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Sample records for organised general practice

  1. Developing organisational vision in general practice.

    PubMed Central

    al-Shehri, A; Stanley, I; Thomas, P

    1993-01-01

    Vision is a fashionable but ill defined term in management circles. Nevertheless, it embodies a significant concept related to guiding an organisation from present realities, through opportunities and hazards, to a viable future. Until recently a typical general practice could assume a stable external environment, but now it is caught up in the uncertainties stemming from the NHS reforms. For such a practice to undertake effective strategic planning it will have to develop a vision connecting the present with aspirations for the future. While vision is usually considered to be an individual talent, it is possible to develop a collective organisational vision within a general practice, and the small size of general practices makes this relatively easy. The vision needs to be broad; it needs to be continuous; and its capacity to predict the future needs to be monitored. PMID:8343704

  2. Organising a physiotherapy service in general practice.

    PubMed

    Waters, W H; Udy, S C; Lunn, J E

    1975-08-01

    This paper describes three years' experience of running a domiciliary physiotherapy service based on general practice and financed by limited voluntary funds.The need arose from the remoteness of, and lack of, open access to, hospital physiotherapy. This was particularly so for elderly patients who were often frail and mentally confused. In addition there were obvious advantages in properly instructing relatives in management and treatment, especially since many of the patients and their relatives expressed a desire for home treatment.There was also a desire on the part of the general practitioners, nurses, and ancillary workers to develop further the teamwork in the health services of the four villages involved. Details of the constitution of the voluntary service and its financial arrangements are given.The results of the service and the nature of its work are described. There were no difficulties experienced in selecting the correct patients for treatment and the type of equipment required was almost all normally available through the health authority nursing service. There was no great need for expensive or heavy equipment and no transport problems arose.It was found that one hour of physiotherapist's time per 1,000 patients per week was adequate to cover all patients requiring short-term intensive therapy and to allow a small amount of palliative therapy in addition, although this had not been the original intention of the service.The physiotherapist averaged about 40 hours work per month and under these conditions the travelling and costs averaged 1.54 miles and 83 pence per visit. With self-determined hours of work and flexible timing, these conditions proved ideal for a married physiotherapist with the responsibility of a young family. Expansion of the hours of work in this particular area would have led to wasteful visits devoted to palliative and placebo therapy; and extension of the service beyond the area defined, would have increased travelling time at

  3. Organisational development in general practice: lessons from practice and professional development plans (PPDPs)

    PubMed Central

    Elwyn, Glyn; Hocking, Paul

    2000-01-01

    Background Improving the quality and effectiveness of clinical practice is becoming a key task within all health services. Primary medical care, as organised in the UK is composed of clinicians who work in independent partnerships (general practices) that collaborate with other health care professionals. Although many practices have successfully introduced innovations, there are no organisational development structures in place that support the evolution of primary medical care towards integrated care processes. Providing incentives for attendance at passive educational events and promoting 'teamwork' without first identifying organisational priorities are interventions that have proved to be ineffective at changing clinical processes. A practice and professional development plan feasibility study was evaluated in Wales and provided the experiential basis for a summary of the lessons learnt on how best to guide organisational development systems for primary medical care. Results Practice and professional development plans are hybrids produced by the combination of ideas from management (the applied behavioural science of organisational development) and education (self-directed adult learning theories) and, in conceptual terms, address the lack of effectiveness of passive educational strategies by making interventions relevant to identified system wide needs. In the intervention, each practice participated in a series of multidisciplinary workshops (minimum 4) where the process outcome was the production of a practice development plan and a set of personal portfolios, and the final outcome was a realised organisational change. It was apparent during the project that organisational admission to a process of developmental planning needed to be a stepwise process, where initial interest can lead to a fuller understanding, which subsequently develops into motivation and ownership, sufficient to complete the exercise. The advantages of introducing expert external

  4. Organisational change theory and the use of indicators in general practice.

    PubMed

    Rhydderch, M; Elwyn, G; Marshall, M; Grol, R

    2004-06-01

    General practices are making greater use of indicators to help shape and develop organisational arrangements supporting the delivery of health care. Debate continues concerning what exactly such indicators should measure and how they should be used to achieve improvement. Organisational theories can provide an analytical backdrop to inform the design of indicators, critique their construction, and evaluate their use. Systems theory, organisational development, social worlds theory, and complexity theory each has a practical contribution to make to our understanding of how indicators work in prompting quality improvements and why they sometimes don't. This paper argues that systems theory exerts the most influence over the use of indicators. It concludes that a strategic framework for quality improvement should take account of all four theories, recognising the multiple realities that any one approach will fail to reflect. PMID:15175493

  5. Relational Coordination and Organisational Social Capital Association with Characteristics of General Practice

    PubMed Central

    Knudsen, Thomas Bøllingtoft; Larsen, Pia Veldt; Søndergaard, Jens

    2014-01-01

    Background. Relational coordination (RC) and organisational social capital (OSC) are measures of novel aspects of an organisation's performance, which have not previously been analysed together, in general practice. Objectives. The aim of this study was to analyse the associations between RC and OSC, and characteristics of general practice. Methods. Questionnaire survey study comprising 2074 practices in Denmark. Results. General practitioners (GPs) rated both RC and OSC in their general practice higher than their secretaries and nurses. The practice form was statistically significantly associated with high RC and OSC. RC was positively associated with the number of patients listed with a practice per staff, where staff is defined as all members of a practice including both owners and employees. Conclusion. The study showed that RC and OSC were significantly associated with type of profession and practice type. RC was also found to be significantly positively associated with number of patients per staff. However, the low response rate must be taken into consideration when interpreting the self-reported results of this study. PMID:25045537

  6. Relational coordination and organisational social capital association with characteristics of general practice.

    PubMed

    Lundstrøm, Sanne Lykke; Edwards, Kasper; Knudsen, Thomas Bøllingtoft; Larsen, Pia Veldt; Reventlow, Susanne; Søndergaard, Jens

    2014-01-01

    Background. Relational coordination (RC) and organisational social capital (OSC) are measures of novel aspects of an organisation's performance, which have not previously been analysed together, in general practice. Objectives. The aim of this study was to analyse the associations between RC and OSC, and characteristics of general practice. Methods. Questionnaire survey study comprising 2074 practices in Denmark. Results. General practitioners (GPs) rated both RC and OSC in their general practice higher than their secretaries and nurses. The practice form was statistically significantly associated with high RC and OSC. RC was positively associated with the number of patients listed with a practice per staff, where staff is defined as all members of a practice including both owners and employees. Conclusion. The study showed that RC and OSC were significantly associated with type of profession and practice type. RC was also found to be significantly positively associated with number of patients per staff. However, the low response rate must be taken into consideration when interpreting the self-reported results of this study. PMID:25045537

  7. Validation of an instrument to measure inter-organisational linkages in general practice

    PubMed Central

    Amoroso, Cheryl; Proudfoot, Judith; Bubner, Tanya; Jayasinghe, Upali W.; Holton, Christine; Winstanley, Julie; Beilby, Justin; Harris, Mark F.

    2007-01-01

    Purpose Linkages between general medical practices and external services are important for high quality chronic disease care. The purpose of this research is to describe the development, evaluation and use of a brief tool that measures the comprehensiveness and quality of a general practice's linkages with external providers for the management of patients with chronic disease. In this study, clinical linkages are defined as the communication, support, and referral arrangements between services for the care and assistance of patients with chronic disease. Methods An interview to measure surgery-level (rather than individual clinician-level) clinical linkages was developed, piloted, reviewed, and evaluated with 97 Australian general practices. Two validated survey instruments were posted to patients, and a survey of locally available services was developed and posted to participating Divisions of General Practice (support organisations). Hypotheses regarding internal validity, association with local services, and patient satisfaction were tested using factor analysis, logistic regression and multilevel regression models. Results The resulting General Practice Clinical Linkages Interview (GP-CLI) is a nine-item tool with three underlying factors: referral and advice linkages, shared care and care planning linkages, and community access and awareness linkages. Local availability of chronic disease services has no affect on the comprehensiveness of services with which practices link, however, comprehensiveness of clinical linkages has an association with patient assessment of access, receptionist services, and of continuity of care in their general practice. Conclusions The GP-CLI may be useful to researchers examining comparable health care systems for measuring the comprehensiveness and quality of linkages at a general practice-level with related services, possessing both internal and external validity. The tool can be used with large samples exploring the impact

  8. Experience as a doctor in the developing world: does it benefit the clinical and organisational performance in general practice?

    PubMed Central

    2009-01-01

    organisational performance between GPs with and without medical experience in developing countries and between their practices. It is not possible to attribute these differences to this experience, because the choice for medical experience in a tropical country probably reflects individual differences in professional motivation and personality. Experience in a developing country may be just as valuable for later performance in general practice as experience at home. PMID:20003532

  9. Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams.

    PubMed

    Grant, Suzanne; Ring, Adele; Gabbay, Mark; Guthrie, Bruce; McLean, Gary; Mair, Frances S; Watt, Graham; Heaney, David; O'Donnell, Catherine

    2015-01-01

    In the UK National Health Service, primary care organisation (PCO) managers have traditionally relied on the soft leadership of general practitioners based on professional self-regulation rather than direct managerial control. The 2004 general medical services contract (nGMS) represented a significant break from this arrangement by introducing new performance management mechanisms for PCO managers to measure and improve general practice work. This article examines the impact of nGMS on the governance of UK general practice by PCO managers through a qualitative analysis of data from an empirical study in four UK PCOs and eight general practices, drawing on Hood's four-part governance framework. Two hybrids emerged: (i) PCO managers emphasised a hybrid of oversight, competition (comptrol) and peer-based mutuality by granting increased support, guidance and autonomy to compliant practices; and (ii) practices emphasised a broad acceptance of increased PCO oversight of clinical work that incorporated a restratified elite of general practice clinical peers at both PCO and practice levels. Given the increased international focus on the quality, safety and efficiency in primary care, a key issue for PCOs and practices will be to achieve an effective, contextually appropriate balance between the counterposing governance mechanisms of peer-led mutuality and externally led comptrol. PMID:25601063

  10. Leadership Practices in German and UK Organisations

    ERIC Educational Resources Information Center

    McCarthy, Grace

    2005-01-01

    Purpose: The aim of this research was to determine whether leadership practices vary between German and UK organisations. Design/methodology/approach: The author used self-assessment documents submitted by German and UK organisations to the European Foundation for Quality Management (EFQM), to identify leadership practices in both countries. A…

  11. Organising Communities-of-Practice: Facilitating Emergence

    ERIC Educational Resources Information Center

    Akkerman, Sanne; Petter, Christian; de Laat, Maarten

    2008-01-01

    Purpose: The notion of communities of practice (CoP) has received great attention in educational and organisational practice and research. Although the concept originally refers to collaborative practices that emerge naturally, educational and HRD practitioners are increasingly searching for ways to create these practices intentionally in order to…

  12. 'Organised' cervical screening 45 years on: How consistent are organised screening practices?

    PubMed

    Williams, Jane H; Carter, Stacy M; Rychetnik, Lucie

    2014-11-01

    Organised screening programmes have been remarkably successful in reducing incidence and mortality from cervical cancer, while opportunistic screening varies in its effectiveness. Experts recommend that cervical screening or HPV testing be carried out only in the context of an organised programme. We sought to answer the following study questions: What does it mean for a cervical screening programme to be organised? Is there a place for opportunistic screening (in an organised programme)? We reviewed 154 peer-reviewed papers on organised and opportunistic approaches to cervical screening published between 1970 and 2014 to understand how the term 'organised' is used, formally and in practice. We found that despite broad recognition of a prescriptive definition of organisation, in practice the meaning of organisation is much less clear. Our review revealed descriptions of organised programmes that differ significantly from prescribed norms and from each other, and a variety of ways that opportunistic and organised programmes intersect. We describe the breadth of the variation in cervical cancer screening programmes and examine the relationships and overlaps between organised and opportunistic screening. Implications emerging from the review include the need to better understand the breadth of organisation in practice, the drivers and impacts of opportunistic screening and the impact of opportunistic screening on population programme outcomes. Appreciation of the complexity of cervical screening programmes will benefit both screeners and women as programmes are changed to reflect a partially vaccinated population, new evidence and new technologies. PMID:25282406

  13. General practice in Croatia, Yugoslavia

    PubMed Central

    Skupnjak, B.; Novosel, M.

    1976-01-01

    The position and importance of general practice in the Yugoslavian Health Service is being reviewed in a study of the working conditions, the composition and relationship of the primary health care team, the workload, and the opinions of the patients in Croatia, Yugoslavia. We found that many practices had barely half the recommended equipment, that the average workload was 40 patients a day, and that many general practitioners expected others to improve their organisation rather than undertaking it themselves. Those general-practitioner teams which we rated highly were also the most popular with patients. The job satisfaction of nurses varied and was highest when the doctors in the team did not have a high need for status for themselves. We consider general practice to be of crucial importance in the total system of health care in our country and believe that general practitioners should have the same status as specialists. PMID:1003392

  14. Practical methodological guide for hydrometric inter-laboratory organisation

    NASA Astrophysics Data System (ADS)

    Besson, David; Bertrand, Xavier

    2015-04-01

    Discharge measurements performed by the French governmental hydrometer team feed a national database. This data is available for general river flows knowkedge, flood forecasting, low water survey, statistical calculations flow, control flow regulatory and many other uses. Regularly checking the measurements quality and better quantifying its accuracy is therefore an absolute need. The practice of inter-laboratory comparison in hydrometry particularly developed during the last decade. Indeed, discharge measurement can not easily be linked to a standard. Therefore, on-site measurement accuracy control is very difficult. Inter-laboratory comparison is thus a practical solution to this issue. However, it needs some regulations in order to ease its practice and legitimize its results. To do so, the French government hydrometrics teams produced a practical methodological guide for hydrometric inter-laboratory organisation in destination of hydrometers community in view of ensure the harmonization of inter-laboratory comparison practices for different materials (ADCP, current meter on wadind rod or gauging van, tracer dilution, surface speed) and flow range (flood, low water). Ensure the results formalization and banking. The realisation of this practice guide is grounded on the experience of the governmental teams & their partners (or fellows), following existing approaches (Doppler group especially). The guide is designated to validate compliance measures and identify outliers : Hardware, methodological, environmental, or human. Inter-laboratory comparison provides the means to verify the compliance of the instruments (devices + methods + operators) and provides methods to determine an experimental uncertainty of the tested measurement method which is valid only for the site and the measurement conditions but does not address the calibration or periodic monitoring of the few materials. After some conceptual definitions, the guide describes the different stages of an

  15. When Is It OK to Learn at Work? The Learning Work of Organisational Practices

    ERIC Educational Resources Information Center

    Scheeres, Hermine; Solomon, Nicky; Boud, David; Rooney, Donna

    2010-01-01

    Purpose: The purpose of this paper is to examine the use of "learning" through what we have termed "integrated development practices". These are common organisational practices that both enhance organisational effectiveness and contribute to organisational and employee learning. Design/methodology/approach: The paper analyses the ways in which…

  16. [Manual therapy in general practice].

    PubMed

    Березуцкий, Владимир И

    2016-01-01

    The article is devoted to manual therapy practice for diagnostics and treatment of vertebrogenic pain syndrome in general practice. Analytical roundup of sources proves medical advantage of implementation of manual therapy basic methods by general practice specialists. PMID:27487550

  17. Content of general practice.

    PubMed

    Lim, T O

    1991-06-01

    Eight general practitioners participated in a survey of content of general practice. This is useful as an indicator or morbidity in the community as well as of workload of general practice. A total of 3164 consultations were recorded, of which 2764 (87%) were because of an illness and the rest (13%) for other reasons like medical examinations, antenatal check, family planning advice, pregnancy tests, pap smear and vaccination. The old and the young have high consultation rates for an illness, men consulted as often as women. The most common illness seen was upper respiratory tract infections, accounting for 37% of all illnesses. Other common minor illnesses were skin infections (6%), genito-urinary infections (5%), minor musculoskeletal (6%) and gastrointestinal (6%) complaints as well as minor injuries and cuts (4%). Major disorders form an unusually low proportion (18%) of all illnesses seen, in comparison with figures from United Kingdom. The common major disorders seen were hypertension, asthma, chronic rheumatic disorders and diabetes. Circulatory disorders were remarkably rare, accounting for only 1% of illnesses. Psychological disorders, both major and minor, were also rarely seen, accounting for only 1% of illnesses which is in marked contrast with figures from the United Kingdom. Factors contributing to these notable findings are discussed. PMID:1839420

  18. Training for general practice: a national survey.

    PubMed Central

    Crawley, H S; Levin, J B

    1990-01-01

    OBJECTIVES--(a) To compare current vocational training in general practice with that ascertained by a survey in 1980; (b) to compare the training of trainees in formal training schemes with that of trainees arranging their own hospital and general practice posts. DESIGN--National questionnaire survey of United Kingdom and armed services trainees who were in a training practice on 1 April 1989. Questionnaires were distributed by course organisers. SETTING--Research project set up after an ad hoc meeting of trainees at the 1988 national trainee conference. SUBJECTS--2132 Of the 2281 trainees (93%) known to be in a training practice on 1 April 1989. RESULTS--1657 Trainees returned the questionnaires, representing 73% of all trainees known to be in a training practice on 1 April 1989. Between 1980 and 1989 there were significant improvements in the trainee year, and there was also evidence of improvements in general practice study release courses. There was no evidence of improvement in other aspects of training. General practice trainees spent an average of three years in junior hospital posts, which provided very little opportunity for study related to general practice. Training received during tenure of hospital posts differed significantly between trainees in formal schemes and those arranging their own hospital posts. During the trainee year training was almost the same for those in formal schemes and those arranging their own posts. Regions varied significantly in virtually all aspects of general practice training. CONCLUSIONS--The trainee year could be improved further by enforcing the guidelines of the Joint Committee on Postgraduate Training for General Practice. The poor training in junior hospital posts reflected the low priority that training is generally given during tenure of these posts. A higher proportion of general practice trainees should be attached to vocational training schemes. More hospital trainees could attend general practice study release

  19. A Qualitative Study of the Experiences of Training in General Practice: A Community of Practice?

    ERIC Educational Resources Information Center

    Cornford, Charles S.; Carrington, Bruce

    2006-01-01

    Doctors training to become general practitioners (GPs) enter new "communities of practice". For instance, they initially experience various types of isolation, need new skills and knowledge and find the organisation of general practice different to hospitals. "Communities of practice" concepts help explain some of their experiences. The social…

  20. Bridging Theory and Practice: A Conceptual Framework for Consulting Organisations

    ERIC Educational Resources Information Center

    Mohammed, Meca B.; Welch, Jennie; Hazle Bussey, Leslie

    2015-01-01

    A growing number of organisations are emerging as partners to districts pursuing systemic improvement. Given the critical role a consulting organisation could play in supporting system reform efforts, how does a district leader looking to establish a consulting partnership determine what characteristics in a consulting organisation may be more…

  1. Obesity in general practice

    PubMed Central

    Malterud, Kirsti; Ulriksen, Kjersti

    2010-01-01

    Objective To explore obese patients' experiences with GPs' management of their weight problems. Methods Focus-group study with a purposive sample of 13 participants (eight women and five men), aged 30–55 years, with BMI above 40, or BMI above 35 with additional weight-related problems. Two focus-group interviews were conducted, inviting the participants to speak about their health care experiences from general practice. Analysis applied Systematic Text Condensation inspired by Giorgi's approach, searching for issues describing or discussing participants' experiences of GPs' obesity management. Results Obese patients want their GPs to put their weight problems on the agenda. When the patient appears reluctant, it may be a sign of embarrassment rather than rejection of the issue. However, restricted attention to obesity could lead to neglect of patients' problems. Participants complained that GPs often demonstrated insufficient engagement and knowledge regarding service resources for obesity treatment, leaving the responsibility for information on available referral resources to the patient. Finally, considerate attitudes in the GPs are needed for follow-up to be experienced as helpful by the patients. Vulnerable feelings of failure could be reinforced by well-intended advice. Degrading attitudes were perceived as especially subversive when they came from doctors. Conclusions The challenge for the GP is to increase his or her competence in individualized and evidence-based counselling, while acknowledging the efforts needed by the patient to achieve permanent change, and shifting attention from shame to coping. PMID:20942741

  2. The Power of Professionally Situated Practice Analysis in Redesigning Organisations: A Psychosociological Approach

    ERIC Educational Resources Information Center

    Scaratti, Giuseppe; Gorli, Mara; Ripamonti, Silvio

    2009-01-01

    Purpose: This paper seeks to provoke thoughts around the possibility of using the lever of practices and situated knowledge to trigger organisational change and to redesign it with the involvement of the whole organisation. Design/methodology/approach: The paper presents connections between a psychosociological approach and a practice-based…

  3. The Contributions of Organisational and Technological Practices to the Speedup of New Product Development

    ERIC Educational Resources Information Center

    Sun, Hongyi

    2007-01-01

    Based on data from 700 companies in 20 countries, this paper records the research that investigates the contribution of organisational and technological practices to speed up New Product Development (NPD). The organisational practice is found positively correlated with the speed of NPD. However, no significant direct relationship was found between…

  4. Ethics and health promotion practice: exploring attitudes and practices in Western Australian health organisations.

    PubMed

    Reilly, T; Crawford, G; Lobo, R; Leavy, J; Jancey, J

    2016-04-01

    Issue addressed Evidence-informed practice underpinned by ethics is fundamental to developing the science of health promotion. Knowledge and application of ethical principles are competencies required for health promotion practice. However, these competencies are often inconsistently understood and applied. This research explored attitudes, practices, enablers and barriers related to ethics in practice in Western Australian health organisations. Methods Semistructured, in-depth interviews were conducted with 10 health promotion practitioners, purposefully selected to provide a cross-section of government and non-government organisations. Interviews were recorded, transcribed and then themed. Results The majority of participants reported consideration of ethics in their practice; however, only half reported seeking Human Research Ethics Committee (HREC) approval for projects in the past 12 months. Enablers identified as supporting ethics in practice and disseminating findings included: support preparing ethics applications; resources and training about ethical practice; ability to access HRECs for ethics approval; and a supportive organisational culture. Barriers included: limited time; insufficient resourcing and capacity; ethics approval not seen as part of core business; and concerns about academic writing. Conclusion The majority of participants were aware of the importance of ethics in practice and the dissemination of findings. However, participants reported barriers to engaging in formal ethics processes and to publishing findings. So what? Alignment of evidence-informed and ethics-based practice is critical. Resources and information about ethics may be required to support practice and encourage dissemination of findings, including in the peer-reviewed literature. Investigating the role of community-based ethics boards may be valuable to bridging the ethics-evidence gap. PMID:27041127

  5. Walking as a social practice: dispersed walking and the organisation of everyday practices.

    PubMed

    Harries, Tim; Rettie, Ruth

    2016-07-01

    This paper uses social practice theory to study the interweaving of walking into everyday practices and considers how greater awareness of everyday walking can influence its position within the organisation and scheduling of everyday life. Walking is of policy interest because of its perceived benefits for health. This paper asserts that increased awareness of everyday walking allows users to become more active without having to reschedule existing activities. Using Schatzki's distinction between dispersed and integrative practices, it argues that increasing awareness of dispersed walking can enlist walking into the teleoaffective organisation of some social practices and prompt the performance of new 'health practices' within everyday domains of life such as shopping and employment. While this analysis offers useful insights for the design of behaviour change strategies, it also points to some unintended consequences of using digital feedback to increase walking awareness. In directing the gaze of participants at one particular element of their daily practices, the paper suggests, digital walking feedback provides a 'partial' view of practices: by highlighting the exercise value of walking at the expense of other values it can prompt feedback recipients to pass moral judgements on themselves based on this partial view. A Virtual Abstract of this paper can be found at: https://youtu.be/WV7DUnKD5Mw. PMID:26853086

  6. General practice 'going places'.

    PubMed

    Hughes, C

    1992-05-01

    This paper, which was presented at the Annual General Meeting of the Royal Australian College of General Practitioners in September 1991, outlines possible roles for the general practitioner in the public health system. Four fundamental steps need to be taken: affirmative action by health boards to include GPs in all activities; representation of the RACGP on health boards; adequate remuneration; and part time employment of GPs in all health care delivery service units. PMID:1520131

  7. [European general practice research agenda].

    PubMed

    Mäntyselkä, Pekka; Koskela, Tuomas

    2014-01-01

    The EGPRN (European General Practice Research Network) research agenda is a review compiling the strengths and areas of development of European general practice, based on a systematic literature survey and its versatile analysis. The research agenda is a framework paper sharpening the definition and functions of general practice as well as its significance for researchers and decisionmakers. The agenda is useful in structuring the research, evaluation of research needs, strengthening of infrastructure and strategic planning of new research. PMID:24961062

  8. The new Australian after-hours general practice incentive payment mechanism: equity for rural general practice?

    PubMed

    Neil, Amanda L; Nelson, Mark; Palmer, Andrew J

    2016-07-01

    In July 2015, a national scheme for after-hours incentive funding for general practices was re-introduced in Australia, 2-years after funding was transferred to regional primary health care organisations (Medicare Locals). The re-introduction was recommended in a 2014 review of after-hours primary care reflecting the "overwhelming desire" among general practice. Given the centrality of after-hours care provision in rural and remote practices identified in the review, we compare and contrast the current and historical after-hours incentive funding mechanisms focussing on fairness towards rural general practices. While there are similarities between the current and historical mechanisms, significant differences exist. The comparison is not straightforward. The major consistency is utilisation of practice standardised whole patient equivalents (SWPE) as the basis of funding, inherently favouring large urban general practices. This bias is expected to increase given a shift in focus from practices with no option but to provide 24/7 care to any practice providing 24/7 care; and an associated increased funding per SWPE. Differences primarily pertain to classification processes, in which the realities of rural service provision and recognition of regional support mechanisms are given minimal consideration. Rapid introduction of the new general practice after-hours incentive funding mechanism has led to inconsistencies and has exacerbated inherent biases, particularly inequity towards rural providers. Impact on morale and service provision in non-urban areas should be monitored. PMID:27237945

  9. General Practice in Northern Norway

    PubMed Central

    Black, D. P.

    1975-01-01

    A study was made of general practice in northern Norway where conditions are similar to parts of rural Canada. The Norwegian general practitioner has developed expertise in the preventive and psychosocial aspects of practice and the team concept is highly developed. Since the general practitioner is separated from the hospital, his facilities for procedures and diagnostic workups are primitive. Involvement of general practitioners in medical education is not yet well developed although all new graduates spend a compulsory period in rural practice. PMID:20469187

  10. Organisation of workplace learning: a case study of paediatric residents' and consultants' beliefs and practices.

    PubMed

    Skipper, Mads; Nøhr, Susanne Backman; Jacobsen, Tine Klitgaard; Musaeus, Peter

    2016-08-01

    Several studies have examined how doctors learn in the workplace, but research is needed linking workplace learning with the organisation of doctors' daily work. This study examined residents' and consultants' attitudes and beliefs regarding workplace learning and contextual and organisational factors influencing the organisation and planning of medical specialist training. An explorative case study in three paediatric departments in Denmark including 9 days of field observations and focus group interviews with 9 consultants responsible for medical education and 16 residents. The study aimed to identify factors in work organisation facilitating and hindering residents' learning. Data were coded through an iterative process guided by thematic analysis. Findings illustrate three main themes: (1) Learning beliefs about patient care and apprenticeship learning as inseparable in medical practice. Beliefs about training and patient care expressed in terms of training versus production caused a potential conflict. (2) Learning context. Continuity over time in tasks and care for patients is important, but continuity is challenged by the organisation of daily work routines. (3) Organisational culture and regulations were found to be encouraging as well inhibiting to a successful organisation of the work in regards to learning. Our findings stress the importance of consultants' and residents' beliefs about workplace learning as these agents handle the potential conflict between patient care and training of health professionals. The structuring of daily work tasks is a key factor in workplace learning as is an understanding of underlying relations and organisational culture in the clinical departments. PMID:26696031

  11. Violence in general practice: a gendered risk?

    PubMed

    Elston, Mary Ann; Gabe, Jonathan

    2016-03-01

    This article focuses on the extent to which violence against family doctors in England is experienced in gendered terms. It draws on data from two studies: a postal survey of 1,300 general practitioners (GPs) (62% response rate) and in-depth interviews with 26 doctors who have been assaulted or threatened; and 13 focus groups with primary care teams and 19 in-depth interviews with GPs who had expressed an interest in the topic of violence against doctors. Most GPs, regardless of gender, reported receiving verbal abuse over the last two years, often interpreted as a consequence of declining deference to professionals, while actual physical assaults and threats were much rarer and more likely to be reported by men. Overall, women GPs were much more likely to express concern about violence and to take personal precautions, although younger male GPs working in inner-city practices also had high levels of concern. The study shows how some aspects of family doctors' work has been organised on gendered lines and how these contribute to the differences in experience of violence. We suggest that the increasing proportion of women among family doctors may have implications for these, often tacit, organisational routines. PMID:26498299

  12. Educating Global Citizens: A Good "Idea" or an Organisational Practice?

    ERIC Educational Resources Information Center

    Lilley, Kathleen; Barker, Michelle; Harris, Neil

    2015-01-01

    Higher education emphasises training and skills for employment, yet while the "idea" of educating global citizens appears in university discourse, there is limited evidence demonstrating how the "idea" of the global citizen translates into practice. Recent research emphasises a desire for graduates to be local and global…

  13. Certifying leaders? high-quality management practices and healthy organisations: an ISO-9000 based standardisation approach

    PubMed Central

    MONTANO, Diego

    2016-01-01

    The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach. PMID:26860787

  14. Certifying leaders? high-quality management practices and healthy organisations: an ISO-9000 based standardisation approach.

    PubMed

    Montano, Diego

    2016-08-01

    The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach. PMID:26860787

  15. An evaluation of a new instrument to measure organisational safety culture values and practices.

    PubMed

    Díaz-Cabrera, D; Hernández-Fernaud, E; Isla-Díaz, R

    2007-11-01

    The main aim of this research is to evaluate a safety culture measuring instrument centred upon relevant organisational values and practices related to the safety management system. Seven dimensions that reflect underlying safety meanings are proposed. A second objective is to explore the four cultural orientations in the field of safety arising from the competing values framework. The study sample consisted of 299 participants from five companies in different sectors. The results show six dimensions of organisational values and practices and different company profiles in the organisations studied. The four cultural orientations proposed by the competing values framework are not confirmed. Nevertheless, a coexistence of diverse cultural orientations or paradoxes in the companies is observed. PMID:17920844

  16. Social Workers and General Practice

    PubMed Central

    Evans, J. W.; Lovel, T. W. I; Eaton, K. K.

    1969-01-01

    Weekly case conferences have been found valuable in the management of problem families in a general practice in a new town. These are attended by health visitors, mental welfare and child care officers, welfare officers, and psychiatric social workers, as well as by the family doctors. The conferences are a quick and easy way of exchanging important information and leading to rapid decisions. PMID:5761898

  17. Organised Governmental Learning: Vocational Education and Training Practices between Peer Review and Peer Learning

    ERIC Educational Resources Information Center

    Speer, Sandra

    2011-01-01

    Peer learning has already existed for a long time, as an informal as well as a formal practice between people from the same professional area. However, peer learning systems on the macro level are relatively newer concepts. Policy learning can be fostered by various types of organised activities, ranging from peer review frameworks, which often…

  18. The relationship between quality management practices and organisational performance: A structural equation modelling approach

    NASA Astrophysics Data System (ADS)

    Jamaluddin, Z.; Razali, A. M.; Mustafa, Z.

    2015-02-01

    The purpose of this paper is to examine the relationship between the quality management practices (QMPs) and organisational performance for the manufacturing industry in Malaysia. In this study, a QMPs and organisational performance framework is developed according to a comprehensive literature review which cover aspects of hard and soft quality factors in manufacturing process environment. A total of 11 hypotheses have been put forward to test the relationship amongst the six constructs, which are management commitment, training, process management, quality tools, continuous improvement and organisational performance. The model is analysed using Structural Equation Modeling (SEM) with AMOS software version 18.0 using Maximum Likelihood (ML) estimation. A total of 480 questionnaires were distributed, and 210 questionnaires were valid for analysis. The results of the modeling analysis using ML estimation indicate that the fits statistics of QMPs and organisational performance model for manufacturing industry is admissible. From the results, it found that the management commitment have significant impact on the training and process management. Similarly, the training had significant effect to the quality tools, process management and continuous improvement. Furthermore, the quality tools have significant influence on the process management and continuous improvement. Likewise, the process management also has a significant impact to the continuous improvement. In addition the continuous improvement has significant influence the organisational performance. However, the results of the study also found that there is no significant relationship between management commitment and quality tools, and between the management commitment and continuous improvement. The results of the study can be used by managers to prioritize the implementation of QMPs. For instances, those practices that are found to have positive impact on organisational performance can be recommended to

  19. Developing Policy and Practice for Dyslexia across a Local Authority: A Case Study of Educational Psychology Practice at Organisational Level

    ERIC Educational Resources Information Center

    Woods, Kevin; Stothard, Jan; Lydon, Jackie; Reason, Rea

    2013-01-01

    In this paper two premises are set out: first, that within Children's Services educational psychologists (EPs) have a distinctive contribution to make towards policy and practice in relation to "dyslexia"; second, that they may be well placed to lead development work at an organisational level within a local authority. Building on…

  20. Included or Excluded? The Dual Influences of the Organisational Field and Organisational Practices on New Female Academics

    ERIC Educational Resources Information Center

    Elg, Ulf; Jonnergard, Karin

    2010-01-01

    A number of measures have been taken by the society to ensure gender equality in higher education. Nevertheless, women still face great difficulties when pursuing an academic career. Our aim is to increase the understanding of how the society, conceptualised as the organisational field, interacts with organisational factors and personal actions as…

  1. Effectiveness of organisational infrastructures to promote evidence-based nursing practice

    PubMed Central

    Flodgren, Gerd; Rojas-Reyes, Maria Ximena; Cole, Nick; Foxcroft, David R

    2014-01-01

    Background Nurses and midwives form the bulk of the clinical health workforce and play a central role in all health service delivery. There is potential to improve health care quality if nurses routinely use the best available evidence in their clinical practice. Since many of the factors perceived by nurses as barriers to the implementation of evidence-based practice (EBP) lie at the organisational level, it is of interest to devise and assess the effectiveness of organisational infrastructures designed to promote EBP among nurses. Objectives To assess the effectiveness of organisational infrastructures in promoting evidence-based nursing. Search methods We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, LILACS, BIREME, IBECS, NHS Economic Evaluations Database, Social Science Citation Index, Science Citation Index and Conference Proceedings Citation Indexes up to 9 March 2011. We developed a new search strategy for this update as the strategy published in 2003 omitted key terms. Additional search methods included: screening reference lists of relevant studies, contacting authors of relevant papers regarding any further published or unpublished work, and searching websites of selected research groups and organisations. Selection criteria We considered randomised controlled trials, controlled clinical trials, interrupted times series (ITSs) and controlled before and after studies of an entire or identified component of an organisational infrastructure intervention aimed at promoting EBP in nursing. The participants were all healthcare organisations comprising nurses, midwives and health visitors. Data collection and analysis Two authors independently extracted data and assessed risk of bias. For the ITS analysis, we reported the change in the slopes of the regression lines, and the change in the level effect of the outcome at 3

  2. Transcultural general practice in Scandinavia.

    PubMed

    Löfvander, Monica; Dyhr, Lise

    2002-03-01

    During the past 20 years, many immigrants from all over the world have settled in Scandinavia. Primary care physicians today are therefore meeting patients from a variety of socio-cultural, religious, and ethnic backgrounds. In addition to endemic diseases, the new immigrants are exposed to Western illness and disease patterns and psychic reactions to life events, and the on-going adaptive process may add to the dilemmas of segregation in housing and work. During consultations, doctors and patients frame this ill health by culturally determined ideas of health, illness, and treatment. This paper deals with Scandinavian studies concerning transcultural issues in primary care by exploring the Scandinavian literature. Relatively few studies were found in the databases. Many of them were small, making it difficult to generalise the findings. Descriptive explorative studies suggest problems in communication, behaviour, mental ill health, physiotherapy, and organisation of care. No studies were found concerning issues such as genital mutilation, environmental diseases, family conflicts, or chronic disorders other than pain. From action research studies or randomised-controlled trials, it can be cautiously concluded that psychiatric care may be little accepted in many immigrant groups and that immigrants with non-specific pain are best handled in primary care where dialogue about pain is to be preferred to traditional treatment. Brief advice regarding communication and organisation of care is also given. In our opinion, studies using action research methods are to be preferred, since clinical transcultural care deals with complex illness patterns, including many emotional dilemmas. PMID:12086287

  3. Organisational Intelligence

    ERIC Educational Resources Information Center

    Yolles, Maurice

    2005-01-01

    Purpose: Seeks to explore the notion of organisational intelligence as a simple extension of the notion of the idea of collective intelligence. Design/methodology/approach: Discusses organisational intelligence using previous research, which includes the Purpose, Properties and Practice model of Dealtry, and the Viable Systems model. Findings: The…

  4. Human resource management in general practice: survey of current practice.

    PubMed Central

    Newton, J; Hunt, J; Stirling, J

    1996-01-01

    BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters

  5. Evaluating oral health promotion activity within a general dental practice.

    PubMed

    Richards, W

    2013-07-01

    The prevention of the common dental diseases is fundamental to modern day general dental practice. Oral health promotion (OHP) is therefore key to facilitating health outcomes within organisations. The literature surrounding OHP stresses the importance of evaluation in order to assess the effectiveness of OHP activities. This paper describes the evaluation of OHP within a general dental practice setting. Early attendance, the use of adult toothpastes during childhood and consequential fluorosis are investigated. A small service evaluation study of 100 consecutive patients was undertaken. The results support the ongoing promotion of early attendance and the use of toothpastes with adequate fluoride levels. There was no evidence of unsightly fluorosis in the sample studied. PMID:23887535

  6. [Psychotic disorders: special aspects in general practice].

    PubMed

    Kurmann, Julius

    2015-09-30

    In emergency situations the general practitioner is often the first professional contact psychotic patients have. The following article conveys basic knowledge about psychotic disorders and their clinical features typically seen in general practice. PMID:26422072

  7. Supporting General Educators' Inclusive Practices.

    ERIC Educational Resources Information Center

    Coombs-Richardson, Rita; Mead, Jean

    2001-01-01

    This article describes Project Inclusion, a state-funded project at Southeastern Louisiana University, which provided financial support for general educators to take university courses to develop their knowledge and skills concerning students with disabilities. The courses emphasized collaboration techniques, curricular modifications, and behavior…

  8. General Education: Practice Without Theory.

    ERIC Educational Resources Information Center

    Kridel, Craig

    The contemporary literature on general education, most of which is aimed at college and university reform, is evaluated. The underlying assumptions of some of the representive works on this topic are examined, and persistent issues in the field are identified and alternatives proposed. Although the emphasis of the analysis is directed to "Missions…

  9. Evaluation of portable haemoglobinometer in general practice.

    PubMed Central

    Neville, R G

    1987-01-01

    The HemoCue system for estimating haemoglobin was evaluated within urban general practice. It gave excellent results when used within a laboratory environment (on 103 paired samples) but disappointing ones when evaluated by practice nurses within general practice (on 235 paired samples). The most likely source of error was inadequate mixing of the blood specimens before sampling, which might be obviated by using a rotating mixer. It is emphasised that equipment intended for use in general practice should be evaluated under normal working conditions envisaged. PMID:3109609

  10. 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

  11. The future of bereavement care in British general practice.

    PubMed

    Woof, W R

    1997-06-01

    This paper discusses the future of bereavement care in British general practice by providing an insight into existing practice and then speculating on influences that may shape developments. There have been calls for the specialty to build on this traditional role and expand its bereavement service. Specific suggestions for the content of such a service are summarised. This emphasis reflects the increasing awareness in bereavement by other health organisations. This image of an expanding service needs to be contextualised within a primary care system that is feeling more pressurised due to increasing workload. This will continue to inhibit extensive service development. In addition it is important for the profession to consider the appropriateness of this activity. This complex debate has received little attention and research is required to inform and provide the necessary direction. PMID:9233164

  12. Organisation of Workplace Learning: A Case Study of Paediatric Residents' and Consultants' Beliefs and Practices

    ERIC Educational Resources Information Center

    Skipper, Mads; Nøhr, Susanne Backman; Jacobsen, Tine Klitgaard; Musaeus, Peter

    2016-01-01

    Several studies have examined how doctors learn in the workplace, but research is needed linking workplace learning with the organisation of doctors' daily work. This study examined residents' and consultants' attitudes and beliefs regarding workplace learning and contextual and organisational factors influencing the organisation and planning of…

  13. Patient Experience of Australian General Practices.

    PubMed

    Narayanan, Ajit; Greco, Michael

    2016-03-01

    The number of data-based research articles focusing on patient sociodemographic profiling and experience with healthcare practices is still relatively small. One of the reasons for this relative lack of research is that categorizing patients into different demographic groups can lead to significant reductions in sample numbers for homogeneous subgroups. The aim of this article is to identify problems and issues when dealing with big data that contains information at two levels: patient experience of their general practice, and scores received by practices. The Practice Accreditation and Improvement Survey (PAIS) consisting of 27 five-point Likert items and 11 sociodemographic questions is a Royal Australian College of General Practitioners (RACGP)-endorsed instrument for seeking patient views as part of the accreditation of Australian general practices. The data were collected during the 3-year period May 2011-July 2014, during which time PAIS was completed for 3734 individual general practices throughout Australia involving 312,334 anonymous patients. This represents over 60% of practices in Australia, and ∼75% of practices that undergo voluntary accreditation. The sampling method for each general practice was convenience sampling. The results of our analysis show how sociodemographic profiles of Australian patients can affect their ratings of practices and also how the location of the practice (State/Territory, remote access area) can affect patient experience. These preliminary findings can act as an initial set of results against which future studies in patient experience trends can be developed and measured in Australia. Also, the methods used in this article provide a methodological framework for future patient experience researchers to use when dealing with data that contain information at two levels, such as the patient and practice. Finally, the outcomes demonstrate that different subgroups can experience healthcare provision differently, especially

  14. Clinical placements in general practice: relationships between practice nurses and tertiary institutions.

    PubMed

    Peters, Kathleen; Halcomb, Elizabeth J; McInnes, Susan

    2013-05-01

    As a practice-based discipline a key component of undergraduate nurse education is clinical practice experience. The quality of clinical experiences has a significant impact on the students' ability to function competently post graduation. The relationship between higher education institutions (HEIs) and health service placement providers impacts upon the quality of clinical placements. In Australia, the growth of primary care nursing and the shortage of acute clinical places has prompted HEIs to explore the placement of students in general practice. Given the increasing attention being paid to non-traditional clinical placements, it is timely to explore how universities are establishing relationships and models of clinical placement. This paper uses qualitative research methods to explore the perspectives of 12 Australian general practice nurses who have experience in facilitating undergraduate clinical placements about the relationships between HEIs and nurses. Findings are presented in the following three themes: (1) Appropriate preparation for placement: They don't know what primary health really means, (2) Seeking greater consultation in the organisation of clinical placements: they've got to do it one way for everyone, and (3) Uncertainty and lack of support: I had no contact with the university. Clinical placements in general practice can be an innovative strategy providing non-traditional, yet high quality, teaching and learning experiences for undergraduate nursing students. To optimise the quality of these placements, however, it is essential that HEIs provide appropriate support to the practice nurses mentoring these students. PMID:23069694

  15. Negotiating the role of the practice nurse in general practice.

    PubMed

    Atkin, K; Lunt, N

    1996-09-01

    The debate about the role of the practice nurse is not only about practice nursing per se, but raises broader issues about the organization of primary health care. Two related issues emerge as significant: the role of the practice nurse in providing primary health care; and the effective use of the practice nurse resource in the 'new' National Health Service. This paper, by drawing on material from a qualitative study, specifically examines the type of work performed by practice nurses and the factors that influence this. The responses of practice nurses, general practitioners, Family Health Service Authority (FHSA) advisers, community nurse purchasers and managers of community nursing provider units suggest that a consensus on the future development of practice nursing is unlikely. The different stakeholders emphasized different issues, reflecting their own priorities and backgrounds. Practice nurses' accounts of the future, for example, focused on professional issues. General practitioners stressed the importance of role development which met their General Medical Service responsibilities. Purchasing agencies, provider units and FHSAs adopted a wider perspective and were more concerned to develop an effective and integrated primary health care service. The tensions generated by their different interests and perspectives, and the subsequent organizational and policy initiatives that emerge, will provide the context in which the role of practice nurses will be negotiated. PMID:8876409

  16. The care work of general practice receptionists.

    PubMed

    Neuwelt, Pat M; Kearns, Robin A; Cairns, Isobel R

    2016-06-01

    INTRODUCTION The care work of general practice receptionists has received limited research attention, despite receptionists position at the beginning of patients' journeys in many health care systems. We examine receptionists' perceptions of their work and the opportunities and constraints they experience in caring for patients while providing administrative support to practices. METHODS Data were collected in focus group interviews with 32 receptionists from urban and rural general practices in the Auckland and Northland regions of New Zealand. We employed tools from inductive thematic analysis and Straussian grounded theory in interpreting the data. FINDINGS We found that the way receptionists identified with a caring role strongly challenged the pejorative view of them in public discourse. Receptionists provide care in two key ways: for the practice and for patients. The juggling they do between the demands of the practice and of patients creates considerable work tensions that are often invisible to other staff members. CONCLUSION Receptionists have a critical role as the first step in the patient care pathway, bridging health care system and community. For general practice to be patient-centred and improve accessibility for the most vulnerable, the care work of receptionists must be considered core. KEYWORDS Receptionists; general practice; care; New Zealand. PMID:27477554

  17. Teachers' Organisational Practices and Their Perceptions of the Benefits of Support by Withdrawal for Mathematics in Irish Primary Schools

    ERIC Educational Resources Information Center

    Travers, Joseph

    2011-01-01

    This study was designed to ascertain the organisational practices of learning support teachers and their perceptions of the benefits, if any, of support by withdrawal for mathematics in Irish primary schools. The study reports on the views of a sample of 137 teachers who have postgraduate qualifications in learning support/special education from…

  18. Treating organisational illness: a practical approach to facilitating improvements in health care.

    PubMed

    Hindle, Don; Natsagdorj, Tserendorj

    2002-01-01

    The health sector contains many problems that are widely recognised and ought to be easily resolved, and yet some organisations seem to be powerless to act. We argue that this mainly reflects weaknesses in the organisational culture, and present an approach that we have been using to address them. We describe some simple analytical tools, and report our experiences in using them in organisations in several countries. We conclude that most people believe organisational weaknesses are important, are willing and eager to try to address them, and do in fact find ways of making some useful changes--at least, in the short-term. PMID:12536877

  19. Workplace assessment for licensing in general practice

    PubMed Central

    Swanwick, Tim; Chana, Nav

    2005-01-01

    With the redesign of general practice training implicit in the Department of Health's programme of reform, Modernising Medical Careers, there is the opportunity to bring summative assessment and the MRCGP examination together into a unified assessment framework for licensing. It is likely that assessment in the workplace will play a central role in such a process. Workplace assessment is of high validity and has the potential to reconnect teaching and testing in general practice. Five principles to underpin the design of a workplace assessment are proposed, namely that it should be: competency-based, developmental, evidential, locally assessed, and triangulated. Successful implementation of workplace assessment will not only serve to reduce the current testing burden on trainees, but will also harness the involvement of medical teachers. In doing so, general practice has the opportunity to create a powerful tool for professional development. PMID:15970071

  20. Organisational Learning as an Emerging Process: The Generative Role of Digital Tools in Informal Learning Practices

    ERIC Educational Resources Information Center

    Za, Stefano; Spagnoletti, Paolo; North-Samardzic, Andrea

    2014-01-01

    Increasing attention is paid to organisational learning, with the success of contemporary organisations strongly contingent on their ability to learn and grow. Importantly, informal learning is argued to be even more significant than formal learning initiatives. Given the widespread use of digital technologies in the workplace, what requires…

