pandemic influenza. The factors associated with reporting being vaccinated were quite different from one vaccine to another. For some or all four vaccines, we found a significant positive association (p<0.05) with the following factors in the multivariate analysis: GP's male gender, high volume of activity, no particular mode of exercise (e.g. homoeopathy), no use of Internet at the practice, Continuing Medical Education sessions, discussing the benefits and risks of vaccination with the patients and performing prevention investigations for oneself (lipid profile). Being vaccinated for one vaccine also increased the VC for some or all three other studied vaccines. All these findings argue for public health campaigns using messages adapted to each vaccine. PMID:23806242

  18. 37 CFR 10.31 - Communications concerning a practitioner's services.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... practitioner's services. (a) No practitioner shall with respect to any prospective business before the Office... threaten any prospective applicant or other person having immediate or prospective business before...

  19. 37 CFR 10.31 - Communications concerning a practitioner's services.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... practitioner's services. (a) No practitioner shall with respect to any prospective business before the Office... threaten any prospective applicant or other person having immediate or prospective business before...

  20. 37 CFR 10.31 - Communications concerning a practitioner's services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... practitioner's services. (a) No practitioner shall with respect to any prospective business before the Office... threaten any prospective applicant or other person having immediate or prospective business before...

  1. 48 CFR 1552.203-71 - Display of EPA Office of Inspector General Hotline poster.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Inspector General Hotline poster. 1552.203-71 Section 1552.203-71 Federal Acquisition Regulations System... Provisions and Clauses 1552.203-71 Display of EPA Office of Inspector General Hotline poster. As prescribed... all contract options. Display of EPA Office of Inspector General Hotline Poster (AUG 2000) (a) For...

  2. 48 CFR 1552.203-71 - Display of EPA Office of Inspector General Hotline poster.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Inspector General Hotline poster. 1552.203-71 Section 1552.203-71 Federal Acquisition Regulations System... Provisions and Clauses 1552.203-71 Display of EPA Office of Inspector General Hotline poster. As prescribed... all contract options. Display of EPA Office of Inspector General Hotline Poster (AUG 2000) (a) For...

  3. 48 CFR 1552.203-71 - Display of EPA Office of Inspector General Hotline poster.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Inspector General Hotline poster. 1552.203-71 Section 1552.203-71 Federal Acquisition Regulations System... Provisions and Clauses 1552.203-71 Display of EPA Office of Inspector General Hotline poster. As prescribed... all contract options. Display of EPA Office of Inspector General Hotline Poster (AUG 2000) (a) For...

  4. 48 CFR 1552.203-71 - Display of EPA Office of Inspector General Hotline poster.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Inspector General Hotline poster. 1552.203-71 Section 1552.203-71 Federal Acquisition Regulations System... Provisions and Clauses 1552.203-71 Display of EPA Office of Inspector General Hotline poster. As prescribed... all contract options. Display of EPA Office of Inspector General Hotline Poster (AUG 2000) (a) For...

  5. 48 CFR 1552.203-71 - Display of EPA Office of Inspector General Hotline poster.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Inspector General Hotline poster. 1552.203-71 Section 1552.203-71 Federal Acquisition Regulations System... Provisions and Clauses 1552.203-71 Display of EPA Office of Inspector General Hotline poster. As prescribed... all contract options. Display of EPA Office of Inspector General Hotline Poster (AUG 2000) (a) For...

  6. Moving general practitioner training into primary care with cluster-based learning: a qualitative study in the West Midlands.

    PubMed

    Doug, Manjo; Johnson, Neil; Wilkinson, Martin

    2010-03-01

    This study sought to explore the early implementation of cluster-based learning (CBL) pilots in one part of the UK. A qualitative study using semi-structured one-to-one interviews was conducted with 10 key informants responsible for managing and delivering local training programmes across 14 general practice specialty training schemes. Data were analysed using thematic content analysis using the constant comparative method. Wide variation existed in the running of CBL pilots between different schemes. The principal reasons for trialling CBL were the high numbers of general practitioner trainees, resulting in extra pressure placed on postgraduate education facilities. Training programme directors (TPDs) managed and facilitated the current pilots. Effective facilitation of the groups was considered essential, along with good organisation and planning, and enthusiastic facilitators. Having a mixture of specialist trainees from different stages of training promoted shared learning in the group. The cluster-based approach was also judged to enable the targeting of training to meet the needs of learners and to address specific local needs. Responders considered that CBL should ultimately comprise learner-led sessions facilitated by educational supervisors, with TPDs being responsible for leading the improvement of the quality of educational and clinical supervision. The main reasons why CBL was not implemented were anxieties about the risks of losing the perceived benefits of the current training format in the absence of evidence of the added value of CBL. The reluctance of trainers to get involved was a major barrier - this resulted mainly from a lack of confidence with facilitating small groups and funding for their time. PMID:20359387

  7. Use of marketing to disseminate brief alcohol intervention to general practitioners: promoting health care interventions to health promoters.

    PubMed

    Lock, C A; Kaner, E F

    2000-11-01

    Health research findings are of little benefit to patients or society if they do not reach the audience they are intended to influence. Thus, a dissemination strategy is needed to target new findings at its user group and encourage a process of consideration and adoption or rejection. Social marketing techniques can be utilized to aid successful dissemination of research findings and to speed the process by which new information reaches practice. Principles of social marketing include manipulating the marketing mix of product, price, place and promotion. This paper describes the development of a marketing approach and the outcomes from a trial evaluating the effectiveness and cost-effectiveness of manipulating promotional strategies to disseminate actively a screening and brief alcohol intervention (SBI) programme to general practitioners (GPs). The promotional strategies consisted of postal marketing, telemarketing and personal marketing. The study took place in general practices across the Northern and Yorkshire Regional Health Authority. Of the 614 GPs eligible for the study, one per practice, 321 (52%) took the programme and of those available to use it for 3 months (315), 128 (41%) actively considered doing so, 73 (23%) actually went on to use it. Analysis of the specific impact of the three different promotional strategies revealed that while personal marketing was the most effective overall dissemination and implementation strategy, telemarketing was more cost-effective. The findings of our work show that using a marketing approach is promising for conveying research findings to GPs and in particular a focus on promotional strategies can facilitate high levels of uptake and consideration in this target group. PMID:11133118

  8. Experiences of general practitioners in the Ga-Rankuwa and Mabopane areas in dealing with patients who have sexual problems

    PubMed Central

    Govender, Indiran; Hugo, Jannie

    2015-01-01

    Abstract Background Sexual problems are common. Many patients with sexual health dysfunction use self-help literature or are often managed in general practice. However, many general practitioners (GPs) find it difficult to discuss sexual health issues because they feel uncomfortable with this and lack training in these matters. These GPs are now referring patients with sexual dysfunction to specialists. Aim We sought to explore how GPs working in the Mabopane and Ga-Rankuwa areas of handle sexual problems of their patients. Setting The setting was the Mabopane and Ga-Rankuwa areas of North-West Tshwane, in Gauteng Province. Methods A qualitative study comprising eight free attitude interviews with purposefully selected four male and four female GPs. All interviews were conducted in English and tape-recorded. Field notes in the form of a detailed diary was kept. The tapes were transcribed verbatim, and the transcriptions were checked against the tapes for omissions and inaccuracies. Results Six themes emerged from the interviews: causes of sexual problems; presentation of sexual problems to the doctor; management of sexual health problems; sex is a taboo topic; society's need for sexual health discussions, and these discussions have already begun; previous limited exposure and training, and a need for more sexual health training. Conclusion This study confirms earlier findings that patients could be either reluctant to discuss their problems or are open about them when presenting to doctors with sexual dysfunction. GPs were not exposed to sexual health training at medical school and, because of this shortcoming, felt that training in sexual medicine should be part of the curriculum. PMID:26842520

  9. Health care consumers’ perspectives on pharmacist integration into private general practitioner clinics in Malaysia: a qualitative study

    PubMed Central

    Saw, Pui San; Nissen, Lisa M; Freeman, Christopher; Wong, Pei Se; Mak, Vivienne

    2015-01-01

    Background Pharmacists are considered medication experts but are underutilized and exist mainly at the periphery of the Malaysian primary health care team. Private general practitioners (GPs) in Malaysia are granted rights under the Poison Act 1952 to prescribe and dispense medications at their primary care clinics. As most consumers obtain their medications from their GPs, community pharmacists’ involvement in ensuring safe use of medicines is limited. The integration of a pharmacist into private GP clinics has the potential to contribute to quality use of medicines. This study aims to explore health care consumers’ views on the integration of pharmacists within private GP clinics in Malaysia. Methods A purposive sample of health care consumers in Selangor and Kuala Lumpur, Malaysia, were invited to participate in focus groups and semi-structured interviews. Sessions were audio recorded and transcribed verbatim and thematically analyzed using NVivo 10. Results A total of 24 health care consumers participated in two focus groups and six semi-structured interviews. Four major themes were identified: 1) pharmacists’ role viewed mainly as supplying medications, 2) readiness to accept pharmacists in private GP clinics, 3) willingness to pay for pharmacy services, and 4) concerns about GPs’ resistance to pharmacist integration. Consumers felt that a pharmacist integrated into a private GP clinic could offer potential benefits such as to provide trustworthy information on the use and potential side effects of medications and screening for medication misadventure. The potential increase in costs passed on to consumers and GPs’ reluctance were perceived as barriers to integration. Conclusion This study provides insights into consumers’ perspectives on the roles of pharmacists within private GP clinics in Malaysia. Consumers generally supported pharmacist integration into private primary health care clinics. However, for pharmacists to expand their capacity in

  10. Practices used for recommending sickness certification by general practitioners: a conversation analytic study of UK primary care consultations.

    PubMed

    Wheat, Hannah C; Barnes, Rebecca K; Byng, Richard

    2015-02-01

    Existing research indicates that many patients and doctors find the process of negotiating sickness certification for time off work to be a difficult one. This study examined how patients and general practitioners (GPs) managed these negotiations in a sample of UK primary care consultations. The study made use of an existing dataset of audio-recorded consultations between 13 GPs and 506 unselected adult patients in five general practices in London. Forty-nine consultations included discussions for both initial and repeat sickness certification across a wide range of conditions. Here we report our findings on doctor practices for recommending, as opposed to patient practices for advocating for, sickness certification (n = 26 cases). All cases were transcribed in detail and analysed using conversation analytic methods. Four main communication practices were observed: (1) declarative statements of need for sickness certification; (2) 'do you need' offers for sickness certification; (3) 'do you want' offers for sickness certification; and (4) conditional 'If X, Y' offers for sickness certification. These different communication practices indexed doctor agency, doctor endorsement and patient entitlement to varying degrees. In the main, recommendations to patients presenting with biomedical problems or a repeat occurrence of a psychosocial problem displayed stronger doctor endorsement and patient entitlement. Contrastingly, recommendations to patients presenting with new psychosocial and biopsychosocial problems, displayed weaker endorsement and patient entitlement. This study offers new evidence to support the Parsonian argument that becoming sick involves entering a social role with special rights and obligations. Through documenting doctors' orientations to their gatekeeping role as well as patients' orientations to differential rights vis à vis legitimacy, we demonstrate the contrasting stances of doctors in situ when giving sick notes for biomedical problems as

  11. Mental health problems of undocumented migrants in the Netherlands: A qualitative exploration of recognition, recording, and treatment by general practitioners

    PubMed Central

    Van Bavel, Eric; Van Den Driessen Mareeuw, Francine; Macfarlane, Anne; Van Weel-Baumgarten, Evelyn; Van Den Muijsenbergh, Maria; Van Weel, Chris

    2015-01-01

    Objective. To explore the views and experiences of general practitioners (GPs) in relation to recognition, recording, and treatment of mental health problems of undocumented migrants (UMs), and to gain insight in the reasons for under-registration of mental health problems in the electronic medical records. Design. Qualitative study design with semi-structured interviews using a topic guide. Subjects and setting. Sixteen GPs in the Netherlands with clinical expertise in the care of UMs. Results. GPs recognized many mental health problems in UMs. Barriers that prevented them from recording these problems and from delivering appropriate care were their low consultation rates, physical presentation of mental health problems, high number of other problems, the UM’s lack of trust towards health care professionals, and cultural differences in health beliefs and language barriers. Referrals to mental health care organizations were often seen as problematic by GPs. To overcome these barriers, GPs provided personalized care as far as possible, referred to other primary care professionals such as social workers or mental health care nurses in their practice, and were a little less restrictive in prescribing psychotropics than guidelines recommended. Conclusions. GPs experienced a variety of barriers in engaging with UMs when identifying or suspecting mental health problems. This explains why there is a gap between the high recognition of mental health problems and the low recording of these problems in general practice files. It is recommended that GPs address mental health problems more actively, strive for continuity of care in order to gain trust of the UMs, and look for opportunities to provide mental care that is accessible and acceptable for UMs. PMID:25961462

  12. Effect of Systematic Follow-Up by General Practitioners after Deliberate Self-Poisoning: A Randomised Controlled Trial

    PubMed Central

    2015-01-01

    Objective To assess whether systematic follow-up by general practitioners (GPs) of cases of deliberate self-poisoning (DSP) by their patients decreases psychiatric symptoms and suicidal behaviour compared with current practice. Design Randomised clinical trial with two parallel groups. Setting General practices in Oslo and the eastern part of Akershus County. Participants Patients aged 18–75 years admitted to hospital for DSP. We excluded patients diagnosed with psychoses, without a known GP, those not able to complete a questionnaire, and patients admitted to psychiatric in-patient care or other institutions where their GP could not follow them immediately after discharge. Intervention The GPs received a written guideline, contacted the patients and scheduled a consultation within one week after discharge, and then provided regular consultations for six months. We randomised the patients to either intervention (n = 78) or treatment as usual (n = 98). Main Outcome Measures Primary outcome measure was the Beck Scale for Suicide Ideation (SSI). Secondary outcomes were Beck Depression Inventory (BDI) and Beck Hopelessness Scale (BHS), self-reported further self-harm and treatment for DSP in a general hospital or an emergency medical agency (EMA). We assessed patients on entry to the trial and at three and six months. We collected data from interviews, self-report questionnaires, and hospital and EMA medical records. Results There were no significant differences between the groups in SSI, BDI, or BHS mean scores or change from baseline to three or six months. During follow-up, self-reported DSP was 39.5% in the intervention group vs. 15.8% in controls (P = 0.009). Readmissions to general hospitals were similar (13% in both groups (P = 0.963), while DSP episodes treated at EMAs were 17% in the intervention group and 7% in the control group (P = 0.103). Conclusion Structured follow-up by GPs after an episode of DSP had no significant effect on suicide ideation

  13. GPAQ-R: development and psychometric properties of a version of the General Practice Assessment Questionnaire for use for revalidation by general practitioners in the UK

    PubMed Central

    2013-01-01

    general practitioners (e.g. receptionists, telephone access) which meet other survey requirements of the National Health Service in England. Use of GPAQ-R has the potential to reduce the number of surveys that GPs need to carry out in their practices to meet the various regulatory requirements which they face. PMID:24138508

  14. U.S. Department of Energy Office of Inspector General fiscal year 1999 annual performance plan

    SciTech Connect

    1998-10-01

    This plan is published pursuant to requirements of the Government Performance and Results Act of 1993. The plan outlines the goals, objectives, and strategies that the Office of Inspector General intends to implement and execute in FY 1999. The plan also includes the details of this office`s efforts to continually improve customer service.

  15. Child and adolescent psychiatry: which knowledge and skills do primary care physicians need to have? A survey in general practitioners and paediatricians.

    PubMed

    Lempp, Thomas; Heinzel-Gutenbrunner, Monika; Bachmann, Christian

    2016-04-01

    Primary care physicians (PCPs) play a key role in the initial assessment and management of children and adolescents with mental health problems. However, it is unclear whether current medical education curricula sufficiently equip PCPs for this task. The aim of this study was to investigate, which child and adolescent psychiatry (CAP)-related skills and knowledge PCPs say they require in their daily practice. A questionnaire was generated, employing a modified two-step Delphi approach. Besides socio-demographic items, the questionnaire contained 17 CAP-related knowledge items and 13 CAP-related skills items, which had to be rated by importance in daily practice. The questionnaire was distributed to 348 office-based paediatricians and 500 general practitioners (GPs) in Germany. The overall return rate was 51.3 % (435/848). Regarding CAP-related knowledge, both paediatricians and GPs rated somatoform disorders and obesity as highly important for daily practice. Moreover, paediatricians also deemed regulatory disorders during infancy (e.g. crying, sleep disorders) as important, while GPs assessed knowledge on paediatric depression as relevant. For paediatricians and GPs, the most relevant CAP-related skills were communicating with children and adolescents and their parents. Additionally, paediatricians rated differentiating between non-pathologic and clinically relevant behaviour problems very relevant, while GPs considered basic psychotherapeutic skills essential. The CAP-related knowledge and skills perceived relevant for doctors in primary care differ from the majority of current medical school CAP curricula, which cover mainly typical, epitomic CAP disorders and are predominantly knowledge-oriented. Therefore, medical education in CAP should be amended to reflect the needs of PCPs to improve healthcare for children and adolescents with mental health problems. PMID:26250895

  16. The use of tetanus post-exposure prophylaxis guidelines by general practitioners and emergency departments in the Netherlands: a cross-sectional questionnaire study

    PubMed Central

    2014-01-01

    Background The Dutch National Immunisation Programme includes six tetanus toxoid (TT) vaccinations and reaches a high rate of vaccination coverage. In the Netherlands, several guidelines related to tetanus post-exposure prophylaxis (T-PEP) are in place. In 2003, the Dutch Health Council (HC) reviewed the use of T-PEP. The aim of this study is to evaluate whether the HC recommendations have been implemented. Methods We asked 178 Dutch General Practitioner (GP) offices and 60 Emergency Departments (EDs) to participate in a cross-sectional questionnaire study and requested that participating facilities send in the T-PEP guidelines adopted by their practice. The differences, based on categories mentioned in the HC recommendations, between GPs and EDs and the type of T-PEP guidelines adopted were assessed. Results The response rates for the GPs and EDs were 38% (n = 67) and 70% (n = 42), respectively. 98% percent (n = 107) of the participants reported having T-PEP guidelines. Of the guidelines described in the survey responses, 28% (n = 23; EDs 41%, GPs 21%) were consistent with the HC-recommendations, 36% (n = 29; EDs 7%, GPs 52%) adhered to the guidelines of the College of GPs (CGP), which restricts the use of T-PEP to tetanus prone wounds but for these wounds is in line with the recommendations of the HC. The remaining 36% had adopted other guidelines, most of which can lead to over-prescription of T-PEP. Information on T-PEP was lacking in patients with higher risk vaccination histories. Conclusion Almost all participants have adopted T-PEP guidelines. Strict adherence to the HC recommendations is low. More than half of GPs have adopted the more restrictive CGP-guideline, which limits T-PEP to tetanus prone wounds. PMID:24910158