  1. Challenges to prevention in Dutch general practice.

    PubMed

    Drenthen, T

    1997-06-01

    In the Netherlands the general practitioner (GP) plays an important role in prevention. Every Dutch citizen has to be registered with one GP and GPs know their patients well. Face-to-face contact is a relatively effective means of influencing behavior; if preventive advice is related to a patient's state of health, compliance may be stimulated. However, Dutch GPs have shown reluctance toward preventive work. Curing rather than preventing disease is emphasized in medical school. Many GPs doubt that they are entitled to interfere with a patients' lifestyle unless asked. Some GPs are aware of their limited knowledge of nutrition. Preventive work requires some reorganization of medical practice and can lead to an increased workload, without financial compensation. Then there is the "prevention paradox": preventive actions that have a demonstrable effect on the whole population bring only small benefits for individuals. Since 1989 the Dutch College of General Practitioners has published 60 standards for general practice. Several of these include advice on lifestyle and diet, eg, for non-insulin-dependent diabetes mellitus, hypertension, hypercholesterolemia, peptic ulcer, and heart failure. Prevention work in general practice must use only interventions proved to be effective and they must be feasible in the context of general practice. A trial collaboration of 118 GPs and 5 public health authorities between 1988 and 1990 for screening and lifestyle management of hypertension was a limited success. It brought to light the practical problems of this type of work in general practice. Present government priorities for GP-public health collaboration are influenza vaccination and cervical screening. PMID:9174499

  2. 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

  3. Practice organisational characteristics can impact on compliance with the BTS/SIGN asthma guideline: Qualitative comparative case study in primary care

    PubMed Central

    Wiener-Ogilvie, Sharon; Huby, Guro; Pinnock, Hilary; Gillies, John; Sheikh, Aziz

    2008-01-01

    Background Although the BTS-SIGN asthma guideline is one of the most well known and widely respected guidelines in the world, implementation in UK primary care remains patchy. Building on extensive earlier descriptive work, we sought to explore the way teamwork and inter-professional relationships impact on the implementation of the BTS-SIGN guideline on asthma in general practice. Methods Qualitative comparative case study using nine in-depth interviews and 2 focus groups with general practitioners and practice nurses, involved in delivering asthma care. Participants were purposively recruited from practices in a Scottish health board with high and low compliance with the BTS-SIGN asthma guideline. Results There was a marked difference in the way respondents from practices with high compliance and respondents from practices with low compliance spoke about the value of guidelines and the challenges of implementing them. On both accounts, the former were more positive than the latter and were able to be more specific about the strategies they used to overcome barriers to implementation. We explored the reason for this difference in response and identified practice organisation, centring on delegation of work to nurses, as a factor mediating the practice's level of compliance. Effective delegation was underpinned by organisation of asthma work among practice members who have the appropriate level of skills and knowledge, know and understand each others' work and responsibilities, communicate well among themselves and trust each others' skills. It was the combination of these factors which made for successful delegation and guideline implementation, not any one factor in isolation. Conclusion In our sample of practices, teamwork and organisation of care within practices appeared to impact on guideline implementation and further larger studies are needed to explore this issue further. Isolated interventions such as measures to improve staff's knowledge or increased

  4. 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

  5. What can management theories offer evidence-based practice? A comparative analysis of measurement tools for organisational context

    PubMed Central

    French, Beverley; Thomas, Lois H; Baker, Paula; Burton, Christopher R; Pennington, Lindsay; Roddam, Hazel

    2009-01-01

    Background Given the current emphasis on networks as vehicles for innovation and change in health service delivery, the ability to conceptualise and measure organisational enablers for the social construction of knowledge merits attention. This study aimed to develop a composite tool to measure the organisational context for evidence-based practice (EBP) in healthcare. Methods A structured search of the major healthcare and management databases for measurement tools from four domains: research utilisation (RU), research activity (RA), knowledge management (KM), and organisational learning (OL). Included studies were reports of the development or use of measurement tools that included organisational factors. Tools were appraised for face and content validity, plus development and testing methods. Measurement tool items were extracted, merged across the four domains, and categorised within a constructed framework describing the absorptive and receptive capacities of organisations. Results Thirty measurement tools were identified and appraised. Eighteen tools from the four domains were selected for item extraction and analysis. The constructed framework consists of seven categories relating to three core organisational attributes of vision, leadership, and a learning culture, and four stages of knowledge need, acquisition of new knowledge, knowledge sharing, and knowledge use. Measurement tools from RA or RU domains had more items relating to the categories of leadership, and acquisition of new knowledge; while tools from KM or learning organisation domains had more items relating to vision, learning culture, knowledge need, and knowledge sharing. There was equal emphasis on knowledge use in the different domains. Conclusion If the translation of evidence into knowledge is viewed as socially mediated, tools to measure the organisational context of EBP in healthcare could be enhanced by consideration of related concepts from the organisational and management sciences

  6. Ethnographic study of ICT-supported collaborative work routines in general practice

    PubMed Central

    2010-01-01

    Background Health informatics research has traditionally been dominated by experimental and quasi-experimental designs. An emerging area of study in organisational sociology is routinisation (how collaborative work practices become business-as-usual). There is growing interest in the use of ethnography and other in-depth qualitative approaches to explore how collaborative work routines are enacted and develop over time, and how electronic patient records (EPRs) are used to support collaborative work practices within organisations. Methods/design Following Feldman and Pentland, we will use 'the organisational routine' as our unit of analysis. In a sample of four UK general practices, we will collect narratives, ethnographic observations, multi-modal (video and screen capture) data, documents and other artefacts, and analyse these to map and compare the different understandings and enactments of three common routines (repeat prescribing, coding and summarising, and chronic disease surveillance) which span clinical and administrative spaces and which, though 'mundane', have an important bearing on quality and safety of care. In a detailed qualitative analysis informed by sociological theory, we aim to generate insights about how complex collaborative work is achieved through the process of routinisation in healthcare organisations. Discussion Our study offers the potential not only to identify potential quality failures (poor performance, errors, failures of coordination) in collaborative work routines but also to reveal the hidden work and workarounds by front-line staff which bridge the model-reality gap in EPR technologies and via which "automated" safety features have an impact in practice. PMID:21190583

  7. General practice update: chlamydia infection in women.

    PubMed Central

    Oakeshott, P; Hay, P

    1995-01-01

    The prevalence of cervical Chlamydia trachomatis infection in general practice populations ranges between 2% and 12%. Untreated infection can cause pelvic inflammatory disease, tubal infertility and ectopic pregnancy. These risks are increased by cervical invasive procedures, especially termination of pregnancy. However, most women with chlamydia infection have no symptoms. General practitioners and practice nurses carrying out pelvic examinations should have facilities for taking endocervical specimens for chlamydia. Routine chlamydia screening, should be considered if the local prevalence of infection is over 6%. Otherwise chlamydia testing should be offered to women requesting termination of pregnancy and to those who have risk factors: aged less than 25 years, absence of barrier contraception, recent change of sexual partner, vaginal discharge, friable cervix or sterile pyuria. Women found to have chlamydia infection need appropriate antibiotics, advice about contact tracing and referral to a genitourinary medicine clinic. Good communication between general practitioners and genitourinary physicians is essential. Both general practitioners and practice nurses have an important role to play in reducing the prevalence of cervical chlamydia infection and its potentially devastating consequences. PMID:8554843

  8. Organisational innovation and control practices: the case of public-private mix in tuberculosis control in India.

    PubMed

    Engel, Nora; van Lente, Harro

    2014-07-01

    Partnerships between public and private healthcare providers are often seen as an important way to improve health care in resource-constrained settings. Despite the reconfirmed policy support for including private providers into public tuberculosis control in India, the public-private mix (PPM) activities continue to face apprehension at local implementation sites. This article investigates the causes for those difficulties by examining PPM initiatives as cases of organisational innovation. It examines findings from semi-structured interviews, observations and document analyses in India around three different PPM models and the attempts of innovating and scaling up. The results reveal that in PPM initiatives underlying problem definitions and different control practices, including supervision, standardisation and culture, continue to clash and ultimately hinder the scaling up of PPM. Successful PPM initiatives require organisational control practices which are rooted in different professions to be bridged. This entails difficult balancing acts between innovation and control. The innovators handle those differently, based on their own ideas of the problem that PPM should address and their own control practices. We offer new perspectives on why collaboration is so difficult and show a possible way to mitigate the established apprehensions between professions in order to make organisational innovations, such as PPM, sustainable and scalable. PMID:24372316

  9. Competing and coexisting logics in the changing field of English general medical practice.

    PubMed

    McDonald, Ruth; Cheraghi-Sohi, Sudeh; Bayes, Sara; Morriss, Richard; Kai, Joe

    2013-09-01

    Recent reforms, which change incentive and accountability structures in the English National Health Service, can be conceptualised as trying to shift the dominant institutional logic in the field of primary medical care (general medical practice) away from medical professionalism towards a logic of "population based medicine". This paper draws on interviews with primary care doctors, conducted during 2007-2009 and 2011-2012. It contrasts the approach of active management of populations, in line with recent reforms with responses to patients with medically unexplained symptoms. Our data suggest that rather than one logic becoming dominant, different dimensions of organisational activity reflect different logics. Although some aspects of organisational life are relatively untouched by the reforms, this is not due to 'resistance' on the part of staff within these organisations to attempts to 'control' them. We suggest that a more helpful way of understanding the data is to see these different aspects of work as governed by different institutional logics. PMID:23906120

  10. From general practice to primary care: the industrialisation of family medicine in Britain.

    PubMed

    Iliffe, Steve

    2002-01-01

    Health services are multi-unit enterprises providing multi-component services, and organisationally are equivalent to very large, diversified companies. Although public health services like Britain's National Health service (NHS) are not for-profit enterprises, they may share characteristics of such enterprises, particularly where these characteristics offer methods of cost-containment. Since all health services, however organised, face the same problem of resources being insufficient to meet demand for health care, they exhibit an underlying tendency towards solving problems in health care using mechanisms borrowed from other industries. This paper attempts to answer the question: to what extent has general practice (family medicine) in Britain's NHS adopted industrial modes of organisation from productive (for-profit) industries? PMID:12013714

  11. Practical calculation scheme for generalized seniority

    NASA Astrophysics Data System (ADS)

    Jia, L. Y.

    2015-11-01

    We propose a scheme or procedure for performing practical calculations with generalized seniority. It reduces the total computing time by precalculating a set of intermediate quantities. We show that practically the computational (time and space) complexity of the algorithm does not depend on the valence particle number, in sharp contrast to the standard shell model. The method is demonstrated in semi-magic nuclei {}{46,48,50}Ca, 116Sn, and 182Pb, where the low-lying states could be well reproduced through achieved convergence at high generalized seniority. Odd particle-number systems or possible three-body terms from the Hamiltonian could be treated by the same formalism without complication.

  12. Feasibility of contact surveys in general practice.

    PubMed Central

    Phillips, A; Mant, D

    1987-01-01

    Surveys to evaluate risk factors for disease in the general population are popular with health authorities for assessing the effectiveness of their preventive measures. A contact survey of the lifestyles of 2000 randomly selected patients aged 25-64 was conducted in five general practices over 18 months; the medical records of the patients selected were tagged, and when the patients first visited the surgery they were given a questionnaire by the receptionists, which they completed in the waiting room. Over the 18 months at least 1400 of these patients visited the practices, of whom 1106 (55%) completed a questionnaire and 20 refused to do so; 896 (81%) completed it within one year. Information on the patients who were not surveyed was obtained by sending the questionnaire by post and by audit of medical records. The population surveyed on contact with the surgeries contained a higher proportion of young women, and possibly a higher proportion of patients from social classes IIIM-V, than the other patients. No important or consistent bias towards unhealthy patients at high risk was identified in the contact survey. A one year contact survey of a random, tagged sample is feasible in estimating the risk factors in a population and may be the method of choice in general practice because of its low cost and adaptability. PMID:3120900

  13. Transforming general practice: the redistribution of medical work in primary care.

    PubMed

    Charles-Jones, Huw; Latimer, Joanna; May, Carl

    2003-01-01

    The paper focuses on the redistribution of medical work within primary health care teams. It reports the results of the analysis of interviews with general practitioners, practice nurses and managers, undertaken as part of an ethnographic study of primary care organisation and practice during a period of rapid organisational change. By examining the ways in which the respondents account for how work is being redefined and redistributed, we explore how current government policy and professional discourses combine to reconfigure both the identities of those who work in primary care and the nature of patienthood. In particular, we show how general practitioners are being reconfigured as medical specialists or consultants in ways that seem to depart radically from earlier claims that general practice is a distinctive field of social or biographical medicine. Within this new discourse medical work is distributed between doctors, nurses and unqualified staff in ways which make explicit the reduction of general practice work to sets of biomedical problems or tasks. At the same time, the devolution of much general practice work to less qualified and cheaper personnel is justified by drawing on a discourse of person-centred medicine. PMID:14498945

  14. Communities of Practice in a Voluntary Youth Organisation: Reaching for the Sky and Building Social Capital

    ERIC Educational Resources Information Center

    Chan, Bill; Short, Tom

    2011-01-01

    The study is situated within a national youth organisation called the Australian Air League Inc (Air League). We examine the recent progress of the Air League in South Australia, starting as a loose network of volunteers engaged in a sporadic array of activities, to become a learning community that worked collaboratively and then developed further…

  15. The Impact of Organisational Structure and Practices on Learning in the Workplace

    ERIC Educational Resources Information Center

    Ashton, David N.

    2004-01-01

    The main thrust of the research effort into workplace learning has been to identify the characteristics of workplace learning as experienced by the learner. The impact of the wider organisational process in which that learning is embedded have been played down. This paper, building on the work of Koike and Darrah, uses research conducted in a…

  16. Organisational Learning Approaches to School Leadership and Management: Teachers' Values and Perceptions of Practice

    ERIC Educational Resources Information Center

    Pedder, David; MacBeath, John

    2008-01-01

    In this article, we report results of a survey of 1,397 teachers in 26 primary and 17 secondary schools in England as part of the Learning How to Learn project. We consider how school self-evaluation can be understood within an organisational learning frame. Factor analysis of teachers' responses helped us identify 4 dimensions of organisational…

  17. A training programme for rural general practice.

    PubMed

    Hays, R B

    1990-11-01

    An improvement in methods of training graduates for general practice has been recommended as a result of several investigations into the problems faced by rural medical practitioners. This paper describes a rural vocational training programme conducted by the Family Medicine Programme in North Queensland. The programme combines educational support, professional support and mentorship with a medical educator experienced in rural practice. The educational support is partly chosen by members of the rural group, and is designed to meet needs of group members and the communities they serve. The cost of such a programme is high, due to travel and communication over long distances, but is justifiable if it improves recruitment and retention of rural practitioners. PMID:2233478

  18. The practice characterization model: the importance of organizational life cycles and targeted interventions in general medical practice.

    PubMed

    Atkins, E M; Duffy, M C; Bain, D J

    2001-01-01

    In response to a climate of constant change and increasing demand for services, general practice in the UK has undergone significant modification over the last 10 years. It has become a multi-disciplinary organisation encouraged by funding bodies to plan for service delivery using a more structured team based approach. In Tayside in 1996, practices were charged with producing formal Practice Development Plans (PDPs) which would focus on priority areas aligned with the Health Boards own strategic plan--those were teamwork, information management and technology, and clinical service delivery. The University of Dundee's Department of General Practice successfully applied for funding to develop ways of facilitating practices so that they could a) identify their own development priorities, and b) plan and implement action and learning to see these priorities through. Using action research methodology, the project attempted to create a climate for change, provide support and training to see the changes implemented, and ensure commitment to the changes from all members of the practice team. The Facilitator adopted a flexible style varying her role between expert, guide and support. Analysis of progress made by different practices, coupled with the Facilitator's in depth knowledge of them, suggested the importance of certain key aspects of practice organisation and culture. A practice characterisation model identified practices which were stable, currently coping, proactive and ready to face the challenge of change as best placed to engage in a full scale development programme. Other profiles suggested a range of alternative interventions as more likely to be acceptable and productive. PMID:11499046

  19. Outcomes of endodontic therapy in general practice

    PubMed Central

    Bernstein, Susan D.; Horowitz, Allan J.; Man, Martin; Wu, Hongyu; Foran, Denise; Vena, Donald A.; Collie, Damon; Matthews, Abigail G.; Curro, Frederick A.; Thompson, Van P.; Craig, Ronald G.

    2014-01-01

    Background The authors undertook a study involving members of a dental practice-based research network to determine the outcome and factors associated with success and failure of endodontic therapy. Methods Members in participating practices (practitioner-investigators [P-Is]) invited the enrollment of all patients seeking treatment in the practice who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years previously. If a patient had more than one tooth so treated, the P-I selected as the index tooth the tooth treated earliest during the three- to five-year period. The authors excluded from the study any teeth that served as abutments for removable partial dentures or overdentures, third molars and teeth undergoing active orthodontic endodontic therapy. The primary outcome was retention of the index tooth. Secondary outcomes, in addition to extraction, that defined failure included clinical or radiographic evidence (or both) of periapical pathosis, endodontic retreatment or pain on percussion. Results P-Is in 64 network practices enrolled 1,312 patients with a mean (standard deviation) time to follow-up of 3.9 (0.6) years. During that period, 3.3 percent of the index teeth were extracted, 2.2 percent underwent retreatment, 3.6 percent had pain on percussion and 10.6 percent had periapical radiolucencies for a combined failure rate of 19.1 percent. The presence of preoperative periapical radiolucency with a diagnosis of either irreversible pulpitis or necrotic pulp was associated with failure after multivariate analysis, as were multiple canals, male sex and Hispanic/Latino ethnicity. Conclusions These results suggest that failure rates for endodontic therapy are higher than previously reported in general practices, according to results of studies based on dental insurance claims data. Clinical Implications The results of this study can help guide the practitioner in deciding the most appropriate course of therapy for

  20. Implications of Harold Shipman for general practice.

    PubMed

    Baker, R

    2004-06-01

    Harold Shipman was an English general practitioner who murdered at least 215 of his patients between 1974 and 1998. A public inquiry is underway, but general practitioners and all doctors also need to consider the implications for their profession. The aim of this paper is to stimulate debate. Issues identified as important to consider include: trust between doctors; attitudes towards failing systems such as cremation certification; acceptance of the duty of accountability; ensuring patients can have reasonable confidence in their doctors; commitment to preventing such a case occurring again; and relationships with patients. It is argued that restricting debate to methods to detect doctors who murder would limit the opportunity to improve medical practice and would constitute a failure to fulfil the duty owed by doctors to Shipman's victims and their families. PMID:15192157

  1. Nutrition and general practice: an Australian perspective.

    PubMed

    Helman, A

    1997-06-01

    Australia has a government-subsidized, private medical system in which general practitioners (GPs) form the core component of primary care. There are approximately 20,000 active GPs and 80% of the population consults a GP each year. A new vocational register of GPs has been set up that requires training in general practice, followed by formal continuing education. I briefly review sources of information about Australian GPs' practices and knowledge of and attitudes toward nutrition. About 15-17% of GPs say they have a special interest in nutrition (20% of female GPs and 13% of male GPs). The main conditions for which advice is given are heart disease, hyperlipidemia, obesity, and diabetes. The extent of nutrition counseling by GPs is considerably less than might be expected from the strength of their statements about the importance of nutrition and long-term health. Obstacles to nutrition counseling are lack of time, lack of confidence, and inadequate nutrition knowledge, the last documented by objective testing. GPs express interest in learning more about nutrition (which may be partly driven by consumer pressure) but there is still little coherent teaching on the subject, specifically tailored for GPs. When asked their preferences for nutrition education, GPs tend to prefer educational material (such as diet charts) to give to patients. PMID:9174498

  2. Influencing organisational change in the NHS: lessons learned from workplace wellness initiatives in practice.

    PubMed

    Blake, Holly; Lloyd, Scott

    2008-01-01

    This article presents a discussion of the key issues in influencing organisational change in NHS settings, in the development of workplace wellness interventions to improve employee health and wellbeing. To tackle poor public health and associated rising healthcare costs, there must be a focus on the root cause of many preventable diseases - unhealthy lifestyle choices. Workplace wellness initiatives are now an important prevention strategy adopted by socially responsible organisations to target the health and wellbeing of working age adults. Lessons learned from initiatives in secondary care suggest that effective implementation requires change in organisational 'health culture', through a combination of education, behaviour change intervention, needs-based facilities, and services and strategies for developing supportive and health-promoting work environments. Most of all, employers must demonstrate a commitment to health and wellness that is fully integrated with their mission, values and long-term vision, paving the way for sustainable lifestyle changes. Evaluation systems must be in place to measure the impact and outcomes of wellness schemes. PMID:19094421

  3. Successful clinical and organisational change in endodontic practice: a qualitative study.

    PubMed

    Koch, M; Englander, M; Tegelberg, Å; Wolf, E

    2014-08-01

    The aim of this study was to explicate and describe the qualitative meaning of successful clinical and organizational change in endodontic practice, following a comprehensive implementation program, including the integration of the nickel-titanium-rotary-technique. After an educational intervention in the Public Dental Service in a Swedish county, thematic in-depth interviews were conducted, with special reference to the participants' experience of the successful change. Interviews with four participants, were purposively selected on the basis of occupation (dentist, dental assistant, receptionist, clinical manager), for a phenomenological human scientific analysis. Four constituents were identified as necessary for the invariant, general structure of the phenomenon: 1) disclosed motivation, 2) allowance for individual learning processes, 3) continuous professional collaboration, and 4) a facilitating educator. The perceived requirements for achieving successful clinical and organizational change in endodontic practice were clinical relevance, an atmosphere which facilitated discussion and allowance for individual learning patterns. The qualities required in the educator were acknowledged competence with respect to scientific knowledge and clinical expertise, as well as familiarity with conditions at the dental clinics. The results indicate a complex interelationship among various aspects of the successful change process. PMID:24118746

  4. Covert checks by standardised patients of general practitioners' delivery of new periodic health examinations: clustered cross-sectional study from a consumer organisation

    PubMed Central

    Thaler, Kylie; Harris, Mark F

    2012-01-01

    Objective To assess if data collected by a consumer organisation are valid for a health service research study on physicians' performance in preventive care. To report first results of the analysis of physicians performance like consultation time and guideline adherence in history taking. Design Secondary data analysis of a clustered cross-sectional direct observation survey. Setting General practitioners (GPs) in Vienna, Austria, visited unannounced by mystery shoppers (incognito standardised patients (ISPs)). Participants 21 randomly selected GPs were visited by two different ISPs each. 40 observation protocols were realised. Main outcome measures Robustness of sampling and data collection by the consumer organisation. GPs consultation and waiting times, guideline adherence in history taking. Results The double stratified random sampling method was robust and representative for the private and contracted GPs mix of Vienna. The clinical scenarios presented by the ISPs were valid and believable, and no GP realised the ISPs were not genuine patients. The average consultation time was 46 min (95% CI 37 to 54 min). Waiting times differed more than consultation times between private and contracted GPs. No differences between private and contracted GPs in terms of adherence to the evidence-based guidelines regarding history taking including questions regarding alcohol use were found. According to the analysis, 20% of the GPs took a perfect history (95% CI 9% to 39%). Conclusions The analysis of secondary data collected by a consumer organisation was a valid method for drawing conclusions about GPs preventive practice. Initial results, like consultation times longer than anticipated, and the moderate quality of history taking encourage continuing the analysis on available clinical data. PMID:22872721

  5. Home visits in primary care: contents and organisation in daily practice. Study protocol of a cross-sectional study

    PubMed Central

    Voigt, Karen; Bojanowski, Stefan; Taché, Stephanie; Voigt, Roger; Bergmann, Antje

    2016-01-01

    Introduction Medical care of homebound patients by home visits is an integral part of primary care in Germany and other industrialised countries. Owing to the sociodemography and changes in the health system, the need for home visits is projected to increase rather than decrease. Our study will provide information on content and organisation of home visits. This evidence is needed to assure sufficient medical care for homebound patients. Germany is one of the European nations with highest proportions of elderly age groups, so that our results will be indicative for other European countries with comparable organisation of primary care. Methods and analysis This cross-sectional study is conducted over a period of 12 months. All home visits of each participating family practice are documented within a 1-week time period. The anonymous documentation of home visits is carried out by the family practitioner or medical assistant conducting the home visit. All Saxon Family practitioners received study information and were personally invited to participate in our study. Almost 303 (of 2677) family practitioners expressed their interest to participate to generate data on the content and organisational characteristics of home visits. Data analysis of more than 4000 home visits will take into account several patient-related and system-related parameters. Descriptive and multivariate analysis will be carried out by using non-parametric methods. Regarding expected cluster structure of the data, a multilevel analysis will be necessary. Ethics and dissemination The study received ethical approval by the Ethical Commission of the TU Dresden and adheres to the Declaration of Helsinki. Considering that the results of our project will be indicative for ageing societies with comparable organisation of primary care, we will publish them in international open access journals concerned with healthcare and primary care research and disseminate them by a final symposium and at national

  6. Improving infection control in general practice.

    PubMed

    Farrow, S C; Zeuner, D; Hall, C

    1999-03-01

    Infection control measures in the health care setting should protect patients and staff from cross-infection. The prevention of harm is an essential part of good medical practice and failure might result in professional misconduct proceedings by the General Medical Council (GMC) and prosecution under the Health and Safety at Work legislation, as well as civil liability. For a health authority, overall responsibility for public health includes arrangements for the control of communicable diseases and infection in hospital and the community (NHS Management Executive, 1993), a function usually led by the Consultant in Communicable Disease Control (CCDC). This paper describes one district's collaborative approach between public health and GPs to assess and improve local infection control standards. PMID:10327810

  7. [Talking about alcohol in general practice].

    PubMed

    Beyeler, Yves; Gache, Pascal

    2007-07-01

    Talking about alcohol in general practice Talking about alcohol drinking remains a real challenge for the internist. The high level of morbidity and mortality related to alcohol consumption is presently well-known but it is still difficult for the internist of talking alcohol with his patients. Because of a lack of medical education or often afraid of patients reactions, the internist could be driven to avoid the topic. And rarely the patient wants to talk about it by his own. Some tools are useful and are key for opening the conversation. Skinner pyramid, standard drinks, "J" curve, AUDIT or FACE questionnaires are easily available. They give to the practitioner opportunities to talk about alcohol before the situation has become really serious and discouraging. PMID:17726901

  8. The World Health Organisation analgesic ladder: its place in modern Irish medical practice.

    PubMed

    Balding, L

    2013-04-01

    Pain is the single most common reason why patients seek medical care. Worldwide, there are 10 million new cases of cancer each year, with 6 million deaths annually. The World Health Organisation (WHO) first published Cancer Pain Relief in 1986, designed to be a simple, intuitive and accessible guide to the management of cancer pain that would be applicable and useful whatever the language, culture, economy, country and clinical setting. In Ireland today, we have ready access to many different opioids, and the WHO guidelines may seem inadequate and outdated. This article describes the evolution and use of the WHO guidelines, as viewed from the global perspective of its 193 member nations. The WHO ladder still remains valid today in Ireland, even as we await the imminent publication of new evidence-based national cancer pain guidelines this year. PMID:23691849

  9. Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study

    PubMed Central

    Greenhalgh, Trisha; Russell, Jill; Myall, Michelle

    2011-01-01

    Objective To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality. Design Ethnographic case study. Setting Four urban UK general practices with diverse organisational characteristics using electronic patient records that supported semi-automation of repeat prescribing. Participants 395 hours of ethnographic observation of staff (25 doctors, 16 nurses, 4 healthcare assistants, 6 managers, and 56 reception or administrative staff), and 28 documents and other artefacts relating to repeat prescribing locally and nationally. Main outcome measures Potential threats to patient safety and characteristics of good practice. Methods Observation of how doctors, receptionists, and other administrative staff contributed to, and collaborated on, the repeat prescribing routine. Analysis included mapping prescribing routines, building a rich description of organisational practices, and drawing these together through narrative synthesis. This was informed by a sociological model of how organisational routines shape and are shaped by information and communications technologies. Results Repeat prescribing was a complex, technology-supported social practice requiring collaboration between clinical and administrative staff, with important implications for patient safety. More than half of requests for repeat prescriptions were classed as “exceptions” by receptionists (most commonly because the drug, dose, or timing differed from what was on the electronic repeat list). They managed these exceptions by making situated judgments that enabled them (sometimes but not always) to bridge the gap between the idealised assumptions about tasks, roles, and interactions that were built into the electronic patient record and formal protocols, and the actual repeat prescribing routine as it played out in practice. This work was creative and demanded both explicit and tacit knowledge

  10. World Organisation for Animal Health

    MedlinePlus

    World Organisation for Animal Health Home About us Presentation Director general office Biography Photos Strategic plan Our ... Food safety and animal welfare History General organisation World Assembly Council Headquarters OIE Regional Representations OIE Regional ...

  11. The evolution of general practice training in Australia.

    PubMed

    Trumble, Stephen C

    2011-06-01

    Training for general practice in Australia has undergone a 60-year evolutionary process punctuated by revolutionary events. The discipline of general practice has also evolved significantly over this period. Today's Australian general practice training program strongly resembles its ancestors, with adaptations that better suit its regionalised environment. General practice training has been affected frequently by political and professional forces. Many of these forces were powered by the government's need for general practice training to deliver immediate workforce solutions, and the profession's struggle to respond. Pressure on general practitioners to train increasing numbers of clinical learners is challenging traditional apprenticeship models. The Australian general practice training program needs to continue to evolve if it is to remain successful within its volatile environment. PMID:21644854

  12. Engaging Musical Practices: A Sourcebook for Middle School General Music

    ERIC Educational Resources Information Center

    Burton, Suzanne L., Ed.

    2012-01-01

    Middle school general music may be a student's last encounter with school music. A practical book with accessible pedagogical resources on middle school general music is needed for methods courses and music practitioners' use. The book "Engaging Musical Practices: A Sourcebook for Middle School General Music" presents numerous ways to engage…

  13. Clinical and administrative review in general practice

    PubMed Central

    Stott, N. C. H.; Davis, R. H.

    1975-01-01

    Clinical and administrative review in primary medical care can be an enjoyable and creative part of group-practice life. A series of such reviews are described which improve internal or external communication for the primary care team. PMID:1223278

  14. The World Health Organisation. Interview with the director general. Interview by Fiona Godlee.

    PubMed Central

    Nakajima, H.

    1995-01-01

    Dr Hiroshi Nakajima was elected director general of WHO in 1988. Born in Japan, he trained as a psychiatrist before joining WHO in 1973. He was WHO's regional director for the Western Pacific from 1979 to 1988. His term of office has been marked by criticism of his management style and allegations of misuse of WHO's funds. I spoke to him at WHO's headquarters in Geneva in July. I have presented the interview in the form of questions and answers. It would be misleading, however, not to make clear that in doing so I have transcribed conversation which was at times extremely difficult to follow. I feel that it is important to emphasise this in the context of an interview with an international leader, one of whose primary tasks must be to communicate his views on health to people across the world. The interviews gave me first hand experience of the difficulties in communication that staff, diplomats, and others, including Japanese leaders, have consistently commented on since Dr Nakajima took office. Images p583-a p584-a p585-a p586-a PMID:7888938

  15. Stakeholder experiences with general practice pharmacist services: a qualitative study

    PubMed Central

    Tan, Edwin C K; Stewart, Kay; Elliott, Rohan A; George, Johnson

    2013-01-01

    Objectives To explore general practice staff, pharmacist and patient experiences with pharmacist services in Australian general practice clinics within the Pharmacists in Practice Study. Design Qualitative study. Setting Two general practice clinics in Melbourne, Australia, in which pharmacists provided medication reviews, patient and staff education, medicines information and quality assurance services over a 6-month period. Participants Patients, practice staff and pharmacists. Method Semi-structured telephone interviews with patients, focus groups with practice staff and semi-structured interviews and periodic narrative reports with practice pharmacists. Data were analysed thematically and theoretical frameworks used to explain the findings. Results 34 participants were recruited: 18 patients, 14 practice staff (9 general practitioners, 4 practice nurses, 1 practice manager) and 2 practice pharmacists. Five main themes emerged: environment; professional relationships and integration; pharmacist attributes; staff and patient benefits and logistical challenges. Participants reported that colocation and the interdisciplinary environment of general practice enabled better communication and collaboration compared to traditional community and consultant pharmacy services. Participants felt that pharmacists needed to possess certain attributes to ensure successful integration, including being personable and proactive. Attitudinal, professional and logistical barriers were identified but were able to be overcome. The findings were explained using D'Amour's structuration model of collaboration and Roger's diffusion of innovation theory. Conclusions This is the first qualitative study to explore the experiences of general practice staff, pharmacists and patients on their interactions within the Australian general practice environment. Participants were receptive of colocated pharmacist services, and various barriers and facilitators to integration were identified. Future

  16. Laser therapy in general dental practice

    NASA Astrophysics Data System (ADS)

    Darbar, Arun A.

    2006-02-01

    This is a clinical presentation on the use of laser therapy in a private dental practice using a 810nm diode. A wide range of conditions involving pain management, treatment and as an adjunct to procedures to enhance patient comfort and experience. This will include cases treated for TMD (Temporo mandibular dysfunction), apthous ulcers, angular chelitis, cold sores, gingival retraction, periodontal treatment and management of failing dental implants. The case presentation will include the protocols used and some long term reviews. The results have been very positive and will be shared to enable this form of treatment to be used more frequently and with confidence within dental practice.

  17. The organization of cervical screening in general practice

    PubMed Central

    Havelock, Christine; Edwards, Robert; Cuzick, Jack; Chamberlain, Jocelyn

    1988-01-01

    Well organized cervical screening in general practice can have considerable clinical and financial rewards. Yet in a randomized survey of general practitioners in the United Kingdom only 43% operated a system for cervical screening which allows previously untested women to be identified and invited for testing. A younger age of general practitioner, a more rural practice, a larger practice size, employment of a practice nurse, a belief in the effectiveness of cervical screening and a positive view of the time spent on screening were all strong predictors of an organized approach to cervical screening within a practice. Being female or having a female partner was not statistically associated with systematic screening. The results demonstrate a need for education within general practice which emphasizes the relevance and significance of cervical screening and the essential contribution that can be made by each individual general practitioner to the success of the whole cervical screening programme. PMID:3210183

  18. General Practice Teaching--Within the Hospital

    ERIC Educational Resources Information Center

    Drury, M.

    1976-01-01

    A program of integrated teaching by consultants and general practitioners is described. The teaching took place in the hospitals used for the purpose by the Medical Faculty of the University of Birmingham. (Author)

  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. 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

  1. Voluntary Organisation

    ERIC Educational Resources Information Center

    Williams, Shirley; Spiret, Claire; Dimitriadi, Yota; McCrindle, Rachel

    2013-01-01

    The World Association of Girl Guides and Girl Scouts (WAGGGS) is the umbrella organisation for Member Organisations from 145 countries, with a total membership of 10 million. While Member Organisations offer training and development within their own countries, WAGGGS offers international opportunities, such as leadership development at…

  2. Organisational Structure

    ERIC Educational Resources Information Center

    National Centre for Vocational Education Research (NCVER), 2006

    2006-01-01

    An understanding of organisational structure can provide guidance for organisations that want to change and innovate. Many writers agree that this understanding allows organisations to shape how their work is done to ultimately achieve their business goals--and that too often structure is given little consideration in business strategy and…

  3. 47 CFR 76.1001 - Unfair practices generally.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... MULTICHANNEL VIDEO AND CABLE TELEVISION SERVICE Competitive Access to Cable Programming § 76.1001 Unfair practices generally. (a) Unfair practices generally. No cable operator, satellite cable programming vendor in which a cable operator has an attributable interest, or satellite broadcast programming...

  4. 47 CFR 76.1001 - Unfair practices generally.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... control with a cable operator or cable operators, satellite cable programming vendor or vendors in which a... attributable interest, or satellite broadcast programming vendor or vendors that wholly own or control, or are... practices generally. (a) Unfair practices generally. No cable operator, satellite cable programming...

  5. 47 CFR 76.1001 - Unfair practices generally.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... control with a cable operator or cable operators, satellite cable programming vendor or vendors in which a... attributable interest, or satellite broadcast programming vendor or vendors that wholly own or control, or are... practices generally. (a) Unfair practices generally. No cable operator, satellite cable programming...

  6. 47 CFR 76.1001 - Unfair practices generally.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... control with a cable operator or cable operators, satellite cable programming vendor or vendors in which a... attributable interest, or satellite broadcast programming vendor or vendors that wholly own or control, or are... practices generally. (a) Unfair practices generally. No cable operator, satellite cable programming...

  7. Improvisational Practices in Elementary General Music Classrooms

    ERIC Educational Resources Information Center

    Gruenhagen, Lisa M.; Whitcomb, Rachel

    2014-01-01

    Despite historic and ongoing support for the inclusion of improvisation in the elementary general music curriculum, music educators consistently report challenges with implementation of improvisational activities in their classes. This study was designed to examine (a) the extent to which improvisational activities were occurring in the…

  8. [Euthanasia and general practice in Belgium].

    PubMed

    Thomas, J M

    2014-09-01

    In Belgium, the GP can perform euthanasia or be called as a consultant. He must know the laws concerning the end of life and be able to explain his rights to his patients. He will know the best practices and techniques for euthanasia. If necessary, he will call help or refer to a more competent colleague. He negotiates with the patient an advanced care planning following the evolution of its pathologies and will witness its wishes regarding end of life against other institutions and doctors. PMID:25675647

  9. The ethics of general practice and advertising.

    PubMed Central

    Colman, R D

    1989-01-01

    UK general practitioners (GPs) are self-employed entrepreneurs running small businesses with commercial considerations. In this situation there is no clear distinction between information, self-promotion and advertising. In response to the growing public demand for more information about medical services, the medical profession should voluntarily accept the notion of soft self-promotion in the form of 'notices' or 'announcements' placed in newspapers. Newspapers are the most effective way of giving easy access to information. The resistance to newspapers may be more concerned with preserving certain medical traditions than consideration of the public interest. The General Medical Council's (GMC's) arguments against soft self-promotion are seen as misguided paternalism, inconsistent and irrational. PMID:2746609

  10. A Multi-Level Examination of Leadership Practices in Quality Management: Implications for Organisational Performance in Healthcare

    ERIC Educational Resources Information Center

    Akdere, Mesut

    2007-01-01

    Organisations are continuously challenged to become more strategic, productive and cost-effective. As a result, quality management has become increasingly important to achieve desired organisational performance outcomes. Quality management considers leadership an important component to implement and sustain quality products and services to…

  11. A review of general practice reports: the need for standardisation.

    PubMed Central

    Wilton, J

    1990-01-01

    Fifty general practice annual reports were reviewed with a checklist to determine how much information was commonly included and whether they described the patients, the practice, and practice activity. The reports varied widely: important information was sometimes missing, practice activity was measured in different ways, and terms were often not defined. About half the reports reviewed did not draw conclusions or suggest plans for the future. Annual reports should include comparable basic information about patients, the practice, and the practice activity to optimise their usefulness in evaluation, planning, and decision making. Many relevant data are available from family practitioner committees and district health authorities. PMID:2337701

  12. Organisational Learning and Organisational Design

    ERIC Educational Resources Information Center

    Curado, Carla

    2006-01-01

    Purpose: The purpose of this paper is to explore a new idea presenting the possible relationship between organisational learning and organisational design. Design/methodology/approach: The establishment of this relation is based upon extensive literature review. Findings: Organisational learning theory has been used to understand several…

  13. Improving communication between health-care professionals and patients with limited English proficiency in the general practice setting.

    PubMed

    Attard, Melanie; McArthur, Alexa; Riitano, Dagmara; Aromataris, Edoardo; Bollen, Chris; Pearson, Alan

    2015-01-01

    Quality service provision and patient safety and satisfaction in encounters with health-care professionals relies on effective communication between the practitioner and patient. This study aimed to identify effective practices for improving communication between clinical staff in general practice and patients with limited English proficiency, and to promote their implementation in general practice. Effective interventions and strategies were identified from a review of international research. Experiences with their use in practice were explored via focus group discussions with general practitioners and practice nurses. The results suggest that, wherever possible, communication in the patient's primary language is preferable; use of a qualified medical interpreter should be promoted, and practices should have a standardised and documented procedure for accessing interpreter services. General practice staff must increase their awareness about services that are available to facilitate communication with patients with limited English proficiency, and also develop attitudes, both individual and organisational, that will maximise the effectiveness of these strategies. These findings were used to develop brief, evidence-based practice guidelines that were disseminated to focus group participants for evaluation of utility and general feedback. This evidence-based guidance is now available to assist clinical and administrative general practice staff across regional and metropolitan South Australia. PMID:24216076

  14. Tumor Ablation: Common Modalities and General Practices

    PubMed Central

    Knavel, Erica M.; Brace, Christopher L.

    2014-01-01

    Tumor ablation is a minimally invasive technique that is commonly used in the treatment of tumors of the liver, kidney, bone, and lung. During tumor ablation, thermal energy is used to heat or cool tissue to cytotoxic levels (less than −40°C or more than 60°C). An additional technique is being developed that targets the permeability of the cell membrane and is ostensibly nonthermal. Within the classification of tumor ablation, there are several modalities used worldwide: radiofrequency, microwave, laser, high-intensity focused ultrasound, cryoablation, and irreversible electroporation. Each technique, although similar in purpose, has specific and optimal indications. This review serves to discuss general principles and technique, reviews each modality, and discusses modality selection. PMID:24238374

  15. Satisfaction and comfort with nursing in Australian general practice.

    PubMed

    2015-01-01

    The practice nursing workforce has grown exponentially in recent years. Whilst evidence has shown the important contributions of nurses to general practice service delivery, the consumer perspective of nursing in general practice has received limited attention. Given that acceptability of nurses is influenced by patient satisfaction which can in turn improve both treatment adherence and clinical outcomes, this is an important area for investigation. The primary aim of this study was to evaluate consumer satisfaction with chronic disease management by nurses in general practice (NiGP) and comfort with the tasks undertaken by nurses in general practice. Consumers receiving chronic disease services from nurses in general practice participating in a larger study were recruited to complete a survey. The survey comprised of demographic information, and items related to satisfaction with the nurse encounter (SPN-9) and consumer comfort with nurse roles in general practice (CPN-18). Eighty-one consumers participated in the study. Cronbach's alpha values of the SPN-9 and the CPN-18 were 0.95 and 0.97 respectively. SPN-9 results demonstrated high levels of satisfaction with PN consultations. Bivariate analysis did not show any significant differences within the consumer group relating to satisfaction. However, those who presented for diabetes-related reasons were more likely to report high comfort levels with the nurse encounter compare to those who presented to general practice for other chronic disease conditions (38% versus 14%, p = 0.016). The results of this study demonstrate that consumers are generally satisfied with nursing consultations in general practice related to chronic disease. However, further research evaluating consumer confidence, comfort and satisfaction with nursing care is needed to ensure that nursing services meet consumer needs. PMID:26281408

  16. A study of bereavement in general practice

    PubMed Central

    Levy, B.; Sclare, A. Balfour

    1976-01-01

    Forty six bereaved relatives were assessed by a general practitioner four to eight weeks after the bereavement. In 36 (78·3 per cent) the immediate reaction to bereavement was one of numbness or stupefaction; in seven (15·2 per cent) emotional relief occurred; and in three cases (6·5 per cent) there was no obvious immediate reaction. The numbness reaction was limited in duration to a week or less in 31 of the 36 instances. At four to eight weeks after bereavement 29 (63·0 per cent) of the subjects continued to experience difficulty in coming to terms with their loss. Twenty subjects reported guilt feelings and a similar number expressed aggressive reactions. The bereaved subjects tended to increase their consumption of cigarettes and alcohol, while their appetite and weight tended to be reduced. Thirty six (78·3 per cent) of the subjects reported physical symptoms, notably headache, dizziness, generalised aches, and abdominal complaints. The most prominent psychological features of bereavement were found to be: preoccupation with thoughts of the deceased, idealisation of the lost person, depressive mood, and loneliness. The findings are discussed and reference made to the role of the family doctor in the management of bereavement reactions. PMID:957295

  17. PGD training and its impact on general dentist practice patterns.

    PubMed

    Atchison, Kathryn A; Mito, Ronald S; Rosenberg, Dara Jean; Lefever, Karen H; Lin, Sylvia; Engelhardt, Rita

    2002-12-01

    This study compares the practice patterns of general dentists with and without formal advanced training in AGED or GPR programs. The UCLA School of Dentistry surveyed a random selection of dentists from graduating years 1989, 1993, and 1997 as part of a Health Resources Services Administration (HRSA)-supported evaluation of the impact of federal funding on postgraduate general dentistry (PGD) programs. Using a sample drawn by the American Dental Association (ADA), 6,725 dentists were surveyed about their practice, advanced training, patients served, and services provided. Of the 2,029 dentists (30 percent) who responded, 49 percent were practicing dentists with no formal advanced training in general dentistry or one of the eight ADA specialties; 7 percent had Advanced Education in General Dentistry (AEGD) experience; 20 percent trained in a General Practice Residency (GPR); and 24 percent were specialists. Additionally, 7 percent of respondents had PGD training and a clinical specialty. GPR-trained dentists were significantly more likely to be on a hospital staff and to treat medically compromised patients even after ten years of practice. PGD dentists were less likely to seek specialty training. Major reasons for seeking PGD training were increasing treatment speed, learning to treat medically compromised patients, and wanting hospital experience. Primary reasons for not selecting training were starting a practice and having a great practice opportunity. Our conclusion is that PGD training has an enduring impact on practice patterns and improves access to dental care for underserved populations. PMID:12521061

  18. Case stories in general practice: a focus group study

    PubMed Central

    Abildsnes, Eirik; Flottorp, Signe; Stensland, Per

    2012-01-01

    Objectives To explore the interactive process of sharing case stories in small-group activity in general practice. Design Qualitative focus group study. Setting Peer-group meetings of doctors attending specialist training or continuous medical education in general practice. Participants Twenty female and 30 male doctors working in general practice in Norway. Results The storyline of case presentations included detailed stories with emotional engagement, co-authored by other group members. The stories initiated discussions and reflections concerning patients’ and doctors’ perspectives, medical ethics as well as clinical problems. The safe atmosphere allowed testing out boundaries of socially shared knowledge. Conclusions Sharing case stories in small groups in general practice initiated interaction that facilitated meaning-making, reflection and peer support. PMID:22874630

  19. An Initial Evaluation of a Predoctoral General Practice Program.

    ERIC Educational Resources Information Center

    Rekow, Marlin F.; And Others

    1994-01-01

    The University of Maryland Dental School's revised predoctoral general practice program includes a clinical component simulating actual practice, including patient, personnel and office management, team-building, marketing, specialist referrals, and quality control. The program is described and patient, student, and faculty responses to it are…

  20. 14 CFR 61.43 - Practical tests: General procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Practical tests: General procedures. 61.43 Section 61.43 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... weather conditions, aircraft airworthiness, or any other safety-of-flight concern. (f) If a practical...

  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. Cost-Justification of Computers in General Practice in Canada

    PubMed Central

    McAlister, Neil Harding; Covvey, H. Dominic; McAlister, Nazlin K.

    1978-01-01

    In General Practice, computers might assist clinical decision-making,perform business procedures, and support health care delivery research. Before being used, however, computers first must be economically justifiable. The cost of computer systems is known. One can estimate their potential dollar benefit in primary care. Computer technology was therefore assessed for its potential to save money in a model General Practice. Information processing needs were noted, functional specifications were developed, and typical costs for systems appropriate to practices of varying size were calculated. Computers might improve primary care in many ways, but savings accrue only from support of billing and accounting. Savings might equal or exceed the cost of a computer system in groups of practitioners, optimally composed of between six and eight doctors. If computers could pay for themselves by performing essential business functions, they would then be readily available for other purposes in General Practice.