  17. Perceptions of general practitioners towards the use of a new system for treating back pain: a qualitative interview study

    PubMed Central

    2011-01-01

    Background Changing clinicians' behaviour is recognised as a major challenge. It is clear that behaviour change not only depends on demonstrating the proven effectiveness of clinical interventions; contextual and occupational factors, such as 'change readiness', may be central to their implementation. This paper highlights the context of behaviour change in relation to a healthcare innovation introduced within primary care, highlighting the importance of organisational and interpersonal factors that may help explain the dynamics of implementation. Methods Qualitative interviews were conducted with general practitioners (GPs) before (n = 32) and after (n = 9) the introduction of a subgrouping for targeted treatment system. GPs were offered an electronic six-item subgrouping tool, to identify patients according to their risk of poor outcome ('high', 'low') in order to help inform their decision making about treatment approaches. Recruitment was based on a 'maximum diversification sample', to obtain a wide representation of views across all five practices. A coding scheme was developed based on the emergent findings, and the data were analysed using 'constant comparison', drawing upon insights and developing connections between themes. We adopted the normalisation process theory (NPT) to explain the uptake of the new system and to examine the relevance of coherence for the implementation of innovations in organisations. Results GPs perceived back pain as a low clinical priority, and highlighted the importance of 'practical' and 'relational' coherence in decisions to adopt and engage with the new subgrouping for targeted treatment system. Health professionals often engage in 'sense making' about new innovations to 'road test' their applicability or relevance to daily clinical routines. Low back pain was generally perceived as an 'uninteresting' and clinically unchallenging health problem by GPs, which may partly explain their lack of engagement with the new subgrouping

  18. Physicians' Characteristics Associated with Exploring Suicide Risk among Patients with Depression: A French Panel Survey of General Practitioners

    PubMed Central

    Bocquier, Aurélie; Pambrun, Elodie; Dumesnil, Hélène; Villani, Patrick; Verdoux, Hélène; Verger, Pierre

    2013-01-01

    Background General practitioners (GPs) have a key role to play in suicide prevention, but the rates at which they question patients with depression about suicidal thoughts and plans are rather low. Little is known about GPs' characteristics associated with such inquiries. Our objectives were to describe GPs' attitudes, perceived barriers, and self-reported practices in this questioning of these patients and to analyze factors associated with these practices. Methodology This cross-sectional survey was conducted among participants in a panel of randomly selected French GPs (1249/1431 participated: 87.3%). GPs were interviewed with a standardized questionnaire covering their professional and personal characteristics, attitudes, and practices in exploring the suicide risk of their patients with depression. We built a suicide inquiry score by summing the responses to 5 items and used a multiple linear regression analysis to explore the characteristics associated with this score. Principal Findings Most GPs reported inquiring about the presence of suicidal ideation often or very often; less than 30% reported that they frequently explored signs of a specific suicide plan. The mean suicide inquiry score was 12.4 (SD, 2.9; range, 5–20). False ideas, such as thinking that patients who report suicidal ideas do not often commit suicide, were frequent (42.3%). Previous continuing medical education on suicide, participation in a formal mental health network, and patients who committed suicide in the past 5 years were associated with a higher score. Reluctance to question patients about suicide and perception of insufficient skill were associated with a lower score. Conclusions/Significance This study showed great variability in French GPs' practices in exploring suicide risk in patients with depression. Interventions aiming at improving GPs' initial training and continuing medical education in suicide and/or depression, and their collaboration with mental health specialists

  19. Problems and needs for improving primary care of osteoarthritis patients: the views of patients, general practitioners and practice nurses

    PubMed Central

    Rosemann, Thomas; Wensing, Michel; Joest, Katharina; Backenstrass, Matthias; Mahler, Cornelia; Szecsenyi, Joachim

    2006-01-01

    Background Osteoarthritis (OA) is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The general practitioner (GP) often is the first care provider for patients with this chronic disease. The aim of this study was to identify health care needs of patients with OA and to reveal possible obstacles for improvements in primary care management of OA patients. Methods We performed semi-structured interviews with a stratified sample of 20 patients, 20 GPs and 20 practice nurses. Results Diagnosing OA posed no major problem, but during the course of OA, GPs found it difficult to distinguish between complaints resulting from the affection of the joints and complaints related to a concomitant depression. Patients felt to be well informed about the degenerative nature of the disease and possible side effects of medications, but they lacked information on individual consequences of the disease. Therefore, the most important concerns of many patients were pain and fear of disability which they felt to be addressed by GPs only marginally. Regarding pain treatment, physicians and patients had an ambivalent attitude towards NSAIDs and opiates. Therefore, pain treatment was not performed according to prevailing guidelines. GPs felt frustrated about the impact of counselling regarding life style changes but on the other hand admitted to have no systematic approach to it. Patients stated to be aware of the impact of life style on OA but lacked detailed information e.g. on how to exercise. Several suggestions were made concerning improvement. Conclusion GPs should focus more on disability and pain and on giving information about treatment since these topics are inadequately addressed. Advanced approaches are needed to increase GPs impact on patients' life style. Being aware of the problem of labelling patients as chronically ill, a more proactive, patient-centred care is needed. PMID:16749935

  20. Factors affecting the intention of providers to deliver more effective continuing medical education to general practitioners: a pilot study

    PubMed Central

    Winzenberg, Tania; Higginbotham, Nick

    2003-01-01

    Background Despite the importance of continuing medical education (CME) for GPs, there has been little research into how providers decide what types of CME to deliver to GPs. This study aimed to identify factors affecting the intention of providers to provide more effective types of CME; and to design a survey instrument which can be used to test the applicability of Triandis' model of social behaviour to the provision of CME to general practitioners. Methods This was a cross-sectional study on a convenience sample of 11 Australian providers of CME for interviews and a random sample of 25 providers for the pilot test. Open-ended interviews structured on Triandis' theory were performed with key informants who provide CME to GPs. These were used to develop a pilot survey instrument to measure the factors affecting intention, resulting in a revised instrument for use in further research. Results There was a broad range of factors affecting providers' intention to deliver more effective forms of CME identified, and these were classifiable in a manner which was consistent with Triandis' model. Key factors affecting providers' intention were the attitude toward CME within organisations and the time and extra work involved. Conclusions We identified a range of potential factors influencing the intention of providers to provide more effective forms of CME, in all categories of Triandis model. Those interested in increasing the choice of more effective CME activities available to GPs may need to broaden the methods used in working with providers to influence them to use more effective CME techniques. The interview material and questionnaire analysis of the pilot survey support the use of Triandis model. Further research is needed to validate Triandis'model for the intention to deliver more effective forms of CME. Such research will inform future strategies aimed at increasing the amount and choice of effective CME activities available for GPs. PMID:14675493

  1. Norwegian general practitioners' knowledge and beliefs about breastfeeding, and their self-rated ability as breastfeeding counsellor

    PubMed Central

    Svendby, Heidi R; Løland, Beate F; Omtvedt, Marianne; Holmsen, Solveig T; Lagerløv, Per

    2016-01-01

    Background Breastfeeding is considered the best infant-feeding method. Norway is one of the leading countries in terms of breastfeeding initiation and duration. To maintain this high breastfeeding rate, it is important to understand the factors that influence breastfeeding. A doctor s advice can improve the rates of breastfeeding initiation and duration, but not all doctors are competent in breastfeeding counselling. Objectives The aim of this study was to identify the knowledge and beliefs of general practitioners (GPs) about breastfeeding in Norway and to investigate how important they considered guidance about breastfeeding initiation and duration before and after birth. Design A questionnaire study about knowledge and beliefs according to predefined correct responses and about self-perceived competence as an advisor. Subjects 122 GPs engaged in apprenticeship for medical students. Results The response rate was 57%, 69 GPs participated. The questions were answered correctly according to national consensus for 49 % for the knowledge items and 64 % of the belief items. The GPs believed that their guidance was more important after than before birth. Female GPs had more confidence in their guidance ability than male GPs. Confidence in the GPs own guidance after birth was associated with knowledge about contraindications to breastfeeding. Conclusion Although the GPs expressed beliefs favouring breastfeeding they partly lacked basic knowledge. The GPs confidence in own guidance was better after than before birth and was higher among those with more knowledge. Improved knowledge and emphasis on guidance before birth should be promoted among GPs. Key pointsBreastfeeding is the best infant-feeding method. Doctors’ advice improves the rates of breastfeeding, but not all doctors have sufficient knowledge. This study mapped the knowledge and beliefs among Norwegian GPs. The study revealed that:GPs partly lacked basic knowledge to effectively promote breastfeeding.GPs had

  2. Management of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia by general practitioners in Jakarta

    PubMed Central

    Matondang, Faisal Abdi; Rahardjo, Harrina Erlianti

    2014-01-01

    Purpose: This study was performed to describe and evaluate the management of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) by general practitioners (GPs) in Jakarta. Methods: This observational cross-sectional study was peformed between January 2013 and August 2013 in Jakarta. We developed a questionnaire consisting of 10 questions describing the management of male LUTS suggestive of BPH by GPs in their daily practice in the previous month. We collected questionnaires from 200 GPs participating in 4 urology symposiums held in Cipto Mangunkusumo Hospital, Jakarta. Results: Most GPs were aged between 25 and 35 years (71.5%) and had worked for more than 1 year (87.5%). One to 5 cases of male LUTS suggestive of BPH were treated by 81% of GPs each month. At diagnosis, the most common symptoms found were urinary retention (55.5%), frequency (48%), and nocturia (45%). The usual diagnostic workup included digital rectal examination (65%), scoring system (44%), measurement of prostate-specific antigen (PSA) level (23.5%), and renal function assessment (20%). Most GPs referred their male patients with LUTS suggestive of BPH to a urologist (59.5%) and 46.5% of GPs prescribed drugs as an initial therapy. Alpha-adrenergic antagonist monotherapy (71.5%) was the most common drug prescribed. Combination therapy with α-adrenergic antagonists and 5α-reductase inhibitors was not routinely prescribed (13%). Thirty-eight percent of GPs referred their patients when recurrent urinary retention was present and 33% when complications were present. Conclusions: Our study provides evidence that the management of male LUTS suggestive of BPH by GPs in Jakarta suggests referral in part to available guidelines in terms of diagnostic methods and initial therapy. However, several aspects of the guidelines, such as PSA level measurement, renal function assessment, urinalysis, ultrasound examination, and prescription of combination therapies, are still

  3. Understanding public trust in services provided by community pharmacists relative to those provided by general practitioners: a qualitative study

    PubMed Central

    Ward, Paul; McGregor, Lesley

    2012-01-01

    Objectives To apply sociological theories to understand public trust in extended services provided by community pharmacists relative to those provided by general practitioners (GPs). Design Qualitative study involving focus groups with members of the public. Setting The West of Scotland. Participants 26 purposively sampled members of the public were involved in one of five focus groups. The groups were composed to represent known groups of users and non-users of community pharmacy, namely mothers with young children, seniors and men. Results Trust was seen as being crucial in healthcare settings. Focus group discussions revealed that participants were inclined to draw unfavourable comparisons between pharmacists and GPs. Importantly, participants' trust in GPs was greater than that in pharmacists. Participants considered pharmacists to be primarily involved in medicine supply, and awareness of the pharmacist's extended role was low. Participants were often reluctant to trust pharmacists to deliver unfamiliar services, particularly those perceived to be ‘high risk’. Numerous system-based factors were identified, which reinforce patient trust and confidence in GPs, including GP registration and appointment systems, GPs' expert/gatekeeper role and practice environments. Our data indicate that the nature and context of public interactions with GPs fostered familiarity with a specific GP or practice, which allowed interpersonal trust to develop. By contrast, participants' exposure to community pharmacists was limited. Additionally, a good understanding of the GPs' level of training and role promoted confidence. Conclusion Current UK initiatives, which aim to implement a range of pharmacist-led services, are undermined by lack of public trust. It seems improbable that the public will trust pharmacists to deliver unfamiliar services, which are perceived to be ‘high risk’, unless health systems change in a way that promotes trust in pharmacists. This may be

  4. Interface Management between General Practitioners and Rheumatologists—Results of a Survey Defining a Concept for Future Joint Recommendations

    PubMed Central

    Puchner, Rudolf; Edlinger, Michael; Mur, Erich; Eberl, Gabriele; Herold, Manfred; Kufner, Peter; Puchner, Antonia; Puchner, Stephan E.; Redlich, Kurt; Alkin, Alois; Machold, Klaus

    2016-01-01

    Objective To measure the views of general practitioners (GPs) and rheumatologists in a nationwide evaluation, so as to optimise their cooperation in managing patients with inflammatory rheumatic diseases. Methods A questionnaire covering aspects of collaboration was sent, both by mail and/or by email, to all GPs and rheumatologists in Austria. Topics covered were (i) examinations and interventions to be performed before referral, (ii) the spectrum of diseases to be referred, and (iii) the role of GPs in follow-up and continuous management of patients. Results 1,229 GPs of the 4,016 GPs (31%) and 110 of the 180 rheumatologists (61%) responded to the questionnaire. In cases of suspected arthritis, 99% of the GPs and 92% of the rheumatologists recommended specific laboratory tests, and 92% and 70%, respectively, recommended X-rays of affected joints before referral. Rheumatoid arthritis and spondyloarthritis, psoriatic arthritis and connective tissue disease were unanimously seen as indications for referral to a rheumatologist. Only 12% of rheumatologists felt responsible for the treatment of hand osteoarthritis and fibromyalgia. 80% of GPs and 85% of rheumatologists were of the opinion that treatment with disease-modifying drugs should be initiated by a specialist. Subsequent drug prescription and administration by GPs was supported by a majority of GPs and rheumatologists, with a concomitant rheumatologist follow-up every three to six months. Conclusion The considerable consensus between the two professional groups constitutes a solid base for future joint recommendations, with the aim to accelerate the diagnostic process and the initiation of adequate therapy. PMID:26741702

  5. Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study

    PubMed Central

    olde Hartman, Tim C; Hassink-Franke, Lieke J; Lucassen, Peter L; van Spaendonck, Karel P; van Weel, Chris

    2009-01-01

    Background Persistent presentation of medically unexplained symptoms (MUS) is troublesome for general practitioners (GPs) and causes pressure on the doctor-patient relationship. As a consequence, GPs face the problem of establishing an ongoing, preferably effective relationship with these patients. This study aims at exploring GPs' perceptions about explaining MUS to patients and about how relationships with these patients evolve over time in daily practice. Methods A qualitative approach, interviewing a purposive sample of twenty-two Dutch GPs within five focus groups. Data were analyzed according to the principles of constant comparative analysis. Results GPs recognise the importance of an adequate explanation of the diagnosis of MUS but often feel incapable of being able to explain it clearly to their patients. GPs therefore indicate that they try to reassure patients in non-specific ways, for example by telling patients that there is no disease, by using metaphors and by normalizing the symptoms. When patients keep returning with MUS, GPs report the importance of maintaining the doctor-patient relationship. GPs describe three different models to do this; mutual alliance characterized by ritual care (e.g. regular physical examination, regular doctor visits) with approval of the patient and the doctor, ambivalent alliance characterized by ritual care without approval of the doctor and non-alliance characterized by cutting off all reasons for encounter in which symptoms are not of somatic origin. Conclusion GPs feel difficulties in explaining the symptoms. GPs report that, when patients keep presenting with MUS, they focus on maintaining the doctor-patient relationship by using ritual care. In this care they meticulously balance between maintaining a good doctor-patient relationship and the prevention of unintended consequences of unnecessary interventions. PMID:19775481

  6. Effect of reminders mailed to general practitioners on colorectal cancer screening adherence: a cluster-randomized trial.

    PubMed

    Le Breton, Julien; Ferrat, Émilie; Attali, Claude; Bercier, Sandrine; Le Corvoisier, Philippe; Brixi, Zahida; Veerabudun, Kalaivani; Renard, Vincent; Bastuji-Garin, Sylvie

    2016-09-01

    Reminders have been used in various settings, but failed to produce convincing evidence of benefits on patient adherence to colorectal cancer (CRC) screening. The aim of this study was to assess the effectiveness of sending general practitioners (GPs) printed reminders about CRC screening. We conducted a cluster-randomized controlled trial involving 144 GPs in the Val-de-Marne district (France), who provided care for any reason to 20 778 patients eligible for CRC screening between June 2010 and November 2011. Data were collected from the main statutory health-insurance programme and local cancer screening agency. GPs were randomly assigned in a 1 : 1 proportion to the intervention or the control group. Every 4 months, intervention-group GPs received a computer-generated printed list of patients who had not performed scheduled faecal occult blood test (FOBT) screening. The primary outcome was patient adherence to FOBT screening or exclusion from CRC screening for medical reasons. The screening adherence rate was 31.2% [95% confidence interval (CI) 30.3-32.1] in the control group and 32.9% (95% CI 32.0-33.8) in the intervention group [crude relative risk, 1.05 (95% CI 1.01-1.09), P<0.01]. This rate was not significantly different between groups by multilevel modelling accounting for clustering and confounding variables [adjusted relative risk, 1.07 (95% CI 0.95-1.20), P=0.27]. Computer-generated printed reminders sent to GPs did not significantly improve patient adherence to organized CRC screening by the FOBT. PMID:26340058

  7. General Practitioners Views of Implementing a Stratified Treatment Approach for Low Back Pain in Germany: A Qualitative Study

    PubMed Central

    Karstens, Sven; Joos, Stefanie; Hill, Jonathan C.; Krug, Katja; Szecsenyi, Joachim; Steinhäuser, Jost

    2015-01-01

    Background and Objective The STarT Back stratified primary care approach has demonstrated clinical and cost effectiveness in the UK, and is commonly used by General Practitioners (GPs). However, it remains unknown how this approach could be implemented into the German healthcare system. The aim of this study was therefore to explore the views and perceptions of German GPs in respect to using a stratified primary care for low back pain (LBP). Methods A 90-minute think-tank workshop was conducted with 14 male and five female GPs, during which the STarT-Back-Screening-Tool (SBST) and related research evidence was presented. This was followed by two focus groups, based on a semi-structured interview guideline to identify potential implementation barriers and opportunities. Discussions were audiotaped, transcribed and coded using a content analysis approach. Results For the three deductively developed main themes, 15 subthemes emerged: (1) application of the SBST, with the following subthemes: which health profession should administer it, patients known to the GP practice, the reason for the GP consultation, scoring the tool, the tool format, and the anticipated impact on GP practice; (2) psychologically informed physiotherapy, with subthemes including: provision by a physiotherapist, anticipated impact, the skills of physiotherapists, management of patients with severe psychosocial problems, referral and remuneration; (3) the management of low-risk patients, with subthemes including: concern about the appropriate advising health professional, information and media, length of consultation, and local exercise venues. Conclusions The attitudes of GPs towards stratified primary care for LBP indicated positive support for pilot-testing in Germany. However, there were mixed reactions to the ability of German physiotherapists to manage high-risk patients and handle their complex clinical needs. GPs also mentioned practical difficulties in providing extended advice to low

  8. Evaluation of reprocessing medical devices in 14 German regional hospitals and at 27 medical practitioners' offices within the European context - consequences for European harmonization.