  3. How to choose a new partner in general practice.

    PubMed Central

    King, J; Whitfield, M

    1990-01-01

    OBJECTIVE--To provide a guide to choosing a new partner in general practice by using psychometric assessments. DESIGN--A descriptive account of the experience of one practice. SETTING--A general practice in Bristol. RESULTS--The partners found that using a psychologist to assess both themselves and the candidates facilitated the selection process. During the pre-interview stage the partners learnt about the dynamics of the practice and their own personalities. The examination of the candidates by an outside assessor as well as the partners gave a sense of security and a certainty that mistakes were unlikely to be made. CONCLUSION--More practices should consider adopting a selection process using psychometric assessments when appointing a new partner. PMID:2271828

  4. Train the Trainer for general practice trainer - a report of the pilot within the programme Verbundweiterbildungplus

    PubMed Central

    Steinhäuser, Jost; Ledig, Thomas; Szecsenyi, Joachim; Eicher, Christiane; Engeser, Peter; Roos, Marco; Bungartz, Jessica; Joos, Stefanie

    2012-01-01

    Background: Since 2008 the Verbundweiterbildungplus programme of the Competence Centre General Practice Baden-Wuerttemberg offers continual improvement with regards to content and structure of general practice training. The programme uses the didactical concept of the CanMEDs competencies, which were developed in Canada, as a postgraduate medical training framework. Train the trainer (TTT)-programmes are an additional important element of these contentual optimisations of postgraduate training. Within this article we describe the conception and evaluation of the first TTT-workshop within the programme Verbundweiterbildungplus. Methods: The conception of the first TTT-workshop was influenced by results of a survey of general practitioner (GP) trainers and by experiences with teaching GP trainers involved in medical undergraduate teaching. A questionnaire was designed to get a self-assessment about organisational and didactic aspects oriented on the CanMEDs competencies of postgraduate medical training. In addition, the workshop was evaluated by the participants. Results: The workshop lasted 12 teaching units and included the following elements: introduction into the CanMEDs competencies, feedback training, fault management, legal and organisational aspects of post graduate training. From the 29 participating trainers 76% were male and on average 57 years old. The evaluation showed a good to very good acceptance of the workshop. Initial self-rating showed the need of improving in the fields of determining learning objectives, providing formative feedback and incorporation of a trainee. Most trainers rated themselves as very good in procure CanMEDs competencies with the exclusion of the competencies “Manager“ and “Scholar“. Conclusion: A TTT-programme is an important method to improve GP training which has not been used in Germany so far. Such a GP TTT-programme should highlight especially training in providing feedback and teaching in management aspects

  5. 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

  6. Control of infection in general practice: a survey and recommendations.

    PubMed Central

    Hoffman, P. N.; Cooke, E. M.; Larkin, D. P.; Southgate, L. J.; Mayon-White, R. T.; Pether, J. V.; Wright, A. E.; Keenlyside, D.

    1988-01-01

    Twenty general practices in four areas in Britain were surveyed to establish their needs for and practices of sterilising and disinfecting equipment. Of the 327 items of equipment and instruments examined in the survey, 190 were satisfactorily decontaminated, 100 were treated in a way judged to result in doubtful decontamination, and in 37 cases treatment was considered unsatisfactory. Decontamination apparatuses (autoclaves, hot air ovens, and hot water disinfectors) were generally in good working order, but the use of chemical disinfectants was often inappropriate. Recommendations were made on appropriate methods of decontamination for various items in common use in general practice. By virtue of the large numbers of patients treated by general practitioners there is a substantial possibility of transmitting infection; having appropriate methods for decontaminating instruments and equipment is therefore imperative. PMID:3408909

  7. Patient safety in primary care: incident reporting and significant event reviews in British general practice.

    PubMed

    Rea, David; Griffiths, Sarah

    2016-07-01

    Over the past 20 years, healthcare has adapted to the 'quality revolution' by moving away from direct provision and hierarchical control mechanisms. In their place, new structures based on contractual relationships are being developed coupled with attempts to create an organisational culture that shares learning and that scrutinises existing practice so that it can be improved. The issue here is that contractual arrangements require surveillance, monitoring, regulation and governance systems that can be perceived as antipathetic to the examination of practice and subsequent learning. Historically, reporting levels from general practice have remained low; little information is shared and consequently lessons are not shared across the general practice community. Given large-scale under-engagement of general practitioners (GPs) in incident reporting systems, significant event analysis is advocated to encourage sharing of information about incidents to inform the patient safety agenda at a local and national level. Previous research has concentrated on the secondary care environment and little is known about the situation in primary care, where the majority of patient contacts with healthcare occur. To explore attitudes to incident reporting, the study adopted a qualitative approach to GPs working in a mixture of urban and rural practices reporting to a Welsh Local Health Board. The study found that GPs used significant event analysis methodology to report incidents within their practice, but acknowledged under-reporting. They were less enthusiastic about reporting externally. A number of barriers exist to reporting, including insufficient time to report, lack of feedback, fear of blame, and damage to reputations and patient confidence in a competitive environment. If incident reporting processes are perceived as supportive and formative, and where protected time is allocated to discuss incidents, then GPs are willing to participate. They also need to know how the

  8. Slaying the dragon myth: an ethnographic study of receptionists in UK general practice

    PubMed Central

    Hammond, Jonathan; Gravenhorst, Katja; Funnell, Emma; Beatty, Susan; Hibbert, Derek; Lamb, Jonathan; Burroughs, Heather; Kovandžić, Marija; Gabbay, Mark; Dowrick, Christopher; Gask, Linda; Waheed, Waquas; Chew-Graham, Carolyn A

    2013-01-01

    Background General practice receptionists fulfil an essential role in UK primary care, shaping patient access to health professionals. They are often portrayed as powerful ‘gatekeepers’. Existing literature and management initiatives advocate more training to improve their performance and, consequently, the patient experience. Aim To explore the complexity of the role of general practice receptionists by considering the wider practice context in which they work. Design and setting Ethnographic observation in seven urban general practices in the north-west of England. Method Seven researchers conducted 200 hours of ethnographic observation, predominantly in the reception areas of each practice. Forty-five receptionists were involved in the study and were asked about their work as they carried out their activities. Observational notes were taken. Analysis involved ascribing codes to incidents considered relevant to the role and organising these into related clusters. Results Receptionists were faced with the difficult task of prioritising patients, despite having little time, information, and training. They felt responsible for protecting those patients who were most vulnerable, however this was sometimes made difficult by protocols set by the GPs and by patients trying to ‘play’ the system. Conclusion Framing the receptionist–patient encounter as one between the ‘powerful’ and the ‘vulnerable’ gets in the way of fully understanding the complex tasks receptionists perform and the contradictions that are inherent in their role. Calls for more training, without reflective attention to practice dynamics, risk failing to address systemic problems, portraying them instead as individual failings. PMID:23561784

  9. 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

  10. Attitudes of medical students towards general practice: Effects of gender, a general practice clerkship and a modern curriculum

    PubMed Central

    Kruschinski, Carsten; Wiese, Birgitt; Eberhard, Jörg; Hummers-Pradier, Eva

    2011-01-01

    Aims: Planning a career in general practice depends on positive attitudes towards primary care. The aim of this study was to compare attitudes of medical students of a Modern Curriculum at Hannover Medical School with those of the Traditional Curriculum before (pre) and after (post) a three-week clerkship in general practice. In parallel, we aimed to analyse several other variables such as age and gender, which could influence the attitudes. Methods: Prospective survey of n=287 5th-year students. Attitudes (dependent variable, Likert-scale items) as well as socio-demographic characteristics (age, gender, rural/urban background), school leaving examination grades, former qualifications, experiences in general practice and career plans were requested. Attitudes were analysed separately according to these characteristics (e.g. career plans: general practitioner (GP)/specialist), curriculum type and pre/post the clerkship in general practice. Bi- and multivariate statistical analysis was used including a factor analysis for grouping of the attitude items. Results: Most and remarkable differences of attitudes were seen after analysis according to gender. Women appreciated general practice more than men including a greater interest in chronic diseases, communication and psychosocial aspects. The clerkship (a total of n=165 students of the “post” survey could be matched) contributed to positive attitudes of students of both gender, whereas the different curricula did not show such effects. Conclusions: Affective learning goals such as a positive attitude towards general practice have depended more on characteristics of students (gender) and effects of a clerkship in general practice than on the curriculum type (modern, traditional) so far. For the development of outcomes in medical education research as well as for the evolution of the Modern Curriculum such attitudes and other affective learning goals should be considered more frequently. PMID:21818231

  11. Salaried general practice in Czechoslovakia: personal observations and impressions.

    PubMed Central

    Gibbons, B

    1993-01-01

    In 1991, a visit was undertaken, to the former Czechoslovakia, during which discussions were held with general practitioners. Some personal observations and impressions from the visit are presented. For four decades, salaried general practice was a feature of the Czechoslovakian health care system. Primary health care comprised three strands: paediatric services, an occupational health service and community general practitioner care. The main point of service delivery was the polyclinic which, although being large and impersonal, provided easy access to other primary and secondary services. General practitioners, over half of whom were women, had regular leave entitlement and predictable hours of work, out of hours work being provided through separate contracts based on primary care emergency centres. However, doctors were poorly paid compared with industrial workers. Following the 'velvet revolution' in 1989, all aspects of the health service have been subject to major review, and salaried general practice is likely to give way to a more entrepreneurial system. PMID:8251221

  12. The promotion of private health insurance and its implications for the social organisation of healthcare: a case study of private sector obstetric practice in Chile.

    PubMed

    Murray, Susan F; Elston, Mary Ann

    2005-09-01

    This paper examines some of the implications of the process of privatisation of a national healthcare system for the delivery, organisation and, ultimately, the outcome of services. Through a case study of obstetric care in Chile, we illuminate the relationships between the macro-level of political decisions, the meso-level of the organisations through which government reforms were enacted, and the micro-level of clinical practice. We show that, for a significant proportion of Chilean women seeking maternity care, privatisation has led to expanded access and to ostensibly highly-personalised relationships with specialists. However, because of the fragmentation of maternity services, the altered work patterns for obstetricians occasioned by changes in healthcare financing and the relatively weak market position of most obstetricians, this personalised care is dependent on highly technologised obstetric practices. By examining the specific organisational arrangements under which private maternity care is conducted in Chile we shed light on the connection between privately-funded maternity care and high caesarean section rates in this setting. PMID:16283895

  13. 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

  14. Practice nurses experiences of mentoring undergraduate nursing students in Australian general practice.

    PubMed

    Halcomb, Elizabeth J; Peters, Kath; McInnes, Susan

    2012-07-01

    Internationally, the delivery of health services has shifted from secondary to primary care, necessitating an exponential growth of the nursing workforce and expansion of the nursing role in general practice. This growth, and the subsequent need to develop this workforce, has created a need to expose undergraduate nurses to general practice nursing as a viable career option. Concurrently, universities are struggling to find sufficient clinical places for their undergraduate students to gain clinical experience. It is logical, therefore, to increase the number of undergraduate nursing student placements in general practice. Through qualitative research methods, this paper seeks to explore the experiences of practice nurses mentoring undergraduate students on clinical placements within the general practice setting. Findings are presented in the following three themes: (1) Promoting Practice Nursing: We really need to get students in, (2) Mentoring future co-workers: Patience and reassurance, and (3) Reciprocity in learning: It's a bit of a two way street, which show the benefits of such placements. Clinical placements in general practice settings can be mutually beneficial in terms of providing quality teaching and learning experiences for students. Conversely, the experience provides an impetus for practice nurses to maintain currency of their clinical skills and knowledge through mentoring student nurses. PMID:21908081

  15. Discourse analysis in general practice: a sociolinguistic approach.

    PubMed

    Nessa, J; Malterud, K

    1990-06-01

    It is a simple but important fact that as general practitioners we talk to our patients. The quality of the conversation is of vital importance for the outcome of the consultation. The purpose of this article is to discuss a methodological tool borrowed from sociolinguistics--discourse analysis. To assess the suitability of this method for analysis of general practice consultations, the authors have performed a discourse analysis of one single consultation. Our experiences are presented here. PMID:2369986

  16. Nutritional counseling in German general practices: a holistic approach.

    PubMed

    Wiesemann, A

    1997-06-01

    There is consensus among all German health professionals, including primary care physicians, that a holistic approach to healthy living begins with good nutrition. In northern Baden, 2100 general practitioners and internists were asked about their nutritional attitudes and preventive counseling in daily practice. Of responding physicians, 75% attributed great importance to prevention in general and 92% to nutrition in particular, 65% were providing special programs such as "How to treat diabetes by myself" or "Reducing hypertension by losing weight." Together with the highest German Committee of Physicians, the Lectures in General Medicine of the University of Heidelberg held a meeting on nutritional counseling in general practice. The 23 participants collected statements and information on the topics of education and counseling, support for improved teaching, and knowledge about nutritional attitudes and food. The Heidelberg agreements are as follows: 1) good nutritional counseling can reduce morbidity of important diseases, 2) nutritional counseling must be improved in general practice, 3) diagnosis-related written cases for systematic counseling should be available, 4) family doctors should cooperate with nutritionists, and 5) for quality assurance, the three-level strategy of primary care should be recommended because of the positive results of the Bruchsal-Oestringen program (reduction of obesity and hypercholesterolemia). General practice can become a place of improved nutritional counseling and education if the use of programs proven to be successful, additional exercise-based community approaches, and quality assurance can be facilitated. The outcome of practice-based studies may encourage primary care physicians to spend more time and training on nutrition guidance. PMID:9174503

  17. Questioning behaviour in general practice: a pragmatic study.

    PubMed Central

    Barrie, A. R.; Ward, A. M.

    1997-01-01

    OBJECTIVE: To study the extent to which general practitioners' questioning behaviour in routine practice is likely to encourage the adoption of evidence based medicine. DESIGN: Self recording of questions by doctors during consultations immediately followed by semistructured interview. SETTING: Urban Australian general practice. SUBJECTS: Random sample of 27 general practitioners followed over a half day of consultations. MAIN OUTCOME MEASURES: Rate of recording of clinical questions about patients' care which doctors would like answered; frequency with which doctors found answers to their questions. RESULTS: Doctors asked a total of 85 clinical questions, at a rate of 2.4 for every 10 patients seen. They found satisfactory answers to 67 (79%) of these questions. Doctors who worked in small practices (of one or two doctors) had a significantly lower rate of questioning than did those in larger practices (1.6 questions per 10 patients v 3.0 patients, P = 0.049). No other factors were significantly related to rate of questioning. CONCLUSIONS: These results do not support the view that doctors routinely generate a large number of unanswered clinical questions. It may be necessary to promote questioning behaviour in routine practice if evidence based medicine and other forms of self directed learning are to be successfully introduced. PMID:9420495

  18. STORMWATER BEST MANAGEMENT PRACTICES DESIGN GUIDE VOLUME 1 - GENERAL CONSIDERATIONS

    EPA Science Inventory

    This document is Volume 1 of a three volume series that provides guidance on the selection and design of stormwater management Best Management Practices (BMPs). This first volume provides general considerations associated with the selection and design of BMPs.
    Volume I provi...

  19. Chemical Aspects of General Anesthesia: Part II. Current Practices

    ERIC Educational Resources Information Center

    Brunsvold, Robert; Ostercamp, Daryl L.

    2006-01-01

    The basics of balanced general anesthesia developed since 1956 and the update on existing practices of intravenous induction anesthetics and inhalational anesthetics are discussed. Some of the progressive anesthetics discussed are propofol instead of barbiturate such as thiopental or methohexital, inhalational anesthetic halothane,…

  20. 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,…

  1. General practice and primary health care in Denmark.

    PubMed

    Pedersen, Kjeld Møller; Andersen, John Sahl; Søndergaard, Jens

    2012-03-01

    General practice is the corner stone of Danish primary health care. General practitioners (GPs) are similar to family physicians in the United States. On average, all Danes have 6.9 contacts per year with their GP (in-person, telephone, or E-mail consultation). General practice is characterized by 5 key components: (1) a list system, with an average of close to 1600 persons on the list of a typical GP; (2) the GP as gatekeeper and first-line provider in the sense that a referral from a GP is required for most office-based specialists and always for in- and outpatient hospital treatment; (3) an after-hours system staffed by GPs on a rota basis; (4) a mixed capitation and fee-for-service system; and (5) GPs are self-employed, working on contract for the public funder based on a national agreement that details not only services and reimbursement but also opening hours and required postgraduate education. The contract is (re)negotiated every 2 years. General practice is embedded in a universal tax-funded health care system in which GP and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new challenges. Practice units are fairly small: close to 2 GPs per unit plus nurses and secretaries. The units are fully computerized, that is, with computer-based patient records and submission of prescriptions digitally to pharmacies etc. Over the past few years a decrease in solo practices has been seen and is expected to accelerate, in part because of the GP age structure, with many GPs retiring and new GPs not wanting to practice alone. This latter workforce trend is pointing toward a new model with employed GPs, particularly in rural areas. PMID:22403249

  2. '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

  3. Somatic presentation of psychiatric morbidity in general practice.

    PubMed Central

    Weich, S; Lewis, G; Donmall, R; Mann, A

    1995-01-01

    BACKGROUND. Twenty per cent of new illnesses in general practice, and 3% of consecutive attenders, are incident cases of 'pure' somatization. AIM. This study set out to estimate the prevalence of consultations by patients with psychiatric morbidity who present only somatic symptoms (somatic presentation), and to compare this with the likely prevalence of pure somatization. METHOD. A cross-sectional survey of consecutive general practice attenders was carried out. Psychiatric morbidity was measured using the general health questionnaire. Pure somatization was defined as medical consultation for somatic symptoms that were judged by a psychiatrist during an interview to be aetiologically attributable to an underlying psychiatric disorder but which were not recognized as such by the patient. RESULTS. Of attenders 25% were identified as somatic presenters. Of the somatic presenters interviewed one in six were estimated to be pure somatizers, which would extrapolate to 4% of attenders. Though all somatic presenters were probable cases of psychiatric disorder, subjects in this group had lower scores on the general health questionnaire than those who presented with psychological symptoms. General practitioner recognition of psychiatric morbidity was significantly lower among somatic presenters than for other subjects with psychiatric morbidity. CONCLUSION. General practitioner recognition of psychiatric morbidity could be improved for all types of somatic presentation, regardless of the aetiology of patients' somatic symptoms. There is a danger that concentrating attention on pure somatization may mean that psychiatric morbidity in the more common undifferentiated form of somatic presentation will be overlooked. PMID:7772392

  4. Prevalence of STI related consultations in general practice: results from the second Dutch National Survey of General Practice

    PubMed Central

    van Bergen, Jan EAM; Kerssens, Jan J; Schellevis, Francois G; Sandfort, Theo G; Coenen, Ton J; Bindels, Patrick J

    2006-01-01

    Background The role of the GP in the care of sexually transmitted infections (STIs) is unclear. Aim We studied the prevalence of STI related consultations in Dutch general practice in order to obtain insight into the contribution of the GP in STI control. Design of study A descriptive study. Setting The study took place within the framework of the second Dutch National Survey of General Practice in 2001, a large nationally representative population-based survey. Method During 1 year, data of all patient contacts with the participating GPs were recorded in electronic medical records. Contacts for the same health problem were clustered into disease episodes and their diagnosis coded according to the International Classification of Primary Care. All STI and STI related episodes were analysed. Results In total, 1 524 470 contacts of 375 899 registered persons in 104 practices were registered during 1 year and 2460 STI related episodes were found. The prevalence rate of STI was 39 per 10 000 persons and of STI/HIV related questions 23 per 10 000. More than half of all STIs were found in highly urbanised areas and STIs were overrepresented in deprived areas. Three quarters of all STIs diagnosed in the Netherlands are made in general practice. An important number of other reproductive health visits in general practice offer opportunities for meaningful STI counselling and tailored prevention. Discussion GPs contribute significantly to STI control, see the majority of patients with STI related symptoms and questions and are an important player in STI care. In particular, GPs in urban areas and inner-city practices should be targeted for accelerated sexual health programmes. PMID:16464323

  5. Gastroenteritis in sentinel general practices,The Netherlands.

    PubMed Central

    de Wit, M. A.; Koopmans, M. P.; Kortbeek, L. M.; van Leeuwen, N. J.; Bartelds, A. I.; van Duynhoven, Y. T.

    2001-01-01

    From 1996 to 1999, the incidence of gastroenteritis in general practices and the role of a broad range of pathogens in the Netherlands were studied. All patients with gastroenteritis who had visited a general practitioner were reported. All patients who had visited a general practitioner for gastroenteritis (cases) and an equal number of patients visiting for nongastrointestinal symptoms (controls) were invited to participate in a case-control study. The incidence of gastroenteritis was 79.7 per 10,000 person years. Campylobacter was detected most frequently (10% of cases), followed by Giardia lamblia (5%), rotavirus (5%), Norwalk-like viruses (5%) and Salmonella (4%). Our study found that in the Netherlands (population 15.6 million), an estimated 128,000 persons each year consult their general practitioner for gastroenteritis, slightly less than in a comparable study in 1992 to 1993. A pathogen could be detected in almost 40% of patients (bacteria 16%, viruses 15%, parasites 8%). PMID:11266298

  6. Laparoscopic entry: a review of Canadian general surgical practice

    PubMed Central

    Compeau, Christopher; McLeod, Natalie T.; Ternamian, Artin

    2011-01-01

    Background Laparoscopic surgery has gained popularity over open conventional surgery as it offers benefits to both patients and health care practitioners. Although the overall risk of complications during laparoscopic surgery is recognized to be lower than during laparotomy, inadvertent serious complications still occur. Creation of the pneumoperitoneum and placement of laparoscopic ports remain a critical first step during endoscopic surgery. It is estimated that up to 50% of laparoscopic complications are entry-related, and most injury-related litigations are trocar-related. We sought to evaluate the current practice of laparoscopic entry among Canadian general surgeons. Methods We conducted a national survey to identify general surgeon preferences for laparoscopic entry. Specifically, we sought to survey surgeons using the membership database from the Canadian Association of General Surgeons (CAGS) with regards to entry methods, access instruments, port insertion sites and patient safety profiles. Laparoscopic cholecystectomy was used as a representative general surgical procedure. Results The survey was completed by 248 of 1000 (24.8%) registered members of CAGS. Respondents included both community and academic surgeons, with and without formal laparoscopic fellowship training. The demographic profile of respondents was consistent nationally. A substantial proportion of general surgeons (> 80%) prefer the open primary entry technique, use the Hasson trocar and cannula and favour the periumbilical port site, irrespective of patient weight or history of peritoneal adhesions. One-third of surgeons surveyed use Veress needle insufflation in their surgical practices. More than 50% of respondents witnessed complications related to primary laparoscopic trocar insertion. Conclusion General surgeons in Canada use the open primary entry technique, with the Hasson trocar and cannula applied periumbilically to establish a pneumoperitoneum for laparoscopic surgery. This

  7. Catchments of general practice in different countries– a literature review

    PubMed Central

    2014-01-01

    The purpose of this paper is to review the current research on catchment areas of private general practices in different developed countries because healthcare reform, including primary health care, has featured prominently as an important political issue in a number of developed countries. The debates around health reform have had a significant health geographic focus. Conceptually, GP catchments describe the distribution, composition and profile of patients who access a general practitioner or a general practice (i.e. a site or facility comprising one or more general practitioners). Therefore, GP catchments provide important information into the geographic variation of access rates, utilisation of services and health outcomes by all of the population or different population groups in a defined area or aggregated area. This review highlights a wide range of diversity in the literature as to how GP catchments can be described, the indicators and measures used to frame the scale of catchments. Patient access to general practice health care services should be considered from a range of locational concepts, and not necessarily constrained by their place of residence. An analysis of catchment patterns of general practitioners should be considered as dynamic and multi-perspective. Geographic information systems provide opportunities to contribute valuable methodologies to study these relationships. However, researchers acknowledge that a conceptual framework for the analysis of GP catchments requires access to real world data. Recent studies have shown promising developments in the use of real world data, especially from studies in the UK. Understanding the catchment profiles of individual GP surgeries is important if governments are serious about patient choice being a key part of proposed primary health reforms. Future health planning should incorporate models of GP catchments as planning tools, at the micro level as well as the macro level, to assist policies on the

  8. The epidemiology of prescribing in an urban general practice

    PubMed Central

    Murdoch, J. C.

    1980-01-01

    The total prescribing in an urban general practice was recorded over a six-month period and classified according to the length of time that drugs were continued. The number of patients receiving any prescription rose with age, as did the total number of items per patient prescribed for; while the continued items rose with age, the number of items prescribed once only per patient remained constant in all age groups. The bulk of the total prescribing was for the elderly and this was mainly for continued items. The classification also shows that certain drug groups are liable to be continued whereas others are virtually always prescribed once only. The implications of these findings for self-audit of prescribing and the care of the elderly in general practice are discussed. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6. PMID:7452600

  9. General practice--a post-modern specialty?

    PubMed Central

    Mathers, N; Rowland, S

    1997-01-01

    The 'modern' view of the world is based on the premise that we can discover the essential truth of the world using scientific method. The assumption is made that knowledge so acquired has been 'uncontaminated' by the mind of the investigator. Post-modern theory, however, is concerned with the process of knowing and how our minds are part of the process, i.e. our perceptions of reality and the relationships between different concepts are important influences on our ways of knowing. The values of post-modern theory are those of uncertainty, many different voices and experiences of reality and multifaceted descriptions of truth. These values are closer to our experience of general practice than the 'modern' values of scientific rationalism and should be reflected in a new curriculum for general practice. PMID:9167325

  10. Controlled trials in the evaluation of counselling in general practice.

    PubMed Central

    King, M; Broster, G; Lloyd, M; Horder, J

    1994-01-01

    In this paper the difficulties of conducting a controlled evaluation of counselling (brief psychotherapy) in general practice are discussed. Results of a pilot study indicate that patients referred by family doctors to counsellors are often seriously emotionally distressed and recovery is slow. Counsellors come from different backgrounds and use a variety of therapies. Although the results show that controlled research is feasible, in a definitive trial patients should be randomized in a stratified manner, according to severity, by the researcher after initial assessments have been made. Counsellors should have a recognized accreditation and preferably be employed for the trial to ensure uniformity of approach and avoid long waiting lists. Blind assessments of outcome are desirable but are not always feasible and reliance on patient self-report is important. Within the limitations of current knowledge, only controlled evaluations will provide a greater understanding of the efficacy of counselling in general practice. PMID:8204338

  11. Participatory design of a preliminary safety checklist for general practice

    PubMed Central

    Bowie, Paul; Ferguson, Julie; MacLeod, Marion; Kennedy, Susan; de Wet, Carl; McNab, Duncan; Kelly, Moya; McKay, John; Atkinson, Sarah

    2015-01-01

    Background The use of checklists to minimise errors is well established in high reliability, safety-critical industries. In health care there is growing interest in checklists to standardise checking processes and ensure task completion, and so provide further systemic defences against error and patient harm. However, in UK general practice there is limited experience of safety checklist use. Aim To identify workplace hazards that impact on safety, health and wellbeing, and performance, and codesign a standardised checklist process. Design and setting Application of mixed methods to identify system hazards in Scottish general practices and develop a safety checklist based on human factors design principles. Method A multiprofessional ‘expert’ group (n = 7) and experienced front-line GPs, nurses, and practice managers (n = 18) identified system hazards and developed and validated a preliminary checklist using a combination of literature review, documentation review, consensus building workshops using a mini-Delphi process, and completion of content validity index exercise. Results A prototype safety checklist was developed and validated consisting of six safety domains (for example, medicines management), 22 sub-categories (for example, emergency drug supplies) and 78 related items (for example, stock balancing, secure drug storage, and cold chain temperature recording). Conclusion Hazards in the general practice work system were prioritised that can potentially impact on the safety, health and wellbeing of patients, GP team members, and practice performance, and a necessary safety checklist prototype was designed. However, checklist efficacy in improving safety processes and outcomes is dependent on user commitment, and support from leaders and promotional champions. Although further usability development and testing is necessary, the concept should be of interest in the UK and internationally. PMID:25918338

  12. Dental therapists in general dental practices: an economic evaluation.

    PubMed

    Beazoglou, Tryfon J; Lazar, Vickie F; Guay, Albert H; Heffley, Dennis R; Bailit, Howard L

    2012-08-01

    Dental access disparities are well documented and have been recognized as a national problem. Their major cause is the lack of reasonable Medicaid reimbursement rates for the underserved. Specifically, Medicaid reimbursement rates for children average 40 percent below market rates. In addition, most state Medicaid programs do not cover adults. To address these issues, advocates of better oral health for the underserved are considering support for a new allied provider--a dental therapist--capable of providing services at a lower cost per service and in low-income and rural areas. Using a standard economic analysis, this study estimated the potential cost, price, utilization, and dentist's income effects of dental therapists employed in general dental practices. The analysis is based on national general dental practice data and the broadest scope of responsibility for dental therapists that their advocates have advanced, including the ability to provide restorations and extractions to adults and children, training for three years, and minimum supervision. Assuming dental therapists provide restorative, extraction, and pulpal services to patients of all ages and dental hygienists continue to deliver all hygiene services, the mean reduction in a general practice costs ranges between 1.57 and 2.36 percent. For dental therapists treating children only, the range is 0.31 to 0.47 percent. The effects on price and utilization are even smaller. In addition, the effects on most dentists' gross income, hours of work, and net income are negative. The estimated economic impact of dental therapists in the United States on private dental practice is very limited; therefore, the demand for dental therapists by private practices also would probably be very limited. PMID:22855595

  13. [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

  14. General practice training and virtual communities of practice - a review of the literature

    PubMed Central

    2012-01-01

    Background Good General Practice is essential for an effective health system. Good General Practice training is essential to sustain the workforce, however training for General Practice can be hampered by a number of pressures, including professional, structural and social isolation. General Practice trainees may be under more pressure than fully registered General Practitioners, and yet isolation can lead doctors to reduce hours and move away from rural practice. Virtual communities of practice (VCoPs) in business have been shown to be effective in improving knowledge sharing, thus reducing professional and structural isolation. This literature review will critically examine the current evidence relevant to virtual communities of practice in General Practice training, identify evidence-based principles that might guide their construction and suggest further avenues for research. Methods Major online databases Scopus, Psychlit and Pubmed were searched for the terms “Community of Practice” (CoP) AND (Online OR Virtual OR Electronic) AND (health OR healthcare OR medicine OR “Allied Health”). Only peer-reviewed journal articles in English were selected. A total of 76 articles were identified, with 23 meeting the inclusion criteria. There were no studies on CoP or VCoP in General Practice training. The review was structured using a framework of six themes for establishing communities of practice, derived from a key study from the business literature. This framework has been used to analyse the literature to determine whether similar themes are present in the health literature and to identify evidence in support of virtual communities of practice for General Practice training. Results The framework developed by Probst is mirrored in the health literature, albeit with some variations. In particular the roles of facilitator or moderator and leader whilst overlapping, are different. VCoPs are usually collaborations between stakeholders rather than single company

  15. Homoeopathic and herbal prescribing in general practice in Scotland

    PubMed Central

    Ross, Sarah; Simpson, Colin R; McLay, James S

    2006-01-01

    What is already known about this subject Homoeopathy and herbalism are increasingly popular among the public and prescribed by general practitioners in the NHS. Doctors and regulatory authorities have expressed concerns about their efficacy and safety. Studies from the 1990s suggest that between 5.9 and 7.5% of English NHS general practitioners have prescribed homoeopathy, while less than 1% have prescribed herbal remedies. Current levels of prescribing are unknown but are thought to have increased. What this study adds Sixty percent of Scottish general practices now prescribe homoeopathic or herbal remedies. The prevalence of homoeopathic prescribing in those under 16 years has doubled since 2000 and is maximal in children < 1 year old, of whom 1% are prescribed a homoeopathic remedy. Recognized drug–herb interactions were identified in 4% of patients prescribed oral herbal remedies. Aims To investigate the current levels of homoeopathic and herbal prescribing in Scottish general practice. Methods Prescribing of homoeopathic and herbal remedies in primary care was assessed in 1891 669 patients for the year 2003–2004, using computerized prescribing data retrieved from 323 general practices in Scotland. Results Forty-nine percent of practices prescribed homoeopathic and 32% herbal remedies. A total of 193 homoeopathic and 17 herbal remedies were prescribed, with 5% of practices accounting for 46% of patients and 50% of remedies. Four thousand one hundred and sixty patients (2.2/1000 registered patients) were prescribed at least one homoeopathic remedy during the study period, with the highest prevalence to children under 12 months of age (9.5/1000 children of that age). Children under the age of 16 made up 16% of the population prescribed homoeopathic remedies (2.2/1000 registered patients of that age). Three hundred and sixty-one patients (0.2/1000 registered patients) were prescribed at least one herbal remedy during the study period, 44 of whom were children

  16. Women's evaluation of abuse and violence care in general practice: a cluster randomised controlled trial (weave)

    PubMed Central

    2010-01-01

    Background Intimate partner abuse (IPA) is a major public health problem with serious implications for the physical and psychosocial wellbeing of women, particularly women of child-bearing age. It is a common, hidden problem in general practice and has been under-researched in this setting. Opportunities for early intervention and support in primary care need to be investigated given the frequency of contact women have with general practice. Despite the high prevalence and health consequences of abuse, there is insufficient evidence for screening in primary care settings. Furthermore, there is little rigorous evidence to guide general practitioners (GPs) in responding to women identified as experiencing partner abuse. This paper describes the design of a trial of a general practice-based intervention consisting of screening for fear of partner with feedback to GPs, training for GPs, brief counselling for women and minimal practice organisational change. It examines the effect on women's quality of life, mental health and safety behaviours. Methods/Design weave is a cluster randomised controlled trial involving 40 general practices in Victoria, Australia. Approximately 500 women (16-50 years) seen by the GP in the previous year are mailed a short lifestyle survey containing an item to screen for IPA. Women who indicate that they were afraid of a partner/ex-partner in the last year and provide contact details are invited to participate. Once baseline data are collected, GPs are randomly assigned to either a group involving healthy relationship and responding to IPA training plus inviting women for up to 6 sessions of counselling or to a group involving basic education and usual care for women. Outcomes will be evaluated by postal survey at 6 and 12 months following delivery of the intervention. There will be an economic evaluation, and process evaluation involving interviews with women and GPs, to inform understanding about implementation and outcomes. Discussion The

  17. Do quality indicators for general practice teaching practices predict good outcomes for students?

    PubMed

    Bartlett, Maggie; Potts, Jessica; McKinley, Bob

    2016-07-01

    Keele medical students spend 113 days in general practices over our five-year programme. We collect practice data thought to indicate good quality teaching. We explored the relationships between these data and two outcomes for students; Objective Structured Clinical Examination (OSCE) scores and feedback regarding the placements. Though both are surrogate markers of good teaching, they are widely used. We collated practice and outcome data for one academic year. Two separate statistical analyses were carried out: (1) to determine how much of the variation seen in the OSCE scores was due to the effect of the practice and how much to the individual student. (2) to identify practice characteristics with a relationship to student feedback scores. (1) OSCE performance: 268 students in 90 practices: six quality indicators independently influenced the OSCE score, though without linear relationships and not to statistical significance. (2) Student satisfaction: 144 students in 69 practices: student feedback scores are not influenced by practice characteristics. The relationships between the quality indicators we collect for practices and outcomes for students are not clear. It may be that neither the quality indicators nor the outcome measures are reliable enough to inform decisions about practices' suitability for teaching. PMID:27117344

  18. [Professional conditions and satisfaction in general practice in 1993. Practice profile of Norwegian primary physicians].

    PubMed

    Holtedahl, K A; Johnsen, R

    1997-04-20

    European study of General Practice (GP) task profiles was carried out in 30 European countries in 1993. We analyzed the Norwegian results. 164 primary care physicians, 51% of a random sample, answered a questionnaire. 147 kept a diary on their practice for one week. Compared with results from two earlier studies performed 15 years ago, the proportion of female GPs had doubled to 25%, there were more group practices, more time was spent on vocational training and continuous education, and night service was less frequent than in 1978. 45% were specialists in general practice and 7% in community medicine. Job satisfaction was high, and highest for women, fee-for-service GPs on contract, and GPs who cooperated with other health professionals. PMID:9198927

  19. The general practice formulary — its role in rational therapeutics

    PubMed Central

    Green, Philip E.

    1985-01-01

    This paper describes a project in which a voluntary preferred prescribing list (general practice formulary), analogous to those already in use in some hospitals, was created, implemented and monitored. Cooperation between a pharmacist with knowledge of drug information, access to specialist advice and back-up in the form of evaluated information from drug information centres and a group of five general practitioners and their trainees was necessary. The formulary was well accepted with between 68.2% and 89.6% compliance in therapeutic classes corresponding to the recent National Health Service restricted groups. This method enhances the critical appraisal of prescribing rationale, takes into account the needs of doctors and patients, and reduces costs. Such work highlights the value and scope of interdisciplinary liaison between pharmacists, general practitioners and clinical pharmacologists and it could prove beneficial on a national scale. PMID:4093901

  20. Clinical examination for abdominal aortic aneurysm in general practice: report from the Medical Research Council's General Practice Research Framework.

    PubMed Central

    Zuhrie, S R; Brennan, P J; Meade, T W; Vickers, M

    1999-01-01

    At the time of the 1992-1994 annual reviews in the thrombosis prevention trial, general practitioners (GPs) carried out clinical examination for aneurysms by abdominal palpation in 4171 men. When an aneurysm was suspected, the patient was referred to hospital for further investigation. Aneurysm was suspected in 60 men (1.4%) and confirmed in 25 (0.6%), the mean diameter of confirmed aneurysms being 5.0 cm (range = 3.1-8.0 cm). Of the 25 men in whom aneurysm was confirmed, 10 (40%) underwent elective surgery and one died while under investigation. Examination by abdominal palpation for aortic aneurysm, which is not widely used in either general practice or in hospital practice, other than vascular surgery, is clinically worthwhile even though not all aneurysms will be detected by this means. PMID:10756617

  1. Chinese hotel general managers' perspectives on energy-saving practices

    NASA Astrophysics Data System (ADS)

    Zhu, Yidan

    As hotels' concern about sustainability and budget-control is growing steadily, energy-saving issues have become one of the important management concerns hospitality industry face. By executing proper energy-saving practices, previous scholars believed that hotel operation costs can decrease dramatically. Moreover, they believed that conducting energy-saving practices may eventually help the hotel to gain other benefits such as an improved reputation and stronger competitive advantage. The energy-saving issue also has become a critical management problem for the hotel industry in China. Previous research has not investigated energy-saving in China's hotel segment. To achieve a better understanding of the importance of energy-saving, this document attempts to present some insights into China's energy-saving practices in the tourist accommodations sector. Results of the study show the Chinese general managers' attitudes toward energy-saving issues and the differences among the diverse hotel managers who responded to the study. Study results indicate that in China, most of the hotels' energy bills decrease due to the implementation of energy-saving equipments. General managers of hotels in operation for a shorter period of time are typically responsible for making decisions about energy-saving issues; older hotels are used to choosing corporate level concerning to this issue. Larger Chinese hotels generally have official energy-saving usage training sessions for employees, but smaller Chinese hotels sometimes overlook the importance of employee training. The study also found that for the Chinese hospitality industry, energy-saving practices related to electricity are the most efficient and common way to save energy, but older hotels also should pay attention to other ways of saving energy such as water conservation or heating/cooling system.

  2. Healthcare improvement as planned system change or complex responsive processes? a longitudinal case study in general practice

    PubMed Central

    2013-01-01

    Background Interest in how to implement evidence-based practices into routine health care has never been greater. Primary care faces challenges in managing the increasing burden of chronic disease in an ageing population. Reliable prescriptions for translating knowledge into practice, however, remain elusive, despite intense research and publication activity. This study seeks to explore this dilemma in general practice by challenging the current way of thinking about healthcare improvement and asking what can be learned by looking at change through a complexity lens. Methods This paper reports the local level of an embedded case study of organisational change for better chronic illness care over more than a decade. We used interviews, document review and direct observation to explore how improved chronic illness care developed in one practice. This formed a critical case to compare, using pattern matching logic, to the common prescription for local implementation of best evidence and a rival explanation drawn from complexity sciences interpreted through modern sociology and psychology. Results The practice changed continuously over more than a decade to deliver better chronic illness care in line with research findings and policy initiatives – re-designing care processes, developing community linkages, supporting patient self-management, using guidelines and clinical information systems, and integrating nurses into the practice team. None of these improvements was designed and implemented according to an explicit plan in response to a documented gap in chronic disease care. The process that led to high quality chronic illness care exhibited clear complexity elements of co-evolution, non-linearity, self-organisation, emergence and edge of chaos dynamics in a network of agents and relationships where a stable yet evolving way of organizing emerged from local level communicative interaction, power relating and values based choices. Conclusions The current discourse

  3. Improving the management of multimorbidity in general practice: protocol of a cluster randomised controlled trial (The 3D Study)

    PubMed Central

    Chaplin, Katherine; Bower, Peter; Brookes, Sara; Fitzpatrick, Bridie; Guthrie, Bruce; Shaw, Alison; Mercer, Stewart; Rafi, Imran; Thorn, Joanna

    2016-01-01

    Introduction An increasing number of people are living with multimorbidity. The evidence base for how best to manage these patients is weak. Current clinical guidelines generally focus on single conditions, which may not reflect the needs of patients with multimorbidity. The aim of the 3D study is to develop, implement and evaluate an intervention to improve the management of patients with multimorbidity in general practice. Methods and analysis This is a pragmatic two-arm cluster randomised controlled trial. 32 general practices around Bristol, Greater Manchester and Glasgow will be randomised to receive either the ‘3D intervention’ or usual care. 3D is a complex intervention including components affecting practice organisation, the conduct of patient reviews, integration with secondary care and measures to promote change in practice organisation. Changes include improving continuity of care and replacing reviews of each disease with patient-centred reviews with a focus on patients' quality of life, mental health and polypharmacy. We aim to recruit 1383 patients who have 3 or more chronic conditions. This provides 90% power at 5% significance level to detect an effect size of 0.27 SDs in the primary outcome, which is health-related quality of life at 15 months using the EQ-5D-5L. Secondary outcome measures assess patient centredness, illness burden and treatment burden. The primary analysis will be a multilevel regression model adjusted for baseline, stratification/minimisation, clustering and important co-variables. Nested process evaluation will assess implementation, mechanisms of effectiveness and interaction of the intervention with local context. Economic analysis of cost-consequences and cost-effectiveness will be based on quality-adjusted life years. Ethics and dissemination This study has approval from South-West (Frenchay) National Health Service (NHS) Research Ethics Committee (14/SW/0011). Findings will be disseminated via final report, peer

  4. Misunderstandings in prescribing decisions in general practice: qualitative study

    PubMed Central

    Britten, Nicky; Stevenson, Fiona A; Barry, Christine A; Barber, Nick; Bradley, Colin P

    2000-01-01

    Objectives To identify and describe misunderstandings between patients and doctors associated with prescribing decisions in general practice. Design Qualitative study. Setting 20 general practices in the West Midlands and south east England. Participants 20 general practitioners and 35 consulting patients. Main outcome measures Misunderstandings between patients and doctors that have potential or actual adverse consequences for taking medicine. Results 14 categories of misunderstanding were identified relating to patient information unknown to the doctor, doctor information unknown to the patient, conflicting information, disagreement about attribution of side effects, failure of communication about doctor's decision, and relationship factors. All the misunderstandings were associated with lack of patients' participation in the consultation in terms of the voicing of expectations and preferences or the voicing of responses to doctors' decisions and actions. They were all associated with potential or actual adverse outcomes such as non-adherence to treatment. Many were based on inaccurate guesses and assumptions. In particular doctors seemed unaware of the relevance of patients' ideas about medicines for successful prescribing. Conclusions Patients' participation in the consultation and the adverse consequences of lack of participation are important. The authors are developing an educational intervention that builds on these findings. PMID:10678863

  5. [General practice and internal medicine. The fighting with shared issues].

    PubMed

    Beylot, J

    2009-04-01

    The training of the primary care physicians has been neglected for long by the French medical faculties that, since 1958, favoured the hyper-specialization of their students. The initiative of a few primary care physicians supported by some academic internal medicine physicians allowed changing this situation gradually. Commitment of a training period in primary care practice and then the involvement of teaching general medicine physicians in the course of the theoretical training were essential to this shift. Following three decades of reforms that lead to recognize general medicine as a sub-specialty, an acknowledged academic course of general medicine is eagerly expected for 2009 with the first appointments of professors of general medicine with tenure. The general internists who share the same objective of global patient care are determined to support this academic course that they will welcome within the French National Council of Universities. This academic course will have to comply with the same teaching and research requirements than the other medical subspecialties. PMID:19195744

  6. The climate change challenge for general practice in New Zealand.

    PubMed

    Phipps, Rochelle; Randerson, Rebecca; Blashki, Grant

    2011-04-29

    Climate change is one of the greatest public health challenges of our time. Despite some inherent uncertainties in making predictions about climate change, there is wide scientific consensus that global warming is occurring; that it is largely due to manmade greenhouse gas emissions; and that it will have substantial health implications for the future. The predicted health impacts of climate change are now clearer for New Zealand, and general practitioners can take action to mitigate these impacts and adapt to the future environment. Actions required involve a combination of 'top-down' and 'ground-up' approaches; effective leadership and policy from our health institutions and, importantly, individual practice initiatives that transform these goals into practical outcomes. PMID:21750595

  7. Assessment of management in general practice: validation of a practice visit method.

    PubMed Central

    van den Hombergh, P; Grol, R; van den Hoogen, H J; van den Bosch, W J

    1998-01-01

    BACKGROUND: Practice management (PM) in general practice is as yet ill-defined; a systematic description of its domain, as well as a valid method to assess it, are necessary for research and assessment. AIM: To develop and validate a method to assess PM of general practitioners (GPs) and practices. METHOD: Relevant and potentially discriminating indicators were selected from a systematic framework of 2410 elements of PM to be used in an assessment method (VIP = visit instrument PM). The method was first tested in a pilot study and, after revision, was evaluated in order to select discriminating indicators and to determine validity of dimensions (factor and reliability analysis, linear regression). RESULTS: One hundred and ten GPs were assessed with the practice visit method using 249 indicators; 208 of these discriminated sufficiently at practice level or at GP level. Factor analysis resulted in 34 dimensions and in a taxonomy of PM. Dimensions and indicators showed marked variation between GPs and practices. Training practices scored higher on five dimensions; single-handed and dispensing practices scored lower on delegated tasks, but higher on accessibility and availability. CONCLUSION: A visit method to assess PM has been developed and its validity studied systematically. The taxonomy and dimensions of PM were in line with other classifications. Selection of a balanced number of useful and relevant indicators was nevertheless difficult. The dimensions could discriminate between groups of GPs and practices, establishing the value of the method for assessment. The VIP method could be an important contribution to the introduction of continuous quality improvement in the profession. PMID:10198481

  8. Diagnosing dementia in Dutch general practice: a qualitative study of GPs’ practices and views

    PubMed Central

    Prins, Agnes; Hemke, Feia; Pols, Jeannette; van Charante, Eric P Moll

    2016-01-01

    Background GPs play an important role in recognising the symptoms of dementia; however, little is known about how they perceive their actual and future role in diagnosing dementia. Aim To explore Dutch GPs’ perceptions of their current position in diagnosing dementia, their reasons for referral to secondary care, and views on the future diagnostic role of GPs. Design and setting A qualitative study among Dutch GPs. Method Eighteen GPs participated in a semi-structured interview that ranged from 20 to 60 minutes. Interviews were transcribed verbatim and thematic analysis was performed. Results GPs reported that their role in the diagnostic phase of identifying people with suspected dementia is limited to recognising cognitive problems and deciding whether a patient needs to be referred for further investigation, or whether care could be organised without specialist diagnosis. GPs indicated that they were likely to refer patients if patients/caregivers or dementia case managers requested it, or if they thought it could have consequences for treatment. Typically, GPs do not see the need for referral when their patients are very old and declining slowly. GPs would welcome a more prominent role in diagnosing dementia in their own practice. Conclusion Diagnosing dementia involves a complex balance between patient and carer preferences, the consequences for treatment and care, and the burden of referral. Dutch GPs favour a stronger involvement in diagnosing dementia provided that both resources and diagnostic algorithms are improved. PMID:27114209

  9. 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

  10. Computer based learning in general practice--options and implementation.

    PubMed

    Mills, K A; McGlade, K

    1992-01-01

    A survey of the 30 departments of general practice in the UK revealed that only three are currently making use of any form of computer based learning materials for teaching their undergraduate students. One of the reasons for the low level of usage is likely to be the relatively poor availability of suitable courseware and lack of guidance as to how to utilise what is available. This short paper describes the types of courseware that are available and the advantages and disadvantages of using acquired courseware as opposed to writing your own. It also considers alternative strategies for making computer based learning (CBL) courseware available to students. PMID:1608334

  11. Is there still a role for benzodiazepines in general practice?

    PubMed Central

    King, M B

    1992-01-01

    Opinion on benzodiazepines has moved from optimism after their entry onto the market to disillusionment over their potential for dependence. Legal proceedings against manufacturers of benzodiazepines, health authorities and doctors will be taking place this year. Nonetheless, just over 18 million prescriptions for benzodiazepines were issued in 1990, most of which came from general practice. Is there any role left for this group of drugs? This review addresses the issues of dependence on an withdrawal from benzodiazepines and weighs up the evidence for their present vilification. PMID:1389432

  12. Data Content and Exchange in General Practice: a Review

    PubMed Central

    Kalankesh, Leila R; Farahbakhsh, Mostafa; Rahimi, Niloofar

    2014-01-01

    Background: efficient communication of data is inevitable requirement for general practice. Any issue in data content and its exchange among GP and other related entities hinders continuity of patient care. Methods: literature search for this review was conducted on three electronic databases including Medline, Scopus and Science Direct. Results: through reviewing papers, we extracted information on the GP data content, use cases of GP information exchange, its participants, tools and methods, incentives and barriers. Conclusion: considering importance of data content and exchange for GP systems, it seems that more research is needed to be conducted toward providing a comprehensive framework for data content and exchange in GP systems. PMID:25648317

  13. The prevalence of humeral epicondylitis: a survey in general practice

    PubMed Central

    Hamilton, Peter G.

    1986-01-01

    The characteristics of all patients with humeral epicondylitis who presented over a two-year period in a group practice were examined to clarify the epidemiological features of this condition. In all 77 patients were seen. There was no observed difference in incidence between the sexes, lateral epicondylitis being more common than medial in both sexes. Medial epicondylitis is more common in the community than is generally recognized. Epicondylitis is a relapsing condition with a strong bias towards the 35-54 years age group. Analysis revealed no relationship between incidence and socioeconomic class. PMID:3440991

  14. [Diagnostic classification in Denmark with emphasis on general practice].

    PubMed

    Rosendal, Marianne; Falkø, Erik

    2009-03-16

    Diagnostic classification may be used as a structure for the naming of health problems and to create an overview in electronic patient records. Classification also facilitates access to health information and decision support, quality improvement and research. The International Classification Primary Care is now included in the WHO's Family of International Classifications and was introduced into Danish general practice in 1998. This system will be updated to ICPC-2-DK in 2009. In secondary health care, the ICD-10 is currently in use but a new system (SNOMED-CT) is underway. PMID:19284920

  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. Patients' unvoiced agendas in general practice consultations: qualitative study

    PubMed Central

    Barry, Christine A; Bradley, Colin P; Britten, Nicky; Stevenson, Fiona A; Barber, Nick

    2000-01-01

    Objective To investigate patients' agendas before consultation and to assess which aspects of agendas are voiced in the consultation and the effects of unvoiced agendas on outcomes. Design Qualitative study. Setting 20 general practices in south east England and the West Midlands. Participants 35 patients consulting 20 general practitioners in appointment and emergency surgeries. Results Patients' agendas are complex and multifarious. Only four of 35 patients voiced all their agendas in consultation. Agenda items most commonly voiced were symptoms and requests for diagnoses and prescriptions. The most common unvoiced agenda items were: worries about possible diagnosis and what the future holds; patients' ideas about what is wrong; side effects; not wanting a prescription; and information relating to social context. Agenda items that were not raised in the consultation often led to specific problem outcomes (for example, major misunderstandings), unwanted prescriptions, non-use of prescriptions, and non-adherence to treatment. In all of the 14 consultations with problem outcomes at least one of the problems was related to an unvoiced agenda item. Conclusion Patients have many needs and when these are not voiced they can not be addressed. Some of the poor outcomes in the case studies were related to unvoiced agenda items. This suggests that when patients and their needs are more fully articulated in the consultation better health care may be effected. Steps should be taken in both daily clinical practice and research to encourage the voicing of patients' agendas. PMID:10797036

  17. Predictors of a positive attitude of medical students towards general practice – a survey of three Bavarian medical faculties

    PubMed Central

    Schneider, Antonius; Karsch-Völk, Marlies; Rupp, Alica; Fischer, Martin R.; Drexler, Hans; Schelling, Jörg; Berberat, Pascal

    2013-01-01

    Objective: Germany is witnessing an increasing shortage of general practitioners (GPs). The aim was to determine predictors of the job-related motivation of medical students of three medical faculties with different institutionalisation of general practice as an academic discipline. Methods: Medical students were surveyed with a standardised questionnaire about their attitudes towards general practice and their motivation to work as a GP in different working conditions. Predictors for positive attitudes and motivation were calculated using logistic regression models. Results: 940 (15.2%) out of 6182 medical students from three Bavarian medical faculties participated in an online survey. 585 (62.7%) were female, and the average age was 25.0 (standard deviation 3.7). The average grade of a university-entrance diploma was 1.6 (standard deviation 0.5). 718 (76.4%) could imagine working as a GP. However, they favoured being employed within another organisation and not having their own private practice (65.5% vs. 35.1%). “Presence of a professorship of general practice” was associated with a positive attitude towards general practice (OR 1.57; 95%CI 1.13-2.417). Motivation for working as a GP was associated with “being female” (OR 2.56; 95%CI 1.80-3.56) and “presence of a professorship of general practice” (OR 1.68; 95%CI 1.14-2.46). Having a lower grade for one’s university-entrance diploma was associated with a higher preference to work in one’s own practice (OR 1.39; 95%CI 1.02-1.90). Conclusion: A high amount of medical students were open-minded towards general practice. However, they favoured employment within an organization over working in their own practice. Institutionalisation of general practice as an academic discipline might be of importance to gain positive attitudes towards general practice and motivate medical students to work as a GP. PMID:24282448

  18. Qualitative evaluation of general practices developing training for a range of health disciplines.

    PubMed

    Hughes, Lesley A

    2014-01-01

    This study adopted an interpretative approach, using focus groups and face-to-face interviews to evaluate the development of a five-year pilot project within general practice. The aim of the project is for these practices to offer training to a range of health disciplines from varying academic levels, develop capacity and provide interprofessional education as part of the learning ethos. Eight consortia are involved in the project, which is funded by the workforce and education directorate and the Deanery of the Yorkshire and Humber Strategic Health Authority. The evaluation was undertaken 18 months into the project, to understand the views and experiences of primary care practitioners and university educationalists, in order to identify achievements and barriers to the project's development. The study revealed positive attitudes towards the project, and that steps are being taken to engage in dialogue with universities to increase student numbers, but progress is slow. Early experiences of student nurses taking up placements in the practices reveal incompatible learning outcomes between what is expected for curriculum and learning opportunities within primary care. A common concern is the impact increased students may pose on existing support structures, and that this may compromise student learning. Concern is evident over self-belief and competencies to teach across professions, and the ambiguity over the learning outcomes for IPE and the training required to support this. It is recommended that a systems theory be adopted to provide strategic planning across clinical and education organisations to ensure that structures of communication, leadership and training adequately meet the aims of the project. The paper will be of interest to practitioners in primary care who may be considering expanding services and training, and to educationalists seeking to allocate students to placements in primary care. PMID:24423800

  19. Skin cancer control practices among physicians in a university general medicine practice.

    PubMed

    Dolan, N C; Martin, G J; Robinson, J K; Rademaker, A W

    1995-09-01

    Physician counseling about sun protection and routine screening for skin cancer in high-risk individuals have been widely recommended. The purpose of this study was to assess the skin cancer control practices and knowledge among physicians in a university-based general medicine practice. Fifty-two physicians completed a survey on attitudes toward, behaviors in, and knowledge of skin cancer control. In addition, the ability of general medicine residents and attending physicians to correctly identify and make biopsy recommendations for ten photographed skin lesions was compared with that of third-year medical students and dermatology residents and attendings. The results of the survey illustrate a need for improving primary care physicians' knowledge and identification of skin cancer risk factors, and increasing the frequency and consistency with which they perform skin cancer prevention counseling and complete skin examination in high-risk patient groups. PMID:8523156

  20. The Active Role of Instruments in Articulating Knowing and Knowledge: The Case of Animal Qualification Practices in Breeding Organisations

    ERIC Educational Resources Information Center

    Labatut, Julie; Aggeri, Franck; Astruc, Jean-Michel; Bibe, Bernard; Girard, Nathalie

    2009-01-01

    Purpose: The purpose of this paper is to investigate the role of instruments defined as artefacts, rules, models or norms, in the articulation between knowing-in-practice and knowledge, in learning processes. Design/methodology/approach: The paper focuses on a distributed, knowledge-intensive and instrumented activity at the core of any collective…

  1. Evidence based general practice: a retrospective study of interventions in one training practice.

    PubMed Central

    Gill, P.; Dowell, A. C.; Neal, R. D.; Smith, N.; Heywood, P.; Wilson, A. E.

    1996-01-01

    OBJECTIVES--To estimate the proportion of interventions in general practice that are based on evidence from clinical trials and to assess the appropriateness of such an evaluation. DESIGN--Retrospective review of case notes. SETTING--One suburban training general practice. SUBJECTS--122 consecutive doctor-patient consultations over two days. MAIN OUTCOME MEASURES--Proportions of interventions based on randomised controlled trials (from literature search with Medline, pharmaceutical databases, and standard textbooks), on convincing non-experimental evidence, and without substantial evidence. RESULTS--21 of the 122 consultations recorded were excluded due to insufficient data; 31 of the interventions were based on randomised controlled trial evidence and 51 based on convincing non-experimental evidence. Hence 82/101 (81%) of interventions were based on evidence meeting our criteria. CONCLUSIONS--Most interventions within general practice are based on evidence from clinical trials, but the methods used in such trials may not be the most appropriate to apply to this setting. PMID:8608291

  2. Effect of alternative medicinal systems and general practice.

    PubMed

    Verma, Shyam

    2007-10-01

    Alternative medicinal systems like Ayurveda and homeopathy are respected and legitimate sciences. The former was born in India. Colleges abound in this country churning out tens of thousands of graduates of these fields. It is ironic that a large number of them pratice allopathic general practice instead of, or along with, their field of specialisation despite laws prohibiting them to do so. Their gross lack of knowledge of dermatology wreaks a havoc. Even GPs contribute to this confusion for the same reason. Pharmacists contribute to unauthorised sale of dermatologic drugs and promote unsupervised treatment flouting the law. The result is neglected and vitiated dermatoses, unwanted adverse drug reactions and resource depletion for the patient. The practising dermatologist in India is unfortunately the one who bears the brunt of the above confusion. However these situations are also contributory to the enviable clinical skills that Indian dermatologists are so well known for. PMID:17958632

  3. Service-mix in general dental practice in Australia.

    PubMed

    Spencer, A J; Lewis, J M

    1989-02-01

    An understanding of the current service-mix in private general practice in Australia and the factors that may influence its distribution is important in the anticipation of the future practice of dentistry. The present study aimed to describe service-mix, to investigate the association of service-mix with characteristics of presenting patients, and to identify and discuss a number of factors which may be influencing change in service-mix. Service-mix was dominated by restorative, diagnostic and preventive services and a limited number of services accounted for most service provision or dentist time. Both the broad areas of service and more frequently provided services were related to age of presenting patients. Service-mix appears to be changing over time. Changing needs and expectations of patients and philosophies and technologies available to dentists are among factors that push or pull service-mix in new directions. However, changing service-mix and practitioner variation require considerably more exploration. PMID:2495788

  4. Developing Communication Skills for the General Practice Consultation Process

    PubMed Central

    Nystrup, Jørgen; Larsen, Jan-Helge; Risør, Ole

    2010-01-01

    Medical curriculum revisions all over the world in the last 20 years have increased the number of teaching hours in communication skills. This article describes a concrete communication skills teaching programme focused on general practice. Since the spring of 1992, more than 2,000 physicians from Denmark, Sweden and Finland have attended courses within this programme in Kalymnos, Greece. The training mainly takes place in groups of 8 doctors and 1 supervisor. The skills training is based on video feedback using the Window Supervision Method described here. We have identified several classical pitfalls for the doctor which this training programme seeks to address. We have also defined the 9 steps in an effective consultation process, which are given the acronym PRACTICAL. The major issue is to discriminate between the patient’s, the doctor’s and the shared part of the communication process. In our experience, this model shortens the consultation time to c. 15 minutes as doctors collaborate with their patients and build up an agreed agenda in order to deal effectively with the main problems of the patients. PMID:21509251

  5. The variety of primary healthcare organisations in Australia: a taxonomy

    PubMed Central

    2013-01-01

    Background Healthcare policy appears to treat healthcare organisations as being homogenous, despite evidence that they vary considerably. This study develops a taxonomy of primary health care practices using characteristics associated with the job satisfaction of general medical practitioners (GPs) and the practices. Methods The study used data from 3,662 survey respondents who were GPs in the 2009 wave of the MABEL survey. Cluster analyses were used to determine natural groups of medical practices based on multidimensional characteristics. Results Seven configurations of primary health care practices emerged from multivariate cluster analyses: optimised team, independent craft, reactive, winding down, classic, practitioner flexible, and scale efficiency. Conclusions This taxonomy of configurations moves beyond simplistic categorisations such as geographic location and highlights the complexity of primary health care organisations in Australia. Health policy, workforce and procedure interventions informed by taxonomies can engage the diversity of primary health care practices. PMID:23565577

  6. Predicting acute maxillary sinusitis in a general practice population.

    PubMed Central

    Hansen, J. G.; Schmidt, H.; Rosborg, J.; Lund, E.

    1995-01-01

    OBJECTIVE--To evaluate the diagnostic value of symptoms, signs, erythrocyte sedimentation rate, and C reactive protein for acute maxillary sinusitis. DESIGN--Prospective cohort study. SETTING--Danish general practice in cooperation with the otorhinolaryngology and neuroradiology department at Aalborg County Hospital. SUBJECTS--174 patients aged 18-65 years who were suspected by the general practitioner of having acute maxillary sinusitis. MAIN OUTCOME MEASURE--The independent association of symptoms, signs, erythrocyte sedimentation rate, and concentration of C reactive protein in patients with acute maxillary sinusitis defined as purulent or mucopurulent antral aspirate. RESULTS--Only raised erythrocyte sedimentation rate (P = 0.01) and raised C reactive protein (P = 0.007) were found to be independently associated with a diagnosis of acute maxillary sinusitis. The combination of the two variables had a sensitivity of 0.82 and a specificity of 0.57. CONCLUSION--Erythrocyte sedimentation rate and C reactive protein are useful diagnostic criteria for acute maxillary sinusitis. PMID:7627042

  7. Role of general practice in the diagnosis of oral cancer.

    PubMed

    Crossman, Timothy; Warburton, Fiona; Richards, Michael A; Smith, Helen; Ramirez, Amanda; Forbes, Lindsay J L

    2016-02-01

    The incidence of oral cancer is increasing in the United Kingdom. There is evidence that early diagnosis and effective treatment improve survival, but the poor 5-year survival rate (50%), which has not improved for several decades, has been attributed to advanced stage at presentation. To investigate the symptoms associated with cancer of the oral cavity and to explore the role of general practitioners (GP) in the identification and referral of patients, we sent 200 patients questionnaires on the route to diagnosis, symptoms, delay in presentation, and outcomes of consultations with their GP. Of 161 respondents, over half (56%) had been referred to secondary care by their GP and a third (32%) by their dentist. The most commonly reported symptoms were a mouth ulcer (32%), a lump in the face or neck (28%), and pain or soreness in the mouth or throat (27%). Fifteen per cent delayed presentation for more than 3 months. After consultation with a GP (n=109), 53% were referred to a specialist, 22% were referred for tests, 12% were told that their symptom was not serious, and 12% were treated for another condition. GPs have an important role in the identification and referral of people with oral cancer, and the clearly recognised symptoms identified in this study can be used to aid assessment and decision-making. Interventions to promote the prompt identification of oral cancer in general practice such as the opportunistic screening of high-risk patients may help to improve the poor survival rates. PMID:26682494

  8. Vocational thresholds: developing expertise without certainty in general practice medicine.

    PubMed

    Vaughan, Karen

    2016-06-01

    INTRODUCTION This paper argues that particular experiences in the workplace are more important than others and can lead to transformational learning. This may enable practitioners to cross 'vocational thresholds' to new ways of being. AIM A notion of 'vocational thresholds' is developed, aiming to help build an understanding of the most powerful learning experiences of general practitioners (GPs). Vocational thresholds takes its cue from the idea of 'threshold concepts' - concepts that transform perspectives and integrate previously disconnected or hidden knowledge, sometimes in ways that are 'troublesome' to previously held beliefs. METHODS The paper is based on a thematic analysis of 57 GPs' brief written accounts of a particularly powerful learning experience during their development. Accounts were provided in a conference session about an ongoing study of workplace-based structured learning arrangements in the fields of general practice medicine, engineering, and building. FINDINGS Most GPs' accounts focused on development of dispositional attributes that moved them to a new understanding of themselves in relation to their work and patients. Just under two-thirds picked out informal and formal collegial relationships within purposeful learning arrangements as pivotal. A third picked out direct experiences with patients as shifting their perspective. CONCLUSION The emergent idea of vocational thresholds is offered as a way to frame the most important learning experiences identified by GPs. It supports a focus in early and ongoing development beyond accumulating clinical expertise and skills (knowing and doing), to dispositional capability (being) - vital for practitioners negotiating inherent and daily uncertainty. KEYWORDS General practitioners; Medical education; Vocational education; Identity; Learning experiences; Threshold concepts. PMID:27477551

  9. Long Term Effect on Professionals’ Knowledge, Practice and Attitudes towards User Involvement Four Years after Implementing an Organisational Development Plan: A Controlled Study

    PubMed Central

    Rise, Marit By; Steinsbekk, Aslak

    2016-01-01

    Background Health service organisations are increasingly implementing user involvement initiatives according to requirements from governments, such as user representation in administrational boards, better information to users, and more involvement of the users during treatment. Professionals are vital in all initiatives to enhance user involvement, and initiatives to increase involvement should influence the professionals’ practice and attitudes. The implementation of a development plan intending to enhance user involvement in a mental health hospital in Central Norway had no effect on the professionals after 16 months. The objective was therefore to investigate the long term effect on the professionals’ knowledge, practice and attitudes towards user involvement after four years. Methods This was a non-randomized controlled study including professionals from three mental health hospitals in Central Norway. A development plan intended to enhance user participation was implemented in one of the hospitals, including establishing a patient education centre and a user office, purchasing of user expertise, appointing contact professionals for next of kin, and improving of the centre’s information and the professional culture. The professionals at two other hospitals constituted the control group. All professionals were invited to answer the Consumer Participation Questionnaire (CPQ) and additional questions, at a four year interval. Results A total of 399 professionals participated (43% response rate). Comparing the changes in the intervention group with the changes in the control group, the results showed that the plan had improved some aspects of the professionals’ knowledge about the user involvement taking place in the hospital. In addition, some parts of the professionals’ practice of providing information to the service users was improved, and the development plan might have raised their awareness about insufficient involvement of next of kin

  10. Changing remuneration systems: effects on activity in general practice.

    PubMed Central

    Krasnik, A; Groenewegen, P P; Pedersen, P A; von Scholten, P; Mooney, G; Gottschau, A; Flierman, H A; Damsgaard, M T

    1990-01-01

    OBJECTIVE--To investigate the effects on general practitioners' activities of a change in their remuneration from a capitation based system to a mixed fee per item and capitation based system. DESIGN--Follow up study with data collected from contact sheets completed by general practitioners in one period before (March 1987) a change in their remuneration system and two periods after (March 1988, November 1988), with a control group of general practitioners with a mixed fee per item and capitation based system throughout. SETTING--General practices in Copenhagen city (index group) and Copenhagen county (control group). SUBJECTS--265 General practitioners in Copenhagen city, of whom 100 were selected randomly from the 130 who agreed to participate (10 exclusions) and 326 general practitioners in Copenhagen county. MAIN OUTCOME MEASURES--Number of consultations (face to face and by telephone) and renewals of prescriptions, diagnostic and curative services, and specialist and hospital referrals per 1000 enlisted patients in one week. RESULTS--Of the 75 general practitioners who completed all three sheets, four were excluded for incomplete data. Total contact rates per 1000 patients listed rose significantly compared with the rates before the change index in the city (100.0 before the change v 111.7 (95% confidence interval 106.4 to 117.4 after the change) and over the same time in the control group (100.0 v 106.0), but within a year these rates fell (to 104.2(99.1 to 109.6) and 104.0 respectively). There was an increase in consultations by telephone initially but not thereafter. Rates of examinations and treatments that attracted specific additional remuneration after the change rose significantly compared with those before (diagnostic services, 138.1 (118.7 to 160.5) and 159.5 (137.8 to 184.7) and curative services 194.6 (152.2 to 248.9) and 194.8(152.3 to 249.2) for second and third data collections respectively) and with the control group (diagnostic services 105

  11. Introducing a drug formulary to general practice — effects on practice prescribing costs

    PubMed Central

    Beardon, P.H.G.; Brown, S.V.; Mowat, D.A.E.; Grant, J.A.; McDevitt, D.G.

    1987-01-01

    A drug formulary comprising 249 preparations of 132 drugs and drug combinations was prepared by the partners in a three-doctor general practice serving more than 5000 patients. No attempt was made to change to generic prescribing nor were repeat prescription drugs altered. Introduction of the formulary in September 1981 was followed by an increase in the proportion of prescriptions containing drugs from the formulary from about 55% to more than 60% for both repeat and non-repeat prescriptions. The proportion of formulary drugs on non-repeat prescriptions reached a maximum of 78% within the first year with the additional influence of information feedback. Over the first year the level of formulary drugs used for both repeat and nonrepeat prescribing levelled off at about 62%. Even with these modest changes, when compared with the costs of general practice prescribing in Scotland as a whole, the introduction of the formulary resulted in savings of approximately 10% within the practice for the mean ingredient costs both per patient and per prescription. PMID:3449632

  12. Assessment of general education teachers' Tier 1 classroom practices: contemporary science, practice, and policy.

    PubMed

    Reddy, Linda A; Fabiano, Gregory A; Jimerson, Shane R

    2013-12-01

    Progress monitoring is a type of formative assessment. Most work on progress monitoring in elementary school settings has been focused on students. However, teachers also can benefit from frequent evaluations. Research addressing teacher progress monitoring is critically important given the recent national focus on teacher evaluation and effectiveness. This special topic section of School Psychology Quarterly is the first to showcase the current research on measuring Tier 1 instructional and behavioral management practices used by prekindergarten and elementary school teachers in general education settings. The three studies included in the special section describe the development and validation efforts of several teacher observational and self-report measures of instruction and/or behavioral management. These studies provide evidence for the utility of such assessments for documenting the use of classroom practices, and these assessment results may be leveraged in innovative coaching models to promote best practice. These articles also offer insight and ideas for the next generation of teacher practice assessment for the field. Finally, the special topic is capped by a commentary synthesizing the current work and offers "big ideas" for future measurement development, policy, and professional development initiatives. PMID:24341924

  13. Organisational culture and consultant nurse outcomes: Part 1--Organisational culture.

    PubMed

    Manley, K

    2000-01-01

    Organisational culture is presented as a complex concept underpinned by specific values, beliefs and assumptions that account for the way things are done. Strong organisational cultures and a number of other attributes are highlighted as having influence on performance. The role of leadership is recognised as key to facilitating cultural change, as is the use of approaches which clarify values and highlight contradictions between espoused culture and culture in practice. A three-year study in which a consultant nurse post in critical care was operationalised demonstrated the achievement of an organisational culture with positive impact on the unit in which it was based, on practitioners and their practice, and also on the trust. Transformational leadership combined with other facilitative processes, expertise in the practice of nursing, and other subroles of the consultant nurse are further highlighted as influential. PMID:11235414

  14. 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

  15. Factors associated with achieving continuity of care in general practice

    PubMed Central

    Roland, Martin; Mayor, Vidhu; Morris, Richard

    1986-01-01

    The continuity of care received by 128 patients in four Bristol group practices over a two-year period was measured. A high standard of continuity of care was found for many patients, even though they were registered with large training practices. Patients registered with practices operating personal lists received much better continuity of care than those registered with practices operating combined lists. Patients in the study regarded continuity of care as important, especially if they were registered with practices operating personal lists. All the doctors in the study appeared to regard continuity of care as important, although those operating personal lists were more positive in this view. PMID:3712344

  16. Description of a practice model for pharmacist medication review in a general practice setting

    PubMed Central

    Brandt, Mette; Hallas, Jesper; Graabæk, Trine; Pottegård, Anton

    2014-01-01

    Background Practical descriptions of procedures used for pharmacists’ medication reviews are sparse. Objective To describe a model for medication review by pharmacists tailored to a general practice setting. Methods A stepwise model is described. The model is based on data from the medical chart and clinical or laboratory data. The medication review focuses on the diagnoses of the patient instead of the individual drugs. Patient interviews are not part of the model. The model was tested in a pilot study by conducting medical reviews on 50 polypharmacy patients (i.e. receiving 7 or more drugs for regular use). Results The model contained seven main steps. Information about the patient and current treatment was collected in the first three steps, followed by identification of possible interventions related to either diagnoses or drugs in the fourth and fifth step. The sixth and seventh step concerned the reporting of interventions and the considerations of the GPs. 208 interventions were proposed among the 50 patients. The acceptance rate among the GPs was 82%. The most common interventions were lack of clinical or laboratory data (n=57, 27%) and drugs that should be discontinued as they had no indication (n=47, 23%). Most interventions were aimed at cardiovascular drugs. Conclusion We have provided a detailed description of a practical approach to pharmacists’ medication review in a GP setting. The model was tested and found to be usable, and to deliver a medication review with high acceptance rates. PMID:25243030

  17. Barriers to, and facilitators in, introducing integrated diabetes care in Ireland: a qualitative study of views in general practice

    PubMed Central

    Mc Hugh, Sheena; O'Mullane, Monica; Perry, Ivan J; Bradley, Colin

    2013-01-01

    Objective To examine the barriers to, and facilitators in, improving diabetes management from the general practice perspective, in advance of the implementation of an integrated model of care in Ireland. Design Qualitative using semistructured interviews. Setting Primary care in the Republic of Ireland. Participants Purposive sample of 29 general practitioners (GPs) and two practice nurses. Methods Data were analysed using a framework approach. Results The main barriers and facilitators occurred at the level of the health system but had a ripple effect at an organisational, professional and patient level. The lack of targeted remuneration for diabetes management in the Irish health system created apathy in general practice and was perceived to be indicative of the lack of value placed on chronic disease management in the health system. There were ‘pockets of interest’ among GPs motivated by ‘vocational’ incentives such as a sense of professional duty; however, this was not sufficient to drive widespread improvement. The hospital service was seen as an essential support for primary care management, although some participants referred to emerging tension between settings. The lack of coordination at the primary–secondary interface resulted in avoidable duplication and an ‘in the meantime’ period of uncertainty around when patients would be called or recalled by specialist services. Facilitators included the availability of nursing support and serendipitous access to services. The lack of resources in the community was considered to be at odds with policy to shift routine management to general practice, which is fast reaching saturation. Conclusions At present, intrinsic motivation is driving the improvement of diabetes care in Ireland. This will not be sufficient to implement the proposed reform including a national model of integrated care. Policymakers need to assess and prepare for the disparate levels of interest and infrastructure in primary care

  18. 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

  19. Ad Hoc Supervision of General Practice Registrars as a "Community of Practice": Analysis, Interpretation and Re-Presentation

    ERIC Educational Resources Information Center

    Clement, T.; Brown, J.; Morrison, J.; Nestel, D.

    2016-01-01

    General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also…

  20. Chemical hazards in the organisation.

    PubMed

    Winder, Chris

    2012-01-01

    The use of hazardous chemicals in organisations represents a substantial risk to occupational health, safety and the environment (OHSE). Organisational directors and managers have a responsibility to provide and maintain organisational management systems that manage these risks. The risk management approach of establishing organisational considerations, identifying chemical hazards (health and environmental), assessing and controlling risks and evaluating management activities has become the de facto means of managing organisational hazards in general and may be satisfactorily applied to the management of chemicals in the organisation. The Globally Harmonized System for the Classification and Labelling of Chemicals (GHS) is now at the forefront of major regulatory issues facing the chemicals manufacturing industry and downstream users of chemicals. The GHS offers one system for the classification of all dangerous, toxic and environmental (ecotoxic) effects of chemicals. Organisations should develop occupational health, safety and environment (OHSE) management systems which contain programs and procedures that contain systems for inventory control, hazard communication, competency training, risk assessment and control, transport and storage, monitoring and health surveillance, chemical emergencies (including accident investigation), waste minimisation and disposal, record keeping and management system review. PMID:22945564

  1. The practical usefulness of dermoscopy in general dermatology.

    PubMed

    Errichetti, E; Stinco, G

    2015-10-01

    Beside to traditional use, dermoscopy is more and more used in the assessment of other "general" dermatologic conditions, namely scalp and hair disorders (trichoscopy), nails abnormalities (onychoscopy), skin infections and infestations (entomodermoscopy), and cutaneous inflammatory diseases (inflammoscopy). Among the list of new applications of dermoscopy, the study of inflammatory dermatoses is probably the most promising topic in terms of development and usefulness, considering the large number of such disorders and the frequent problems in their differential diagnosis which the dermatologist encounters in own daily clinical practice. In this paper, we report selected relatively common clinical differential diagnosis issues concerning inflammatory dermatoses (and some clinically related noninflammatory conditions), analysing them by a dermoscopic point of view in order to assist their noninvasive resolution according to the available literature data and our personal experience, including papulosquamous dermatoses (guttate psoriasis, pityriasis lichenoides chronica, pityriasis rosea, lichen planus, lymphomatoid papulosis, classic pityriasis rubra pilaris, papulosquamous sarcoidosis, disseminated forms of porokeratosis and papulosquamous chronic GVHD), dermatoses presenting with erythematous-desquamative patches/plaques (plaque psoriasis, eczematous dermatitis, pityriasis rosea, mycosis fungoides, subacute cutaneous lupus erythematosus), palmar psoriasis vs. chronic hand eczema, scalp psoriasis vs. seborrheic dermatitis, erythematous-desquamative disorders typically involving the elbows (psoriasis vulgaris, circumscribed juvenile pityriasis rubra pilaris, dermatomyositis/Gottron's sign), itchy papulonodular dermatoses (hypertrophic lichen planus, prurigo nodularis, nodular scabies and acquired perforating dermatosis), common facial inflammatory skin diseases (rosacea, seborrheic dermatitis and demodicidosis), lichen sclerosus vs. morphea, urticaria vs. urticarial

  2. Constructing professional and organisational fields.

    PubMed

    Gurney, Robert

    2016-01-01

    Purpose - The purpose of this paper is to fill an apparent gap in the literature addressing issues of leadership and change - the development and activities of constructing and leading sports sciences and medicine professions, and similarly, the construction and leadership of multidisciplinary/inter-disciplinary organisations that practice sports sciences and medicine. Design/methodology/approach - This study incorporated explorations through conducting both interviews and survey questionnaires with members of Sports Medicine Australia (SMA). The interviews (qualitative) were semi-structured and asked questions addressing what changed, why change and how change was implemented. Findings - The health sciences and medicine professions moving to specialised sports sciences and medicine disciplines and SMA, evolved through forces driving the need for change (legitimacy, resource dependency, positioning and core competencies). Practical implications - The knowledge developed from understanding activities of change that traditional professions conducted to become specialised Disciplines and parallel changes in a single Discipline organisation evolving to an umbrella organisation (SMA), comprised a membership of specialised Disciplines, can act as a catalyst for inquiry by other professional and organisational groups. Originality/value - The findings of this study contributes to the literature investigating change in professional and organisations fields. More specifically, this study promotes inquiry into leadership practices of sports sciences and medicine, as contributors to the field of health services. PMID:26764964

  3. Practices, patients and (im)perfect data - feasibility of a randomised controlled clinical drug trial in German general practices

    PubMed Central

    2011-01-01

    Background Randomised controlled clinical (drug) trials supply high quality evidence for therapeutic strategies in primary care. Until now, experience with drug trials in German general practice has been sparse. In 2007/2008, the authors conducted an investigator-initiated, non-commercial, double-blind, randomised controlled pilot trial (HWI-01) to assess the clinical equivalence of ibuprofen and ciprofloxacin in the treatment of uncomplicated urinary tract infection (UTI). Here, we report the feasibility of this trial in German general practices and the implementation of Good Clinical Practice (GCP) standards as defined by the International Conference on Harmonisation (ICH) in mainly inexperienced general practices. Methods This report is based on the experience of the HWI-01 study conducted in 29 German general practices. Feasibility was defined by 1) successful practice recruitment, 2) sufficient patient recruitment, 3) complete and accurate data collection and 4) appropriate protection of patient safety. Results The final practice recruitment rate was 18%. In these practices, 79 of 195 screened UTI patients were enrolled. Recruitment differed strongly between practices (range 0-12, mean 2.8 patients per practice) and was below the recruitment goal of approximately 100 patients. As anticipated, practice nurses became the key figures in the screening und recruitment of patients. Clinical trial demands, in particular for completing symptom questionnaires, documentation of source data and reporting of adverse events, did not agree well with GPs' documentation habits and required support from study nurses. In many cases, GPs and practice staff seemed to be overwhelmed by the amount of information and regulations. No sudden unexpected serious adverse reactions (SUSARs) were observed during the trial. Conclusions To enable drug trials in general practice, it is necessary to adapt the setup of clinical research infrastructure to the needs of GPs and their practice

  4. Correlates of the Orthodontic Aspects of the General Dentist's Practice.

    ERIC Educational Resources Information Center

    Manasse, Robert J.; Dooley, Raynard J.

    1980-01-01

    A study undertaken to determine the extent of orthodontic referrals and treatment performed by general dentists is discussed. Results indicate that general practitioners who graduated after 1945 tend to make more referrals, and general practitioners who had treated patients orthodontically in their predoctoral training tend to continue in…

  5. General Education: Concept and Practice. ASHE Annual Meeting 1981 Paper.

    ERIC Educational Resources Information Center

    Flexner, Hans; Berrettini, Robert

    The perceptions of faculty and administrators regarding the following issues were assessed: the distinction between general and liberal education; the supporting philosophical or conceptual bases of general education; its societal goals and intellectual orientation; the place within general education of interdisciplinarity; and the role of general…

  6. An ethnography of midwifery work patterns during organisational redesign.

    PubMed

    Wilson, S M

    2000-01-01

    Despite a substantial increase in midwifery research since the early 1990's, there remains a lack of available research into the everyday practice of midwives. In general, hospitals are striving to reduce costs and increase efficiencies, so many hospital-based midwives are being exposed to hospital restructuring processes. The primary purpose of my research was to learn about the work patterns of hospital midwives during organisational redesign. A large Brisbane hospital, as part of its hospital-wide organisational redesign plan, merged two postnatal wards to create a new, larger unit. With this amalgamation, the ward midwives were exposed to several service delivery changes. Midwifery work patterns during this organisational change revealed a milieu characterised by a culture of business. The impact of change introduced ritual and personal elements that influenced midwifery work patterns. PMID:10947604

  7. Economic impact of homeopathic practice in general medicine in France.

    PubMed

    Colas, Aurélie; Danno, Karine; Tabar, Cynthia; Ehreth, Jenifer; Duru, Gérard

    2015-12-01

    Health authorities are constantly searching for new ways to stabilise health expenditures. To explore this issue, we compared the costs generated by different types of medical practice in French general medicine: i.e. conventional (CM-GP), homeopathic (Ho-GP), or mixed (Mx-GP).Data from a previous cross-sectional study, EPI3 La-Ser, were used. Three types of cost were analysed: (i) consultation cost (ii) prescription cost and (iii) total cost (consultation + prescription). Each was evaluated as: (i) the cost to Social Security (ii) the remaining cost (to the patient and/or supplementary health insurance); and (iii) health expenditure (combination of the two costs).With regard to Social Security, treatment by Ho-GPs was less costly (42.00 vs 65.25 for CM-GPs, 35 % less). Medical prescriptions were two-times more expensive for CM-GPs patients (48.68 vs 25.62 ). For the supplementary health insurance and/or patient out-of-pocket costs, treatment by CM-GPs was less expensive due to the lower consultation costs (6.19 vs 11.20 for Ho-GPs) whereas the prescription cost was comparable between the Ho-GPs and the CM-GPs patients (15.87 vs 15.24 respectively) . The health expenditure cost was 20 % less for patients consulting Ho-GPs compared to CM-GPs (68.93 vs 86.63 , respectively). The lower cost of medical prescriptions for Ho-GPs patients compared to CM-GPs patients (41.67 vs 63.72 ) was offset by the higher consultation costs (27.08 vs 22.68 respectively). Ho-GPs prescribed fewer psychotropic drugs, antibiotics and non-steroidal anti-inflammatory drugs.In conclusions management of patients by homeopathic GPs may be less expensive from a global perspective and may represent an important interest to public health. PMID:26152791

  8. 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

  9. 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

  10. Audit in general practice by a receptionist: a feasibility study.

    PubMed Central

    Essex, B; Bate, J

    1991-01-01

    OBJECTIVE--To examine whether audit can be done cost effectively by a practice's receptionist. DESIGN--The practice set goals for various aspects of care, and forms were devised for the receptionist to collect, analyse, and present data to assess whether these goals had been achieved in the previous year. SETTING--Six doctor practice in south London looking after 11,500 patients. MAIN OUTCOME MEASURES--Ability of receptionist to present data showing the level of attainment of the practice's goals; time spent on audit by receptionist each week. RESULTS--The practice set goals for immunisation; follow up of patients with abnormal cervical smears; frequency of recording of blood pressure and smoking habit; screening of patients over 75; care of diabetic patients and patients with serious mental illness; antenatal care; variations in workload; and availability of appointments. The receptionist was able to audit all these tasks in four hours a week; this increased her job satisfaction and extended her skills. A small amount of regular supervision was necessary--roughly 30 minutes a week in the first year of the study and 30 minutes a fortnight in the second--to ensure accuracy and deal with any difficulties that arose. CONCLUSION--The method developed enabled a receptionist to audit aspects of the practice cost effectively. There is great scope for enlarging the conventional role of the receptionist. PMID:1902382

  11. Organisational Blogs: Benefits and Challenges of Implementation

    ERIC Educational Resources Information Center

    Baxter, Gavin J.; Connolly, Thomas M.; Stansfield, Mark H.

    2010-01-01

    Purpose: The purpose of this paper is to identify the theoretical link between blogs and organisational learning. It aims to provide a set of practical guidelines on how to overcome the challenges of implementing an organisational blog. Design/methodology/approach: A literature review will be used to examine blogs and their association towards…

  12. Evidence-Based Practice: A Matrix for Predicting Phonological Generalization

    ERIC Educational Resources Information Center

    Gierut, Judith A.; Hulse, Lauren E.

    2010-01-01

    This paper describes a matrix for clinical use in the selection of phonological treatment targets to induce generalization, and in the identification of probe sounds to monitor during the course of intervention. The matrix appeals to a set of factors that have been shown to promote phonological generalization in the research literature, including…

  13. Making Progress in the General Curriculum: Rethinking Effective Instructional Practices

    ERIC Educational Resources Information Center

    Copeland, Susan R.; Cosbey, Joanna

    2009-01-01

    Research strongly supports including students with extensive support needs in general education settings and providing them access to the general curriculum. Yet, there is limited research indicating how to provide them authentic access to this curriculum. This article explores several instructional approaches to provide access including (a) use…

  14. Research in general practice--the germination of an idea.

    PubMed

    Nichols, W P; Dookun, R

    1998-09-12

    The concept, planning and initiation of a research project into the treatment of temporomandibular dysfunction carried out by a group of GDPs in their own practices is described. Reports of the experimental studies will be presented as a further series of papers. PMID:9785629

  15. 47 CFR 76.1001 - Unfair practices generally.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) Unfair practices involving terrestrial cable programming and terrestrial cable programming vendors. (1... cable operator that has an attributable interest in a terrestrial cable programming vendor to unduly or... prices, terms, and conditions for the sale of, terrestrial cable programming to any...

  16. Inservice Best Practices: The Learnings of General Education.

    ERIC Educational Resources Information Center

    Hutson, Harry

    A composite model of exemplary inservice education, derived from a selection of comprehensive sources and basic references in the field, is described. In examining best practice statements, differentiation was made between three domains of inservice. The procedural domain includes chiefly political questions of control, support, and delivery of…

  17. Nurse-led general practice blazes a trail.

    PubMed

    Pearce, Lynne

    2016-02-24

    The nurse-led Cuckoo Lane Surgery in London has been rated outstanding by the Care Quality Commission. Nurses run the practice and deliver most of the care to patients. Patient satisfaction rates are very high, and staff say Cuckoo Lane is an exceptionally rewarding place to work. PMID:26907124

  18. Integrating Geriatric Dentistry into General Practice Residency Programs.

    ERIC Educational Resources Information Center

    Lloyd, Patrick M.; Shay, Kenneth

    1989-01-01

    The predoctoral dental curriculum cannot provide the depth of experience and knowledge needed for the increasing representation of geriatric patients in family dental practices. A curriculum model designed to enhance knowledge and refine clinical skills in caring for the elderly is proposed. (MSE)

  19. 14 CFR 61.43 - Practical tests: General procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Section 61.43 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: PILOTS, FLIGHT INSTRUCTORS, AND GROUND INSTRUCTORS General § 61.43...; and (4) Demonstrating sound judgment. (b) The pilot flight crew complement required during...

  20. 14 CFR 61.43 - Practical tests: General procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Section 61.43 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: PILOTS, FLIGHT INSTRUCTORS, AND GROUND INSTRUCTORS General § 61.43...; and (4) Demonstrating sound judgment. (b) The pilot flight crew complement required during...

  1. 14 CFR 61.43 - Practical tests: General procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Section 61.43 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: PILOTS, FLIGHT INSTRUCTORS, AND GROUND INSTRUCTORS General § 61.43...; and (4) Demonstrating sound judgment. (b) The pilot flight crew complement required during...

  2. 14 CFR 61.43 - Practical tests: General procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Section 61.43 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: PILOTS, FLIGHT INSTRUCTORS, AND GROUND INSTRUCTORS General § 61.43...; and (4) Demonstrating sound judgment. (b) The pilot flight crew complement required during...

  3. Are Irish adult general practice consultation rates as low as official records suggest? A cross sectional study at six general practices.

    PubMed

    Behan, W; Molony, D; Beamer, C; Cullen, W

    2013-01-01

    Accurate data on primary care activity is key to health services planning and reconfiguration. Official data estimate general practice adult consultation rates to be 3.2 visits annually, based on patient self reports. We aim to estimate the consultation rate using practice based data and compare this to official estimates. We interrogated six general practices' information systems and estimated consultation rates based on practice, telephone, domiciliary and out of hours consultations by patients aged 18 years or older. The study population (20,706 patients) was representative of the national population in terms of age and GMS status. The mean consultation rate was 5.17, though this was higher among GMS-eligible patients and among older age groups. Estimates of consultation rates derived from practice based data are likely to be higher than that derived from other approaches. Using multiple sources of data will enhance accuracy of workload estimates and this will benefit service planning. PMID:24579407

  4. [General Strategies for Implementation of Clinical Practice Guidelines].

    PubMed

    Valenzuela-Flores, Adriana Abigail; Viniegra-Osorio, Arturo; Torres-Arreola, Laura Laura

    2015-01-01

    The need to use clinical practice guidelines (CPG) arises from the health conditions and problems that public health institutions in the country face. CPG are informative documents that help improve the quality of care processes and patient safety; having among its objectives, to reduce the variability of medical practice. The Instituto Mexicano del Seguro Social designed a strategic plan for the dissemination, implementation, monitoring and control of CPG to establish an applicable model in the medical units in the three levels of care at the Instituto. This paper summarizes some of the strategies of the plan that were made with the knowledge and experience of clinicians and managers, with which they intend to promote the adoption of the key recommendations of the guidelines, to promote a sense of belonging for health personnel, and to encourage changes in organizational culture. PMID:26506498

  5. Dialogue medicine: a health-liberating attitude in general practice.

    PubMed

    Hellström, O

    1998-11-01

    Dialogue medicine is presented as the prime means of understanding patients' illnesses. It is a practical attitude especially aimed to assist or inspire patients to consider, see and manage their illness-demanding efforts to unwittingly suppress or disguise such self-reproaching thoughts as are worse to bear than the feeling of being afflicted with disease. Along with diagnosing patients' perceived bodily disorders, doctors can choose to see them as persons whose ailments stand for efforts to manage their existence as communicative human beings. The core of the paper is an encounter between the author and a female patient which illuminates the usefulness of genuine dialogue in medical practice. The paper illustrates how the dialogical attitude helps patients to see and manage their difficult life-situations and how the doctor can be inspired to change and develop and improve his/her skills as a dialogue partner. Doctors' dialogical attitude in the encounter encompasses for example openness, empathy, sensitivity, courage, attentiveness and responsiveness, accompanied by concern, trust, respect, affection, appreciation and hope. The philosophical and theoretical foundations of the concept of dialogue medicine are sketched out and some practically significant traits are described. PMID:9887854

  6. 19 CFR 177.1 - General ruling practice and definitions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... from importers and other interested parties for rulings or information setting forth, with respect to a... information. Generally, a ruling may be requested under the provisions of this part only with respect to... Bulletin. (2) An “information letter” is a written statement issued by the Customs Service that does...

  7. 29 CFR 780.146 - Importance of relationship of the practice to farming generally.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 3 2012-07-01 2012-07-01 false Importance of relationship of the practice to farming... in Conjunction Withâ the Farming Operations § 780.146 Importance of relationship of the practice to farming generally. The inclusion of incidental practices in the definition of agriculture was not...

  8. 29 CFR 780.146 - Importance of relationship of the practice to farming generally.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Importance of relationship of the practice to farming... in Conjunction Withâ the Farming Operations § 780.146 Importance of relationship of the practice to farming generally. The inclusion of incidental practices in the definition of agriculture was not...

  9. 29 CFR 780.146 - Importance of relationship of the practice to farming generally.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 3 2011-07-01 2011-07-01 false Importance of relationship of the practice to farming... in Conjunction Withâ the Farming Operations § 780.146 Importance of relationship of the practice to farming generally. The inclusion of incidental practices in the definition of agriculture was not...

  10. 29 CFR 780.146 - Importance of relationship of the practice to farming generally.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 3 2014-07-01 2014-07-01 false Importance of relationship of the practice to farming... in Conjunction Withâ the Farming Operations § 780.146 Importance of relationship of the practice to farming generally. The inclusion of incidental practices in the definition of agriculture was not...

  11. 29 CFR 780.146 - Importance of relationship of the practice to farming generally.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 3 2013-07-01 2013-07-01 false Importance of relationship of the practice to farming... in Conjunction Withâ the Farming Operations § 780.146 Importance of relationship of the practice to farming generally. The inclusion of incidental practices in the definition of agriculture was not...