    PubMed

    Thiede, Birgit; Kramer, Axel

    2013-01-01

    Safe reprocessing of medical devices through cleaning, disinfection, and sterilization is essential for the prevention of health care associated infections (HAI) and to guarantee patient safety. Several studies detected residual contamination and even severe infections of patients, despite carrying out reprocessing. To develop appropriate solutions, the existing situation in Germany and selected European countries was analyzed. Additionally, in 27 medical practitioners' offices and 14 hospitals, the true practice of reprocessing was analyzed using a questionnaire, a checklist, and inspection on site. A structured analysis of potential alternatives to the internal reprocessing was conducted within the German and European context. The results indicate that the conditions for the execution of the reprocessing process in the analyzed health facilities in southern Hesse (Germany) do not satisfy legal requirements. The detected deficiencies were consistent with other reports from Germany and Europe. The analysis gave insight into several reasons for the detected deficiencies. The three main reasons were the high costs for proper implementation, the subjective value assigned to the reprocessing unit in health care facilities, and deficits in monitoring by the health authority. Throughout the European Union, a similar regulatory framework for the performance of the reprocessing process exists, while the environment, structures of the health systems and administrative supervision vary significantly. The German states as well as selected European countries are currently discussing the challenges of increased quality-assured execution of the reprocessing process. For instance, the same supervisory system for hospitals and medical practitioners should be established at an equal standard. Alternatives such as the use of single-use medical devices, outsourcing the decontamination processes, or the cooperation of health facilities may be considered. This paper also discusses

  9. Use and Uptake of eHealth in General Practice: A Cross-Sectional Survey and Focus Group Study Among Health Care Users and General Practitioners

    PubMed Central

    Krijgsman, Johan W; Brabers, Anne E; Jong, Judith D De; Friele, Roland D

    2016-01-01

    Background Policy makers promote the use of eHealth to widen access to health care services and to improve the quality and safety of care. Nevertheless, the enthusiasm among policy makers for eHealth does not match its uptake and use. eHealth is defined in this study as “health services delivered or enhanced through the Internet and related information and communication technologies.” Objective The objective of this study was to investigate (1) the current use of eHealth in the Netherlands by general practitioners (GPs) and health care users, (2) the future plans of GPs to provide eHealth and the willingness of health care users to use eHealth services, and (3) the perceived positive effects and barriers from the perspective of GPs and health care users. Methods A cross-sectional survey of a sample of Dutch GPs and members of the Dutch Health Care Consumer Panel was conducted in April 2014. A pre-structured questionnaire was completed by 171 GPs (12% response) and by 754 health care users (50% response). In addition, two focus groups were conducted in June 2014: one group with GPs (8 participants) and one with health care users (10 participants). Results Three-quarters of Dutch GPs that responded to the questionnaire (67.3%, 115/171) offered patients the possibility of requesting a prescription via the Internet, and half of them offered patients the possibility of asking a question via the Internet (49.1%, 84/171). In general, they did intend to provide future eHealth services. Nonetheless, many of the GPs perceived barriers, especially concerning its innovation (eg, insufficient reliable, secure systems) and the sociopolitical context (eg, lack of financial compensation for the time spent on implementation). By contrast, health care users were generally not aware of existing eHealth services offered by their GPs. Nevertheless, half of them were willing to use eHealth services when offered by their GP. In general, health care users have positive attitudes

  10. 14 CFR 1261.417 - Referral to Department of Justice (DJ) or General Accounting Office (GAO).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... omission of one or more of the administrative collection actions enumerated in this subpart (see 4 CFR part... General Accounting Office (GAO). 1261.417 Section 1261.417 Aeronautics and Space NATIONAL AERONAUTICS AND....417 Referral to Department of Justice (DJ) or General Accounting Office (GAO). (a) Prompt...

  11. 5 CFR 1215.31 - Referral to the Department of Justice or the General Accounting Office.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... the General Accounting Office. 1215.31 Section 1215.31 Administrative Personnel MERIT SYSTEMS PROTECTION BOARD ORGANIZATION AND PROCEDURES DEBT MANAGEMENT Claims Collection § 1215.31 Referral to the Department of Justice or the General Accounting Office. Debts over $600 but less than $100,000 which the...

  12. 5 CFR 1215.31 - Referral to the Department of Justice or the General Accounting Office.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... the General Accounting Office. 1215.31 Section 1215.31 Administrative Personnel MERIT SYSTEMS PROTECTION BOARD ORGANIZATION AND PROCEDURES DEBT MANAGEMENT Claims Collection § 1215.31 Referral to the Department of Justice or the General Accounting Office. Debts over $600 but less than $100,000 which the...

  13. 5 CFR 1215.31 - Referral to the Department of Justice or the General Accounting Office.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... the General Accounting Office. 1215.31 Section 1215.31 Administrative Personnel MERIT SYSTEMS PROTECTION BOARD ORGANIZATION AND PROCEDURES DEBT MANAGEMENT Claims Collection § 1215.31 Referral to the Department of Justice or the General Accounting Office. Debts over $600 but less than $100,000 which the...

  14. 5 CFR 1215.31 - Referral to the Department of Justice or the General Accounting Office.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... the General Accounting Office. 1215.31 Section 1215.31 Administrative Personnel MERIT SYSTEMS PROTECTION BOARD ORGANIZATION AND PROCEDURES DEBT MANAGEMENT Claims Collection § 1215.31 Referral to the Department of Justice or the General Accounting Office. Debts over $600 but less than $100,000 which the...

  15. 14 CFR 1261.417 - Referral to Department of Justice (DJ) or General Accounting Office (GAO).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... omission of one or more of the administrative collection actions enumerated in this subpart (see 4 CFR part... General Accounting Office (GAO). 1261.417 Section 1261.417 Aeronautics and Space NATIONAL AERONAUTICS AND....417 Referral to Department of Justice (DJ) or General Accounting Office (GAO). (a) Prompt...

  16. 10 CFR 733.6 - Consultation with the DOE Office of the Inspector General.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Consultation with the DOE Office of the Inspector General. 733.6 Section 733.6 Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.6 Consultation with the DOE Office of the Inspector General. Upon receipt of an allegation of research...

  17. 10 CFR 733.6 - Consultation with the DOE Office of the Inspector General.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Consultation with the DOE Office of the Inspector General. 733.6 Section 733.6 Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.6 Consultation with the DOE Office of the Inspector General. Upon receipt of an allegation of research...

  18. 10 CFR 733.6 - Consultation with the DOE Office of the Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Consultation with the DOE Office of the Inspector General. 733.6 Section 733.6 Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.6 Consultation with the DOE Office of the Inspector General. Upon receipt of an allegation of research...

  19. 10 CFR 733.6 - Consultation with the DOE Office of the Inspector General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Consultation with the DOE Office of the Inspector General. 733.6 Section 733.6 Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.6 Consultation with the DOE Office of the Inspector General. Upon receipt of an allegation of research...

  20. 10 CFR 733.6 - Consultation with the DOE Office of the Inspector General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Consultation with the DOE Office of the Inspector General. 733.6 Section 733.6 Energy DEPARTMENT OF ENERGY ALLEGATIONS OF RESEARCH MISCONDUCT § 733.6 Consultation with the DOE Office of the Inspector General. Upon receipt of an allegation of research...

  1. 5 CFR 1215.31 - Referral to the Department of Justice or the General Accounting Office.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... the General Accounting Office. 1215.31 Section 1215.31 Administrative Personnel MERIT SYSTEMS PROTECTION BOARD ORGANIZATION AND PROCEDURES DEBT MANAGEMENT Claims Collection § 1215.31 Referral to the Department of Justice or the General Accounting Office. Debts over $600 but less than $100,000 which the...

  2. 75 FR 81276 - Office of Inspector General; Delegation of Authorities

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-27

    ... Inspector General to request information protected by the Privacy Act for a civil or criminal law... a civil or criminal law enforcement activity from the Inspector General to the FHFA-OIG Principal... Law 110-289, 122 Stat. 2654, 2913, abolished both the Federal Housing Finance Board (FHFB),...

  3. Scientific uncertainty and the role of expert advice: the case of health checks for coronary heart disease prevention by general practitioners in the UK.