  12. General practice observed. A do-it-yourself medical centre.

    PubMed Central

    Ganner, A N; Lockie, A C

    1979-01-01

    A group practice commissioned a local building company to build their own medical centre comprising 370 m2 (4000 ft2) of building with an adequate car park at a total cost of 60 000 pounds with design to completion in nine months. A bank loan for 10 years was assigned to the partnership and each partner made his own arrangements for repayment. The updated cost for June 1979 is 80 000-85 000 pounds. Building a centre in this way is professionally and financially rewarding. Images FIG 2 PMID:519410

  13. [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

  14. An evaluation of direct access radiology in general practice

    PubMed Central

    Smith, G. Lindsay

    1979-01-01

    An analysis of the use of direct access to radiology by 71 general practitioners in Scotland is described and is based on 2,596 x-ray examinations in 2,409 patients during a period of six months. Almost half of the patients had to travel more than five miles for their examinations, but time lost in travelling was a much less important factor than the interval elapsing before the requested examination was completed. Nearly one third waited at least two weeks. Referral for diagnosis was by far the commonest reason and direct access was estimated to save 270 hospital outpatient appointments per month. I believe that general practitioners under-use rather than abuse radiology, which might be extended by a selective system of appointments. PMID:529241

  15. Organisational Structure & Change

    ERIC Educational Resources Information Center

    National Centre for Vocational Education Research (NCVER), 2006

    2006-01-01

    Structural change is seen as a way to meet the challenges of the future that face many organisations. While some writers agree that broad-ranging structural change may not always transform an organisation or enhance its performance, others claim that innovation will be a major source of competitive advantage to organisations, particularly when…

  16. A modified framework for rural general practice: the importance of recruitment and retention.

    PubMed

    Humphreys, J S; Rolley, F

    1998-04-01

    Whilst definitions of what constitutes general practice vary according to purpose, the pivotal role of general practitioners as key providers of health and medical services is acknowledged. Recent concerns to address both what general practitioners and their patients want and get from general practice stem from a recognized need to include stakeholder concerns about the adequacy of general practice alongside workforce issues such as recruitment and retention. Nowhere is this need so crucial as in rural areas where the range of health services is limited and major inequities exist in the availability of general practitioners. An extended framework for evaluating what general practitioners and their patients expect and receive from general practice, with particular reference to rural general practice in Australia is presented. Three inter-related dimensions of recruitment, retention and a whole patient/whole family approach to health care are suggested as underpinning this framework. The significance of each dimension to ensuring the provision of quality general practice care in rural communities, and the links between them, are outlined in the proposed framework. PMID:9579746

  17. Deliberate practice and acquisition of expert performance: a general overview.

    PubMed

    Ericsson, K Anders

    2008-11-01

    Traditionally, professional expertise has been judged by length of experience, reputation, and perceived mastery of knowledge and skill. Unfortunately, recent research demonstrates only a weak relationship between these indicators of expertise and actual, observed performance. In fact, observed performance does not necessarily correlate with greater professional experience. Expert performance can, however, be traced to active engagement in deliberate practice (DP), where training (often designed and arranged by their teachers and coaches) is focused on improving particular tasks. DP also involves the provision of immediate feedback, time for problem-solving and evaluation, and opportunities for repeated performance to refine behavior. In this article, we draw upon the principles of DP established in other domains, such as chess, music, typing, and sports to provide insight into developing expert performance in medicine. PMID:18778378

  18. Training for systemic general practice: a new approach from the Tavistock Clinic.

    PubMed Central

    Launer, J; Lindsey, C

    1997-01-01

    A new course at the Tavistock Clinic offers general practitioners (GPs) and primary care nurses a training based on family therapy principles but directed at developing skills and conceptualization across the whole range of general practice work. The course may point to a new way forward for postgraduate training in general practice, creating links with the social sciences and giving doctors and nurses appropriate training for the 'postmodern' world. PMID:9281876

  19. General Practice and Pandemic Influenza: A Framework for Planning and Comparison of Plans in Five Countries

    PubMed Central

    Patel, Mahomed S.; Phillips, Christine B.; Pearce, Christopher; Kljakovic, Marjan; Dugdale, Paul; Glasgow, Nicholas

    2008-01-01

    Background Although primary health care, and in particular, general practice will be at the frontline in the response to pandemic influenza, there are no frameworks to guide systematic planning for this task or to appraise available plans for their relevance to general practice. We aimed to develop a framework that will facilitate planning for general practice, and used it to appraise pandemic plans from Australia, England, USA, New Zealand and Canada. Methodology/Principal Findings We adapted the Haddon matrix to develop the framework, populating its cells through a multi-method study that incorporated the peer-reviewed and grey literature, interviews with general practitioners, practice nurses and senior decision-makers, and desktop simulation exercises. We used the framework to analyse 89 publicly-available jurisdictional plans at similar managerial levels in the five countries. The framework identifies four functional domains: clinical care for influenza and other needs, public health responsibilities, the internal environment and the macro-environment of general practice. No plan addressed all four domains. Most plans either ignored or were sketchy about non-influenza clinical needs, and about the contribution of general practice to public health beyond surveillance. Collaborations between general practices were addressed in few plans, and inter-relationships with the broader health system, even less frequently. Conclusions This is the first study to provide a framework to guide general practice planning for pandemic influenza. The framework helped identify critical shortcomings in available plans. Engaging general practice effectively in planning is challenging, particularly where governance structures for primary health care are weak. We identify implications for practice and for research. PMID:18509538

  20. Bipolar disorder in general practice: challenges and opportunities.

    PubMed

    Piterman, Leon; Jones, Kay M; Castle, David J

    2010-08-16

    General practitioners are involved in the continuing care and shared care of patients with chronic mental illness, including bipolar disorder. Psychiatrists are particularly reliant on GPs to monitor and treat comorbidities as well as the psychiatric condition itself. Management of chronic mental illness is compromised by a number of factors, including problems with diagnosis, physical comorbidity, erratic attendance and poor compliance with treatment. Diagnosis of bipolar disorder is often delayed, and differential diagnoses to be considered include unipolar depression, anxiety disorder, drug and alcohol dependence, personality disorder, attention deficit hyperactivity disorder, and general medical and central nervous system diseases. New Medicare items have been introduced under the Better Access to Mental Health Care initiative. However, uptake for patients with chronic psychiatric illness, including bipolar disorder, is low. Patients with bipolar disorder may be prone to a range of comorbid psychological, social and physical problems, and GPs need to be vigilant to detect and manage comorbidity and social problems as part of the overall plan. This includes assistance with certification for sickness and unemployment benefits. GPs may become involved during crises affecting patients and this may pose significant problems for GPs who need to provide ongoing care following patient discharge from hospital. Despite these difficulties, opportunities exist for GPs to play a vital and ongoing role in the management of patients with bipolar disorder. PMID:20712554

  1. Nonverbal treatment of neurosis; techniques for general practice.

    PubMed

    BATTEN, C T

    1959-03-01

    "Psychosomatic medicine" does not demand that the general practitioner function as a psychiatrist; rather, it is a psychiatric orientation that can increase the effectiveness of purely medical treatment for such conditions as neuroses. The general practitioner to whom the patient turns may achieve permanent results with nonverbal techniques where formal psychotherapy would be impracticable or unacceptable. The first aim is to relieve pressure so that the patient can regain his mental balance and thereby his self-confidence. Arts, hobbies, sports, and the like can be prescribed rather specifically according to the patient's personality and needs. Nutrition can be improved simply at first by prescribing needed additions to diet rather than imposing restrictions. Vitamin deficiency may by itself be the cause of neurosis or more serious mental disease, whereas psychic stress by itself may create a need for additional vitamin intake. Hormone therapy may be extremely helpful but must be based on clear indication and limited to specific purposes. Since lack of sleep and rest quickly impairs mental function, it is important for neurotic persons to learn relaxation as a necessity for sleep. Sedatives may be used in a crisis but should be abandoned as soon as possible. With all drugs there are problems of excess and habituation. The least, the mildest, the shortest dosage is the ideal. THE INITIAL STEPS OF PSYCHOTHERAPY ARE AVAILABLE TO ANY PHYSICIAN: Establishing rapport, noting how complaints are stated, encouraging ventilation, winning confidence rather than immediate results. PMID:13638823

  2. NONVERBAL TREATMENT OF NEUROSIS—Techniques for General Practice

    PubMed Central

    Batten, Charles T.

    1959-01-01

    “Psychosomatic medicine” does not demand that the general practitioner function as a psychiatrist; rather, it is a psychiatric orientation that can increase the effectiveness of purely medical treatment for such conditions as neuroses. The general practitioner to whom the patient turns may achieve permanent results with nonverbal techniques where formal psychotherapy would be impracticable or unacceptable. The first aim is to relieve pressure so that the patient can regain his mental balance and thereby his self-confidence. Arts, hobbies, sports, and the like can be prescribed rather specifically according to the patient's personality and needs. Nutrition can be improved simply at first by prescribing needed additions to diet rather than imposing restrictions. Vitamin deficiency may by itself be the cause of neurosis or more serious mental disease, whereas psychic stress by itself may create a need for additional vitamin intake. Hormone therapy may be extremely helpful but must be based on clear indication and limited to specific purposes. Since lack of sleep and rest quickly impairs mental function, it is important for neurotic persons to learn relaxation as a necessity for sleep. Sedatives may be used in a crisis but should be abandoned as soon as possible. With all drugs there are problems of excess and habituation. The least, the mildest, the shortest dosage is the ideal. The initial steps of psychotherapy are available to any physician: Establishing rapport, noting how complaints are stated, encouraging ventilation, winning confidence rather than immediate results. PMID:13638823

  3. The effort to control time in the 'new' general practice.

    PubMed

    Macbride-Stewart, Sara

    2013-05-01

    Since the 1980s and 1990s doctors in the UK have reported a lack of time; this has been reproduced in the reorganisation of work through various contracts and regulatory mechanisms. I draw on interviews with 32 General Practitioners (GPs) in Wales about their everyday work, focusing on accounts about the limited nature of their time. I use Adams' analysis of the rationalisation of work time through the processes of commodification, compression, and colonisation, to explore tensions between traditional and new ways of doctoring. While it was possible to find evidence of traditional ways of managing time that shaped the activities of doctors and controlled those activities, the doctors were not passive participants in the rationalisation of work time. Rather they actively modified its processes using notions of professionalism that are aligned to traditional doctoring, and which offer new ways of doing and being a professional. PMID:22765280

  4. Comorbidity Patterns in Patients with Chronic Diseases in General Practice

    PubMed Central

    García-Olmos, Luis; Salvador, Carlos H.; Alberquilla, Ángel; Lora, David; Carmona, Montserrat; García-Sagredo, Pilar; Pascual, Mario; Muñoz, Adolfo; Monteagudo, José Luis; García-López, Fernando

    2012-01-01

    Introduction Healthcare management is oriented toward single diseases, yet multimorbidity is nevertheless the rule and there is a tendency for certain diseases to occur in clusters. This study sought to identify comorbidity patterns in patients with chronic diseases, by reference to number of comorbidities, age and sex, in a population receiving medical care from 129 general practitioners in Spain, in 2007. Methods A cross-sectional study was conducted in a health-area setting of the Madrid Autonomous Region (Comunidad Autónoma), covering a population of 198,670 individuals aged over 14 years. Multiple correspondences were analyzed to identify the clustering patterns of the conditions targeted. Results Forty-two percent (95% confidence interval [CI]: 41.8–42.2) of the registered population had at least one chronic condition. In all, 24.5% (95% CI: 24.3–24.6) of the population presented with multimorbidity. In the correspondence analysis, 98.3% of the total information was accounted for by three dimensions. The following four, age- and sex-related comorbidity patterns were identified: pattern B, showing a high comorbidity rate; pattern C, showing a low comorbidity rate; and two patterns, A and D, showing intermediate comorbidity rates. Conclusions Four comorbidity patterns could be identified which grouped diseases as follows: one showing diseases with a high comorbidity burden; one showing diseases with a low comorbidity burden; and two showing diseases with an intermediate comorbidity burden. PMID:22359665

  5. Urinary tract infections in adult general practice patients.

    PubMed Central

    Hummers-Pradier, Eva; Kochen, Michael M

    2002-01-01

    Urinary tract infections (UTIs) are symptomatic infections of the urinary tract, mainly caused by the bacterium Escherichia coli. One in two women suffers from a UTI at least once in her life. The young and sexually active are particulaly affected, but it is also seen in elderly, postmenopausal women. The likelihood of recurrence is high. Diagnosis is made with regard to typical complaints and the presence of leucocytes and nitrites in the urine. A culture is unnecessary in most cases. Uncomplicated UTI should be distinguished from complicated UTI, which has a risk of severe illness. The treatment of choice--short-term therapy with trimethoprim or nitrofurantoin--is successful in over 80% of the cases. Co-trimoxazol fluoroquinolones or cephalsporins are not considered first-choice drugs. There are indications that general practitioners' (GPs') management of UTI is not always optimal, specifically concerning diagnostic tests, the application of second-choice antibiotics, and the length of prescribed treatment courses. Many points relevant to GPs requirefurther research, such as epidemiology and resistance of urinary pathogens in the community and natural history of UTI, as well as optimal management in elderly or complicated patients and men. PMID:12236281

  6. General practice, clinical intention and the Sexual Offences Act 2003

    PubMed Central

    2009-01-01

    General practitioners must be capable of regularly taking ‘ultimate’ responsibility for difficult decisions in situations of clinical complexity and uncertainty. The Sexual Offences Act 2003 criminalises all sexual activity with a child under the age of 16. However, those who act with the purpose of protecting a child from a sexually transmitted infection, protecting the physical safety of a child, preventing the child from becoming pregnant or promoting the child's emotional well-being by the giving of advice will not commit an offence. Medicolegal academic writers have compared the legal separation of intention and foreseeability with the special defence of double-effect used in the palliative care context. This paper seeks to draw upon legal principles in constructing an ethical framework for analysis of this issue. It is hoped that this case study will stimulate further discussion, clarify the moral reasoning underpinning the existing guidelines for GPs and how the doctrine or principle of double effect can be used outside the palliative medicine context. PMID:25949594

  7. Action Research and Organisational Learning: A Norwegian Approach to Doing Action Research in Complex Organisations

    ERIC Educational Resources Information Center

    Eikeland, Olav

    2012-01-01

    The purpose of this article is to present a specific approach to the practice of action research "in complex organisations". Clearly, there are many approaches to the challenge of doing action research in organisations; approaches that are, and also must be, quite context dependent and specific. But my purpose is neither to give an overview nor a…

  8. Organisational Learning and the Organisational Life Cycle: The Differential Aspects of an Integrated Relationship in SMEs

    ERIC Educational Resources Information Center

    Tam, Steven; Gray, David E.

    2016-01-01

    Purpose: The purpose of this study is to relate the practice of organisational learning in small- and medium-sized enterprises (SMEs) to the organisational life cycle (OLC), contextualising the differential aspects of an integrated relationship between them. Design/methodology/approach: It is a mixed-method study with two consecutive phases. In…

  9. Problems in Communications with Patients in General Surgery Outpatient Practice

    PubMed Central

    Yilmaz, Tonguc Utku; Gumus, Enes; Salman, Bulent

    2015-01-01

    Objective: Communication between the patient and physician is central to medical care. However communication skills in Turkey haven’t been gained so much concern. This situation effect the national quality of health care. Here, we tried to perform some basic communication skills and to find the problems with the possible solution suggestions. Materials and Methods: The study was conducted for a month in general surgery outpatient department located in the slum part of Ankara with low socio-economic population. Basic communication skills were performed. The age, sex, education levels of the patients were obtained. Total symptom expression and interview time were recorded. Previous medical histories were asked. Interruptions including telephone, door knocking were noted. The questions of the patients at the end of the interview classified as hospital setting, nutrition and treatment. Results: Total 410 interviews were analysed. Mean symptom expression and interview times were 22.9 sec and 7.05 min, respectively. Educated patients, males and young patients expressed symptoms longer than the others (p<0.05). There were 174 interruptions in which total interview time signifantly increased than the non interrupted ones (p<0.05). Final questions about hospital setting were signifantly higher in illiterate patients than the educated ones (p<0.05). Awareness of medical history is higher in educated and young patients. Conclusion: Basic communications skills can be performed whether in rural regions. Much more concern should be given to the education of communication skills. The obstacles in communication in medicine are low education levels, and unorganised health system. PMID:26644767

  10. Factors predicting team climate, and its relationship with quality of care in general practice

    PubMed Central

    2009-01-01

    Background Quality of care in general practice may be affected by the team climate perceived by its health and non-health professionals. Better team working is thought to lead to higher effectiveness and quality of care. However, there is limited evidence available on what affects team functioning and its relationship with quality of care in general practice. This study aimed to explore individual and practice factors that were associated with team climate, and to explore the relationship between team climate and quality of care. Methods Cross sectional survey of a convenience sample of 14 general practices and their staff in South Tyneside in the northeast of England. Team climate was measured using the short version of Team Climate Inventory (TCI) questionnaire. Practice characteristics were collected during a structured interview with practice managers. Quality was measured using the practice Quality and Outcome Framework (QOF) scores. Results General Practitioners (GP) had a higher team climate scores compared to other professionals. Individual's gender and tenure, and number of GPs in the practice were significantly predictors of a higher team climate. There was no significant correlation between mean practice team climate scores (or subscales) with QOF scores. Conclusion The absence of a relationship between a measure of team climate and quality of care in this exploratory study may be due to a number of methodological problems. Further research is required to explore how to best measure team functioning and its relationship with quality of care. PMID:19653911

  11. Simulated patients in general practice: a different look at the consultation.

    PubMed Central

    Rethans, J J; van Boven, C P

    1987-01-01

    To develop a better empirical basis for developing quality assessment in general practice three simulated patients made appointments with 48 general practitioners during actual surgery hours and collected facts about their performance. The simulated patients were indistinguishable from real patients and presented a standardised story of a symptomatic urinary tract infection. Two months later the same general practitioners received a written simulation about a patient who had the same urinary tract infection and were asked how they would handle this in real practice. Both results were scored against an existing consensus standard. The overall score for both methods did not show any substantial differences. A more differentiated analysis, however, showed that general practitioners performed significantly better with simulated patients. It also showed that general practitioners answering the written simulation performed significantly more unnecessary and superfluous actions. The results of this study show that the use of simulated patients seems to show the efficient performance of general practitioners in practice. PMID:3105753

  12. Consultation competence in general practice: establishing the face validity of prioritized criteria in the Leicester assessment package.

    PubMed Central

    Fraser, R C; McKinley, R K; Mulholland, H

    1994-01-01

    AIM. This study set out to test the face validity of prioritized criteria of consultation competence in general practice as contained in the Leicester assessment package. METHOD. A questionnaire was sent to a geographically stratified random sample of 100 members of the United Kingdom Association of Course Organisers to seek their views on the categories, components and weightings contained in the Leicester assessment package and to determine the proportion of respondents who rejected or suggested a new category, component or weighting or reallocated components to other categories or amended weightings. Their views were sought on a six-point scale (strongly approve, approve, tend to approve, tend to disapprove, disapprove and strongly disapprove). RESULTS. There was a 73% response rate. Of the respondents 99% either strongly approved or approved of the overall set of categories of consultation competence. Only two respondents (3%) expressed any disapproval of individual categories. Thirty five of the 39 suggested components of consultation competence were supported by more than 80% of respondents. There was minimal support for excluding any categories or components of consultation competence, for moving any components to different categories or for the inclusion of new categories or components. Eighty eight per cent of respondents were in favour of the need to identify priorities between any agreed categories of consultation competence and 79% expressed approval of the suggested weightings. Although 42% of respondents indicated a wish for some alteration in weightings, the mean values for all consultation categories suggested by all respondents were almost identical to the original weightings in the Leicester package. CONCLUSION. The face validity of the categories and components of consultation competence contained in the Leicester assessment package has been established, and the suggested weightings of consultation categories have been validated. Consequently

  13. Missed appointments in general practice: retrospective data analysis from four practices.

    PubMed

    Neal, R D; Lawlor, D A; Allgar, V; Colledge, M; Ali, S; Hassey, A; Portz, C; Wilson, A

    2001-10-01

    Little is known about which patients miss appointments or why they do so. Using routinely collected data from four practices, we aimed to determine whether patients who missed appointments differed in terms of their age, sex, and deprivation scores from those who did not, and to examine differences between the practices with respect to missed appointments. The likelihood of someone missing at least one appointment was independently associated with being female, living in a deprived area, and being a young adult. Living in a deprived area was associated with a threefold increase in the likelihood of missing an appointment, and the extent of this association was the same across all four practices. Interventions aimed at reducing missed appointments need to be based upon these findings. PMID:11677708

  14. Contribution of academic departments of general practice to undergraduate teaching, and their plans for curriculum development.

    PubMed Central

    Robinson, L A; Spencer, J A; Jones, R H

    1994-01-01

    BACKGROUND. In 1991, the General Medical Council suggested the development of a new undergraduate curriculum, on a 'core plus electives' basis. The combination of National Health Service reforms and the rising profile of academic departments of general practice had led to a consideration of general practice as an alternative teaching environment. These departments now face escalating expectations from their medical schools of their ability to provide additional community based teaching. AIM. The aim of this study was to investigate the present contribution of academic departments of general practice to undergraduate teaching and their plans for curriculum development, including the introduction of community-based clinical skills teaching. METHOD. A questionnaire was circulated in June 1993 to all academic departments of general practice in the United Kingdom and Eire. RESULTS. Twenty seven out of 28 questionnaires were returned. Twenty two departments provided pre-clinical teaching and all provided a clinical practice attachment. Eight medical schools were organizing community-based clinical skills teaching, and in two this formed the basis for a community-based medical attachment. Eight planned to reduce the factual content of their curricula and introduce problem-based learning while nine were contemplating a 'core plus electives' option. Fourteen medical schools had primary care input in teaching basic clinical skills and an additional seven planned to introduce this. Problems encountered by the general practitioner tutors in teaching clinical skills included insufficient time and resources and poor self-esteem; they identified a need for good central and peripheral organization. CONCLUSION. Compared with a 1988 study, academic departments of general practice are increasingly involved in teaching both general practice and general medical skills at undergraduate level. Curriculum change is occurring rapidly, with an increasing trend towards community teaching

  15. 'Ethos' Enabling Organisational Knowledge Creation

    NASA Astrophysics Data System (ADS)

    Matsudaira, Yoshito

    This paper examines knowledge creation in relation to improvements on the production line in the manufacturing department of Nissan Motor Company and aims to clarify embodied knowledge observed in the actions of organisational members who enable knowledge creation will be clarified. For that purpose, this study adopts an approach that adds a first, second, and third-person's viewpoint to the theory of knowledge creation. Embodied knowledge, observed in the actions of organisational members who enable knowledge creation, is the continued practice of 'ethos' (in Greek) founded in Nissan Production Way as an ethical basis. Ethos is knowledge (intangible) assets for knowledge creating companies. Substantiated analysis classifies ethos into three categories: the individual, team and organisation. This indicates the precise actions of the organisational members in each category during the knowledge creation process. This research will be successful in its role of showing the indispensability of ethos - the new concept of knowledge assets, which enables knowledge creation -for future knowledge-based management in the knowledge society.

  16. Mackenzie's puzzle--the cornerstone of teaching and research in general practice.

    PubMed

    Murdoch, J C

    1997-10-01

    The new-found popularity of generalism as a political force has emphasized the need to clarify the essential philosophy that underpins its practice, teaching, and research. Drawing on the example of Sir James Mackenzie, the author seeks to clarify certain essential issues that need to be emphasized if we are to promote and develop general practice as a distinct academic discipline. Dissatisfaction, uncertainty about our role, and continuing contact with real people seems to be essential to continuing creativity. PMID:9474833

  17. Mackenzie's puzzle--the cornerstone of teaching and research in general practice.

    PubMed Central

    Murdoch, J C

    1997-01-01

    The new-found popularity of generalism as a political force has emphasized the need to clarify the essential philosophy that underpins its practice, teaching, and research. Drawing on the example of Sir James Mackenzie, the author seeks to clarify certain essential issues that need to be emphasized if we are to promote and develop general practice as a distinct academic discipline. Dissatisfaction, uncertainty about our role, and continuing contact with real people seems to be essential to continuing creativity. PMID:9474833

  18. The Influence of Advanced General Dentistry Training on Practice Patterns of Iowa Dental Graduates.

    ERIC Educational Resources Information Center

    Bolden, Aljernon J.; And Others

    1992-01-01

    A study compared the practice patterns of 41 dentists with graduate training in general dentistry with those of 41 dentists without such training, in terms of number and types of procedures performed, patient characteristics, professional and community activities, and practice characteristics. Some differences were found, particularly in patient…

  19. The readability and utility of general dental practice patient information leaflets: an evaluation.

    PubMed

    Newton, J T

    1995-05-01

    One hundred and seventy-nine practice leaflets were assessed for readability and the amount of information they contained. In general most leaflets were quite difficult to read and provided only a minimum of information. Recommendations are made for practitioners who wish to improve their practice leaflets. PMID:7766454

  20. "Empathy" and "Sympathy" in Action: Attending to Patients' Troubles in Finnish Homeopathic and General Practice Consultations

    ERIC Educational Resources Information Center

    Ruusuvuori, Johanna

    2005-01-01

    This paper analyzes "empathy" and "sympathy" as situated practices, sequential processes that are coconstructed by the participants in the situation. The data consists of 228 sequences of patients' descriptions of their problematic experiences and professionals' responses to them in videorecorded general practice and homeopathic consultations. One…

  1. European COPD Audit: design, organisation of work and methodology.

    PubMed

    López-Campos, Jose Luis; Hartl, Sylvia; Pozo-Rodriguez, Francisco; Roberts, C Michael

    2013-02-01

    Clinical audit has an important role as an indicator of the clinical practice in a given community. The European Respiratory Society (ERS) chronic obstructive pulmonary disease (COPD) audit was designed as a pilot study to evaluate clinical practice variability as well as clinical and organisational factors related to outcomes for COPD hospital admissions across Europe. The study was designed as a prospective observational noninterventional cohort trial, in which 422 hospitals from 13 European countries participated. There were two databases: one for hospital's resources and organisation and one for clinical information. The study was comprised of an initial 8-week phase during which all consecutive cases admitted to hospital due to an exacerbation of COPD were identified and information on clinical practice was gathered. During the 90-day second phase, mortality and readmissions were recorded. Patient data were anonymised and encrypted through a multi-lingual web-tool. As there is no pan-European Ethics Committee for audits, all partners accepted the general ethical rules of the ERS and ensured compliance with their own national ethical requirements. This paper describes the methodological issues encountered in organising and delivering a multi-national European audit, highlighting goals, barriers and achievements, and provides valuable information for those interested in developing clinical audits. PMID:22599361

  2. General practitioners’ and students’ experiences with feedback during a six-week clerkship in general practice: a qualitative study

    PubMed Central

    Gran, Sarah Frandsen; Brænd, Anja Maria; Lindbæk, Morten; Frich, Jan C.

    2016-01-01

    Objective Feedback may be scarce and unsystematic during students' clerkship periods. We wanted to explore general practitioners' (GPs) and medical students' experiences with giving and receiving supervision and feedback during a clerkship in general practice, with a focus on their experiences with using a structured tool (StudentPEP) to facilitate feedback and supervision. Design Qualitative study. Setting Teachers and students from a six-week clerkship in general practice for fifth year medical students were interviewed in two student and two teacher focus groups. Subjects 21 GPs and nine medical students. Results We found that GPs first supported students' development in the familiarization phase by exploring the students' expectations and competency level. When mutual trust had been established through the familiarization phase GPs encouraged students to conduct their own consultations while being available for supervision and feedback. Both students and GPs emphasized that good feedback promoting students' professional development was timely, constructive, supportive, and focused on ways to improve. Among the challenges GPs mentioned were giving feedback on behavioral issues such as body language and insensitive use of electronic devices during consultations or if the student was very insecure, passive, and reluctant to take action or lacked social or language skills. While some GPs experienced StudentPEP as time-consuming and unnecessary, others argued that the tool promoted feedback and learning through mandatory observations and structured questions. Conclusion Mutual trust builds a learning environment in which supervision and feedback may be given during students' clerkship in general practice. Structured tools may promote feedback, reflection and learning. Key PointsObserving the teacher and being supervised are essential components of Medical students' learning during general practice clerkships.Teachers and students build mutual trust in the

  3. Safety climate in English general practices: workload pressures may compromise safety

    PubMed Central

    Reeves, David; Marsden, Kate; Avery, Anthony

    2015-01-01

    Abstract Objectives Although most health care interactions in the developed world occur in general practice, most of the literature on patient safety has focused on secondary care services. To address this issue, we have constructed a patient safety toolkit for English general practices. We report how practice and respondent characteristics affect scores on our safety climate measure, the PC‐Safequest, and address recent concerns with high levels of workload in English general practices. Methods We administered the PC‐Safequest, a 30‐item tool that was designed to measure safety climate in primary care practices, to 335 primary care staff members in 31 practices in England. Practice characteristics, such as list size and deprivation in the area the practice served, and respondent characteristics, such as whether the respondent was a manager, were also collected and used in a multilevel analysis to predict PC‐Safequest scores. Results Managers gave their practices significantly higher safety climate scores than did non‐managers. Respondents with more years of experience had a more negative perception of the level of workload in their practice. Practices with more registered patients and in areas of higher deprivation provided lower safety climate scores. Conclusions Managers rated their practices more positively on our safety climate measure, so the differences between the perceptions of managers and other staff may need to be reduced in order to build a strong safety culture. Excessive workload for more experienced staff and lower safety climate scores for larger practices may reflect ‘burnout’. Concerns that pressures in primary care could affect patient safety are discussed. PMID:26278127

  4. Corporate information systems in health organisations.

    PubMed

    Smith, J

    1997-01-01

    This paper presents an overview of the nature of corporate information systems and their applications in health organisations. It emphasises the importance of financial and human resource information in the creation of a corporate data model. The paper summarises the main features of finance and human resource systems as they are used in health organisations. It looks at a series of case studies carried out in health organisations, which were selected on the basis of their representation of different aspects of service delivery. It also discusses the theoretical and practical perspectives of the systems themselves, their roles in information management, executive and decision support, and in planning and forecasting. PMID:10173702

  5. A qualitative evaluation of New Zealand consumers perceptions of general practice nurses

    PubMed Central

    2013-01-01

    Background An important consideration in health service delivery is ensuring that services meet consumer needs and that consumers are satisfied with service delivery. Patient satisfaction can impact on compliance with suggested treatments and therefore impact on health outcomes. Comparatively few studies have explored consumer satisfaction with nurses in general practice. Methods A sub-group of 18 consumers from a larger quantitative evaluation of consumer satisfaction with New Zealand general practice nurses participated in semi-structured telephone interviews. Interview data was analysed using thematic analysis. Results Four major themes emerged from the data. These themes highlighted that, despite confusion experienced by some consumers regarding the practice nurse role, consumers were happy with the level of care provided by them. Consumers felt valued by Practice Nurses and considered them competent and highly knowledgeable. Findings also convey that consumers appreciate the accessibility and financial benefits of utilising the services of practice nurses. Conclusions Consumers are highly satisfied with practice nurse service delivery and value their relationships with these health professionals. Consumers revealed that greater clarity around the practice nurse role and their scope of practice may enhance their utilisation. Spreading the message of practice nurses being the right person to deliver care, within their scope of practice, at the right time may have the potential to provide more timely care within the primary care setting. PMID:23433311

  6. Testing for sexually transmitted infections in general practice: cross-sectional study

    PubMed Central

    2010-01-01

    Background Primary care is an important provider of sexual health care in England. We sought to explore the extent of testing for chlamydia and HIV in general practice and its relation to associated measures of sexual health in two contrasting geographical settings. Methods We analysed chlamydia and HIV testing data from 64 general practices and one genitourinary medicine (GUM) clinic in Brent (from mid-2003 to mid-2006) and 143 general practices and two GUM clinics in Avon (2004). We examined associations between practice testing status, practice characteristics and hypothesised markers of population need (area level teenage conception rates and Index of Multiple Deprivation, IMD scores). Results No HIV or chlamydia testing was done in 19% (12/64) of general practices in Brent, compared to 2.1% (3/143) in Avon. In Brent, the mean age of general practitioners (GPs) in Brent practices that tested for chlamydia or HIV was lower than in those that had not conducted testing. Practices where no HIV testing was done had slightly higher local teenage conception rates (median 23.5 vs. 17.4/1000 women aged 15-44, p = 0.07) and served more deprived areas (median IMD score 27.1 vs. 21.8, p = 0.05). Mean yearly chlamydia and HIV testing rates, in practices that did test were 33.2 and 0.6 (per 1000 patients aged 15-44 years) in Brent, and 34.1 and 10.3 in Avon, respectively. In Brent practices only 20% of chlamydia tests were conducted in patients aged under 25 years, compared with 39% in Avon. Conclusions There are substantial geographical differences in the intensity of chlamydia and HIV testing in general practice. Interventions to facilitate sexually transmitted infection and HIV testing in general practice are needed to improve access to effective sexual health care. The use of routinely-collected laboratory, practice-level and demographic data for monitoring sexual health service provision and informing service planning should be more widely evaluated. PMID:21047396

  7. Algorithm linking patients and general practices in Denmark using the Danish National Health Service Register

    PubMed Central

    Kjaersgaard, Maiken Ina Siegismund; Vedsted, Peter; Parner, Erik Thorlund; Bech, Bodil Hammer; Vestergaard, Mogens; Flarup, Kaare Rud; Fenger-Grøn, Morten

    2016-01-01

    Background The patient list system in Denmark assigns virtually all residents to a general practice. Nevertheless, historical information on this link between patient and general practice is not readily available for research purposes. Objectives To develop, implement, and evaluate the performance of an algorithm linking individual patients to their general practice by using information from the Danish National Health Service Register and the Danish Civil Registration System. Materials and methods The National Health Service Register contains information on all services provided by general practitioners from 1990 and onward. On the basis of these data and information on migration history and death obtained from the Civil Registration System, we developed an algorithm that allocated patients to a general practice on a monthly basis. We evaluated the performance of the algorithm between 2002 and 2007. During this time period, we had access to information on the link between patients and general practices. Agreement was assessed by the proportion of months for which the algorithm allocated patients to the correct general practice. We also assessed the proportion of all patients in the patient list system for which the algorithm was able to suggest an allocation. Results The overall agreement between algorithm and patient lists was 98.6%. We found slightly higher agreement for women (98.8%) than for men (98.4%) and lower agreement in the age group 18–34 years (97.1%) compared to all other age groups (≥98.6%). The algorithm had assigned 83% of all patients in the patient list system after 1 year of follow-up, 91% after 2 years of follow-up, and peaked at 94% during the fourth year. Conclusion We developed an algorithm that enables valid and nearly complete linkage between patients and general practices. The algorithm performs better in subgroups of patients with high health care needs. The algorithm constitutes a valuable tool for primary health care research. PMID

  8. An ethnographic exploration of influences on prescribing in general practice: why is there variation in prescribing practices?

    PubMed Central

    2013-01-01

    Background Prescribing is a core activity for general practitioners, yet significant variation in the quality of prescribing has been reported. This suggests there may be room for improvement in the application of the current best research evidence. There has been substantial investment in technologies and interventions to address this issue, but effect sizes so far have been small to moderate. This suggests that prescribing is a decision-making process that is not sufficiently understood. By understanding more about prescribing processes and the implementation of research evidence, variation may more easily be understood and more effective interventions proposed. Methods An ethnographic study in three Scottish general practices with diverse organizational characteristics. Practices were ranked by their performance against Audit Scotland prescribing quality indicators, incorporating established best research evidence. Two practices of high prescribing quality and one practice of low prescribing quality were recruited. Participant observation, formal and informal interviews, and a review of practice documentation were employed. Results Practices ranked as high prescribing quality consistently made and applied macro and micro prescribing decisions, whereas the low-ranking practice only made micro prescribing decisions. Macro prescribing decisions were collective, policy decisions made considering research evidence in light of the average patient, one disease, condition, or drug. Micro prescribing decisions were made in consultation with the patient considering their views, preferences, circumstances and other conditions (if necessary). Although micro prescribing can operate independently, the implementation of evidence-based, quality prescribing was attributable to an interdependent relationship. Macro prescribing policy enabled prescribing decisions to be based on scientific evidence and applied consistently where possible. Ultimately, this influenced prescribing

  9. Generalization of Tactics in Tag Rugby from Practice to Games in Middle School Physical Education

    ERIC Educational Resources Information Center

    Lee, Myung-Ah; Ward, Phillip

    2009-01-01

    Background: Many of the issues relating to game performance of students found in the physical education literature can be considered a failure of generalization from practices to games, and from games to games. However, no study in secondary physical education has examined generalization effects as a result of effective game pedagogy in the…

  10. An Investigation of Inclusionary Practices by General Education Teachers in Middle School Classrooms

    ERIC Educational Resources Information Center

    Massingill, Charmaine Shawntel

    2011-01-01

    This study investigated teacher-reported inclusionary practices and strategies in general education classrooms grades 6, 7, and 8. Students with disabilities are being educated in the general education classroom for varying amounts of time during the school day by classroom teachers with varying amounts of experience with special education…

  11. Relation between night visit rates and deprivation measures in one general practice.

    PubMed Central

    Carlisle, R D; Johnstone, S P; Pearson, J C

    1993-01-01

    OBJECTIVE--To compare night visit rates in different electoral wards of one general practice with the Jarman and Townsend deprivation scores and unemployment rates. DESIGN--Analysis of computerised workload data. SETTING--General practice in centre of Mansfield, Nottinghamshire. OUTCOME MEASURE--Visits made in 588 nights to the 11,998 patients on the practice list. RESULTS--Night visit rates in 15 electoral wards varied from 19.6 to 55.3 visits per 1000 patients per year. The rates showed a significant association with the Townsend score (p = 0.004) and the unemployment rate (p = 0.03) but not with the Jarman score (p = 0.3). The Townsend score explained 49% of the variability; unemployment explained 31% and the Jarman score explained 9%. CONCLUSIONS--Even in a general practice not eligible for deprivation payments there was a 2.8-fold variation in night visit rates between wards. In this practice the Townsend score was significantly better at predicting night visit rates than the Jarman score. This method of looking at internal variation in workloads in computerised practices could give more direct data on the relation between deprivation and general practice workload than has previously been available. PMID:8518606

  12. A study of young peoples' attitudes to opportunistic Chlamydia testing in UK general practice

    PubMed Central

    Heritage, Joanne; Jones, Melvyn

    2008-01-01

    Objective The objective of this study was to assess young people's perceptions of being offered a chlamydia screening test in United Kingdom (UK) general practice. Methods This is qualitative study that uses focus groups and individual interviews with young adults (age 16 – 18) to assess their views. Results These young adults were a difficult group to gain access to. Two focus groups, one in a school, the other in a general practice (family practice), and 2 individual interviews were undertaken (total sample 18). Respondents were unfamiliar with Chlamydia, but broadly aware of sexually transmitted infections. General practice (family practice) was perceived as an acceptable place to deliver opportunistic screening, but participants felt that tests should not be initiated by GP receptionists. Novel delivery routes such as schools and "Pub"/Bar dispensing machines were discussed. Issues around stigma and confidentiality were also raised. Conclusion Opportunistic Chlamydia screening in UK general practice (family practic seems acceptable to young adults. While this is a difficult group to gain access to for research, attempts need to made to ensure acceptability to users of this programme. PMID:19099571

  13. The relationship between census-derived socio-economic variables and general practice consultation rates in three town centre practices.

    PubMed Central

    Carlisle, R; Johnstone, S

    1998-01-01

    BACKGROUND: The relationship between socio-economic factors and consultation rates is important in determining resource allocation to general practices. AIM: To determine the relationship between general practice surgery consultation rates and census-derived socio-economic variables for patients receiving the same primary and secondary care. METHOD: A retrospective analysis was taken of computerized records in three general practices in Mansfield, North Nottinghamshire, with 29,142 patients spread over 15 electoral wards (Jarman score range from -23 to +25.5). Linear regression analysis of surgery consultation rates at ward and enumeration district levels was performed against Jarman and Townsend deprivation scores and census socio-economic variables. RESULTS: Both the Townsend score (r2 = 59%) and the Jarman score (r2 = 39%) were associated with surgery consultation rates at ward level. The Townsend score had a stronger association than the Jarman score because all four of its component variables were individually associated with increased consultations compared with four out of eight Jarman components. CONCLUSIONS: Even in practices not eligible for deprivation payments there were appreciable differences in consultation rates between areas with different socio-economic characteristics. The results suggest that the variables used to determine deprivation payments should be reconsidered, and they support suggestions that payments should be introduced at a lower level of deprivation and administered on an enumeration district basis. PMID:10071401

  14. Clinical placements in Australian general practice: (Part 1) the experiences of pre-registration nursing students.

    PubMed

    McInnes, Susan; Peters, Kath; Hardy, Jennifer; Halcomb, Elizabeth

    2015-11-01

    An international shift towards strengthening primary care services has stimulated the growth of nursing in general (family) practice. As learning in the clinical setting comprises a core component of pre-registration nursing education, it is logical that clinical placement opportunities would follow the workforce growth in this setting. Beyond simply offering placements in relevant clinical areas, it is vital to ensure high quality learning experiences that meet the educational needs of pre-registration nurses. Part 1 of a two part series reports on the qualitative study of a mixed methods project. Fifteen pre-registration nursing students participated in semi-structured interviews following a clinical placement in an Australian general practice. Interviews were transcribed verbatim and underwent a process of thematic analysis. Findings are presented in the following four themes; (1) Knowledge of the practice nurse role: I had very limited understanding, (2) Quality of the learning experience: It was a fantastic placement, (3) Support, belonging and mutual respect: I really felt part of the team, (4) Employment prospects: I would really, really love to go to a general practice but …… General practice placements exposed students to a diverse range of clinical skills which would equip them for future employment in primary care. Exposure to nursing in general practice also stimulated students to consider a future career in this clinical setting. PMID:25979152

  15. Getting back into the emergency department: diversifying general practice while relieving emergency medicine workforce shortages.

    PubMed

    Willcock, Simon M

    2008-07-21

    New medical graduates expect to work in an environment that allows scope for flexibility and change across a career in medicine. Recruitment to general practice is adversely affected by its perceived limited scope of practice. Training in procedural and hospital skills is not difficult to access for general practice trainees, but complex and inconsistent credentialling criteria and protectionist attitudes among some specialist colleges mean that many skilled general practitioners are unable to utilise the full range of their skills in clinical practice. The discipline of emergency medicine is also experiencing difficulty in recruiting trainees. The employment of skilled GPs in emergency departments (including metropolitan departments) could improve vocational satisfaction for GPs and emergency physicians, and possibly also improve patient outcomes and flow through the emergency department. PMID:18637784

  16. Patient and professional attitudes towards research in general practice: the RepR qualitative study

    PubMed Central

    2014-01-01

    Background Since the 1990s, professional institutions worldwide have emphasised the need to develop research in general practice to improve the health of the population. The recent creation of professorships in general practice in French Universities should foster research in this field. Our aim was to explore the views of patients and relevant professionals on research in general practice. Methods Qualitative study, using the grounded theory approach according to Strauss and Corbin, conducted in 2010 in three French regions. Nine focus groups were run to data saturation, and included 57 participants in four different categories: patients, non-academic GPs, academic GPs, academics in other disciplines. Results Most of the participants in the four categories described research in general practice as specific to the population managed and relevant for health care. They considered that its grounding in day-to-day practice enabled pragmatic approaches. The influence of the pharmaceutical industry, rivalries between university disciplines and a possible gap between research and practice were considered as pitfalls. The barriers identified were representations of the medical researcher as a “laboratory worker”, the lack of awareness of any research in the discipline, and lack of time and training. While the views of patients and non-academic GPs are mostly focused on professional issues and the views of academics other than GPs on technical issues, academic GPs are in a position to play a role of interface between the universities and general practices. Conclusions Although the role of GPs in research is perceived differently by the various protagonists, research in general practice has an undisputed legitimacy in France. Solutions for overcoming the identified barriers include research networks with appropriate resources and training and scientifically sound collaborative research projects, as already implemented in leading countries. PMID:25047280

  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. Telephone triage in general practices: A written case scenario study in the Netherlands

    PubMed Central

    Smits, Marleen; Hanssen, Suzan; Huibers, Linda; Giesen, Paul

    2016-01-01

    Objective General practices increasingly use telephone triage to manage patient flows. During triage, the urgency of the call and required type of care are determined. This study examined the organization and adequacy of telephone triage in general practices in the Netherlands. Design Cross-sectional observational study using a web-based survey among practice assistants including questions on background characteristics and triage organization. Furthermore, practice assistants were asked to assess the required type of care of written case scenarios with varying health problems and levels of urgency. To determine the adequacy of the assessments, a comparison with a reference standard was made. In addition, the association between background characteristics and triage organization and the adequacy of triage was examined. Setting Daytime general practices. Subjects Practice assistants. Main outcome measures Over- and under-estimation, sensitivity, specificity. Results The response rate was 41.1% (n = 973). The required care was assessed adequately in 63.6% of cases, was over-estimated in 19.3%, and under-estimated in 17.1%. The sensitivity of identifying patients with a highly urgent problem was 76.7% and the specificity was 94.0%. The adequacy of the assessments of the required care was higher for more experienced assistants and assistants with fixed daily work meetings with the GP. Triage training, use of a triage tool, and authorization of advice were not associated with adequacy of triage. Conclusion Triage by practice assistants in general practices is efficient (high specificity), but potentially unsafe in highly urgent cases (suboptimal sensitivity). It is important to train practice assistants in identifying highly urgent cases. Key pointsGeneral practices increasingly use telephone triage to manage patient flows, but little is known about the organization and adequacy of triage in daytime practices.Telephone triage by general practice assistants is

  19. Investigation of benefits and costs of an ophthalmic outreach clinic in general practice.

    PubMed Central

    Gillam, S J; Ball, M; Prasad, M; Dunne, H; Cohen, S; Vafidis, G

    1995-01-01

    BACKGROUND: With the advent of general practitioner fundholding, there has been growth in outreach clinics covering many specialties. The benefits and costs of this model of service provision are unclear. AIM: A pilot study aimed to evaluate an outreach model of ophthalmic care in terms of its impact on general practitioners, their use of secondary ophthalmology services, patients' views, and costs. METHOD: A prospective study, from April 1992 to March 1993, of the introduction of an ophthalmic outreach service in 17 general practices in London was undertaken. An ophthalmic outreach team, comprising an ophthalmic medical practitioner and an ophthalmic nurse, held clinics in the practices once a month. Referral rates to Edgware General Hospital ophthalmology outpatient department over one year from the study practices were compared with those from 17 control practices. General practitioners' assessments of the scheme and its impact on their knowledge and practice of ophthalmology were sought through a postal survey of all partners and interviews with one partner in each practice. Patient surveys were conducted using self-administered structured questionnaires. A costings exercise compared the outreach model with the conventional hospital ophthalmology outpatient clinic. RESULTS: Of 1309 patients seen by the outreach team in the study practices, 480 (37%) were referred to the ophthalmology outpatient department. The annual referral rate to this department from control practices was 9.5 per 10,000 registered patients compared with 3.8 per 10,000 registered patients from study practices. A total of 1187 patients were referred to the outpatient department from control practices. An increase in knowledge of ophthalmology was reported by 18 of 47 general practitioners (38%). Nineteen (40%) of 47 general practitioners took advantage of the opportunity for inservice training with the outreach team; they were more likely to change their routine practice for ophthalmic care

  20. Integrating a pharmacist into the general practice environment: opinions of pharmacist’s, general practitioner’s, health care consumer’s, and practice manager’s

    PubMed Central

    2012-01-01

    Background Pharmacists are viewed as highly trained yet underutilised and there is growing support to extend the role of the pharmacist within the primary health care sector. The integration of a pharmacist into a general practice medical centre is not a new concept however is a novel approach in Australia and evidence supporting this role is currently limited. This study aimed to describe the opinions of local stakeholders in South-East Queensland on the integration of a pharmacist into the Australian general practice environment. Methods A sample of general practitioners, health care consumers, pharmacists and practice managers in South-East Queensland were invited to participate in focus groups or semi-structured interviews. Seeding questions common to all sessions were used to facilitate discussion. Sessions were audio recorded and transcribed verbatim. Leximancer software was used to qualitatively analyse responses. Results A total of 58 participants took part in five focus groups and eighteen semi-structured interviews. Concepts relating to six themes based on the seeding questions were identified. These included positively viewed roles such as medication reviews and prescribing, negatively viewed roles such as dispensing and diagnosing, barriers to pharmacist integration such as medical culture and remuneration, facilitators to pharmacist integration such as remuneration and training, benefits of integration such as access to the patient’s medical file, and potential funding models. Conclusions These findings and future research may aid the development of a new model of integrated primary health care services involving pharmacist practitioners. PMID:22852792

  1. Organisational Pattern Driven Recovery Mechanisms

    NASA Astrophysics Data System (ADS)

    Giacomo, Valentina Di; Presenza, Domenico; Riccucci, Carlo

    The process of reaction to system failures and security attacks is strongly influenced by its infrastructural, procedural and organisational settings. Analysis of reaction procedures and practices from different domains (Air Traffic Management, Response to Computer Security Incident, Response to emergencies, recovery in Chemical Process Industry) highlight three key requirements for this activity: smooth collaboration and coordination among responders, accurate monitoring and management of resources and ability to adapt pre-established reaction plans to the actual context. The SERENITY Reaction Mechanisms (SRM) is the subsystem of the SERENITY Run-time Framework aimed to provide SERENITY aware AmI settings (i.e. socio-technical systems with highly distributed dynamic services) with functionalities to implement applications specific reaction strategies. The SRM uses SERENITY Organisational S&D Patterns as run-time models to drive these three key functionalities.

  2. Understanding bullying in healthcare organisations.

    PubMed

    Allen, Belinda

    2015-12-01

    Bullying is a pervasive problem in healthcare organisations. Inquiries and reports on patient care and poor practice in the NHS have emphasised the substantial negative effects this behaviour may have on patient care. If bullying is to be addressed, it is crucial we develop clarity about what behaviours constitute bullying and how these behaviours differ from other negative behaviours in the workplace. It is important that we recognise the extent of the problem; statistics on the prevalence of bullying are likely to be an underestimate because of under-reporting of bullying. Effective interventions may only be designed and implemented if there is knowledge about what precipitates bullying and the magnitude of the changes required in organisations to tackle bullying. Individuals should also be aware of the options that are available to them should they be the target of bullying behaviour and what they should do if they witness bullying in their workplace. PMID:26639294

  3. Creating a general practice data set: new role for Northumberland Local Medical Committee.

    PubMed Central

    Hutchinson, A; Mitford, P; Aylett, M

    1987-01-01

    As a first step in planning primary care services for a whole district, the Northumberland Local Medical Committee undertook a postal survey of all 51 practices in the county. Questionnaires were returned by 154 doctors (95%). Information was collected from every practice on doctors' qualifications and postgraduate training, aspects of professional commitments in addition to patient care, professional appointments outside the practice, and clinical services being offered by the practice. A wide range of clinical services was reported. In general, preventive services in singlehanded practices were provided within normal consulting sessions while the larger practices offered many special sessions and a multidisciplinary approach. In addition to establishing baseline information for planning primary care initiatives, this first exercise provided valuable experience in data collection and management. Having shown that such a role is feasible, the experience will be used to expand the information and planning activities of the committee. PMID:3120862

  4. Receptionists' experiences of occupational violence in general practice: a qualitative study

    PubMed Central

    Magin, Parker; Joyce, Terry; Adams, Jon; Goode, Susan; Cotter, Georgina

    2009-01-01

    Background The significance of occupational violence in general practice is well established, but research has focused almost exclusively on the experiences of GPs. Only limited research has examined the role of general practice receptionists despite their acknowledged vulnerability to violent patient behaviour. No qualitative research has explored this problem. Aim To explore the experiences of general practice receptionists regarding occupational violence and the effects of violence on their psychological and emotional wellbeing and on their work satisfaction and performance. Design of study Qualitative study. Setting Constituent practices of an Australian network of research general practices. Practices were located in a range of socioeconomic settings. Method Semi-structured interviews were conducted with practice receptionists. The interviews were audiotaped, transcribed, and subjected to thematic analysis employing a process of constant comparison in which data collection and analysis were cumulative and concurrent. Qualitative written responses from a cross-sectional questionnaire-based study performed concurrently with the qualitative study were similarly analysed. Results Nineteen interviews were conducted and 12 written responses were received. Violence was found to be a common, sometimes pervasive, experience of many receptionists. Verbal abuse, both ‘across the counter’ and telephone abuse, was the most prominent form of violence, although other violence, including assault and threats with guns, was reported. Experiences of violence could have marked emotional and psychological effects and could adversely affect job satisfaction, performance, and commitment. Conclusion It is apparent that occupational violence is a whole-of-practice problem and strategies for GP and staff safety will need to take a whole-of-practice approach. PMID:22751233

  5. Patient satisfaction surveys as a market research tool for general practices.

    PubMed Central

    Khayat, K; Salter, B

    1994-01-01

    BACKGROUND. Recent policy developments, embracing the notions of consumer choice, quality of care, and increased general practitioner control over practice budgets have resulted in a new competitive environment in primary care. General practitioners must now be more aware of how their patients feel about the services they receive, and patient satisfaction surveys can be an effective tool for general practices. AIM. A survey was undertaken to investigate the use of a patient satisfaction survey and whether aspects of patient satisfaction varied according to sociodemographic characteristics such as age, sex, social class, housing tenure and length of time in education. METHOD. A sample of 2173 adults living in Medway District Health Authority were surveyed by postal questionnaire in September 1991 in order to elicit their views on general practice services. RESULTS. Levels of satisfaction varied with age, with younger people being consistently less satisfied with general practice services than older people. Women, those in social classes 1-3N, home owners and those who left school aged 17 years or older were more critical of primary care services than men, those in social classes 3M-5, tenants and those who left school before the age of 17 years. CONCLUSION. Surveys and analyses of this kind, if conducted for a single practice, can form the basis of a marketing strategy aimed at optimizing list size, list composition, and service quality. Satisfaction surveys can be readily incorporated into medical audit and financial management. PMID:8204335

  6. The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients

    PubMed Central

    Rognstad, Sture; Brekke, Mette; Fetveit, Arne; Spigset, Olav; Wyller, Torgeir Bruun; Straand, Jørund

    2009-01-01

    Objective To establish a clinically relevant list with explicit criteria for pharmacologically inappropriate prescriptions in general practice for elderly people ≥70 years. Design A three-round Delphi process for validating the clinical relevance of suggested criteria (n = 37) for inappropriate prescriptions to elderly patients. Setting A postal consensus process undertaken by a panel of specialists in general practice, clinical pharmacology, and geriatrics. Main outcome measures The Norwegian General Practice (NORGEP) criteria, a relevance-validated list of drugs, drug dosages, and drug combinations to be avoided in the elderly (≤70 years) patients. Results Of the 140 invited panellists, 57 accepted to participate and 47 completed all three rounds of the Delphi process. The panellists reached consensus that 36 of the 37 suggested criteria were clinically relevant for general practice. Relevance of three of the criteria was rated significantly higher in Round 3 than in Round 1. At the end of the Delphi process, a significant difference between the different specialist groups’ scores was seen for only one of the 36 criteria. Conclusion The NORGEP criteria may serve as rules of thumb for general practitioners (GPs) related to their prescribing practice for elderly patients, and as a tool for evaluating the quality of GPs’ prescribing in settings where access to clinical information for individual patients is limited, e.g. in prescription databases and quality improvement interventions. PMID:19462339

  7. How Do General Practitioners Conceptualise Advance Care Planning in Their Practice? A Qualitative Study

    PubMed Central

    De Vleminck, Aline; Pardon, Koen; Beernaert, Kim; Houttekier, Dirk; Vander Stichele, Robert; Deliens, Luc

    2016-01-01

    Objectives To explore how GPs conceptualise advance care planning (ACP), based on their experiences with ACP in their practice. Methods Five focus groups were held with 36 GPs. Discussions were analysed using a constant comparative method. Results Four overarching themes in the conceptualisations of ACP were discerned: (1) the organisation of professional care required to meet patients’ needs, (2) the process of preparing for death and discussing palliative care options, (3) the discussion of care goals and treatment decisions, (4) the completion of advance directives. Within these themes, ACP was both conceptualised in terms of content of ACP and/or in terms of tasks for the GP. A specific task that was mentioned throughout the discussion of the four different themes was (5) the task of actively initiating ACP by the GP versus passively waiting for patients’ initiation. Conclusions This study illustrates that GPs have varying conceptualisations of ACP, of which some are more limited to specific aspects of ACP. A shared conceptualisation and agreement on the purpose and goals of ACP is needed to ensure successful implementation, as well as a systematic integration of ACP in routine practice that could lead to a better uptake of all the important elements of ACP. PMID:27096846

  8. Ad hoc supervision of general practice registrars as a 'community of practice': analysis, interpretation and re-presentation.

    PubMed

    Clement, T; Brown, J; Morrison, J; Nestel, D

    2016-05-01

    General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also provide an opportunity for learning and teaching. Wenger's (Communities of practice: learning, meaning, and identity. Cambridge University Press, New York, 1998) social theory of learning ('communities of practice') guided a secondary analysis of audio-recordings of ad hoc encounters. Data from one encounter is re-presented as an extended sequence to maintain congruence with the theoretical perspective and enhance vicariousness. An interpretive commentary communicates key features of Wenger's theory and highlights the researchers' interpretations. We argue that one encounter can reveal universal understandings of clinical supervision and that the process of naturalistic generalisation allows readers to transfer others' experiences to their own contexts. The paper raises significant analytic, interpretive, and representational issues. We highlight that report writing is an important, but infrequently discussed, part of research design. We discuss the challenges of supporting the learning and teaching that arises from adopting a socio-cultural lens and argue that such a perspective importantly captures the complex range of issues that work-based practitioners have to grapple with. This offers a challenge to how we research and seek to influence work-based learning and teaching in health care settings. PMID:26384813

  9. B.M.A. Planning Unit Survey of General Practice 1969

    PubMed Central

    Irvine, Donald; Jeffreys, Margot

    1971-01-01

    A postal survey of 776 principals representative of general practice in Britain is described. Doctors working in health centres are compared both with colleagues in other group practices and with doctors who have no group practice allowance. Young doctors are mainly in group practice, especially health centres; the proportion of doctors who are not in groups is diminishing steadily, and they are mainly older. With some notable exceptions health centres provide most space, equipment, and staff; group practitioners in privately-owned premises spend more of their money on their practices, more often use appointment systems, and tend to make more efficient use of premises and staff. Overall, however, the picture is still one of general practice geared to the needs of practitioners working alone. Premises with space for sophisticated organization and for future teaching needs are unusual. Scotland, the North of England, and Wales have fewer young doctors. Average lists are higher in the North of England, and less money is invested in practice premises. Young doctors look for modern premises and the tools and staff for the job. If their career expectations are to be met the tremendous improvements made in some practices must be extended rapidly to the remainder. PMID:5128210

  10. Using patient and general practice characteristics to explain variations in cervical smear uptake rates.

    PubMed Central

    Majeed, F. A.; Cook, D. G.; Anderson, H. R.; Hilton, S.; Bunn, S.; Stones, C.

    1994-01-01

    OBJECTIVES--To produce practice and patient variables for general practices from census and family health services authority data, and to determine the importance of these variables in explaining variation in cervical smear uptake rates between practices. DESIGN--Population based study examining variations in cervical smear uptake rates among 126 general practices using routine data. SETTING--Merton, Sutton, and Wandsworth Family Health Services Authority, which covers parts of inner and outer London. MAIN OUTCOME MEASURE--Percentage of women aged 25-64 years registered with a general practitioner who had undergone a cervical smear test during the five and a half years preceding 31 March 1992. RESULTS--Cervical smear uptake rates varied from 16.5% to 94.1%. The estimated percentage of practice population from ethnic minority groups correlated negatively with uptake rates (r = -0.42), as did variables associated with social deprivation such as overcrowding (r = -0.42), not owning a car (r = -0.41), and unemployment (r = -0.40). Percentage of practice population under 5 years of age correlated positively with uptake rate (r = 0.42). Rates were higher in practices with a female partner than in those without (66.6% v 49.1%; difference 17.5% (95% confidence interval 10.5% to 24.5%)), and in computerised than in non-computerised practices (64.5% v 50.5%; 14.0% (6.4% to 21.6%)). Rates were higher in larger practices. In a stepwise multiple regression model that explained 52% of variation, five factors were significant predictors of uptake rates: presence of a female partner; children under 5; overcrowding; number of women aged 35-44 as percentage of all women aged 25-64; change of address in past year. CONCLUSIONS--Over half of variation in cervical smear uptake rates can be explained by patient and practice variables derived from census and family health services authority data; these variables may have a role in explaining variations in performance of general practices

  11. Examining variations in prescribing safety in UK general practice: cross sectional study using the Clinical Practice Research Datalink

    PubMed Central

    Kontopantelis, Evangelos; Akbarov, Artur; Rodgers, Sarah; Avery, Anthony J; Ashcroft, Darren M

    2015-01-01

    Study question What is the prevalence of different types of potentially hazardous prescribing in general practice in the United Kingdom, and what is the variation between practices? Methods A cross sectional study included all adult patients potentially at risk of a prescribing or monitoring error defined by a combination of diagnoses and prescriptions in 526 general practices contributing to the Clinical Practice Research Datalink (CPRD) up to 1 April 2013. Primary outcomes were the prevalence of potentially hazardous prescriptions of anticoagulants, anti-platelets, NSAIDs, β blockers, glitazones, metformin, digoxin, antipsychotics, combined hormonal contraceptives, and oestrogens and monitoring by blood test less frequently than recommended for patients with repeated prescriptions of angiotensin converting enzyme inhibitors and loop diuretics, amiodarone, methotrexate, lithium, or warfarin. Study answer and limitations 49 927 of 949 552 patients at risk triggered at least one prescribing indicator (5.26%, 95% confidence interval 5.21% to 5.30%) and 21 501 of 182 721 (11.8%, 11.6% to 11.9%) triggered at least one monitoring indicator. The prevalence of different types of potentially hazardous prescribing ranged from almost zero to 10.2%, and for inadequate monitoring ranged from 10.4% to 41.9%. Older patients and those prescribed multiple repeat medications had significantly higher risks of triggering a prescribing indicator whereas younger patients with fewer repeat prescriptions had significantly higher risk of triggering a monitoring indicator. There was high variation between practices for some indicators. Though prescribing safety indicators describe prescribing patterns that can increase the risk of harm to the patient and should generally be avoided, there will always be exceptions where the indicator is clinically justified. Furthermore there is the possibility that some information is not captured by CPRD for some practices—for example, INR results in

  12. Prospective, observational study comparing automated and visual point-of-care urinalysis in general practice

    PubMed Central

    van Delft, Sanne; Goedhart, Annelijn; Spigt, Mark; van Pinxteren, Bart; de Wit, Niek; Hopstaken, Rogier

    2016-01-01

    Objective Point-of-care testing (POCT) urinalysis might reduce errors in (subjective) reading, registration and communication of test results, and might also improve diagnostic outcome and optimise patient management. Evidence is lacking. In the present study, we have studied the analytical performance of automated urinalysis and visual urinalysis compared with a reference standard in routine general practice. Setting The study was performed in six general practitioner (GP) group practices in the Netherlands. Automated urinalysis was compared with visual urinalysis in these practices. Reference testing was performed in a primary care laboratory (Saltro, Utrecht, The Netherlands). Primary and secondary outcome measures Analytical performance of automated and visual urinalysis compared with the reference laboratory method was the primary outcome measure, analysed by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and Cohen's κ coefficient for agreement. Secondary outcome measure was the user-friendliness of the POCT analyser. Results Automated urinalysis by experienced and routinely trained practice assistants in general practice performs as good as visual urinalysis for nitrite, leucocytes and erythrocytes. Agreement for nitrite is high for automated and visual urinalysis. κ's are 0.824 and 0.803 (ranked as very good and good, respectively). Agreement with the central laboratory reference standard for automated and visual urinalysis for leucocytes is rather poor (0.256 for POCT and 0.197 for visual, respectively, ranked as fair and poor). κ's for erythrocytes are higher: 0.517 (automated) and 0.416 (visual), both ranked as moderate. The Urisys 1100 analyser was easy to use and considered to be not prone to flaws. Conclusions Automated urinalysis performed as good as traditional visual urinalysis on reading of nitrite, leucocytes and erythrocytes in routine general practice. Implementation of automated

  13. Rheumatology education and management skills in general practice: a national study of trainees.

    PubMed Central

    Lanyon, P; Pope, D; Croft, P

    1995-01-01

    OBJECTIVE--To evaluate current rheumatology education and skills during vocational training in general practice. METHODS--A postal questionnaire survey was sent to all general practice trainees who were in United Kingdom training practices in June 1992. A second survey was made of general practice trainers in the UK. RESULTS--Questionnaires were returned by 1624 trainees, representing 70% of all trainees known to be in a training practice on 1 April 1992. Of the 1075 responders who were at the end of their trainee year, 35% had not received any tutorials on rheumatological topics with their trainer, and only 43% had experienced specific rheumatology teaching on local day release courses. Although 84% of these trainees had injected or aspirated the knee, fewer than 40% had acquired shoulder injection skills. Lack of experience was matched by low reported confidence. Trainees rated the amount of their rheumatology education as inadequate. Nine hundred trainers returned questionnaires--a response rate of 33%. Their estimate of the amount of local training provided was similar to that among the trainees, but this sample of trainers reported a higher level of practical teaching than the trainees indicated they had received. CONCLUSIONS--Rheumatology education during vocational training needs to be improved, particularly the component provided by trainers and local day release courses. This process might be facilitated by the development of a standard rheumatology curriculum which could be incorporated into all training schemes. PMID:7495345

  14. General practice after-hours incentive funding: a rationale for change.

    PubMed

    Neil, Amanda L; Nelson, Mark R; Richardson, Tracy; Mann-Leonard, Meghan; Palmer, Andrew J

    2015-07-20

    After-hours incentive funding for general practice was introduced in 1998 through the introduction of the Practice Incentives Program (PIP). In 2010, a national audit of the PIP identified after-hours incentive funding as having the greatest levels of non-compliance across 12 PIP components. The audit specified the need for secondary data sources to ensure practice compliance. In this article, we examine the drivers of the 1998-2013 PIP mechanism to inform development of a fair, transparent and auditable after-hours incentive funding scheme for Tasmania. The PIP after-hours incentive funding mechanism paid, at diminishing levels, for anticipated burden of care (practice size), claimed method of providing care (stream) and remoteness of practice. Increasing remoteness rather than practice size or stream is the primary determinant of urgent after-hours attendances per practice in Tasmania; after-hours attendances to residential aged care facilities are unrelated to individual practice location or stream but concentrated in urban areas. The PIP after-hours incentive funding mechanism does not preferentially support practices that provide after-hours care and arguably led to perverse incentives. A new after-hours incentive funding mechanism embodying pre-specified objectives - such as support for (unavoidable) burden and/or provision of care to residential aged care facilities - is required. Claimed provision is considered an inappropriate funding determinant. PMID:26175246

  15. The relationship between symptoms and diagnoses of minor psychiatric disorder in general practice.

    PubMed

    Grayson, D A; Bridges, K; Duncan-Jones, P; Goldberg, D P

    1987-11-01

    In an earlier paper (Goldberg et al. 1987) 36 common symptoms of minor psychiatric disorder in general practice were analysed using the technique of latent trait analysis. From this analysis two dimensions of illness emerged, corresponding to anxiety and depression. In the present paper, this symptom-based representation of minor psychiatric illness is used as a framework for comparing four diagnostic systems: General Practitioner (GP) diagnoses, the ID-CATEGO diagnostic system, the DSM-III system and the Bedford College diagnostic system. This analysis clarifies the reasons for disagreement among systems of diagnostic criteria and examines the practical effects of alternative diagnostic algorithms. PMID:3432467

  16. Benefits of ICT adoption and use in regional general medical practices: a pilot study.

    PubMed

    MacGregor, Rob; Hyland, Peter; Harvei, Charles; Lee, Boon-Chye; Dalley, Andrew; Ramu, Sangeetha

    2006-01-01

    This paper presents a pilot study of benefits derived from information and communications technology(ICT) adoption and use in medical practices in regional Australia. The study involved 122 regional medical practitioners. The results show that like the more general small business sector, the perception of certain benefits is associated with the size of the practice (in terms of employee levels) and/or the gender of the respondent practitioner. The data also showed that the level of skill of certain software used within the practice was significantly associated with the level of perceived benefit derived from ICT adoption and use. PMID:18195425

  17. Development of a Comprehensive Approach for the Early Diagnosis of Geriatric Syndromes in General Practice

    PubMed Central

    Senn, Nicolas; Monod, Stéfanie

    2015-01-01

    According to demographic projections, a significant increase in the proportion of the elderly population is anticipated worldwide. This aging of the population will lead to an increase in the prevalence of chronic diseases and functional impairment. This expected increase will result in growing use of the health care system that societies are largely unprepared to address. General practitioners (GPs) are at the front line of this huge epidemiological challenge, but appropriate tools to diagnose and manage elderly patients in routine general practice are lacking. Indeed, while primary prevention and the management of common chronic diseases, such as hypertension, diabetes, or cardiac ischemic diseases, are routinely and mostly adequately performed in primary care, the management of geriatric syndromes is often incomplete. In order to address these shortcomings, this theoretical work aims to first develop, based on the best available evidence, a brief assessment tool (BAT) specifically designed for geriatric syndromes identification in general practice and, second, to propose a conceptual framework for the management of elderly patients in general practice that integrates the BAT instrument into the usual care of GPs. To avoid proposing unachievable goals for the care of elderly patients in general practice (for example, performing all the best screening tools for geriatric conditions identification and care), this work proposes an innovative way to combine geriatric assessment with the management of common chronic diseases. PMID:26636085

  18. Organizational values in general practice and public involvement: case studies in an urban district.

    PubMed

    Brown, I

    2001-05-01

    A multiple case study design was used to explore dimensions of organizational values in general practice with respect to developing public involvement. The study was undertaken in an urban district in England with data collected through in-depth individual and focus group interviews with service providers and service users. Four general practice organizations were randomly selected for study after sorting all in the district according to their record of developing involvement activities. The case studies provide evidence of how organizational values can differ markedly in general practice in relation to ideas of public involvement, with consequences for the quantity and quality of activities for involving local people and service users. The differences manifest themselves in the beliefs and attitudes of service providers about the purpose of the organization and the types of relationships that are appropriate with service users and local people. Service users appear to be very perceptive to the underlying ethos and purpose to their practice organization and this affects their responsiveness to initiatives for their involvement. The dimensions of the different values found in the study appear to be essentially the same as a number of established empirical findings of variations in values in general practice: an orientation to a narrow medical role and to general practice as a business are associated with a low valuation of involvement; an orientation to teamwork and to a broader social role appear more congruent with the development of involvement. Power is a critical issue in this setting with evidence in the study of the dominance of the medical practitioners in establishing organizational values and the nature of public involvement activities. PMID:11560732

  19. Drugs to support smoking cessation in UK general practice: are evidence based guidelines being followed?

    PubMed Central

    Wilson, A; Sinfield, P; Rodgers, S; Hammersley, V; Coleman, T

    2006-01-01

    Background Prescribing drugs to support smoking cessation is one of the most cost effective interventions in primary care, but there is evidence they are underused. Little is known about how far guidelines have been adopted. Aims To examine the context in which nicotine replacement therapy (NRT) and bupropion are prescribed in UK general practice and whether guidelines are being followed. Design Patient questionnaire survey. Setting Twenty five general practices from the Trent Focus Collaborative Research Network in South Yorkshire and East Midlands, UK. Methods Participating practices posted a questionnaire to up to 40 patients prescribed NRT and bupropion respectively in the previous 3–9 months. Results The response rate for people prescribed NRT was 44.7% (323/723) and for bupropion 42.5% (77/181). Patients reported initiating the prescription request in 258 cases (65%), whereas GPs were reported as suggesting it in 49 (12%), smoking cessation services (SCS) in 38 (10%), and practice nurses in 36 (9%). Of those who could recall the content of the consultation in which NRT or bupropion was prescribed, 191 (79%) reported receiving advice on treatment use and 209 (68%) were encouraged to set a quit date. Follow up by SCS was recommended to 186 (64%) and practice follow up was offered to 212 (63%), but 41 (15%) reported no offer of follow up support. Conclusions The majority of patients reported receiving advice and follow up in line with guidelines. However, relatively few prescriptions were suggested by GPs or practice nurses and, in a significant minority of cases, neither follow up by the practice nor additional support from SCS was recommended. More active implementation of guidelines could increase the impact of general practice on the prevalence of smoking. PMID:16885254

  20. Effectiveness and cost of different strategies for information feedback in general practice.

    PubMed Central

    Szczepura, A; Wilmot, J; Davies, C; Fletcher, J

    1994-01-01

    AIM. The aim of this study was to determine the effectiveness and relative cost of three forms of information feedback to general practices--graphical, graphical plus a visit by a medical facilitator and tabular. METHOD. Routinely collected, centrally-held data were used where possible, analysed at practice level. Some non-routine practice data in the form of risk factor recording in medical notes, for example weight, smoking status, alcohol consumption and blood pressure, were also provided to those who requested it. The 52 participating practices were stratified and randomly allocated to one of the three feedback groups. The cost of providing each type of feedback was determined. The immediate response of practitioners to the form of feedback (acceptability), ease of understanding (intelligibility), and usefulness of regular feedback was recorded. Changes introduced as a result of feedback were assessed by questionnaire shortly after feedback, and 12 months later. Changes at the practice level in selected indicators were also assessed 12 and 24 months after initial feedback. RESULTS. The resulting cost per effect was calculated to be 46.10 pounds for both graphical and tabular feedback, 132.50 pounds for graphical feedback plus facilitator visit and 773.00 pounds for the manual audit of risk factors recorded in the practice notes. The three forms of feedback did not differ in intelligibility or usefulness, but feedback plus a medical facilitator visit was significantly less acceptable. There was a high level of self-reported organizational change following feedback, with 69% of practices reporting changes as a direct result; this was not significantly different for the three types of feedback. There were no significant changes in the selected indicators at 12 or 24 months following feedback. The practice characteristic most closely related to better indicators of preventive practice was practice size, smaller practices performing significantly better. Separate

  1. Learning to listen to the organisational rhetoric of primary health and social care integration.

    PubMed

    Warne, T; McAndrew, S; King, M; Holland, K

    2007-11-01

    The sustained modernisation of the UK primary health care service has resulted in individuals and organisations having to develop more integrated ways of working. This has resulted in changes to the structure and functioning of primary care organisations, changes to the traditional workforce, and an increase in scope of primary care practice. These changes have contributed to what for many staff has become a constantly turbulent organisational and practice environment. Data from a three-year project, commissioned by the North West Development Agency is used to explore how staff involved in these changes dealt with this turbulence. Three hundred and fifty staff working within primary care participated in the study. A multimethods approach was used which facilitated an iterative analysis and data collection process. Thematic analysis revealed a high degree of congruence between the perceptions of all staff groups with evidence of a generally well-articulated, but often rhetorical view of the organisational and professional factors involved in how these changes were experienced. This rhetoric was used by individuals as a way of containing both the good and bad elements of their experience. This paper discusses how these defense mechanisms need to be recognised and understood by managers so that a more supportive organisational culture is developed. PMID:17391812

  2. Developing a general practice library: a collaborative project between a GP and librarian.

    PubMed

    Pearson, D; Rossall, H

    2001-12-01

    The authors report on a self-completed questionnaire study from a North Yorkshire based general practice regarding the information needs of its clinicians. The work was carried out with a particular focus on the practice library, and the findings identified that a new approach to maintaining and developing the library was needed. The literature regarding the information needs of primary care clinicians and the role of practice libraries is considered, and compared to those of the clinicians at the practice. Discussion follows on how a collaborative project was set up between the practice and a librarian based at the local NHS Trust library in order to improve the existing practice library. Difficulties encountered and issues unique to the project are explored, including training implications presented by the implementation of electronic resources. Marketing activities implemented are discussed, how the library will operate in its new capacity, and how ongoing support and maintenance of the library will be carried out. It is concluded that although scepticism still exists regarding librarian involvement in practice libraries, collaboration between clinicians and librarians is an effective approach to the successful development and maintenance of a practice library, and recommendations are therefore made for similar collaborative work. PMID:11791859

  3. Primary health care and general practice--a comparison between Australia and Malaysia.

    PubMed

    Ee-Ming Khoo; Kidd, Michael Richard

    2002-01-01

    The Australian and Malaysian systems of general practice were examined and compared. The issues of similarity and difference identified are discussed in this paper. Quality clinical practice and the importance of compulsory vocational training prior to entry into general practice and continuing professional development is one important area. A move towards preventive health care and chronic disease management was observed in both countries. Practice incentive programmes to support such initiatives as improved rates of immunisation and cervical smear testing and the implementation of information technology and information management systems need careful implementation. The Medicare system used in Australia may not be appropriate for general practitioners in Malaysia and, if used, a pharmaceutical benefit scheme would also need to be established. In both countries the corporatisation of medical practice is causing concern for the medical profession. Rural and aboriginal health issues remain important in both countries. Graduate medical student entry is an attractive option but workforce requirements mean that medical education will need individual tailoring for each country. Incorporating nurses into primary health care may provide benefits such as cost savings. The integration model of community centres in Malaysia involving doctors, nurses and allied health professionals, such as physiotherapists, in a single location deserves further examination. PMID:12862408

  4. Knowledge, illness perceptions and stated clinical practice behaviour in management of gout: a mixed methods study in general practice.

    PubMed

    Spaetgens, Bart; Pustjens, Tobias; Scheepers, Lieke E J M; Janssens, Hein J E M; van der Linden, Sjef; Boonen, Annelies

    2016-08-01

    The objective of the present study is to explore knowledge, illness perceptions and stated practice behaviour in relation to gout in primary care. This is a mixed methods study among 32 general practitioners (GPs). The quantitative assessment included the Gout Knowledge Questionnaire (GKQ; range 0-10; better) and Brief Illness Perceptions Questionnaire (BIPQ; nine items, range 0-10; stronger). Structured individual interviews obtained further qualitative insight into knowledge and perceptions, in the context of daily practice. Among 32 GPs, 18 (56.3 %) were male, mean age 44.4 years (SD 9.6) and mean working experience 17.1 years (SD 9.7). Median score [interquartile ranges (IQR)] on the GKQ was 7.8 [6.7-8.9] and 9.0 [8.0-10.0], when presented as open or multiple-choice questions, respectively. The BIPQ (median; [IQR]) revealed that gout was seen as a chronic disease (8.0; [7.0-9.0]), affecting life and emotions moderately (6.5; [5.0-7.0]), having many severe symptoms (8.0; [7.0-9.0]) and in which treatment could be very helpful (8.0; [7.0-9.0]). Further interviews revealed large variation in specific aspects of knowledge and about gaps concerning indications for uric acid-lowering therapy (UALT), duration of UALT, target serum uric acid (sUA) level or duration of prophylactic treatment. Finally, patients' adherence was not checked systematically. Specific knowledge gaps and discrepancies between perceptions and stated practice behaviour were identified, which might hamper effective management of this well-treatable disease. Improving evidence on the rationale and effectiveness of treatment targets and adherence interventions, tailoring guidelines to general practice and intensification of implementation of guidelines in primary health care seem to be needed. PMID:26898982

  5. Vicarious Trauma among Therapists Working with Sexual Violence, Cancer and General Practice

    ERIC Educational Resources Information Center

    Kadambi, Michaela A.; Truscott, Derek

    2004-01-01

    Vicarious trauma, traumatic stress and burnout were investigated among three separate groups of mental health professionals working primarily with three different client populations (sexual violence, cancer, general practice). Participants (N=221) completed the Traumatic Stress Institute Belief Scale Revision M (TSI), the Maslach Burnout Inventory…

  6. Food parenting practices and child dietary behavior. Prospective relations and the moderating role of general parenting.

    PubMed

    Sleddens, Ester F C; Kremers, Stef P J; Stafleu, Annette; Dagnelie, Pieter C; De Vries, Nanne K; Thijs, Carel

    2014-08-01

    Research on parenting practices has focused on individual behaviors while largely failing to consider the context of their use, i.e., general parenting. We examined the extent to which food parenting practices predict children's dietary behavior (classified as unhealthy: snacking, sugar-sweetened beverage; and healthy: water and fruit intake). Furthermore, we tested the moderating role of general parenting on this relationship. Within the KOALA Birth Cohort Study, in the Netherlands, questionnaire data were collected at 6 and 8 years (N = 1654). Correlations were computed to assess the association between food parenting practices and general parenting (i.e., nurturance, behavioral control, structure, coercive control, and overprotection). Linear regression models were fitted to assess whether food parenting practices predict dietary behavior. Instrumental and emotional feeding, and pressure to eat were found to have associations with undesirable child dietary behavior (increased unhealthy intake/decreased healthy intake), whereas associations were in the desirable direction for covert control, encouragement and restriction. Moderation analyses were performed by evaluating interactions with general parenting. The associations of encouragement and covert control with desirable child dietary behaviors were found to be stronger for children who were reared in a positive parenting context. Future research should assess the influence of contextual parenting factors moderating the relationships between food parenting and child dietary behavior as the basis for the development of more effective family-based interventions. PMID:24727101

  7. Preservation Conditions, Practices, and Needs in the General Libraries. A Report by the Preservation Committee.

    ERIC Educational Resources Information Center

    Texas Univ., Austin. General Libraries.

    The survey documented in this report was conducted in 1981 to investigate the preservation conditions, practices, and needs of the units of the University of Texas at Austin General Libraries. The report is divided into six major portions. The first five sections report the responses to questionnaires on specific formats: books and serials;…

  8. Physical Activity Promotion in General Practices of Barcelona: A Case Study

    ERIC Educational Resources Information Center

    Puig Ribera, Anna; McKenna, Jim; Riddoch, Chris

    2006-01-01

    This case study aimed to generate explanations for the lack of integration of physical activity (PA) promotion in general practices of Barcelona, the capital of Catalonia. This explanatory study adopted a qualitative approach, based on three techniques; focus groups (n = 3), semi-structured (n = 25) and short individual interviews (n = 5). These…

  9. Mathematics Instructional Practices and Assessment Accommodations by Secondary Special and General Educators

    ERIC Educational Resources Information Center

    Maccini, Paula; Gagnon, Joseph Calvin

    2006-01-01

    A nationwide random sample of 179 secondary general education math and special education teachers completed a survey asking them about their use of specific instructional practices to help teach math to students with learning disabilities (LD) and emotional/behavioral disorders (EB/D) and their use of specific assessment accommodations with these…

  10. 76 FR 39749 - Practice and Procedure: Rules of General Application, Safeguards, Antidumping and Countervailing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-06

    ...The United States International Trade Commission (``Commission'') proposes to amend its rules of practice and procedure concerning rules of general application, safeguards, antidumping and countervailing duty, and adjudication and enforcement. The amendments are necessary to implement a new Commission requirement for electronic filing of most documents with the agency. The intended effects of......

  11. Beliefs and Practices of Elementary School Principals Regarding Collaboration between General and Special Education Staff

    ERIC Educational Resources Information Center

    Mitra, Sue

    2010-01-01

    This study examined elementary school principals' beliefs and practices regarding the types of resources that facilitate collaboration between general and special education staff working on prereferral intervention/Response to Intervention (RtI) teams and serving students with Individualized Education Programs (IEPs). In June 2009, elementary…

  12. Effectiveness of a Smoking Cessation Intervention in Dutch Pharmacies and General Practices

    ERIC Educational Resources Information Center

    Hoving, Ciska; Mudde, Aart N.; Dijk, Froukje; de Vries, Hein

    2010-01-01

    Purpose: The purpose of this paper is to test the effectiveness of a computer-tailored smoking cessation intervention, distributed through 75 Dutch general practices (GP) and 65 pharmacies (PH) in a randomised control trial. Design/methodology/approach: Respondents receive a tailored letter or a thank you letter (control condition). Main outcome…

  13. Management of Overweight during Childhood: A Focus Group Study on Health Professionals' Experiences in General Practice

    PubMed Central

    Larsen, Lone Marie; Ledderer, Loni; Jarbøl, Dorte Ejg

    2015-01-01

    Background. Because of the increasing prevalence of overweight and obesity in childhood in the Western world, focus on the management in general practice has also increased. Objective. To explore the experiences of general practitioners (GPs) and practice nurses participating in a randomised controlled trial (RCT) comparing two management programmes in general practice for children who are overweight or obese. Methods. Three focus groups with GPs and nurses participating in the RCT. Transcribed data were analysed using systematic text condensation followed by thematic analysis. Results. Health professionals considered it their responsibility to offer a management programme to overweight children. They recognised that management of overweight during childhood was a complex task that required an evidence-based strategy with the possibility of supervision. Health professionals experienced a barrier to addressing overweight in children. However, increasing awareness of obesity in childhood and its consequences in society was considered helpful to reach an understanding of the articulations concerning how best to address the issue. Conclusions. Health professionals in general practice recognised that they have a special obligation, capacity, and role in the management of obesity in childhood. Implementation of future management programmes must address existing barriers beyond an evidence-based standardised strategy. PMID:26236505

  14. "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…

  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. Atopic dermatitis, asthma and allergic rhinitis in general practice and the open population: a systematic review

    PubMed Central

    Pols, D. H. J.; Wartna, J. B.; Moed, H.; van Alphen, E. I.; Bohnen, A. M.; Bindels, P. J. E.

    2016-01-01

    Objective To examine whether significant differences exist between the self-reported prevalence of atopic disorders in the open population compared with physician diagnosed prevalence of atopic disorders in general practice. Methods Medline (OvidSP), PubMed Publisher, EMBASE, Google Scholar and the Cochrane Controlled Clinical Trials Register databases were systematically reviewed for articles providing data on the prevalence of asthma, allergic rhinitis and eczema in a GP setting. Studies were only included when they had a cross-sectional or cohort design and included more than 100 children (aged 0-18 years) in a general practice setting. All ISAAC studies (i.e. the open population) that geographically matched a study selected from the first search, were also included. A quality assessment was conducted. The primary outcome measures were prevalence of eczema, asthma and allergic rhinitis in children aged 0-18 years. Results The overall quality of the included studies was good. The annual and lifetime prevalences of the atopic disorders varied greatly in both general practice and the open population. On average, the prevalence of atopic disorders was higher in the open population. Conclusion There are significant differences between the self-reported prevalence of atopic disorders in the open population compared with physician diagnosed prevalence of atopic disorders in general practice. Data obtained in the open population cannot simply be extrapolated to the general practice setting. This should be taken into account when considering a research topic or requirements for policy development. GPs should be aware of the possible misclassification of allergic disorders in their practice. Key PointsEpidemiological data on atopic disorders in children can be obtained from various sources, each having its own advantages and limitations.On average, the prevalence of atopic disorders is higher in the open population.GPs should take into account the possible

  17. Moving to paperlessness: a case study from a large general practice.

    PubMed

    Carr-Bains, Stephen; de Lusignan, Simon

    2003-01-01

    This case study reports the reasons why this large, multi-site general practice decided to move towards paperless practice in late 2001, and describes the progress and lessons learned to date. The principal operational reasons for this decision were problems associated with moving paper medical records between surgeries, and the realisation that resources to improve the computerised medical record could only come from redeploying the time spent handling paper records. A comprehensive plan was put in place to shift toward paperlessness. Motivating and changing working practices for clinical and support staff was as a great a challenge as upgrading the technology. The practice upgraded its computer system, and has installed scanning and automated generation of referral and other letters. The support staff skills have evolved from moving records to scanning documents and coding data. All clinical staff now consult on their computer, and code diagnoses and key clinical data. A networked digital dictation system allows typing to be centralised at one location, with the networking allowing printing at any site. Audit and quality improvement activities have increased, as the output from computer searches increasingly represents the quality of care provided. The implications of this case study are that a committed general practice can achieve a largely paperless environment in approximately two years. The practice is now fit to be part of any move towards integration of records within its local health community, and can demonstrate from its computer records that it meets the quality targets for primary care. PMID:14680539

  18. 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

  19. What do general practice receptionists think and feel about their work?

    PubMed Central

    Eisner, M; Britten, N

    1999-01-01

    BACKGROUND: Although there is some published work acknowledging that the general practice receptionist's role is both important and difficult, receptionists' own views have rarely been sought. AIM: To explore general practice receptionists' ideas and feelings about their work. METHOD: A questionnaire was distributed to all 150 receptionists in a representative sample of 26 practices in the area covered by Leeds family health services authority. Semi-structured interviews were conducted with a representative group of 20 receptionists selected from the questionnaire sample. RESULTS: All responders were women, 60% were over 40 years old, and about half had been in the post for more than five years; four-fifths worked part-time. They had chosen the job because it dovetailed with the rest of their lives. Responders derived satisfaction from helping patients, meeting people, having good relationships with colleagues, and doing varied work. Sources of stress included difficult patients, work pressure, problems finding appointments for patients, and feeling caught between doctors' and patients' demands. Responders' experiences and views of training were diverse. Practice managers were important in making them feel consulted and supported. All had a sense of teamwork with colleagues, but many did not perceive the whole practice as a team. Many felt doctors failed to appreciate the pressure and complexity of their work. CONCLUSIONS: Receptionists' work is complex, demanding and intense, involving a high level of commitment to patients, colleagues, and the practice. Recommendations include improved appointment systems, a positive role for practice managers in relation to reception staff, and individual planning of receptionists' training. Effective teamwork among receptionists should be recognized and developed. General practitioners (GPs) are recommended to develop a greater understanding of receptionists' work. PMID:10326260

  20. Developing a preliminary ‘never event’ list for general practice using consensus-building methods

    PubMed Central

    de Wet, Carl; O’Donnell, Catherine; Bowie, Paul

    2014-01-01

    Background The ‘never event’ concept has been implemented in many acute hospital settings to help prevent serious patient safety incidents. Benefits include increasing awareness of highly important patient safety risks among the healthcare workforce, promoting proactive implementation of preventive measures, and facilitating incident reporting. Aim To develop a preliminary list of never events for general practice. Design and setting Application of a range of consensus-building methods in Scottish and UK general practices. Method A total of 345 general practice team members suggested potential never events. Next, ‘informed’ staff (n =15) developed criteria for defining never events and applied the criteria to create a list of candidate never events. Finally, UK primary care patient safety ‘experts’ (n = 17) reviewed, refined, and validated a preliminary list via a modified Delphi group and by completing a content validity index exercise. Results There were 721 written suggestions received as potential never events. Thematic categorisation reduced this to 38. Five criteria specific to general practice were developed and applied to produce 11 candidate never events. The expert group endorsed a preliminary list of 10 items with a content validity index (CVI) score of >80%. Conclusion A preliminary list of never events was developed for general practice through practitioner experience and consensus-building methods. This is an important first step to determine the potential value of the never event concept in this setting. It is now intended to undertake further testing of this preliminary list to assess its acceptability, feasibility, and potential usefulness as a safety improvement intervention. PMID:24567655

  1. 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

  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:26464546

  3. Stressors, social support, religious practice, and general well-being among Korean adult immigrants.

    PubMed

    Lee, Kyoung Hag; Woo, Hyeyoung

    2013-10-01

    Through this cross-sectional study the authors explore how stressors, social support, and religious practice are associated with the general well-being of 147 Korean adult immigrants through interviews. Hierarchical regression analysis reveals that low English proficiency and financial hardship are significantly related to low general well-being. However, high social support and religious practice are significantly associated with high general well-being. Social service and health care providers need to carefully assess stressors, social support systems, and spiritual issues for providing appropriate services/programs for English, culture, or social activities as well as spiritual intervention to maximize the strengths of Korean immigrants coping with health issues. PMID:24066632

  4. Mix of methods is needed to identify adverse events in general practice: A prospective observational study

    PubMed Central

    Wetzels, Raymond; Wolters, René; van Weel, Chris; Wensing, Michel

    2008-01-01

    Background The validity and usefulness of incident reporting and other methods for identifying adverse events remains unclear. This study aimed to compare five methods in general practice. Methods In a prospective observational study, with five general practitioners, five methods were applied and compared. The five methods were physician reported adverse events, pharmacist reported adverse events, patients' experiences of adverse events, assessment of a random sample of medical records, and assessment of all deceased patients. Results A total of 68 events were identified using these methods. The patient survey accounted for the highest number of events and the pharmacist reports for the lowest number. No overlap between the methods was detected. The patient survey accounted for the highest number of events and the pharmacist reports for the lowest number. Conclusion A mix of methods is needed to identify adverse events in general practice. PMID:18554418

  5. Organisational Learning in the "Knots": Discursive Capacities Emerging in a School-University Collaboration

    ERIC Educational Resources Information Center

    Fenwick, Tara

    2007-01-01

    Purpose: Drawing from findings of a case study of inter-organisational collaboration, this paper aims to employ organisational theory to examine the potential learning that opens between educational organisations. The focus is discursive practices. Two questions guide the analysis. What (unique) practices are implicated in the "knotworking" of…

  6. The importance of list size and consultation length as factors in general practice.

    PubMed

    Knight, R

    1987-01-01

    It is commonly believed that longer consultations are essential to better care and that this can only be achieved by lowering list sizes. The results of a survey of general practitioner trainers show that, on average, the time given to each patient was longer when general practitioners had lower list sizes, but that for a substantial minority of doctors list size played no part. Although the evidence is inconclusive, patients registered with lower list size general practitioners consulted more and received prompter attention. Doctors with smaller lists worked shorter hours and felt less overworked. However most of the correlates were weak owing to great individual differences of practice style between general practitioners. If a case for lower list sizes is to carry force, stronger evidence is needed that patients will receive more of their general practitioners' attention. PMID:3668917

  7. Multilevel assessment of immunisation uptake as a performance measure in general practice.

    PubMed Central

    Jones, K; Moon, G

    1991-01-01

    OBJECTIVE--To provide a measure of general practitioners' performance regarding uptake of immunisation against pertussis, taking account of the impact of patient characteristics on levels of uptake. DESIGN--Multilevel model of immunisation status against six measures of patient characteristics (level 1 predictor variables) with practice constraints as level 2 variables. SETTING--126 practices in southern England. SUBJECTS--2048 infants identified from infant surveillance and immunisation records. MAIN OUTCOME MEASURES--Top 10 practices with respect to uptake of pertussis immunisation according to a "null" model (model A) and according to a model that included six level 1 variables (model B); differences in ranking between the two models. RESULTS--Practices with low numbers of infants' requiring immunisation had imprecise and unstable uptake rates (range 0%-100%). With the multilevel procedure, after controlling for patient characteristics, practices in suburban catchment areas comprised largely of mature or young professionals performed best. Most improved performances when patient characteristics were taken into account were in practices in areas with a stable population and local authority housing--one such practice improved its ranking by 47 places. CONCLUSIONS--Crude uptake rates are inadequate performance indicators. Alternative approaches suggest that praiseworthy efforts to raise immunisation rates in unpromising areas are unrewarded by simple target based assessments. PMID:1859953

  8. Assessment and management of lifestyle risk factors in rural and urban general practices in Australia.

    PubMed

    Passey, Megan; Fanaian, Mahnaz; Lyle, David; Harris, Mark F

    2010-01-01

    Prevention of cardiovascular disease is a major public health challenge. Many chronic health problems are amenable to lifestyle interventions, which can ameliorate progression of disease and contribute to primary prevention. Prior to a large randomised controlled trial we assessed preventive care in trial practices. General practitioners and practice nurses completed a preventive care questionnaire covering frequency of assessing and managing behavioural and physiological risk factors, which was developed from previously validated instruments. Factor analysis confirmed 10 scales. Scores for rural and urban respondents were contrasted using univariate statistics. Sixty-three general practitioners and practice nurses completed the questionnaire (27 urban and 36 rural). The clinicians reported high levels of assessment and advice for cardiovascular risk factors but less frequent referral. There were no differences between urban and rural practitioners in relation to assessment of risk or stage of change, referral or barriers to referral or management of high blood pressure. Rural practitioners had lower scores for frequency of advice, and management of obesity/overweight, pre-diabetes and high lipids. Although clinicians report frequently advising high risk patients to exercise more, there remain significant gaps in provision of dietary advice and referral. Greater attention to addressing these issues is required to maximise the potential benefits for cardiovascular disease prevention in general practice. PMID:21133303

  9. Compatibility of scientific research and specialty training in General Practice. A cross-sectional study

    PubMed Central

    Kötter, Thomas; Carmienke, Solveig; Herrmann, Wolfram J.