    PubMed

    Florin, D

    1999-11-01

    This paper examines some of the ways in which scientific evidence influenced the development of the policy for the payment of general practitioners for coronary heart disease (CHD) prevention in the UK, in particular the introduction of 'health checks'. The specific policy events which are examined are the 1990 and 1993 contracts for health promotion by general practitioners. Data for this paper were provided by oral history interviews with key informants including general practitioners, public health doctors, civil servants and academics. The study shows the way in which complex scientific evidence interacted with other, professional and political, factors to produce a policy for which there was variable scientific evidence. The relationship between science and policy was complicated and tortuous but two aspects were particularly salient, the way in which scientific uncertainty influenced the content of the policy and the contribution of expert advice to policy making. The existence of social and technical uncertainty about the effectiveness of health checks allowed different players to hold different views depending on their professional affiliation or other agendas. The mechanisms by which scientific advice was given to policy makers were primarily by medical civil servants and through informal contacts and networks. There was no independent systematic formal system to assess and disseminate scientific advice to policy makers, for instance by an expert committee. These factors in turn allowed policy makers to ignore or misinterpret scientific evidence according to other policy imperatives. PMID:10501646

  4. [The general practitioner faced with the choice of hospitalization: an analysis of the data from the Follow-Up System computerized network].

    PubMed

    Palombi, L; Buonomo, E; Capozzi, C; Fusiello, S; Mariotti, S; Noce, A

    1997-09-01

    The Project "Informatization of the General Practitioner" aimed at networking the work stations of a randomized set of 150 general practitioners equipped with the "Follow-Up System" software, for the collection of information related to the activity carried out, to be electronically transferred to a central unit was developed in the frame of the finalized Project of the National Research Council: "Prevention and Control of the Disease Factors". During the project activity, a study on prescribed hospitalizations was carried out. The contents of items regarding hospitalization diagnosis show that diagnoses concerning diseases included in chapter ICD-9: "Symptoms, signs and morbid conditions not well defined" represent 30.3% of the total; most of these undefined syndromes can be identified under the item "abdominal pain" with 18.2% of cases. Obviously in the case of appendicitis (12.1% of hospitalizations) the hospitalization carried out by the physician resulted to be necessary, in the case of biliary lithiasis (8 cases, 7.4%), the physician could have treated the patient without hospitalization. The interest of such data is to induce a sort of provocation in order to observe, within 8% of hospitalizations following abdominal pain, what rate of hospitalization could be avoided, giving the adequate support to the general practitioner in order to decide the behaviour to have. PMID:9380941

  5. Exploring Patients’ Views Toward Giving Web-Based Feedback and Ratings to General Practitioners in England: A Qualitative Descriptive Study

    PubMed Central

    Cain, Rebecca; Neailey, Kevin; Hooberman, Lucy

    2016-01-01

    Background Patient feedback websites or doctor rating websites are increasingly being used by patients to give feedback about their health care experiences. There is little known about why patients in England may give Web-based feedback and what may motivate or dissuade them from giving Web-based feedback. Objective The aim of this study was to explore patients’ views toward giving Web-based feedback and ratings to general practitioners (GPs), within the context of other feedback methods available in primary care in England, and in particular, paper-based feedback cards. Methods A descriptive exploratory qualitative approach using face-to-face semistructured interviews was used in this study. Purposive sampling was used to recruit 18 participants from different age groups in London and Coventry. Interviews were transcribed verbatim and analyzed using applied thematic analysis. Results Half of the participants in this study were not aware of the opportunity to leave feedback for GPs, and there was limited awareness about the methods available to leave feedback for a GP. The majority of participants were not convinced that formal patient feedback was needed by GPs or would be used by GPs for improvement, regardless of whether they gave it via a website or on paper. Some participants said or suggested that they may leave feedback on a website rather than on a paper-based feedback card for several reasons: because of the ability and ease of giving it remotely; because it would be shared with the public; and because it would be taken more seriously by GPs. Others, however, suggested that they would not use a website to leave feedback for the opposite reasons: because of accessibility issues; privacy and security concerns; and because they felt feedback left on a website may be ignored. Conclusions Patient feedback and rating websites as they currently are will not replace other mechanisms for patients in England to leave feedback for a GP. Rather, they may motivate a

  6. Nursing: What's a Nurse Practitioner?

    MedlinePlus

    ... nurses, or APNs) have a master's degree in nursing (MS or MSN) and board certification in their ... Nurse Practitioners (NAPNAP) and through local hospitals or nursing schools. In addition, many doctors share office space ...

  7. Educational interventions to improve the effectiveness in clinical competence of general practitioners: problem-based versus critical reading-based learning

    PubMed Central

    2012-01-01

    Background Evidence suggests that continuing medical education improves the clinical competence of general practitioners and the quality of health care services. Thus, we evaluated the relative impact of two educational strategies, critical reading (CR) and problem based learning (PBL), on the clinical competence of general practitioners in a healthcare system characterized by excessive workload and fragmentation into small primary healthcare centers. Methods Clinical competence was evaluated in general practitioners assigned to three groups based on the educational interventions used: 1) critical reading intervention; 2) problem based learning intervention; and 3) no intervention (control group, which continued clinical practice as normal). The effect on the clinical competence of general practitioners was evaluated in three dimensions: the cognitive dimension, via a self-administered questionnaire; the habitual behavioral dimension, via information from patient’s medical records; and the affective dimension, through interviews with patients. A paired Student´s t-test was used to evaluate the changes in the mean clinical competence scores before and after the intervention, and a 3 x 2 ANOVA was used to analyze groups, times and their interaction. Results Nine general practitioners participated in the critical reading workshop, nine in the problem-based learning workshop, and ten were assigned to the control group. The participants exhibited no significant differences in clinical competence measures at baseline, or in socio-demographic or job characteristics (p > 0.05). Significant improvements in all three dimensions (cognitive, 45.67 vs 54.89; habitual behavioral, 53.78 vs 82.33; affective, 4.16 vs 4.76) were only observed in the problem-based learning group after the intervention (p > 0.017). Conclusions While no differences in post-intervention scores were observed between groups, we conclude that problem-based learning can be effective, particularly in a

  8. [Marked similarity between the Dutch Institute for Health Care Improvement guideline 'Aspecific low back pain complaints' and the Dutch College of General Practitioners guideline 'Low back pain'].

    PubMed

    Mazel, J A

    2004-02-14

    The Dutch Institute for Healthcare Improvement's (CBO) guideline on the diagnosis and treatment of aspecific, acute and chronic, low back complaints corresponds in general to the Dutch College of General Practitioners' guideline with regard to the following topics: time-contingent treatment, restricted use of X-ray examination, and the options for non-medical treatment. A noteworthy exception in the CBO-guideline is the suggestion of manipulation of the spine as a possible treatment although there is no mention of proof of effectiveness. PMID:15015244

  9. 24 CFR 4.32 - Investigation by Office of Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Investigation by Office of Inspector General. 4.32 Section 4.32 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development HUD REFORM ACT Prohibition of Advance Disclosure of Funding Decisions §...

  10. 78 FR 42149 - Privacy Act; System of Records: State-53, Office of Inspector General Investigation Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-15

    ... Automated Individual Cross-Reference System'' (previously published at 56 FR 7071) to ``Office of Inspector... access to the Department of State computer system. Remote access to the Department of State network from... Act; System of Records: State-53, Office of Inspector General Investigation Management System...

  11. 49 CFR 40.411 - What is the role of the DOT Inspector General's office?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false What is the role of the DOT Inspector General's office? 40.411 Section 40.411 Transportation Office of the Secretary of Transportation PROCEDURES FOR TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Public Interest Exclusions § 40.411 What is the...

  12. 49 CFR 40.411 - What is the role of the DOT Inspector General's office?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 1 2011-10-01 2011-10-01 false What is the role of the DOT Inspector General's office? 40.411 Section 40.411 Transportation Office of the Secretary of Transportation PROCEDURES FOR TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Public Interest Exclusions § 40.411 What is the...

  13. 14 CFR 385.16 - Heads of Offices and Assistant General Counsels.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Heads of Offices and Assistant General Counsels. 385.16 Section 385.16 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION... petitions, applications, motions, complaints, or other pleadings or documents which the respective...

  14. 14 CFR 385.16 - Heads of Offices and Assistant General Counsels.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Heads of Offices and Assistant General Counsels. 385.16 Section 385.16 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION... petitions, applications, motions, complaints, or other pleadings or documents which the respective...

  15. 14 CFR 385.16 - Heads of Offices and Assistant General Counsels.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Heads of Offices and Assistant General Counsels. 385.16 Section 385.16 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION... petitions, applications, motions, complaints, or other pleadings or documents which the respective...

  16. 14 CFR 385.16 - Heads of Offices and Assistant General Counsels.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Heads of Offices and Assistant General Counsels. 385.16 Section 385.16 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION... petitions, applications, motions, complaints, or other pleadings or documents which the respective...

  17. 32 CFR 1702.4 - Notification to Office of General Counsel.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Notification to Office of General Counsel. 1702.4 Section 1702.4 National Defense Other Regulations Relating to National Defense OFFICE OF THE DIRECTOR OF NATIONAL INTELLIGENCE PROCEDURES GOVERNING THE ACCEPTANCE OF SERVICE OF PROCESS §...

  18. 32 CFR 1702.4 - Notification to Office of General Counsel.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 6 2013-07-01 2013-07-01 false Notification to Office of General Counsel. 1702.4 Section 1702.4 National Defense Other Regulations Relating to National Defense OFFICE OF THE DIRECTOR OF NATIONAL INTELLIGENCE PROCEDURES GOVERNING THE ACCEPTANCE OF SERVICE OF PROCESS §...

  19. 32 CFR 1702.4 - Notification to Office of General Counsel.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 6 2014-07-01 2014-07-01 false Notification to Office of General Counsel. 1702.4 Section 1702.4 National Defense Other Regulations Relating to National Defense OFFICE OF THE DIRECTOR OF NATIONAL INTELLIGENCE PROCEDURES GOVERNING THE ACCEPTANCE OF SERVICE OF PROCESS §...

  20. 32 CFR 1702.4 - Notification to Office of General Counsel.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 6 2012-07-01 2012-07-01 false Notification to Office of General Counsel. 1702.4 Section 1702.4 National Defense Other Regulations Relating to National Defense OFFICE OF THE DIRECTOR OF NATIONAL INTELLIGENCE PROCEDURES GOVERNING THE ACCEPTANCE OF SERVICE OF PROCESS §...

  1. 32 CFR 1702.4 - Notification to Office of General Counsel.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Notification to Office of General Counsel. 1702.4 Section 1702.4 National Defense Other Regulations Relating to National Defense OFFICE OF THE DIRECTOR OF NATIONAL INTELLIGENCE PROCEDURES GOVERNING THE ACCEPTANCE OF SERVICE OF PROCESS §...

  2. Life Expectancy in Police Officers: A Comparison with the U.S. General Population

    PubMed Central

    Violanti, John M.; Hartley, Tara A.; Gu, Ja K.; Fekedulegn, Desta; Andrew, Michael E.; Burchfiel, Cecil M.

    2016-01-01

    Previous epidemiological research indicates that police officers have an elevated risk of death relative to the general population overall and for several specific causes. Despite the increased risk for mortality found in previous research, controversy still exists over the life expectancy of police officers. The goal of the present study was to compare life expectancy of male police officers from Buffalo New York with the U.S. general male population utilizing an abridged life table method. On average, the life expectancy of Buffalo police officers in our sample was significantly lower than the U.S. population (mean difference in life expectancy =21.9 years; 95% CI: 14.5-29.3; p<0.0001). Life expectancy of police officers was shorter and differences were more pronounced in younger age categories. Additionally, police officers had a significantly higher average probability of death than did males in the general population (mean difference= 0.40; 95% CI: 0.26,-0.54; p<0.0001). The years of potential life lost (YPLL) for police officers was 21 times larger than that of the general population (Buffalo male officers vs. U.S. males = 21.7, 95% CI: 5.8-37.7). Possible reasons for shorter life expectancy among police are discussed, including stress, shift work, obesity, and hazardous environmental work exposures. PMID:24707585

  3. 13 CFR 120.197 - Notifying SBA's Office of Inspector General of suspected fraud.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Inspector General of suspected fraud. 120.197 Section 120.197 Business Credit and Assistance SMALL BUSINESS... of Inspector General of suspected fraud. Lenders, CDCs, Borrowers, and others must notify the SBA Office of Inspector General of any information which indicates that fraud may have occurred in...

  4. 13 CFR 120.197 - Notifying SBA's Office of Inspector General of suspected fraud.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Inspector General of suspected fraud. 120.197 Section 120.197 Business Credit and Assistance SMALL BUSINESS... of Inspector General of suspected fraud. Lenders, CDCs, Borrowers, and others must notify the SBA Office of Inspector General of any information which indicates that fraud may have occurred in...

  5. 13 CFR 120.197 - Notifying SBA's Office of Inspector General of suspected fraud.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Inspector General of suspected fraud. 120.197 Section 120.197 Business Credit and Assistance SMALL BUSINESS... of Inspector General of suspected fraud. Lenders, CDCs, Borrowers, and others must notify the SBA Office of Inspector General of any information which indicates that fraud may have occurred in...

  6. 13 CFR 120.197 - Notifying SBA's Office of Inspector General of suspected fraud.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Inspector General of suspected fraud. 120.197 Section 120.197 Business Credit and Assistance SMALL BUSINESS... of Inspector General of suspected fraud. Lenders, CDCs, Borrowers, and others must notify the SBA Office of Inspector General of any information which indicates that fraud may have occurred in...

  7. 13 CFR 120.197 - Notifying SBA's Office of Inspector General of suspected fraud.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Inspector General of suspected fraud. 120.197 Section 120.197 Business Credit and Assistance SMALL BUSINESS... of Inspector General of suspected fraud. Lenders, CDCs, Borrowers, and others must notify the SBA Office of Inspector General of any information which indicates that fraud may have occurred in...

  8. Office of Inspector General semiannual report to Congress: April 1 to September 30, 1997

    SciTech Connect

    1997-10-01

    The report summarizes significant audit, inspection, and investigative accomplishments for the reporting period which facilitated Department of Energy management efforts to improve management controls and ensure efficient and effective operation of its programs. Narratives of the Office`s most significant reports are grouped by measures which the Office of Inspector General uses to gauge its performance. The common thread tying the performance measures together is their emphasis on supporting the Department efforts to produce high quality products at the lowest possible cost to the taxpayer. During this reporting period, the Office of Inspection General issued 59 reports. These reports included recommendations than, when implemented by management, could result in $211.7 million being put to better use. Furthermore, management has committed to taking corrective actions which the Office of Inspector General estimates will result in a more efficient use of funds totaling $57 million. Office of Inspector General investigations led to 7 criminal convictions, as well as criminal and civil prosecutions which resulted in fines and recoveries of approximately $1.95 million. The Office of Inspector General also provided 9 investigative reports to management for recommending positive change.

  9. Office of Inspector General semiannual report to Congress, April 1--September 30, 1995

    SciTech Connect

    1995-10-01

    This Office of Inspector General Semiannual Report to the Congress covers the period from April 1 through September 30, 1995. The report summarizes significant audit, inspection, and investigative accomplishments for the reporting period, a large portion of which facilitated Department of Energy management efforts to improve management controls and ensure efficient and effective operation of its programs. Narratives of the most significant reports are grouped by six primary performance measures which the Office of Inspector General uses to gauge its attainment of the outcomes established in the Office of Inspector General Strategic Plan. The common thread that ties the performance measures together is their emphasis on supporting Department efforts to produce high quality products at the lowest possible cost to the taxpayer. The six performance measures present outcomes of Office of Inspector General work in terms of improvements in Department programs and operations.

  10. General Counsel`s office FY 1995 site support program plan WBS 6.10.5

    SciTech Connect

    Moreno, S.R.

    1994-09-01

    The General Counsel`s office provides legal counsel to all levels of WHC management; administers the intellectual property program; coordinates all WHC investigative activity and supports WHC activities to ensure compliance with all applicable federal, state, and local laws, DOE directives, contractual provisions, and other requirements. In so doing, the Office of General Counsel supports the Hanford site mission of transforming the Hanford site into an environmentally attractive and economically sustainable community. This document briefs the FY95 site support plan.

  11. Cost-Effectiveness of One Year Dementia Follow-Up Care by Memory Clinics or General Practitioners: Economic Evaluation of a Randomised Controlled Trial

    PubMed Central

    Meeuwsen, Els; Melis, René; van der Aa, Geert; Golüke-Willemse, Gertie; de Leest, Benoit; van Raak, Frank; Schölzel-Dorenbos, Carla; Verheijen, Desiree; Verhey, Frans; Visser, Marieke; Wolfs, Claire; Adang, Eddy; Olde Rikkert, Marcel

    2013-01-01

    Objective To evaluate the cost-effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared to general practitioners’ care. Methods A multicentre randomised trial with 175 community dwelling patients newly diagnosed with mild to moderate dementia, and their informal caregivers, with twelve months’ follow-up. Cost-effectiveness was evaluated from a societal point of view and presented as incremental cost per quality adjusted life year. To establish cost-effectiveness, a cost-utility analysis was conducted using utilities based on the EQ-5D. Uncertainty surrounding the incremental cost-effectiveness ratio (difference in costs divided by difference in effects) was calculated by bootstrapping from the original data. Results Compared to general practitioners’ care, treatment by the memory clinics was on average €1024 (95% CI: −€7723 to €5674) cheaper, and showed a non-significant decrease of 0.025 (95% CI: −0.114 to 0.064) quality adjusted life years. The incremental cost-effectiveness point estimate from the bootstrap simulation was € 41 442 per QALY lost if one would use memory clinic care instead of general practitioner care. Conclusion No evidence was found that memory clinics were more cost-effective compared to general practitioners with regard to post-diagnosis treatment and coordination of care of patients with dementia in the first year after diagnosis. Trial Registration ClinicalTrials.gov NCT00554047 PMID:24282511

  12. Exploring Experiences of Delayed Prescribing and Symptomatic Treatment for Urinary Tract Infections among General Practitioners and Patients in Ambulatory Care: A Qualitative Study.

    PubMed

    Duane, Sinead; Beatty, Paula; Murphy, Andrew W; Vellinga, Akke

    2016-01-01

    "Delayed or back up" antibiotic prescriptions and "symptomatic" treatment may help to reduce inappropriate antibiotic prescribing for Urinary Tract Infections (UTI) in the future. However, more research needs to be conducted in this area before these strategies can be readily promoted in practice. This study explores General Practitioner (GP) and patient attitudes and experiences regarding the use of delayed or back-up antibiotic and symptomatic treatment for UTI. Qualitative face to face interviews with General Practitioners (n = 7) from one urban and one rural practice and telephone interviews with UTI patients (n = 14) from a rural practice were undertaken. Interviews were analysed using framework analysis. GPs believe that antibiotics are necessary when treating UTI. There was little consensus amongst GPs regarding the role of delayed prescribing or symptomatic treatment for UTI. Delayed prescribing may be considered for patients with low grade symptoms and a negative dipstick test. Patients had limited experience of delayed prescribing for UTI. Half indicated they would be satisfied with a delayed prescription the other half would question it. A fear of missing a serious illness was a significant barrier to symptomatic treatment for both GP and patient. The findings of this research provide insight into antibiotic prescribing practices in general practice. It also highlights the need for further empirical research into the effectiveness of alternative treatment strategies such as symptomatic treatment of UTI before such strategies can be readily adopted in practice. PMID:27537922

  13. [Collaboration between general practitioners and the school: survey about student's dietary habits in the first classes of secondary school in the province of Carbonia-Iglesias, Sardinia].