    2014-01-01

    Objective: In many departments of General Practice (GP) in Germany, young doctors who are trainees also work as researchers. Often these trainees work part time at the university and part time as a trainee in clinical practice. However, little is known about the situation of the actors involved. The aim of the study was to investigate the perspectives of GP trainees, heads of departments and GP trainers regarding the combination of research and GP training. Methods: We conducted a web-based survey with the heads of all German departments of General Practice, GP trainees who also conduct research and their GP trainers. The questionnaires consisted of open and closed questions. The results were analyzed using descriptive statistics and qualitative methods. Results: 28 heads of GP departments and 20 GP trainees responded. The trainees were mostly very satisfied with their situation as a trainee. However, the trainees considered the combination of research and GP training as difficult. The respondents name as problems the coordination of multiple jobs and the lack of credibility given to research in General Practice. They name as solutions research-enabling training programs and uniform requirements in training regarding research. Conclusion: The combination of GP training and scientific research activity is perceived as difficult. However, well-organized and designed programs can improve the quality of the combination. PMID:25228933

  10. Associations between child emotional eating and general parenting style, feeding practices, and parent psychopathology.

    PubMed

    Braden, Abby; Rhee, Kyung; Peterson, Carol B; Rydell, Sarah A; Zucker, Nancy; Boutelle, Kerri

    2014-09-01

    Emotional eating is the tendency to eat in response to negative emotions. Prior research has identified a relationship between parenting style and child emotional eating, but this has not been examined in clinical samples. Furthermore, the relationship between specific parenting practices (e.g., parent feeding practices) and child emotional eating has not yet been investigated. The current study examined relationships between child emotional eating and both general and specific parenting constructs as well as maternal symptoms of depression and binge eating among a treatment-seeking sample of overweight children. Participants included 106 mother-child dyads who attended a baseline assessment for enrollment in a behavioral intervention for overeating. Ages of children ranged from 8 to 12  years old. Mothers completed self-report measures of their child's emotional eating behavior, their own feeding practices, and symptoms of depression and binge eating. Children completed a self-report measure of their mothers' general parenting style. A stepwise regression analysis was conducted to identify the parent variable that was most strongly related to child emotional eating, controlling for child age and gender. Emotional feeding behavior (i.e., a tendency to offer food to soothe a child's negative emotions) was the parent factor most significantly related to child emotional eating. Findings suggest that emotional feeding practices in parents may be related to emotional eating in children. Treatment with overweight children who engage in emotional eating may be improved by targeting parent feeding practices. PMID:24780349

  11. The prevalence of dentin hypersensitivity in general dental practices in the northwest United States

    PubMed Central

    Cunha-Cruz, Joana; Wataha, John C.; Heaton, Lisa J.; Rothen, Marilynn; Sobieraj, Martin; Scott, JoAnna; Berg, Joel

    2013-01-01

    Background The prevalence of dentin hypersensitivity is uncertain, yet appropriate diagnosis and treatment of dentin hypersensitivity require accurate knowledge regarding its prevalence. The authors conducted a study to estimate the prevalence of dentin hypersensitivity in general dental practices and to investigate associated risk factors. Methods The authors conducted a cross-sectional survey of 787 adult patients from 37 general dental practices within Northwest Practice-based Research Collaborative in Evidence-based DENTistry (PRECEDENT). Dentin hypersensitivity was diagnosed by means of participants’ responses to a question regarding pain in their teeth and gingivae, and practitioner-investigators conducted a clinical examination to rule out alternative causes of pain. Participants recorded their pain level on a visual analog scale and the Seattle Scales in response to a one-second air blast. The authors used generalized estimating equation log-linear models to estimate the prevalence and the prevalence ratios. Results The prevalence of dentin hypersensitivity was 12.3 percent; patients with hypersensitivity had, on average, 3.5 hypersensitive teeth. The prevalence of dentin hypersensitivity was higher among 18- to 44-year olds than among participants 65 years or older; it also was higher in women than in men, in participants with gingival recession than in those without gingival recession and in participants who underwent at-home tooth whitening than in those who did not. Hypersensitivity was not associated with obvious occlusal trauma, noncarious cervical lesions or aggressive toothbrushing habits. Conclusions One in eight participants from general practices had dentin hypersensitivity, which was a chronic condition causing intermittent, low-level pain. Patients with hypersensitivity were more likely to be younger, to be female and to have a high prevalence of gingival recession and at-home tooth whitening. Practical Implications Given dentin

  12. Controlled trial of an audit facilitator in diagnosis and treatment of childhood asthma in general practice.

    PubMed Central

    Bryce, F. P.; Neville, R. G.; Crombie, I. K.; Clark, R. A.; McKenzie, P.

    1995-01-01

    OBJECTIVE--To test whether an audit facilitator could alter the pattern of diagnosis and treatment of childhood asthma. DESIGN--Randomised stratified controlled trial. SETTING--12 general practices in Tayside. SUBJECTS--3373 children aged 1-15 inclusive who had symptoms suggestive of asthma or possible asthma drawn from a systematic review of 10,725 general practice case records. INTERVENTION--Children were targeted for a clinical review by their general practitioner or practice nurses. MAIN OUTCOME MEASURES--Asthma related consultations, prescriptions, hospital attendances, and health service costs 12 months before and after study. RESULTS--Compared with controls (n = 1563) the intervention group (n = 1585) had more practice initiated consultations for asthma (relative risk 2.18 (95% confidence interval 1.74 to 2.73)), new diagnoses of asthma (2.83 (2.26 to 3.54)), and past diagnoses reaffirmed (1.30 (1.08 to 1.58)), and they were more frequently prescribed inhaled cromoglycate (1.52 (1.02 to 2.25)). Hospital inpatient day rates fell from 152 to 122 in the intervention group and rose from 69 to 117 in the control group between the year before and the year after study. Total primary care costs rose from 30,118 pounds to 37,243 pounds in the intervention group and fell from 29,131 pounds to 27,990 pounds in the control group. Hospital care cost fell in the intervention group from 25,406 pounds to 20,727 pounds and rose in the control group from 12,699 pounds to 19,650 pounds. CONCLUSION--An audit facilitator can favourably influence the pattern of diagnosis and treatment of childhood asthma in general practice. This may have an impact on health service costs. PMID:7711623

  13. Ensuring reliability in UK written tests of general practice: the MRCGP examination 1998-2003.

    PubMed

    Munro, Neil; Denney, Mei Ling; Rughani, Amar; Foulkes, John; Wilson, Andrew; Tate, Peter

    2005-01-01

    Reliability in written examinations is taken very seriously by examination boards and candidates alike. Within general education many factors influence reliability including variations between markers, within markers, within candidates and within teachers. Mechanisms designed to overcome, or at least minimize, the impact of such variables are detailed. Methods of establishing reliability are also explored in the context of a range of assessment situations. In written tests of general practice within the Membership of the Royal College of General Practitioner (MRCGP) examination considerable effort has put been put into achieving acceptable levels of reliability. Current mechanisms designed to ensure high reliability are described and related to the evolution of the written component of the examination. In addition to description of marker selection and training, question development including construct a detailed example of specific and generic marking schedules is provided. Examination results for the Written Paper of the MRCGP from 1998 to 2003 are reported including Cronbach's alpha coefficients and standard error of measurements, mean scores (and SD) and pass rates. In addition individual discrimination scores for each question in the October 2002 paper are shown. Consistent high reliability of the written component of the MRCGP examination provides valuable lessons in terms of selection, training and monitoring of markers as well as practical methods of moderating factors affecting candidate variability. The challenge for examination developers is to carry these important lessons forward into a modernized assessment structure of UK general practice. PMID:16147769

  14. Prevalence of eating disorders in three Cambridge general practices: hidden and conspicuous morbidity.

    PubMed Central

    Whitehouse, A M; Cooper, P J; Vize, C V; Hill, C; Vogel, L

    1992-01-01

    The aims of this study were to investigate the prevalence of anorexia nervosa, bulimia nervosa and partial syndromes in women general practice attenders to establish the relative proportions of 'conspicuous' and 'hidden' morbidity. A consecutive series of 540 women patients aged 16-35 years attending their family doctor were screened using a specially devised questionnaire, the weight and dietary practices survey. A total of 115 patients were selected for further assessment and of these 101 patients were interviewed using a standardized diagnostic interview for DSM III-R eating disorders. The prevalence of anorexia nervosa was 0.2% (one case), of bulimia nervosa 1.5% (eight cases) and of partial syndrome bulimia nervosa 5.4% (29 cases). Half of the cases of bulimia nervosa had not been identified by the general practitioner and two of these patients had been referred to specialists for treatment of secondary complications of the eating disorder. Hidden cases of bulimia nervosa or partial syndromes are relatively common in general practice. Certain key questions could be used by general practitioners in order to identify women with eating disorders. PMID:1493006

  15. Vertically integrated shared learning models in general practice: a qualitative study

    PubMed Central

    2013-01-01

    Background The numbers of learners seeking placements in general practice is rapidly increasing as an ageing workforce impacts on General Practitioner availability. The traditional master apprentice model that involves one-to-one teaching is therefore leading to supervision capacity constraints. Vertically integrated (VI) models may provide a solution. Shared learning, in which multiple levels of learners are taught together in the same session, is one such model. This study explored stakeholders’ perceptions of shared learning in general practices in northern NSW, Australia. Methods A qualitative research method, involving individual semi-structured interviews with GP supervisors, GP registrars, Prevocational General Practice Placements Program trainees, medical students and practice managers situated in nine teaching practices, was used to investigate perceptions of shared learning practices. A thematic analysis was conducted on 33 transcripts by three researchers. Results Participants perceived many benefits to shared learning including improved collegiality, morale, financial rewards, and better sharing of resources, knowledge and experience. Additional benefits included reduced social and professional isolation, and workload. Perceived risks of shared learning included failure to meet the individual needs of all learners. Shared learning models were considered unsuitable when learners need to: receive remediation, address a specific deficit or immediate learning needs, learn communication or procedural skills, be given personalised feedback or be observed by their supervisor during consultations. Learners’ acceptance of shared learning appeared partially dependent on their supervisors’ small group teaching and facilitation skills. Conclusions Shared learning models may partly address supervision capacity constraints in general practice, and bring multiple benefits to the teaching environment that are lacking in the one-to-one model. However, the risks

  16. Trainees' experiences of a four-year programme for specialty training in general practice.

    PubMed

    Capewell, Sarah; Stewart, Kirsty; Bowie, Paul; Kelly, Moya

    2014-01-01

    In 2012 the first Scottish cohort of trainees completed a four-year training programme in general practice. In the same year, the Royal College of General Practitioners (RCGP) successfully made the educational case for lengthening training from three to four years in the rest of the UK. This project sought to evaluate the experiences of the initial four-year cohorts (2012 and 2013) to gain the Certificate of Completion of Training (CCT). We aimed to capture trainees' experiences of the training programme and how well it prepared them for independent general practice. We also investigated whether perceived levels of clinical confidence in key areas of the curriculum improved over time. To achieve this we undertook a cross-sectional online questionnaire survey. Open-ended questions were included to elicit more in-depth responses by participants on all issues. A total of 20/49 trainees in 2012 (40%) and 46/50 trainees in 2013 (92%) completed the survey. Perceived mean levels of clinical confidence in the key curriculum domains surveyed in 2012/13 were generally high, particularly in clinical domains or topics such as cancer management (94%) and paediatrics (94%). It was lowest in non-clinical domains such as GP partnership (57%), practice management (68%) and leadership (65%), but also in some skills specific to general practice that are of importance where healthcare delivery is increasingly community-based such as public health (63%) and caring for the long-term unemployed (33%). This small study will inform the implementation of an integrated, community-based model of training to enable GP trainees to achieve the clinical and generalist skills required in the immediate future. PMID:24423797

  17. Challenges of Knowledge Management and Creation in Communities of Practice Organisations of Deaf and Non-Deaf Members: Requirements for a Web Platform

    ERIC Educational Resources Information Center

    de Freitas Guilhermino Trindade, Daniela; Guimaraes, Cayley; Antunes, Diego Roberto; Garcia, Laura Sanchez; Lopes da Silva, Rafaella Aline; Fernandes, Sueli

    2012-01-01

    This study analysed the role of knowledge management (KM) tools used to cultivate a community of practice (CP) in its knowledge creation (KC), transfer, learning processes. The goal of such observations was to determine requirements that KM tools should address for the specific CP formed by Deaf and non-Deaf members of the CP. The CP studied is a…

  18. Managing Intentionally Created Communities of Practice for Knowledge Sourcing across Organisational Boundaries: Insights on the Role of the CoP Manager

    ERIC Educational Resources Information Center

    Garavan, Thomas N.; Carbery, Ronan; Murphy, Eamonn

    2007-01-01

    Purpose: The purpose of this article is to explore strategies used by communities of practice (CoPs) managers when managing intentionally created CoPs. Design/methodology/approach: Four intentionally created CoPs in Ireland are explored, using a qualitative research design with data from observation, interviews and analysis of documents. Findings:…

  19. Adult Learning Strategies and Approaches (ALSA). Resources for Teachers of Adults. A Handbook of Practical Advice on Audio-Visual Aids and Educational Technology for Tutors and Organisers.

    ERIC Educational Resources Information Center

    Cummins, John; And Others

    This handbook is part of a British series of publications written for part-time tutors, volunteers, organizers, and trainers in the adult continuing education and training sectors. It offers practical advice on audiovisual aids and educational technology for tutors and organizers. The first chapter discusses how one learns. Chapter 2 addresses how…

  20. Oral Radiology Safety Standards Adopted by the General Dentists Practicing in National Capital Region (NCR)

    PubMed Central

    Jayaprakash, K.; Shivalingesh, K.K.; Agarwal, Vartika; Gupta, Bhuvandeep; Anand, Richa; Sharma, Abhinav; Kushwaha, Sumedha

    2016-01-01

    Introduction With advancement in diagnostic techniques, the utilization of radiologic examination has risen to many folds in the last two decades. Ionizing radiations from the radiographic examination carry the potential for harm by inducing carcino-genesis in addition to the diagnostic information extracted. Radiation doses utilized in the course of dental treatment might be low for individual examinations but patients are exposed to repeated examinations very often and many people are exposed during the course of dental care. Therefore, principles of radiation protection and safety are necessary for the dentists to follow to ensure minimum and inevitable exposure. Aim The aim of this study was to investigate the knowledge and behaviour of general dentists practicing in the National Capital Region (NCR) regarding radiation safety during oral radiographic procedures. Materials and Methods The study was a questionnaire based cross-sectional study. A total of 500 general dentists were contacted to participate in the study. The target population entailed of general dentists practicing in the National Capital Region. Data was computed and tabulated in Microsoft excel sheet and statistical analysis was performed with the help of SPSS version 21.0. Results The total response rate recovered was 70.6% and the respondents comprised of 59% and 41% males & females respectively. Only 64.8% of the general dentists contemplated thyroid to be the most important organ for radiation protection. Only 28.8% of the general dentists followed the position & distance rule appropriately. Conclusion The results showed that the knowledge and behaviour of the general dentists and the practices adopted by them regarding radiation safety is not satisfactory. To ensure the following of basic and necessary guidelines for radiation safety and protection, strict rules with penalties should be implemented by the state councils and new and interesting methods of education for this spectrum of the

  1. General Anesthesia in Cardiac Surgery: A Review of Drugs and Practices

    PubMed Central

    Alwardt, Cory M.; Redford, Daniel; Larson, Douglas F.

    2005-01-01

    Abstract: General anesthesia is defined as complete anesthesia affecting the entire body with loss of consciousness, analgesia, amnesia, and muscle relaxation. There is a wide spectrum of agents able to partially or completely induce general anesthesia. Presently, there is not a single universally accepted technique for anesthetic management during cardiac surgery. Instead, the drugs and combinations of drugs used are derived from the pathophysiologic state of the patient and individual preference and experience of the anesthesiologist. According to the definition of general anesthesia, current practices consist of four main components: hypnosis, analgesia, amnesia, and muscle relaxation. Although many of the agents highlighted in this review are capable of producing more than one of these effects, it is logical that drugs producing these effects are given in combination to achieve the most beneficial effect. This review features a discussion of currently used anesthetic drugs and clinical practices of general anesthesia during cardiac surgery. The information in this particular review is derived from textbooks, current literature, and personal experience, and is designed as a general overview of anesthesia during cardiac surgery. PMID:16117465

  2. A Case of Undiagnosed Harlequin Syndrome Presenting in General Dental Practice.

    PubMed

    Edwards, Kathryn; Schaefer, Andrew; Greenwood, Mark; Staines, Konrad

    2016-01-01

    Harlequin syndrome is a rare, clinically striking syndrome characterized by distinctly demarcated asymmetric facial flushing and sweating. It may be of idiopathic aetiology or caused by demonstrable ipsilateral damage to the sympathetic nervous system. A case is described where a patient presented to her general dental practitioner complaining of distinctly demarcated unilateral facial flushing and sweating. Onward referral resulted in a diagnosis of Harlequin syndrome. CPD/CLINICAL RELEVANCE: This article highlights the neurological signs and symptoms of Harlequin syndrome, making it easier to recognize if it presents in general dental practice. PMID:27024906

  3. The impact of a general practice group intervention on prescribing costs and patterns.

    PubMed Central

    Walker, Jane; Mathers, Nigel

    2002-01-01

    BACKGROUND: The formation of primary care groups (PCGs) and trusts (PCTs) has shifted the emphasis from individual practice initiatives to group-based efforts to control rising prescribing costs. However, there is a paucity of literature describing such group initiatives. We report the results of a multilevel group initiative, involving input from a pharmaceutical adviser, practice comparison feedback, and peer review meetings. AIM: To determine the impact of a prescribing initiative on the prescribing patterns of a group of general practices. DESIGN OF STUDY: A comparative study with non-matched controls. SETTING: Nine semi-rural/rural practices forming a commissioning group pilot, later a PCG, in Southern Derbyshire with nine practices as controls. METHOD: Practice data were collated for overall prescribing and for therapeutic categories, between the years 1997/1998 and 1998/1999 and analysed statistically. Prescribing expenditure trends were also collated. RESULTS: Although both groups came well within their prescribing budgets, in the study group this was for the first time in five years. Their rate of increase in expenditure slowed significantly following the initiative compared with that of the comparison group, which continued to rise (median practice net ingredient cost/patient unit (nic/PU) increase: Pound Sterling0.69 and Pound Sterling3.80 respectively; P = 0.03). The study group's nic/PU dropped below, and stayed below, that of the comparison group one month after the start of the initiative. For most therapeutic categories the study group had lower increases in costs and higher increases in percentage of generic items than the comparison group. Quality markers were unaffected. CONCLUSION: We suggest that practices with diverse prescribing patterns can work together effectively within a PCT locality to control prescribing costs. PMID:12030659

  4. [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

  5. Is the internet an integral part of general practice in Australia?

    PubMed

    Williams, P A; Maj, S P

    2001-01-01

    Computerisation has seen significant changes in information management and procedures in General Practice. Whilst the majority of changes to date, have been apparent in administration, the clinical aspect of primary care is now increasingly taking advantage of the computer and significantly, the Internet. The professional obligation to maintain currency in medical developments has provided an opportunity to use the Internet as a low cost method to access a wide range of medical research information worldwide. Furthermore traditional methods of communication within the medical community have the potential to be transformed by the availability and use of electronic communication techniques such as email. The incorporation of these new technologies in clinical practice is not without its challenges, and includes quality, timeliness, information management and attitudes to Internet based information. This paper presents the results of a preliminary study of GP's undertaken in Western Australia analysing the usage of, and attitude to, the Internet in clinical practice. PMID:11604771

  6. Patient-reported areas for quality improvement in general practice: a cross-sectional survey

    PubMed Central

    Waller, Amy; Carey, Mariko; Mazza, Danielle; Yoong, Serene; Grady, Alice; Sanson-Fisher, Rob

    2015-01-01

    Background GPs are often a patient’s first point of contact with the health system. The increasing demands imposed on GPs may have an impact on the quality of care delivered. Patients are well placed to make judgements about aspects of care that need to be improved. Aim To determine whether general practice patients perceive that the care they receive is ‘patient-centred’ across eight domains of care, and to determine the association between sociodemographic, GP and practice characteristics, detection of preventive health risks, and receipt of patient-centred care. Design and setting Cross-sectional survey of patients attending Australian general practice clinics. Method Patients completed a touchscreen survey in the waiting room to rate the care received from their GP across eight domains of patient-centred care. Patients also completed the Patient Health Questionnaire (PHQ-9) and self-reported health risk factors. GPs completed a checklist for each patient asking about the presence of health risk factors. Results In total 1486 patients and 51 GPs participated. Overall, 83% of patients perceived that the care they received was patient-centred across all eight domains. Patients most frequently perceived the ‘access to health care when needed’ domain as requiring improvement (8.3%). Not having private health insurance and attending a practice located in a disadvantaged area were significantly associated with perceived need for improvements in care (P<0.05). Conclusion Patients in general practice report that accessibility is an aspect of care that could be improved. Further investigation of how indicators of lower socioeconomic status interact with the provision of patient-centred care and health outcomes is required. PMID:25918336

  7. A decade of caring for drug users entirely within general practice.

    PubMed Central

    Martin, E; Canavan, A; Butler, R

    1998-01-01

    BACKGROUND: The government encourages general practitioners (GPs) to become involved in caring for drug users. However, in some areas of the country, including Bedford, secondary care support is inadequate. GPs in these areas have to decide how to cope with such patients entirely within general practice. AIM: To assess the characteristics and quality of care given without secondary care support to drug users by one practice in Bedford over a decade. METHOD: A search was made of the practice computer for all patients with a problem title of 'addiction drug' between 1986 and 1995. The age, sex, social characteristics, and drug history were recorded. RESULTS: One hundred and ninety-two patients were found, of which 155 took part in the practice programme; i.e. they consulted more than three times. Forty-three patients (37%) who took part and were prescribed Methadone were prescribed this drug as ampoules. Sixty-three patients (40.6%) who took part in the programme stopped using drugs. Thirty-two (33.6%) of the Methadone users became abstinent. A higher proportion of women (13-48%) than men (19-27.7%) stopped using Methadone (P = 0.019). Among patients who had a stable lifestyle, a higher proportion had been prescribed ampoules than mixture (22 out of 28: 78.6%; P = 0.001). Similarly, of those who had a job, eight out of 11 (72%; P = 0.037) had been prescribed methadone ampoules. Two-thirds of all patients prescribed amphetamines stopped using drugs. CONCLUSION: Long-term care of drug users entirely within general practice is feasible. Among those prescribed methadone ampoules, a higher than average proportion had stable lifestyles and had a stable job. PMID:10071402

  8. Undergraduate learning in general practice: the views of 1,000 final-year students

    PubMed Central

    Richardson, I. M.

    1983-01-01

    One thousand final-year medical students were asked to record what they had learned during a three-and-a-half week attachment to a general practice, under the headings of diagnosis, treatment, prevention, workload, use of medical care; they were also invited to criticize the teaching programme. It is suggested that this clinical education and vocational experience should now be made available earlier in the undergraduate course. PMID:6644680

  9. Patient-centred care in general dental practice - a systematic review of the literature

    PubMed Central

    2014-01-01

    Background Delivering improvements in quality is a key objective within most healthcare systems, and a view which has been widely embraced within the NHS in the United Kingdom. Within the NHS, quality is evaluated across three key dimensions: clinical effectiveness, safety and patient experience, with the latter modelled on the Picker Principles of Patient-Centred Care (PCC). Quality improvement is an important feature of the current dental contract reforms in England, with “patient experience” likely to have a central role in the evaluation of quality. An understanding and appreciation of the evidence underpinning PCC within dentistry is highly relevant if we are to use this as a measure of quality in general dental practice. Methods A systematic review of the literature was undertaken to identify the features of PCC relevant to dentistry and ascertain the current research evidence base underpinning its use as a measure of quality within general dental practice. Results Three papers were identified which met the inclusion criteria and demonstrated the use of primary research to provide an understanding of the key features of PCC within dentistry. None of the papers identified were based in general dental practice and none of the three studies sought the views of patients. Some distinct differences were noted between the key features of PCC reported within the dental literature and those developed within the NHS Patient Experience Framework. Conclusions This systematic review reveals a lack of understanding of PCC within dentistry, and in particular general dental practice. There is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient-centredness. Further research is necessary to understand the important features of PCC in dentistry and patients’ views should be central to this research. PMID:24902842

  10. Strengthening the research to policy and practice interface: exploring strategies used by research organisations working on sexual and reproductive health and HIV/AIDS

    PubMed Central

    2011-01-01

    This commentary introduces the HARPS supplement on getting research into policy and practice in sexual and reproductive health (SRH). The papers in this supplement have been produced by the Sexual Health and HIV Evidence into Practice (SHHEP) collaboration of international research, practitioner and advocacy organizations based in research programmes funded by the UK Department for International Development. The commentary describes the increasing interest from research and communication practitioners, policy makers and funders in expanding the impact of research on policy and practice. It notes the need for contextually embedded understanding of ways to engage multiple stakeholders in the politicized, sensitive and often contested arenas of sexual and reproductive health. The commentary then introduces the papers under their respective themes: (1) The theory and practice of research engagement (two global papers); (2) Applying policy analysis to explore the role of research evidence in SRH and HIV/AIDS policy (two papers with examples from Ghana, Malawi, Uganda and Zambia); (3) Strategies and methodologies for engagement (five papers on Kenya, South Africa, Ghana, Tanzania and Swaziland respectively); (4) Advocacy and engagement to influence attitudes on controversial elements of sexual health (two papers, Bangladesh and global); and (5) Institutional approaches to inter-sectoral engagement for action and strengthening research communications (two papers, Ghana and global). The papers illustrate the many forms research impact can take in the field of sexual and reproductive health. This includes discursive changes through carving out legitimate spaces for public debate; content changes such as contributing to changing laws and practices, procedural changes such as influencing how data on SRH are collected, and behavioural changes through partnerships with civil society actors such as advocacy groups and journalists. The contributions to this supplement provide a

  11. Nursing consultations and control of diabetes in general practice: a retrospective observational study

    PubMed Central

    Murrells, Trevor; Ball, Jane; Maben, Jill; Ashworth, Mark; Griffiths, Peter

    2015-01-01

    Background Diabetes affects around 3.6 million people in the UK. Previous research found that general practices employing more nurses delivered better diabetes care, but did not include data on individual patient characteristics or consultations received. Aim To examine whether the proportion of consultations with patients with diabetes provided by nurses in GP practices is associated with control of diabetes measured by levels of glycated haemoglobin (HbA1c). Design and setting A retrospective observational study using consultation records from 319 649 patients with diabetes from 471 UK general practices from 2002 to 2011. Method Hierarchical multilevel models to examine associations between proportion of consultations undertaken by nurses and attaining HbA1c targets over time, controlling for case-mix and practice level factors. Results The proportion of consultations with nurses has increased by 20% since 2002 but patients with diabetes made fewer consultations per year in 2011 compared with 2002 (11.6 versus 16.0). Glycaemic control has improved and was more uniformly achieved in 2011 than 2002. Practices in which nurses provide a higher proportion of consultations perform no differently to those where nurse input is lower (lowest versus highest nurse contact tertile odds ratio [OR] [confidence interval {95% CI}]: HbA1c ≤53 mmol/mol (7%) 2002, 1.04 [95% CI = 0.87 to 1.25] and 2011, 0.95 [95% CI = 0.87 to 1.03]; HbA1c ≤86 mmol/mol (10%) 2002, 0.97 [95% CI = 0.73 to 1.29] and 2011, 0.95 [95% CI = 0.86 to 1.04]). Conclusion Practices that primarily use GPs to deliver diabetes care could release significant resources with no adverse effect by switching their services towards nurse-led care. PMID:26412840

  12. Routine mortality monitoring for detecting mass murder in UK general practice: test of effectiveness using modelling

    PubMed Central

    Guthrie, Bruce; Love, Tom; Kaye, Rebecca; MacLeod, Margaret; Chalmers, Jim

    2008-01-01

    Background The Shipman Inquiry recommended mortality rate monitoring if it could be ‘shown to be workable’ in detecting a future mass murderer in general practice. Aim To examine the effectiveness of cumulative sum (CUSUM) charts, cross-sectional Shewhart charts, and exponentially-weighted, moving-average control charts in mortality monitoring at practice level. Design of study Analysis of Scottish routine general practice data combined with estimation of control chart effectiveness in detecting a ‘murderer’ in a simulated dataset. Method Practice stability was calculated from routine data to determine feasible lengths of monitoring. A simulated dataset of 405 000 ‘patients’ was created, registered with 75 ‘practices’ whose underlying mortality rates varied with the same distribution as case-mix-adjusted mortality in all Scottish practices. The sensitivity of each chart to detect five and 10 excess deaths was examined in repeated simulations. The sensitivity of control charts to excess deaths in simulated data, and the number of alarm signals when control charts were applied to routine data were estimated. Results Practice instability limited the length of monitoring and modelling was consequently restricted to a 3-year period. Monitoring mortality over 3 years, CUSUM charts were most sensitive but only reliably achieved >50% successful detection for 10 excess deaths per year and generated multiple false alarms (>15%). Conclusion At best, mortality monitoring can act as a backstop to detect a particularly prolific serial killer when other means of detection have failed. Policy should focus on changes likely to improve detection of individual murders, such as reform of death certification and the coroner system. PMID:18482483

  13. Patients' experiences with lifestyle counselling in general practice: A qualitative study

    PubMed Central

    Walseth, Liv Tveit; Abildsnes, Eirik; Schei, Edvin

    2011-01-01

    Objective (1) To elucidate the relevance of Habermas's theory as a practical deliberation procedure in lifestyle counselling in general practice, using a patient perspective. (2) To search for topics which patients consider of significance in such consultations. Design Qualitative observation and interview study. Setting General practice. Subjects A total of 12 patients were interviewed after lifestyle consultations with their GPs. Main outcome measures How the patients perceived the counselling, how it affected them, and what they wanted from their GP in follow-up consultations. Results The GP should be a source of medical knowledge and a caretaker, but also actively discuss contextual reasons for lifestyle choices, and be a reflective partner exploring values and norms. The patients wanted their GP to acknowledge emotions and to direct the dialogue towards common ground where advice was adjusted to the concrete life situation. A good, personal doctor–patient relationship created motivation and obligation to change, and allowed counselling to be interpreted as care. Conclusion The findings underscore the necessity of a patient-centred approach in lifestyle counselling and support the relevance of Habermas's theory as practical guidance for deliberation. Implications The findings suggest that GPs should trust the long-term effects of investing in a good relationship and personalized care in lifestyle consultations. The study should incite the GP to act as an encouraging informer, an explorer of everyday life and reasons for behaviour, a reflective partner, and a caretaker, adjusting medical advice to patients' identity, context, and values. PMID:21294605

  14. Body mass index and blood glucose in psychiatric and general practice populations.

    PubMed

    McAvoy, Sarah; Cordiner, Matthew; Kelly, Jackie; Chiwanda, Laura; Jefferies, Christine; Miller, Kirsteen; Shajahan, Polash

    2016-06-01

    Aims and method Using a retrospective observational approach, we aimed to discern whether there was a difference in metabolic parameters between psychiatric and general practice populations in the same locality. Second, we aimed to establish differences in metabolic parameters of patients taking olanzapine, clozapine or aripiprazole. Results Patients with psychiatric illness had a body mass index (BMI) comparable to that of the general practice population (28.7 v. 29.7 kg/m(2)), but blood glucose was significantly lower in the general practice population (4.8 v. 6.1 mmol/L). Olanzapine was associated with the lowest BMI (26.1 kg/m(2)) and aripiprazole the highest (32.2 kg/m(2)), with no difference in blood glucose between antipsychotics. Clinical implications Awareness of environmental factors and how they affect individuals is important and medications are not the only cause of metabolic effects. There may be a channelling bias present, meaning practitioners are cognisant of potential metabolic effects prior to prescribing. Overall monitoring of physical health is important regardless of potential cause. PMID:27280032

  15. Workplace learning from a socio-cultural perspective: creating developmental space during the general practice clerkship.

    PubMed

    van der Zwet, J; Zwietering, P J; Teunissen, P W; van der Vleuten, C P M; Scherpbier, A J J A

    2011-08-01

    Workplace learning in undergraduate medical education has predominantly been studied from a cognitive perspective, despite its complex contextual characteristics, which influence medical students' learning experiences in such a way that explanation in terms of knowledge, skills, attitudes and single determinants of instructiveness is unlikely to suffice. There is also a paucity of research which, from a perspective other than the cognitive or descriptive one, investigates student learning in general practice settings, which are often characterised as powerful learning environments. In this study we took a socio-cultural perspective to clarify how students learn during a general practice clerkship and to construct a conceptual framework that captures this type of learning. Our analysis of group interviews with 44 fifth-year undergraduate medical students about their learning experiences in general practice showed that students needed developmental space to be able to learn and develop their professional identity. This space results from the intertwinement of workplace context, personal and professional interactions and emotions such as feeling respected and self-confident. These forces framed students' participation in patient consultations, conversations with supervisors about consultations and students' observation of supervisors, thereby determining the opportunities afforded to students to mind their learning. These findings resonate with other conceptual frameworks and learning theories. In order to refine our interpretation, we recommend that further research from a socio-cultural perspective should also explore other aspects of workplace learning in medical education. PMID:21188514

  16. Patient empowerment, an additional characteristic of the European definitions of general practice/family medicine.

    PubMed

    Mola, Ernesto

    2013-06-01

    Growing evidence supports the inclusion of patient empowerment as a key ingredient of care for patients with chronic conditions. In recent years, several studies based on patient empowerment, have been carried out in different European countries in the context of general practice and primary care to improve management of chronic diseases. These studies have shown good results of the care model, increasing patient and health professionals' satisfaction, adherence to guidelines and to treatment, and improving clinical outcomes. In 2011, the Wonca European Council included as the twelfth characteristic of the European definitions of general practice/family medicine: 'promote patient empowerment'. The aim of this paper is to clarify the meaning of 'patient empowerment' and to explain why family medicine should be considered the most suitable setting to promote it. The inclusion of patient empowerment as one of the essential characteristics of general practice fills a conceptual gap and clearly suggests to the European health care systems a tested model to face chronic diseases: involving and empowering patients in managing their own conditions to improve health and well-being. PMID:23336328

  17. Distilling the essence of general practice: a learning journey in progress

    PubMed Central

    Gillies, John CM; Mercer, Stewart W; Lyon, Andrew; Scott, Mairi; Watt, Graham CM

    2009-01-01

    Over the past 5 years, general practice in the UK has undergone major change. Starting with the introduction of the new GMS contract in 2004, it has continued apace with the establishment of Postgraduate Medical Education Training Board, a GP training curriculum, and nMRCGP. The NHS is developing very differently in the four countries of the UK. Regulation of the profession is under review, and a system of relicensing, recertification, and revalidation is being introduced. The Essence project, initiated by RCGP Scotland in conjunction with International Futures Forum 4 years ago is a constructive response to these changes. It has included learning journeys, a discussion day for GPs, and commissioned short pieces of 100 words from GPs and patients. From an analysis of these, some characteristics of the essence of general practice have been defined. These include key roles and core personal qualities for GPs. It is argued that general practice has important and unique advantages — trust, coordination, continuity, flexibility, universal coverage, and leadership — which mean that it should continue to be central to the development of primary care throughout the UK. PMID:19401010

  18. Treatment of Iron Deficiency With Intravenous Ferric Carboxymaltose in General Practice: A Retrospective Database Study

    PubMed Central

    Kuster, Martina; Meli, Damian N.

    2015-01-01

    Background Iron deficiency is a frequent problem in general practice. Oral supplementation may in some cases not be well tolerated or not be efficient. Intravenous ferric carboxymaltose may be an alternative for iron supplementation in general practice. The aim of the present study was to analyze the indications for and the efficacy of intravenous ferric carboxymaltose in a primary care center. Methods We retropectively analyzed electronic data from 173 patients given intravenous ferric carboxymaltose between 2011 and 2013 in primary care center with 18 GPs in Bern, Switzerland. Results Of all patients, 34% were treated intravenously due to an inappropriate increase in ferritin levels after oral therapy, 24% had side effects from oral treatment, 10% were treated intravenously due to the patients explicit wish, and in 39% of all cases, no obvious reason of intravenous instead of oral treatment could be found. Intravenous ferric carboxymaltose led to a significant increase in hemoglobin and serum ferritin levels. Side effects of intravenous treatment were found in 2% of all cases. Conclusion We conclude that treatment with intravenous ferric carboxymaltose is an efficient alternative for patients with iron deficiency in general practice, when oral products are not well tolarated or effective. As treatment with iron carboxymaltose is more expensive and potentially dangerous due to side effects, the indication should be placed with (more) care. PMID:25368700

  19. Body mass index and blood glucose in psychiatric and general practice populations

    PubMed Central

    McAvoy, Sarah; Cordiner, Matthew; Kelly, Jackie; Chiwanda, Laura; Jefferies, Christine; Miller, Kirsteen; Shajahan, Polash

    2016-01-01

    Aims and method Using a retrospective observational approach, we aimed to discern whether there was a difference in metabolic parameters between psychiatric and general practice populations in the same locality. Second, we aimed to establish differences in metabolic parameters of patients taking olanzapine, clozapine or aripiprazole. Results Patients with psychiatric illness had a body mass index (BMI) comparable to that of the general practice population (28.7 v. 29.7 kg/m2), but blood glucose was significantly lower in the general practice population (4.8 v. 6.1 mmol/L). Olanzapine was associated with the lowest BMI (26.1 kg/m2) and aripiprazole the highest (32.2 kg/m2), with no difference in blood glucose between antipsychotics. Clinical implications Awareness of environmental factors and how they affect individuals is important and medications are not the only cause of metabolic effects. There may be a channelling bias present, meaning practitioners are cognisant of potential metabolic effects prior to prescribing. Overall monitoring of physical health is important regardless of potential cause. PMID:27280032

  20. Adherence to diabetes care processes at general practices in the National Capital Region-Delhi, India

    PubMed Central

    Shivashankar, Roopa; Bhalla, Sandeep; Kondal, Dimple; Ali, Mohammed K.; Prabhakaran, Dorairaj; Venkat Narayan, K. M.; Tandon, Nikhil

    2016-01-01

    Aim: To assess the level of adherence to diabetes care processes, and associated clinic and patient factors at general practices in Delhi, India. Methods: We interviewed physicians (n = 23) and patients with diabetes (n = 406), and reviewed patient charts at general practices (government = 5; private = 18). We examined diabetes care processes, specifically measurement of weight, blood pressure (BP), glycated hemoglobin (HbA1c), lipids, electrocardiogram, dilated eye, and a foot examination in the last one year. We analyzed clinic and patient factors associated with a number of care processes achieved using multilevel Poisson regression model. Results: The average number of clinic visits per patient was 8.8/year (standard deviation = 5.7), and physicians had access to patient's previous records in only 19.7% of patients. Dilated eye exam, foot exam, and electrocardiogram were completed in 7.4%, 15.1%, and 29.1% of patients, respectively. An estimated 51.7%, 88.4%, and 28.1% had ≥1 measurement of HbA1c, BP, and lipids, respectively. Private clinics, physician access to patient's previous records, use of nonphysicians, patient education, and the presence of diabetes complication were positively associated with a number of care processes in the multivariable model. Conclusion: Adherence to diabetes care processes was suboptimal. Encouraging implementation of quality improvement strategies like Chronic Care Model elements at general practices may improve diabetes care. PMID:27186549

  1. The disappearance of the “revolving door” patient in Scottish general practice: successful policies

    PubMed Central

    2012-01-01

    Background We describe the health of "revolving door" patients in general practice in Scotland, estimate changes in their number over the timescale of the study, and explore reasons for changes, particularly related to NHS and government policy. Methods A mixed methods predominantly qualitative study, using a grounded theory approach, set in Scottish general practice. Semi-structured interviews were conducted with professional key informants, 6 Practitioner Services staff who administer the GP registration system and 6 GPs with managerial or clinical experience of working with “revolving door” patients. Descriptive statistical analysis and qualitative analysis of patient removal episodes linked with routine hospital admissions, outpatient appointments, drug misuse treatment episodes and deaths were carried out with cohorts of “revolving door” patients identified from 1999 to 2005 in Scotland. Results A “revolving door” patient is removed 4 or more times from GP lists in 7 years. Patients had complex health issues including substance misuse, psychiatric and physical health problems and were at high risk of dying. There was a dramatic reduction in the number of “revolving door” patients during the course of the study. Conclusions “Revolving door” patients in general practice had significant health problems. Their numbers have reduced dramatically since 2004 and this probably resulted from improved drug treatment services, pressure from professional bodies to reduce patient removals and the positive ethical regulatory and financial climate of the 2004 GMS GP contract. This is a positive development for the NHS. PMID:23035887

  2. Infection control in general practices in Buffalo City and OR Tambo District Municipalities, South Africa

    PubMed Central

    2012-01-01

    Abstract Background Good infection control practices are effective in reducing rates of infection in health care settings. Studies in primary care in developed countries indicate that many general practitioners (GPs) do not comply with optimal infection control practices. There are no published studies from developing countries in Southern Africa. Objectives The aim of this study was to describe infection control practices in private GP surgeries in the Buffalo City and OR Tambo District Municipalities in the Eastern Cape Province, South Africa. Method A literature review was conducted to appraise current best practice with respect to Standard Infection Control and Transmission Based Precautions. A questionnaire, inquiring into GPs’ actual practices, was posted to each surgery. Results The valid response rate was 34% (47/140). Methods used to sterilise instruments in 40 practices were: ultraviolet sterilisation (23), chemical disinfection (14), boiling water (7), and steam autoclave (2). Compounds used for chemical disinfection included organotin quaternary, chlorhexidine and benzyl ammonium chloride with a quaternary complex. Twenty-two (47%) used a hand rub. Sixteen (35%) GPs stated that they had a policy to promptly triage patients who are coughing, and 23 (50%) had a policy for airflow movement in the surgery. All practices appropriately disposed of sharps. Thirty-seven (80%) expressed interest in a seminar on infection control. Conclusions Overall, GPs were aware of infection control precautions. Ultraviolet sterilisers and chlorhexidine are not recommended, however, for sterilisation or high level disinfection of medical instruments, and their use should be discontinued. Hand rubs are underutilised. GPs should implement Transmission Based Precautions to prevent airborne and droplet infections.

  3. Research in general practice: a survey of incentives and disincentives for research participation.

    PubMed

    Brodaty, Henry; Gibson, Louisa Hr; Waine, Melissa L; Shell, Allan M; Lilian, Ruth; Pond, Constance Dimity

    2013-09-01

    Background Recruitment rates of general practitioners (GPs) to do research vary widely. This may be related to the ability of a study to incorporate incentives for GPs and minimise barriers to participation. Method A convenience sample of 30 GPs, ten each from the Sydney intervention and control groups Ageing in General Practice 'Detection and Management of Dementia' project (GP project) and 10 GPs who had refused participation, were recruited to determine incentives and barriers to participating in research. GPs completed the 11-item 'Meeting the challenges of research in general practice: general practitioner questionnaire' (GP survey) between months 15 and 24 of the GP project, and received brief qualitative interviews from a research GP to clarify responses where possible. Results The most important incentives the 30 GPs gave for participating in the project were a desire to update knowledge (endorsed by 70%), to help patients (70%), and altruism (60%). Lack of time (43%) was the main barrier. GPs also commented on excessive paperwork and an inadequate explanation of research. Conclusions While a desire to update knowledge and help patients as well as altruism were incentives, time burden was the primary barrier and was likely related to extensive paperwork. Future recruitment may be improved by minimising time burden, making studies simpler with online data entry, offering remuneration and using a GP recruiter. PMID:24427184

  4. [Selective screening for hypercholesterolemia. Results from a screening model in general practice].

    PubMed

    Agner, E; Christensen, T E; Mahnfeldt, M S; Baastrup, A; Jacobsen, K; Jensen, S E

    1990-11-01

    At present, it appears to be probable that both dietary changes and medicinal treatment can reduce the risk of development of coronary disease in middle-aged men with moderately to severely raised blood cholesterol values. Internationally, the limits for cholesterol intervention are considerably lower than in Denmark. Extensive cholesterol screening is, however, very expensive and the identified persons with high cholesterol values will frequently be found in sex and age groups where the beneficial effect of intervention is probably limited. A model for selective cholesterol screening in high risk groups in general practice is described here. In 20 general practices, all of the men aged 45-59 years belonging to the practice were invited to examination of cholesterol and blood pressure. Plasma cholesterol was measured by means of a Reflotron (results are available within three minutes) and the blood pressure and tobacco consumption were registered. After this, the patient's own general practitioner calculated with each of the persons the risk for development of myocardial infarction within the next ten years and intervention could be commenced immediately. 41% of those invited came for examination. Out of these, 29% had cholesterol values greater than or equal to 7.0 mmol/l (Danish limiting value), 44% greater than or equal to 6.5 mmol/l (limiting value in the remainder of Western Europe), and 5% greater than or equal to 9.0 mmol/l (severe hypercholesterolaemia) while only 18% had completely normal cholesterol less than 5.2 mmol/l. In every practice, two patients on an average were found with severe hypercholesterolaemia greater than or equal to 9.0 mmol/l. 28% of the participants had at least two of the three risk factors investigated. (ABSTRACT TRUNCATED AT 250 WORDS) PMID:2238223

  5. Touch screen computer health assessment in Australian general practice patients: a cross-sectional study protocol

    PubMed Central

    Carey, Mariko Leanne; Sanson-Fisher, Robert William; Russell, Grant; Mazza, Danielle; Makeham, Meredith; Paul, Christine Louise; Inder, Kerry Jane; D'Este, Catherine

    2012-01-01

    Introduction Cardiovascular disease (CVD) and cancer are leading causes of death globally. Early detection of cancer and risk factors for CVD may improve health outcomes and reduce mortality. General practitioners (GPs) are accessed by the majority of the population and play a key role in the prevention and early detection of chronic disease risk factors. This cross-sectional study aims to assess the acceptability of an electronic method of data collection in general practice patients. The study will describe the proportion screened in line with guidelines for CVD risk factors and cancer as well as report the prevalence of depression, lifestyle risk factors, level of provision of preconception care, cervical cancer vaccination and bone density testing. Lastly, the study will assess the level of agreement between GPs and patients perception regarding presence of risk factors and screening. Methods and analysis The study has been designed to maximise recruitment of GPs by including practitioners in the research team, minimising participation burden on GPs and offering remuneration for participation. Patient recruitment will be carried out by a research assistant located in general practice waiting rooms. Participants will be asked regarding the acceptability of the touch screen computer and to report on a range of health risk and preventive behaviours using the touch screen computer. GPs will complete a one-page survey indicating their perception of the presence of risk behaviours in their patients. Descriptive statistics will be generated to describe the acceptability of the touch screen and prevalence of health risk behaviours. Cohen's κ will be used to assess agreement between GP and patient perception of presence of health risk behaviours. Ethics and dissemination This study has been approved by the human research committees in participating universities. Findings will be disseminated via peer-reviewed publications, conference presentations as well as practice

  6. 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

  7. Nausea and Vomiting as the Reasons for Encounter in General Practice

    PubMed Central

    Frese, Thomas; Klauss, Steffi; Herrmann, Kristin; Sandholzer, Hagen

    2011-01-01

    Background The present study aimed to explore the consultation prevalence, differential diagnoses, and management of patients presenting with nausea or vomiting to their family doctors. Methods Cross-sectional data were collected from randomly selected patients during the SESAM 2 study (October 1, 1999 to September 30, 2000). We contacted 2510 doctors; 270 (10.8%) of them participated in the study. Data were collected from randomly selected patients previously known to the general practitioner. Unpublished but publicly available data from the Dutch Transition Project were also analysed. Results One hundred and sixty-nine of the total 8874 patients consulted their general practitioner for nausea/vomiting; 97 (57.4%) were female and 72 (42.6%) were male. Most patients suffering from nausea or vomiting in general practice were aged between 15 and 64 years. Nearly all patients were given a physical examination. Most diagnoses were made without further investigation, additional diagnostic procedures were found to be necessary in only 7 patients. Drugs were prescribed as the most frequent form of medical treatment, in 76.3% of cases. Non-infectious gastroenteritis or colitis was the most frequent diagnosis. Nausea or vomiting was associated with diarrhoea, fever, and abdominal pain. Headache, general weakness, and epigastric pain were also statistically significantly associated with nausea or vomiting. Conclusions Many disorders cause nausea or vomiting. Although most of the patients were diagnosed with non-infectious gastroenteritis or colitis, the general practitioner also has to bear in mind that nausea and vomiting may be alarm symptoms. Medication was prescribed in most of the cases and there were only a few referrals to a specialist or hospital. Life-threatening disorders (appendicitis, bowel obstruction/ileus) were found in a few cases presenting with nausea or vomiting. Keywords Nausea; Vomiting; General practice; Primary care PMID:22043268

  8. Patterns of Alcohol and Other Drug Use Associated with Major Depression among Gay Men Attending General Practices in Australia

    ERIC Educational Resources Information Center

    Holt, Martin; Bryant, Joanne; Newman, Christy E.; Paquette, Dana M.; Mao, Limin; Kidd, Michael R.; Saltman, Deborah C.; Kippax, Susan C.