    PubMed

    Mereu, A; Massa, R; Cuccu, A; Serra, A R; Martinetti, M; Lisci, L; Montisci, M R; Vincis, G; Contu, P

    2011-01-01

    WHO stresses the importance of promoting balance diet among adolescents. The general practitioners are called at the forefront in the prevention of disorders related to eating habits. The present study describes a project to promote nutrition, created and run by general practitioners in the first classes of 20 secondary schools in seven municipalities, in the province of Carbonia-Iglesias (Italy), for a sample of 509 students (220 females and 289 males). The results also offer an expanded view of the eating habits of adolescents. The results show that adolescents do not give importance to the breakfast that is often not complete or is not consumed, and only 50% of respondents drink milk. The highest percentage of students consuming the first and second course (45-59%) at lunch and dinner consumption of protein was high ranging between 64 and 80% for lunch and dinner at 63 and 66%. That is evidenced by these results can be a valuable aid for future health promotion interventions. PMID:21736002

  14. Resources for the Practitioner.

    ERIC Educational Resources Information Center

    Hackeling, Joan, Comp.

    2003-01-01

    This list of print and electronic resources is designed to act as a springboard to assist practitioners in finding information to start implementing sustainability efforts on their campuses. The resources are listed in the following categories: general, international, K-12, policy/partnerships, campus environmental assessments, green building,…

  15. Office of Inspector General semiannual report to Congress, October 1, 1996--March 31, 1997

    SciTech Connect

    1997-04-01

    This Office of Inspector General Semiannual Report to the Congress covers the period from October 1, 1996, through March 31, 1997. The report summarizes significant audit, inspection, and investigative accomplishments for the reporting period which facilitated Department of Energy management efforts to improve management controls and ensure efficient and effective operation of its programs. Narratives of the most significant reports are grouped by measures which the Office of Inspector General uses to gauge its performance. The common thread that ties the performance measures together is their emphasis on supporting Department efforts to produce high quality products at the lowest possible cost to the taxpayer. Five such performance measures were used during this semiannual period to present outcomes of Office of Inspector General work in terms of improvements in Department programs and operations.

  16. Self-regulatory codes of conduct: are they effective in controlling pharmaceutical representatives' presentations to general medical practitioners?

    PubMed

    Roughead, E E; Gilbert, A L; Harvey, K J

    1998-01-01

    Self-regulatory codes of conduct are used to control the promotional practices of the pharmaceutical industry, but the effectiveness of these codes in controlling pharmaceutical representatives' presentations has not been examined. This is a matter of concern because pharmaceutical representatives have more influence than any other promotional media on prescribing practices. The authors developed a method for monitoring the oral presentations of pharmaceutical representatives when promoting products to medical practitioners. Sixteen audio-recordings, detailing 64 medicines, were obtained; 38 of the 64 products were prescription-only medicines. Information on indications and on dosage and administration was commonly provided, but information on other areas of drug knowledge, particularly product risk, was minimal. Thirteen presentations contained at least one inaccuracy when compared with Australian Approved Product Information. Presentations did not always comply with current guidelines in the Code of Conduct. The Code provides only limited standards for pharmaceutical representatives' presentations, and no active monitoring system is in place to ensure adherence to the code. There is an urgent need for policy development on the role of pharmaceutical representatives, their standards of practice, and regulation of their activities to ensure they contribute to the appropriate use of medicines. PMID:9595344

  17. Effectiveness of Motivational Interviewing in improving lipid level in patients with dyslipidemia assisted by general practitioners: Dislip-EM study protocol

    PubMed Central

    2011-01-01

    Background The non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Thus, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. However, more robust evidence is needed on the effectiveness of Motivational Interviewing in treating chronic pathologies -such as dyslipidemia- in patients assisted by general practitioners. This article describes a protocol to assess the effectiveness of MI as compared with general practice (brief advice), with the aim of improving lipid level control in patients with dyslipidemia assisted by a general practitioner. Methods/Design An open, two-arm parallel, multicentre, cluster, controlled, randomized, clinical trial will be performed. A total of 48-50 general practitioners from 35 public primary care centers in Spain will be randomized and will recruit 436 patients with dyslipidemia. They will perform an intervention based either on Motivational Interviewing or on the usual brief advice. After an initial assessment, follow-ups will be performed at 2, 4, 8 and 12 months. Primary outcomes are lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and cardiovascular risk. The study will assess the degree of dietary and physical activity improvement, weight loss in overweight patients, and adherence to treatment guidelines. Discussion Motivational interview skills constitute the primary strategies GPs use to treat their patients. Having economical, simple, effective and applicable techniques is essential

  18. Use of caries preventive agents on adult patients compared to pediatric patients by general practitioners: findings from The Dental Practice-Based Research Network

    PubMed Central

    Riley, Joseph L.; Gordan, Valeria V.; Rindal, D. Brad; Fellows, Jeffrey L.; Williams, O. Dale; Ritchie, Lloyd K.; Gilbert, Gregg H.

    2010-01-01

    Background Evidence suggests that caries prevention reduces caries in adults. This study tested the frequency of recommended caries prevention agents for children compared to adult patients. Methods This study surveyed 467 Dental Practice-Based Research Network general dentists who practice within the United States and treat both pediatric and adult patients. Dentists were asked the percentage of their patients who are administered or recommended dental sealants, in-office and at-home fluoride, chlorhexidine rinse, and xylitol gum. Results Adults were less likely to receive in-office caries preventive agents compared to pediatric patients. However, the rate of recommendation for at-home preventive regimens was very similar. Dentists with a conservative approach to caries treatment were the most likely to use caries prevention at similar rates in adults as in children. In addition, practices with a greater number of patients with dental insurance were significantly less likely to provide in-office fluoride or sealants to adult patients than to their pediatric patients. Conclusion In-office caries prevention agents are more commonly used by general dentists for their pediatric patients compared to their adult patients. Practice Implications Some general dentists should consider providing additional in-office prevention agents for their adult patients who are at increased risk for dental caries. PMID:20516100

  19. A survey of factors influencing the prescribing of sugar-free medicines for children by a group of general medical practitioners in Northern Ireland.

    PubMed

    Bradley, M; Kinirons, M

    1996-12-01

    Factors which influence the prescribing of sugar-free medicines by 47 general medical practitioners were examined by means of questionnaire. The doctors all practise in the Newry and Mourne district of the Southern Health and Social Services Board, Northern Ireland. Twenty-six (55%) of the doctors stated that they support the principle of prescribing sugar-free medicines for children; the same number stated that they oblige parental requests and 14 (30%) stated that they frequently prescribe a common group of sugar-free medicines. However, only 14 (30%) of the doctors considered that their knowledge of sugar-free medicines was up-to-date. The main sources of information about sugar-free preparations were drug company travelling representatives and professional journals, but a few doctors learned of this issue from other professionals, including dental practitioners. The majority of doctors (especially those with a practice policy of prescribing sugar-free medicines) felt it was important to prescribe sugar-free preparations for all children, not only for those requiring long-term medication. The results show that there is a reasonable level of interest in this issue among the doctors in the area, but that there is an on-going need for further encouragement and provision of information for them, in order to increase as far as possible the use of sugar-free preparations for children. PMID:9161194

  20. Practice nurses and the effects of the new general practitioner contract in the English National Health Service: the extension of a professional project?

    PubMed

    McDonald, Ruth; Campbell, Stephen; Lester, Helen

    2009-04-01

    This paper reports the impact on nurses working in primary health care settings of changes to the general practitioner (GP) contract in England implemented in 2004. Previous changes to the GP contract in 1990, which gave financial rewards for health promotion activities, were seen as enabling nurses to take on work that GPs did not want and providing an impetus for the development of a professional project (Broadbent, J. (1998). Practice nurses and the effects of the new general practitioner contract in the British NHS: the advent of a professional project? Social Science & Medicine, 47(4), 497-506). Our study, which involved interviews with nurses from 20 practices, finds that nurses are taking on work which has previously been the exclusive preserve of medical professionals. An increasing emphasis in nurses' accounts on technical skills and knowledge may help decouple nursing from a narrative of caring, which has been seen as detracting from professional advancement. Our research suggests that practice nurse work is changing to reflect a more medical (and masculine) orientation to service delivery. At the same time, nursing work is described as routine and template driven, which may limit claims to 'professional' status. The reaction of some practice nurses to Health Care Assistants encroaching on what was previously practice nurse territory suggests a policing of boundaries, rather than an inclusive approach to colleagues within the nursing team. This resonates with Davies' (Davies, C. (1995). Gender and the professional predicament in nursing. Bucks: Open University Press) suggestion that professionalisation as a process involves compliance with a masculine notion of professionalism (autonomous, elite, individual, divisive, detached) which marginalises feminine attributes and devalues the work done by women. The study also raises questions about the role of caring in general practice settings where nurses choose to prioritise other concerns. PMID:19254819