    2012-01-01

    Our aim was to clarify the role of alcohol and other drug (AOD) use in major depression among gay men attending general medical practices. A secondary analysis was conducted on survey data collected from 531 gay men attending high-HIV-caseload general practices in Adelaide and Sydney, Australia. The survey contained demographic, social,…

  9. Growth of Self-Perceived Clinical Competence in Postgraduate Training for General Practice and Its Relation to Potentially Influencing Factors

    ERIC Educational Resources Information Center

    Kramer, A. W. M.; Zuithoff, P.; Jansen, J. J. M.; Tan, L. H. C.; Grol, R. P. T. M.; van der Vleuten, C. P. M.

    2007-01-01

    Objective: To examine the increase in self-perceived clinical competence during a three-year postgraduate training in general practice and to explore the relation between the growth of self-perceived competence and several background variables. Design: Cohort, 1995-1998. Setting: Three-year Postgraduate Training for General practice in the…

  10. Patients with persistent medically unexplained physical symptoms: a descriptive study from Norwegian general practice

    PubMed Central

    2014-01-01

    Background Further research on effective interventions for patients with peristent Medically Unexplained Physical Symptoms (MUPS) in general practice is needed. Prevalence estimates of such patients are conflicting, and other descriptive knowledge is needed for development and evaluation of effective future interventions. In this study, we aimed to estimate the consultation prevalence of patients with persistent MUPS in general practice, including patients’ characteristics and symptom pattern, employment status and use of social benefits, and the general practitioners’ (GPs) management strategy. Method During a four-week period the participating Norwegian GPs (n = 84) registered all consultations with patients who met a strict definition of MUPS (>3 months duration and function loss), using a questionnaire with simple tick-off questions. Analyses were performed with descriptive statistics for all variables and split analysis on gender and age. Results The GPs registered 526 patients among their total of 17 688 consultations, giving a consultation prevalence of persistent MUPS of 3%. The mean age of patients was 46 years, and 399 (76%) were women. The most frequent group of symptoms was musculoskeletal problems, followed by asthenia/fatigue. There was no significant gender difference in symptom pattern. Almost half of the patients were currently working (45%), significantly more men. The major GP management strategy was supportive counseling. Conclusion A consultation prevalence rate of 3% implies that patients with persistent MUPS are common in general practice. Our study disclosed heterogeneity among the patients such as differences in employment status, which emphasizes the importance of personalized focus rather than unsubstantiated stereotyping of “MUPS patients” as a group. PMID:24885524

  11. An Appraisal of an Offender Population on the General Educational Development Test as Predicted by the General Educational Development Practice Tests.

    ERIC Educational Resources Information Center

    Agba, Cyprian Peter; Klosowski, Steven M.; Miller, Gary R.

    2002-01-01

    Data from 2,068 Indiana inmates who took the General Educational Development (GED) practice and final tests between 1988-2000 were analyzed. All six practice tests correlated with performance on the GED test. Most accurate were the FF battery (for writing skills), CC (for social studies), BB (for science), EE (for interpreting literature and…

  12. Indicators of the quality of general practice care of patients with chronic illness: a step towards the real involvement of patients in the assessment of the quality of care.

    PubMed Central

    Wensing, M; Grol, R; van Montfort, P; Smits, A

    1996-01-01

    OBJECTIVE--To develop a list of indicators of the general practice care of people with chronic illnesses considered important by both patients and practitioners and to identify the indicators that are considered relevant for patient assessment of health care quality. DESIGN--Qualitative study with focus group interviews and a written consensus procedure. SETTING--General practice in the Netherlands in 1993. SUBJECTS--34 patients with chronic illness, mostly members of patient organisations, and 19 general practitioners with expertise in either chronic disease management or experience with patient surveys. MAIN MEASURES--Aspects of general practice care considered important for the delivery of good quality care that emerged from focus group interviews; the relevance of evaluations of 41 aspects of care for patients explored through the written consensus procedure. Those aspects of general practice care agreed to be both important and relevant by patients and general practitioners were considered to be suitable indicators for patient assessment of the quality of care. RESULTS--Patients and general practitioners differed to some extent in their assessment of the aspects of care that they considered important for quality. They agreed that most indicators of care that related to the ¿doctor-patient relation¿ and to ¿information and support¿ were relevant and therefore suitable as indicators for patient assessment of health care quality. There was less agreement about the relevance of indicators of ¿medical and technical care,¿ ¿availability and accessibility,¿ and ¿organisation of services.¿ CONCLUSIONS--Several indicators of the quality of general practice care of patients with chronic illness were thought to be suitable for the patient assessment of healthcare quality, but other indicators were not, mainly because of reservations by general practitioners. IMPLICATIONS-- Qualitative methods can contribute to the selection of indicators for assessment of the

  13. Improving general practice computer systems for patient safety: qualitative study of key stakeholders

    PubMed Central

    Avery, Anthony J; Savelyich, Boki S P; Sheikh, Aziz; Morris, Caroline J; Bowler, Isobel; Teasdale, Sheila

    2007-01-01

    Objective The authors sought to identify ways in which the use of general practice computer systems could be improved to enhance safety in primary care. Design Qualitative study using semistructured interviews. Participants Thirty one participants, representing a broad range of relevant disciplines and interest groups. Participants included clinicians, computer system and drug database suppliers, academics with interests in health informatics and members of governmental, professional and patient representative bodies. Setting UK. Results Participants identified deficiencies in current systems that pose serious threats to patient safety. To bring about improvements, providers need to supply clinicians with safe, accurate and accessible information for decision support; be aware of the importance of human ergonomics in the design of hazard alerts; consider the value of audit trails and develop mechanisms to allow for the accurate transfer of information between clinical computer systems. These improvements in computer systems will be most likely to occur if mandated through regulations. Individual practices are in need of improved education and training which focuses, in particular, on providing support with recording data accurately and using call, recall and reminders effectively. Conclusion There are significant opportunities for improving the safety of general practice computer systems. Priorities include improving the knowledge base for clinical decision support, paying greater attention to human ergonomics in system design, improved staff training and the introduction of new regulations mandating system suppliers to satisfy essential safety requirements. PMID:17301200

  14. A study of attitudes, beliefs and organisational barriers related to safe emergency oxygen therapy for patients with COPD (chronic obstructive pulmonary disease) in clinical practice and research

    PubMed Central

    O'Driscoll, B Ronan; Bakerly, Nawar Diar; Caress, Ann-Louise; Roberts, June; Gaston, Miriam; Newton, Mark; Yorke, Janelle

    2016-01-01

    Background Patients can be harmed by receiving too little or too much oxygen. There is ongoing disagreement about the use of oxygen in medical emergencies. Methods This was a mixed methods study (survey, telephone interviews and focus groups) involving patients, the public and healthcare professionals (HCPs). Results 62 patients with chronic obstructive pulmonary disease (COPD), 65 members of the public, 68 ambulance crew members, 22 doctors, 22 nurses and 10 hospital managers took part. For five factual questions about oxygen therapy, the average score for correct answers was 28% for patients with COPD, 33% for the general public and 75% for HCPs. The HCPs had an average score of 66% for five technical questions. Patients (79%) and members of the public (68%) were more likely than HCPs (36%) to believe that oxygen was beneficial in most medical emergencies and less likely to have concerns that it might harm some people (35%, 25% and 68%). All groups had complex attitudes about research into oxygen use in medical emergencies. Many participants would not wish for themselves or their loved ones to have their oxygen therapy determined by a randomised protocol, especially if informed consent was not possible in an emergency situation. Conclusions We have found low levels of factual knowledge about oxygen use among patients with COPD and the general public and many false beliefs about the potential benefits and harms of using oxygen. HCPs had a higher level of factual knowledge. All groups had complex attitudes towards research into emergency oxygen use. PMID:27252870

  15. Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial

    PubMed Central

    Verbakel, Natasha J; Langelaan, Maaike; Verheij, Theo JM; Wagner, Cordula; Zwart, Dorien LM

    2015-01-01

    Background A constructive safety culture is essential for the successful implementation of patient safety improvements. Aim To assess the effect of two patient safety culture interventions on incident reporting as a proxy of safety culture. Design and setting A three-arm cluster randomised trial was conducted in a mixed method study, studying the effect of administering a patient safety culture questionnaire (intervention I), the questionnaire complemented with a practice-based workshop (intervention II) and no intervention (control) in 30 general practices in the Netherlands. Method The primary outcome, the number of reported incidents, was measured with a questionnaire at baseline and a year after. Analysis was performed using a negative binomial model. Secondary outcomes were quality and safety indicators and safety culture. Mixed effects linear regression was used to analyse the culture questionnaires. Results The number of incidents increased in both intervention groups, to 82 and 224 in intervention I and II respectively. Adjusted for baseline number of incidents, practice size and accreditation status, the study showed that practices that additionally participated in the workshop reported 42 (95% confidence interval [CI] = 9.81 to 177.50) times more incidents compared to the control group. Practices that only completed the questionnaire reported 5 (95% CI = 1.17 to 25.49) times more incidents. There were no statistically significant differences in staff perception of patient safety culture at follow-up between the three study groups. Conclusion Educating staff and facilitating discussion about patient safety culture in their own practice leads to increased reporting of incidents. It is beneficial to invest in a team-wise effort to improve patient safety. PMID:25918337

  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. Internet Services for Communicating With the General Practice: Barely Noticed and Used by Patients

    PubMed Central

    Vermeulen, Joan; Friele, Roland D; van Schayck, Onno CP; de Jong, Judith D; de Witte, Luc P

    2015-01-01

    Background The Netherlands is one of the frontrunners of eHealth in Europe. Many general practices offer Internet services, which can be used by patients to communicate with their general practice. In promoting and implementing such services, it is important to gain insight into patients’ actual use and intention toward using. Objective The objective of the study is to investigate the actual use and intention toward using Internet services to communicate with the general practice by the general practice population. The secondary objective is to study the factors and characteristics that influence their intention to use such services. Methods There were 1500 members of the Dutch Health Care Consumer Panel, age over 18 years, that were invited to participate in this cross-sectional study. People who had contacted their general practitioner at least once in the past year were included. Participants were asked to fill out a questionnaire about the following services: Internet appointment planning, asking questions on the Internet, email reminders about appointments, Internet prescription refill requests, Internet access to medical data, and Internet video consultation. Participants indicated whether they had used these services in the past year, they would like to use them, and whether they thought their general practice had these services. For the first two services, participants rated items based on the unified theory of acceptance and use of technology complemented with additional constructs. These items were divided into six subscales: effort expectancy, performance expectancy, trust, attitude, facilitating conditions, and social influence. Results There were 546 participants that were included in the analyses out of 593 who met the inclusion criteria. The participants had a mean age of 53 years (SD 15.4), 43.6% (n=238) were male, and 66.8% (n=365) had at least one chronic illness. Actual use of the services varied between 0% (n=0, video consultation) and 10

  18. Trends in sexually transmitted infections in general practice 1990-2000: population based study using data from the UK general practice research database

    PubMed Central

    Cassell, Jackie A; Mercer, Catherine H; Sutcliffe, Lorna; Petersen, Irene; Islam, Amir; Brook, M Gary; Ross, Jonathan D; Kinghorn, George R; Simms, Ian; Hughes, Gwenda; Majeed, Azeem; Stephenson, Judith M; Johnson, Anne M; Hayward, Andrew C

    2006-01-01

    Objective To describe the contribution of primary care to the diagnosis and management of sexually transmitted infections in the United Kingdom, 1990-2000, in the context of increasing incidence of infections in genitourinary medicine clinics. Design Population based study. Setting UK primary care. Participants Patients registered in the UK general practice research database. Main outcome measures Incidence of diagnosed sexually transmitted infections in primary care and estimation of the proportion of major such infections diagnosed in primary care. Results An estimated 23.0% of chlamydia cases in women but only 5.3% in men were diagnosed and treated in primary care during 1998-2000, along with 49.2% cases of non-specific urethritis and urethral discharge in men and 5.7% cases of gonorrhoea in women and 2.9% in men. Rates of diagnosis in primary care rose substantially in the late 1990s. Conclusions A substantial and increasing number of sexually transmitted infections are diagnosed and treated in primary care in the United Kingdom, with sex ratios differing from those in genitourinary medicine clinics. Large numbers of men are treated in primary care for presumptive sexually transmitted infections. PMID:16439371

  19. Prescribing behaviour in general practice: the impact of promoting therapeutically equivalent cheaper medicines.

    PubMed Central

    Roberts, S J; Bateman, D N; Smith, J M

    1997-01-01

    BACKGROUND: The volume and cost of prescribing varies considerably between practices. This variation is at least in part due to the prescribing behaviour of individual doctors, who are often faced with a range of therapeutically equivalent generic and brand-name drugs. AIM: To assess the impact on general practitioners' prescribing behaviour of promoting therapeutically equivalent lower cost prescribing in conjunction with an incentive scheme. METHOD: Annual prescribing data from before (1992-93) and after (1993-94) implementation of the incentive scheme were compared retrospectively for general practices in the former Northern Regional Health Authority. Main outcome measures were the practices' 1993-94 rates of prescribing relative to those in 1992-93 for 18 drugs prescribed by brand name, of which 10 were targeted in the promotion, and for 14 drugs or classes of drugs either with equivalent cheaper alternatives or of limited clinical value (10 targeted and four not). RESULTS: For 17 of the 18 drugs, brand name prescribing rates were significantly lower in 1993-94. Reductions in rates were greater for the 10 drugs appearing in the scheme's promotional literature. For other cost-saving measures, total prescribing rates were lower for seven classes of drugs, unchanged for one, but higher for the other six, all of which had been targeted. According to the growth in their overall per capita prescribing costs between the two study years, the 499 practices were categorized as low, average or high. Overall costs and individual prescribing rates for the majority of drugs studied were similar for these three practice groups in 1992-93. In 1993-94, practices' changes in prescribing volume differed between the groups, with the lowest increases in the low cost-growth group for all but one of the 32 classes of drugs. CONCLUSION: Generic substitution was more easily implemented than more complex hints regarding cost-saving substitutions. Practices with smaller overall cost

  20. General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP).

    PubMed

    2011-01-28

    This report is a revision of the General Recommendations on Immunization and updates the 2006 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2006;55[No. RR-15]). The report also includes revised content from previous ACIP recommendations on the following topics: adult vaccination (CDC. Update on adult immunization recommendations of the immunization practices Advisory Committee [ACIP]. MMWR 1991;40[No. RR-12]); the assessment and feedback strategy to increase vaccination rates (CDC. Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination rates-assessment and feedback of provider-based vaccination coverage information. MMWR 1996;45:219-20); linkage of vaccination services and those of the Supplemental Nutrition Program for Women, Infants, and Children (WIC program) (CDC. Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination coverage by age 2 years-linkage of vaccination and WIC services. MMWR 1996;45:217-8); adolescent immunization (CDC. Immunization of adolescents: recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association. MMWR 1996;45[No. RR-13]); and combination vaccines (CDC. Combination vaccines for childhood immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP], the American Academy of Pediatrics [AAP], and the American Academy of Family Physicians [AAFP]. MMWR 1999;48[No. RR-5]). Notable revisions to the 2006 recommendations include 1) revisions to the tables of contraindications and precautions to vaccination, as well as a separate table of conditions that are commonly misperceived as contraindications and precautions; 2

  1. Does an activity based remuneration system attract young doctors to general practice?

    PubMed Central

    2012-01-01

    Background The use of increasingly complex payment schemes in primary care may represent a barrier to recruiting general practitioners (GP). The existing Norwegian remuneration system is fully activity based - 2/3 fee-for-service and 1/3 capitation. Given that the system has been designed and revised in close collaborations with the medical association, it is likely to correspond - at least to some degree - with the preferences of current GPs (men in majority). The objective of this paper was to study which preferences that young doctors (women in majority), who are the potential entrants to general practice have for activity based vs. salary based payment systems. Methods In November-December 2010 all last year medical students and all interns in Norway (n = 1.562) were invited to participate in an online survey. The respondents were asked their opinion on systems of remuneration for GPs; inclination to work as a GP; risk attitude; income preferences; work pace tolerance. The data was analysed using one-way ANOVA and multinomial logistic regression analysis. Results A total of 831 (53%) responded. Nearly half the sample (47%) did not consider the remuneration system to be important for their inclination to work as GP; 36% considered the current system to make general practice more attractive, while 17% considered it to make general practice less attractive. Those who are attracted by the existing system were men and those who think high income is important, while those who are deterred by the system are risk averse and less happy with a high work pace. On the question of preferred remuneration system, half the sample preferred a mix of salary and activity based remuneration (the median respondent would prefer a 50/50 mix). Only 20% preferred a fully activity based system like the existing one. A salary system was preferred by women, and those less concerned with high income, while a fully activity based system was preferred by men, and those happy with a high work

  2. Qualifications and Skills: The Organisational Perspective

    ERIC Educational Resources Information Center

    Dafou, Efthimia

    2009-01-01

    This paper portrays the inferences that employers in Greece draw from particular aspects of study programmes, as recorded on educational qualifications. Based on semi-structured interviews with human resource managers in 37 industrial and service organisations and general directors of careers offices in eight higher education institutions, and…

  3. Prescribing opioid analgesics for chronic non-malignant pain in general practice – a survey of attitudes and practice

    PubMed Central

    Blake, Holly; Leighton, Paul; van der Walt, Gerrie; Ravenscroft, Andrew

    2015-01-01

    Background: This study replicates a previous postal survey of general practitioners (GPs) to explore whether attitudes to opioid prescribing have changed at a time when the number of opioid prescriptions issued in primary care has increased. Methods: With permission, a 57-item survey instrument previously utilised with GPs in the South-west of England was circulated to 214 GPs in city-centre practices in the East Midlands. The survey instrument included items relating to practice context, prescribing patterns and attitudes about analgesic medication, perceived prescribing frequency and reluctance to prescribe. Results: Responses were received from 94 GPs (45%). Almost three-quarters (72.7%) of GPs reported that they sometimes or frequently prescribed strong opioids for chronic non-cancer pain. Over two-thirds (67.8%) reported that they were sometimes or frequently reluctant to prescribe strong opioids for chronic non-cancer pain. No significant relationships were observed between perceived frequency of prescribing and a range of demographic factors; however, concerns about ‘physical dependence’, ‘long-term commitment to prescribing’ and ‘media reports’ were associated with less frequent reported prescribing of, and greater reluctance to prescribe, strong opioids. Discussion: Given the national trend for increased opioid prescriptions, it is unsurprising that more frequent self-reported prescribing is reported here; however, increased frequency does not translate into less reluctance about prescribing. The effectiveness of strong opioids for chronic pain is recognised, but concerns about addiction, dependence and misuse inform a reluctance to use strong opioids. These juxtapositions highlight a continued need for clearer understanding of GPs’ perceptions of strong opioids and point to the potential benefit of dedicated guidelines or specialist education and training to address their uncertainties. PMID:26526705

  4. Does experience in general practice influence the clinical thinking of foundation trainees?

    PubMed

    Kibble, Sharon; Scallan, Samantha; Wilson, Sally; Odbert, Reg; Lyon-Maris, Johnny; Leach, Camilla

    2014-11-01

    The aim of this exploratory study was to capture and identify changes in clinical thinking amongst foundation trainees after a four-month attachment in general practice, and to develop a means of analysing the data collected to inform understanding about how clinical thinking develops and changes for a trainee - the learner - in the context of clinical experience. We use the term 'clinical thinking' consistently throughout our paper to refer to the trainees' general thinking about a case, and do so in the same way as other academics. Through the innovative use of Mind Maps, we have sought to demonstrate whether there was a significant change in the themes and key features contained in maps drawn by foundation year 2 trainees before and after an attachment in general practice, and to locate the nature of the change if present. Being able to identify such change is potentially valuable as it can assist in revealing a trainee's learning needs and shape future learning. PMID:25693153

  5. Raising the topic of weight in general practice: perspectives of GPs and primary care nurses

    PubMed Central

    Blackburn, Maxine; Stathi, Afroditi; Keogh, Edmund; Eccleston, Christopher

    2015-01-01

    Objective To explore general practitioners’ (GPs) and primary care nurses’ perceived barriers to raising the topic of weight in general practice. Design A qualitative study using the Theoretical Domains Framework (TDF). 34 semistructured interviews were conducted to explore views, opinions and experiences of initiating a discussion about weight. Content and thematic analyses were used to analyse the interview transcripts. Setting General practices located in one primary care trust in the South West of England. Participants 17 GPs and 17 nurses aged between 32 and 66 years. The modal age range for GPs was 30–39 years and for nurses, 40–49 years. Results Barriers were synthesised into three main themes: (1) limited understanding about obesity care, (2) concern about negative consequences, and (3) having time and resources to raise a sensitive topic. Most barriers were related to raising the topic in more routine settings, rather than when dealing with an associated medical condition. GPs were particularly worried about damaging their relationship with patients and emphasised the need to follow their patient's agenda. Conclusions Uncertainty about obesity, concerns about alienating patients and feeling unable to raise the topic within the constraints of a 10 min consultation, is adding to the reluctance of GPs and nurses to broach the topic of weight. Addressing these concerns through training or by providing evidence of effective interventions that are feasible to deliver within consultations may lead to greater practitioner engagement and willingness to raise the topic. PMID:26254471

  6. 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

  7. IAU Public Astronomical Organisations Network

    NASA Astrophysics Data System (ADS)

    Canas, Lina; Cheung, Sze Leung

    2015-08-01

    The Office for Astronomy Outreach has devoted intensive means to create and support a global network of public astronomical organisations around the world. Focused on bringing established and newly formed amateur astronomy organizations together, providing communications channels and platforms for disseminating news to the global community and the sharing of best practices and resources among these associations around the world. In establishing the importance that these organizations have for the dissemination of activities globally and acting as key participants in IAU various campaigns social media has played a key role in keeping this network engaged and connected. Here we discuss the implementation process of maintaining this extensive network, the processing and gathering of information and the interactions between local active members at a national and international level.

  8. The frequency and characteristics of chronic widespread pain in general practice: a case–control study

    PubMed Central

    Rohrbeck, Jens; Jordan, Kelvin; Croft, Peter

    2007-01-01

    Background Chronic widespread pain is common in the community but is not often diagnosed in primary care. One explanation may be that widespread pain is presented and treated in primary care as multiple episodes of regional pain. Aim To determine whether patients who consult with multiple regional pain syndromes have characteristics consistent with chronic widespread pain. Design of study Case–control study. Setting One general practice in North Staffordshire, UK. Method Participants were 148 cases who consulted regularly with different musculoskeletal pains over 5 years, and 524 controls who had not consulted for musculoskeletal pain during the same period. A postal questionnaire survey and medical record review were undertaken. Results Cases with musculoskeletal pain reported more health problems and higher levels of fatigue than controls, and significantly worse general health and greater sleep disturbance (odds ratios 3.3. and 3.1, respectively). They generally reported more severe symptoms and consulted more frequently for a range of problems, but this was not explained by a general propensity to consult. Conclusion Patients who consult in primary care with multiple regional pain syndromes have similar characteristics to those associated with chronic widespread pain and fibromyalgia. Recognising the need for general approaches to pain management, rather than treating each syndrome as a regional problem of pain, may improve the outcome in such patients. PMID:17263927

  9. [Professional practice of nurses who care for cancer patients in general hospitals].

    PubMed

    da Silva, Josiane Travençolo; Matheus, Maria Clara Cassuli; Fustinoni, Suzete Maria; de Gutiérrez, Maria Gaby Rivero

    2012-01-01

    The present article discusses a qualitative study which aimed to understand the typical of nurses' professional practice caring for patient with cancer in general hospitals. In order to find out the reasons that motivate nurse's action, and to put in evidence what is original, significant, specific and typical about this phenomenon, we have taken into consideration the premises of the philosopher Alfred Schütz, which provide us with subsidies to unveil them. The data collected through semi-structured interviews reported that nurses admit not having the required theoretical knowledge and experience or enough practice to take care of a cancer patient. Thus, they don't feel capable of developing actions which may positively influence care on patients and their family members. PMID:23032337

  10. Influence of Organisational Defensive Patterns on Learning ICT

    ERIC Educational Resources Information Center

    Yau, Hon Keung; Cheng, Alison Lai Fong

    2011-01-01

    Purpose: The purpose of this paper is to investigate whether the IT professionals in a Hong Kong public transport company have a general perception of influence of the organisational defensive patterns on learning of ICT; and whether skilled incompetence, organisational defensive routines and fancy footwork are positively associated with each…

  11. Accounting for medical variation: the case of prescribing activity in a New Zealand general practice sample.

    PubMed

    Davis, P B; Yee, R L; Millar, J

    1994-08-01

    Medical practice variation is extensive and well documented, particularly for surgical interventions, and raises important questions for health policy. To date, however, little work has been carried out on interpractitioner variation in prescribing activity in the primary care setting. An analytical model of medical variation is derived from the literature and relevant indicators are identified from a study of New Zealand general practice. The data are based on nearly 9,500 completed patient encounter records drawn from over a hundred practitioners in the Waikato region of the North Island, New Zealand. The data set represents a 1% sample of all weekday general practice office encounters in the Hamilton Health District recorded over a 12-month period. Overall levels of prescribing, and the distribution of drug mentions across diagnostic groupings, are broadly comparable to results drawn from international benchmark data. A multivariate analysis is carried out on seven measures of activity in the areas of prescribing volume, script detail, and therapeutic choice. The analysis indicates that patient, practitioner and practice attributes exert little systematic influence on the prescribing task. The principal influences are diagnosis, followed by practitioner identity. The pattern of findings suggests also that the prescribing task cannot be viewed as an undifferentiated activity. It is more usefully considered as a process of decision-making in which 'core' judgements--such as the decision to prescribe and the choice of drug--are highly predictable and strongly influenced by diagnosis, while 'peripheral' features of the task--such as choosing a combination drug or prescribing generically--are less determinate and more subject to the exercise of clinical discretion.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7939853

  12. 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

  13. Roles and relationships between health professionals involved in insulin initiation for people with type 2 diabetes in the general practice setting: a qualitative study drawing on relational coordination theory

    PubMed Central

    2014-01-01

    Background The majority of care for people with type 2 diabetes occurs in general practice, however when insulin initiation is required it often does not occur in this setting or in a timely manner and this may have implications for the development of complications. Increased insulin initiation in general practice is an important goal given the increasing prevalence of type 2 diabetes and a relative shortage of specialists. Coordination between primary and secondary care, and between medical and nursing personnel, may be important in achieving this. Relational coordination theory identifies key concepts that underpin effective interprofessional work: communication which is problem solving, timely, accurate and frequent and relationships between professional roles which are characterized by shared goals, shared knowledge and mutual respect. This study explores roles and relationships between health professionals involved in insulin initiation in order to gain an understanding of factors which may impact on this task being carried out in the general practice setting. Method 21 general practitioners, practice nurses, diabetes nurse educators and physicians were purposively sampled to participate in a semi-structured interview. Transcripts of the interviews were analysed using framework analysis. Results There were four closely interlinked themes identified which impacted on how health professionals worked together to initiate people with type 2 diabetes on insulin: 1. Ambiguous roles; 2. Uncertain competency and capacity; 3. Varying relationships and communication; and 4. Developing trust and respect. Conclusions This study has shown that insulin initiation is generally recognised as acceptable in general practice. The role of the DNE and practice nurse in this space and improved communication and relationships between health professionals across organisations and levels of care are factors which need to be addressed to support this clinical work. Relational

  14. Increased diagnostic activity in general practice during the year preceding colorectal cancer diagnosis.

    PubMed

    Hansen, Pernille Libach; Hjertholm, Peter; Vedsted, Peter

    2015-08-01

    Accurate diagnostic activity in general practice before colorectal cancer (CRC) diagnosis is crucial for an early detection of CRC. This study aimed to investigate the rates of daytime consultations, hemoglobin (Hb) measurements and medicine prescriptions for hemorrhoids in general practice in the year preceding CRC diagnosis. Using Danish registries, we conducted a population-based matched cohort study including CRC patients aged 40-80 years (n = 19,209) and matched references (n = 192,090). We calculated odds ratios (ORs) using a conditional logistical regression model and incidence rate ratios (IRRs) using a negative binomial regression model. The CRC patients had significantly more consultations from 9 months before diagnosis and significantly increased rates of Hb measurements from up to 17 months before diagnosis compared with references. Furthermore, up to 18 months before diagnosis, CRC patients had significantly higher rates of prescriptions for hemorrhoids; and 2 months before diagnosis, the IRR was 12.24 (95% confidence interval (CI): 10.29-14.55) for men. The positive predictive value (PPV) of CRC for having a first-time prescription for hemorrhoids was highest among men aged 70-80 years [PPV = 3.2% (95% CI: 2.8-3.7)]. High prescription rates were predominantly seen among rectal cancer patients, whereas colon cancer patients had higher rates of consultations and Hb measurements. This study revealed a significant increase in healthcare seeking and diagnostic activity in general practice in the year prior to CRC diagnosis, which indicates the presence of a "diagnostic time window" and a potential for earlier diagnosis of CRC based on clinical signs and symptoms. PMID:25559926

  15. The effectiveness of an acupuncturist working in general practice--an audit.

    PubMed

    Harborow, Patrick W; Ogden, Jane

    2004-12-01

    This audit was based in general practice and examined 49 consecutive referrals to a UK trained traditional Chinese acupuncturist. It aimed to assess the type of patients referred to an acupuncturist, subsequent changes in health status, whether the effectiveness of acupuncture was related to the type of presenting problem and to examine which factors were predictive of the success of acupuncture. The referred patients had a wide variety of conditions which were categorised as to whether or not there was empirical evidence from trials of responsiveness to acupuncture (evidence based vs non evidence based). Patients completed measures of their health status prior to treatment and at two and six month follow ups. In addition, the referring GP's beliefs about the prognosis of the problem and the therapist's and patient's expectations of success were measured at baseline. The results showed that referred patients reported poorer health status than a historical sample of general practice patients and that they showed significant improvements in all aspects of health status following acupuncture. In particular, patients showed improved energy, pain, emotional reactions, sleep and reduced social isolation at two months which were maintained at six months. Physical mobility was improved at six months. In addition, the results indicated that the best predictors of effectiveness were the therapist's and patient's expectations of success at baseline. Effectiveness was not related to the category of condition (evidence based or not) nor to the GP's expectations about the prognosis of the condition. The results are discussed in terms of implications for the role of acupuncture in General Practice and selectively targeting patients who would be responsive to such an approach. PMID:15628779

  16. A comparison of the activities and opinions of attached and employed nurses in general practice

    PubMed Central

    Reedy, B. L. E. C.; Metcalfe, A. V.; de Roumanie, M.; Newell, D. J.

    1980-01-01

    We compared the nursing and medical activities and the opinions of nurses employed by area health authorities and nurses employed by general practitioners by interviewing a random sample of 153 nurses in 113 practices, situated in four rural and five urban area health authorities in England. The availability of a treatment room profoundly affected the work of both kinds of nurse and there were differences between them in the balance between `caring' and `technical' activities which may be largely attributed to the circumstances of their employment. However, their occupational histories and choices of employer appear to reflect both differences in their training and differences in their values about career and marriage. PMID:7452582

  17. The importance of diet and physical activity in the treatment of conditions managed in general practice.

    PubMed Central

    Little, P; Margetts, B

    1996-01-01

    Evidence from meta-analyses, physiological data and individual studies suggests that diet and exercise are important in the aetiology and treatment of many of the conditions that are managed predominantly in primary care (hypercholesterolaemia, hypertension, diabetes, obesity and excess alcohol intake). However, much of the evidence comes from outside primary care, and it is doubtful whether those studies done in primary care used optimal intervention strategies. A priority for future research should be to demonstrate the feasibility, efficacy and efficiency of lifestyle interventions in a general practice setting. PMID:8731628

  18. Helping smokers make decisions: the enhancement of brief intervention for general medical practice.

    PubMed

    Rollnick, S; Butler, C C; Stott, N

    1997-07-01

    Primary care clinicians are often encouraged by government agencies to intervene systematically with all smokers. Pressure of time and pessimism about their own efficacy and patients' capacity to change are some of the reasons why clinicians do not feel it is appropriate to always advise every patient about unhealthy behaviours. Developments in patient centred approaches to the consultation and progress in the addictions field suggest that new consulting methods could be constructed which are more satisfying than giving brief advice to change. The aim of this study was to develop a structured, teachable and acceptable intervention for clinicians to help patients consider their smoking during general medical consultations. Patient centred strategies derived from the stages of change model and motivational interviewing and its adaptations were explored in experimental consultations with 20 volunteer smokers. Feedback from them and from general practice registrars trained in the use of the method informed its development. Acceptability to clinicians was assessed by semi structured telephone interviews with 24 general practice registrars who participated in a randomised controlled trial assessing the effectiveness of the method. Anonymous, written questionnaires were also completed by 20 of the registrars who recruited ten or more patients into the trial. The method is described. Key components are: establishing rapport, assessing motivation and confidence, and then depending on the response, asking standard scaling questions, asking about pros and cons of smoking, non-judgmental information sharing, brainstorming solutions and negotiating attainable goals and follow-up. The clinicians used the method with a total of 270 smokers, taking an average of 9.69 min with each patient. Evaluation reveals that it is acceptable to the group of general practice registrars. Longer consultation time was seen as the main drawback. We conclude that acceptable methods for

  19. [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

  20. Working with Dissociative Fugue in a general psychotherapy practice: a cautionary tale.

    PubMed

    Jasper, Frank J

    2003-04-01

    Dissociative Fugue is a somewhat rare condition that therapists may see only once or twice over the course of a professional career. A brief review of the uses of hypnosis in the treatment of Dissociative Fugue is followed by a presentation of the case of a 51-year-old man who presented with the clinical picture of Dissociative Fugue State and who experienced complete amnesia for the time prior to the fugue state. This article focuses on the pitfalls that the psychotherapist in a general practice may face when working with such a patient and offers specific recommendations and scripts that may be useful in proceeding with treatment. PMID:12722934

  1. Interactive Web-based Learning Modules Prior to General Medicine Advanced Pharmacy Practice Experiences

    PubMed Central

    Walton, Alison M.; Nisly, Sarah A.

    2015-01-01

    Objective. To implement and evaluate interactive web-based learning modules prior to advanced pharmacy practice experiences (APPEs) on inpatient general medicine. Design. Three clinical web-based learning modules were developed for use prior to APPEs in 4 health care systems. The aim of the interactive modules was to strengthen baseline clinical knowledge before the APPE to enable the application of learned material through the delivery of patient care. Assessment. For the primary endpoint, postassessment scores increased overall and for each individual module compared to preassessment scores. Postassessment scores were similar among the health care systems. The survey demonstrated positive student perceptions of this learning experience. Conclusion. Prior to inpatient general medicine APPEs, web-based learning enabled the standardization and assessment of baseline student knowledge across 4 health care systems. PMID:25995515

  2. Drugs Are Not Enough: Some Principles of Psychopharmacology for General Medical Practice

    PubMed Central

    Ross, W. Donald

    1963-01-01

    There is no necessary antagonism between the judicious use of drugs and a psychotherapeutic approach to patients in general medical practice. A table is presented with a simple pragmatic classification of types of drugs for altering emotional and mental states. Three general principles are given for the use of such drugs, illustrated by examples of the use and misuse of tranquillizers. Some differentiation is made between sedatives and tranquillizers and between different types of tranquillizers, particularly with reference to the need to consider depressive features in patients. Suggestions are made for the use of drugs for mild depressions and for depressions accompanying organic disease. One may have to take an “experimental” approach to new drugs to determine which to them are of value in relation to the particular emotional states of one's own patients. ImagesFig. 1 PMID:14060167

  3. For society, state and self: juggling the logics of professionalism in general practice appraisal.

    PubMed

    Entwistle, Tom; Matthews, Elaine

    2015-11-01

    Sociologists repeatedly appeal to notions of altruism, bureaucratisation and self interest in their efforts to explain the changing place of the professions in contemporary society. We treat these three readings as institutional logics that are key to understanding the way in which doctors respond to the appraisal system at the heart of the UK's approach to revalidation. Our analysis of a survey of 998 general practitioners (GPs) working in Wales finds an altruistic commitment to learning and improvement, bureaucratic demands for reporting information and self-regarding resentment of changes in the occupational package provided by general practice. But the data also demonstrate that the maintenance of the appraisal regime is dependent on the preparedness and capacity of individual GPs to do micro-level institutional work on all fronts. PMID:25912303

  4. 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

  5. Embedding effective depression care: using theory for primary care organisational and systems change

    PubMed Central

    2010-01-01

    Background Depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting. Methods We used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT) was identified as an analytical theory to guide the conceptual framework development. Results Five privately owned primary care organisations (general practices) and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action, which proposes that

  6. Does 'healing' benefit patients with chronic symptoms? A quasi-randomized trial in general practice.

    PubMed Central

    Dixon, M

    1998-01-01

    This study was designed to examine the effects of a healer seeing chronically ill patients in a large semirural practice. The 57 patients were allocated alternately either to receive ten weekly healing sessions or to become waiting-list controls. Two weeks after completion of 'healing' 22 (81%) of the 27 study patients thought their symptoms had improved and 15 of these thought they had improved substantially. Study patients scored better than controls on both measures of symptoms (P < 0.05, P < 0.01), on anxiety and depression ratings (P < 0.01, P < 0.05) and on general function measured by the Nottingham Health Profile (P < 0.01). Treatment differences were still evident three months later for one of the measures of symptom change (P < 0.05) and for both anxiety and depression ratings (P < 0.01, P < 0.05). The percentages of natural killer cells (CD16, CD56) did not change greatly in either group. These results suggest that healing may be an effective adjunct for the treatment of chronically ill patients presenting in general practice. They do not distinguish between any specific effects of spiritual healing and non-specific effects such as relaxation; for further investigation, randomized controlled trials will be needed. PMID:9659302

  7. Encounters with patients from Somalia: experience among vocational trainees in Swedish general practice

    PubMed Central

    Mattsson, Bengt; Lepp, Margret

    2013-01-01

    Objectives This study sought to describe how vocational trainees in general medical practice in Sweden experienced encounters with refugee patients from Somalia. Methods Sixteen vocational trainees in general medical practice in Sweden were interviewed in focus groups. The interviews were transcribed verbatim and analyzed according to a phenomenographic approach. Results Three categories with subcategories emerged. In the first category, “meeting the patient”, the family diversity among the patients was noted. Further, the informants noted that few patients presented psychiatric problems. In the second category, “obstacles in the encounter”, the vocational trainees noted difficulties in talking through an interpreter, who often seemed to have an extended dialogue with the patient. Obtaining a medical history was considered a challenge. The third category dealt with how to develop different strategies in the encounter. Conclusions To improve the encounter with patients from Somalia and other minority groups, the importance of curiosity, trust and continuity of care should be discussed in medical education. Health care´s own ways of working and thinking in relation to matters of diversity must be observed in medical training.

  8. The use of COPD maintenance therapy following spirometry in General Practice

    PubMed Central

    Gottlieb, Vibeke; Lyngsø, Anne Marie; Sæbye, Ditte; Frølich, Anne; Backer, Vibeke

    2016-01-01

    Background Several studies have shown that the use of pulmonary medication is widespread and often initiated without initial spirometry. Early detection of chronic obstructive pulmonary disease (COPD) by spirometry in General Practice is essential for an early and correct implementation of medical treatment. Aim The aim of the present study was to evaluate the use of regular therapy following diagnostic spirometry for COPD in General Practice from February 2008 to February 2009. Method Spirometry data and results were linked through Statistics Denmark with information from the Register of Medicinal Product Statistics using the unique personal identification code. Data were analysed to evaluate the impact of screening on use of regular COPD therapy. Primary outcome was initiation of regular therapy following COPD diagnosis with spirometry. Results In a population of 3,376 individuals at risk, 1,458 underwent spirometric assessment with 631 being diagnosed with COPD; 110 of those received regular therapy before assessment with this figure increasing to 161 after spirometry. Of 827 participants not receiving a COPD diagnosis, 36 received regular therapy prior to assessment and 42 received regular therapy after spirometry despite no established COPD diagnosis. Conclusion There is a significant chance of receiving regular therapy after being diagnosed with COPD. However, a large proportion of subjects diagnosed with COPD did not receive regular therapy following diagnosis. Efforts should be made to ensure correct diagnosis and correct medical treatment according to guidelines in individuals with COPD.

  9. [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

  10. 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

  11. Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2015.

    PubMed

    Szostek, Jason H; Wieland, Mark L; Post, Jason A; Sundsted, Karna K; Mauck, Karen F

    2016-08-01

    Identifying new practice-changing articles is challenging. To determine the 2015 practice-changing articles most relevant to outpatient general internal medicine, 3 internists independently reviewed the titles and abstracts of original articles, synopses of single studies and syntheses, and databases of syntheses. For original articles, internal medicine journals with the 7 highest impact factors were reviewed: New England Journal of Medicine, Lancet, Journal of the American Medical Association (JAMA), British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine. For synopses of single studies and syntheses, collections in American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine were reviewed. For databases of synthesis, Evidence Updates and the Cochrane Library were reviewed. More than 100 articles were identified. Criteria for inclusion were as follows: clinical relevance, potential for practice change, and strength of evidence. Clusters of important articles around one topic were considered as a single-candidate series. The 5 authors used a modified Delphi method to reach consensus on inclusion of 7 topics for in-depth appraisal. PMID:27046243

  12. Variation of diabetes mellitus prevalence in general practice and its relation to deprivation.

    PubMed

    Meadows, P

    1995-08-01

    This is an observational study to compare age standardized diabetes prevalences and relate these to socio-economic measures of deprivation. It includes data from eight general (family) practices in the Bristol, UK, area with no ethnic minorities affecting diabetes prevalence. A total population of 71 599 was covered, including 181 Type 1 and 901 Type 2 diabetic patients, 91 of whom were controlled with insulin, 499 with oral hypoglycaemics, and 311 with diet alone. Actual Type 1 and Type 2 diabetes prevalences were standardized to what they would be if each practice had the UK national age profile. Total standardized diabetes prevalence varied from 1.31% to 2.51% (p < 0.001) and Type 2 diabetes prevalence from 0.97% to 2.29% (p < 0.001). There was no significant variation in the prevalence of Type 1 diabetes. The Spearman rank correlation coefficient indicated a significant association between standardized diabetes prevalence and two measures, the Jarman and Townsend indices, of deprivation in the electoral ward where each practice was situated. Total standardized diabetes prevalence was significantly correlated with each of the Jarman and Townsend indices (r = 0.76, p < 0.05). Standardized Type 2 diabetes prevalence was similarly significantly correlated to each deprivation index (rs = 0.74, p < 0.05). Type 2 diabetes prevalence is affected by socio-economic factors with implications for health targets and capitation based budgets. PMID:7587009

  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

    Background The General Practice Assessment Questionnaire (GPAQ) has been widely used to assess patient experience in general practice in the UK since 2004. In 2013, new regulations were introduced by the General Medical Council (GMC) requiring UK doctors to undertake periodic revalidation, which includes assessment of patient experience for individual doctors. We describe the development of a new version of GPAQ – GPAQ-R which addresses the GMC’s requirements for revalidation as well as additional NHS requirements for surveys that GPs may need to carry out in their own practices. Methods Questionnaires were given out by doctors or practice staff after routine consultations in line with the guidance given by the General Medical Council for surveys to be used for revalidation. Data analysis and practice reports were provided independently. Results Data were analysed for questionnaires from 7258 patients relating to 164 GPs in 29 general practices. Levels of missing data were generally low (typically 4.5-6%). The number of returned questionnaires required to achieve reliability of 0.7 were around 35 for individual doctor communication items and 29 for a composite score based on doctor communication items. This suggests that the responses to GPAQ-R had similar reliability to the GMC’s own questionnaire and we recommend 30 completed GPAQ-R questionnaires are sufficient for revalidation purposes. However, where an initial screen raises concern, the survey might be repeated with 50 completed questionnaires in order to increase reliability. Conclusions GPAQ-R is a development of a well-established patient experience questionnaire used in general practice in the UK since 2004. This new version can be recommended for use in order to meet the UK General Medical Council’s requirements for surveys to be used in revalidation of doctors. It also meets the needs of GPs to ask about patient experience relating to aspects of practice care that are not specific to individual

  14. Effect of ethnicity on the prevalence, severity, and management of COPD in general practice

    PubMed Central

    Martin, Alice; Badrick, Ellena; Mathur, Rohini; Hull, Sally

    2012-01-01

    Background Chronic obstructive pulmonary disease (COPD) remains a major cause of mortality and hospital use. Little is known in the UK about the variation in COPD prevalence, severity, and management depending on ethnicity. Aim To examine differences by ethnicity in COPD prevalence, severity, and management. Design & setting Cross-sectional study using routinely collected computerised data from general practice in three east-London primary care trusts (Newham, Tower Hamlets, and City and Hackney) with multiethnic populations of people who are socially deprived. Method Routine demographic, clinical, and hospital admission data from 140 practices were collected. Results Crude COPD prevalence was 0.9%; the highest recorded rates were in the white population. Severity of COPD, measured by percentage-predicted forced expiratory volume in 1 second, did not vary by ethnicity. South Asians and black patients were less likely than white patients to have breathlessness, indicated by a Medical Research Council dyspnoea grade of ≥4 (odds ratio [OR] 0.7 [95% confidence interval (CI) = 0.6 to 0.9] and 0.6 [95% CI = 0.4 to 0.8]). Black patients were less likely than white patients to receive inhaled medications. Influenza and pneumococcal vaccine rates were highest among groups of South Asians (OR 3.0 [95% CI = 2.1 to 4.3] and 1.8 [95% CI = 1.4 to 2.3] respectively). Both minority ethnic groups had low referral rates to pulmonary rehabilitation. In Tower Hamlets, black patients were more likely to be admitted to hospital for respiratory causes. Conclusion Differences in COPD prevalence and severity by ethnicity were identified, and significant differences in drug and non-drug management and hospital admissions observed. Systematic ethnicity recording in general practice is needed to be able to explore such differences and monitor inequalities in healthcare by ethnicity. PMID:22520773

  15. Requests for euthanasia in general practice before and after implementation of the Dutch Euthanasia Act

    PubMed Central

    van Alphen, Jojanneke E; Donker, Gé A; Marquet, Richard L

    2010-01-01

    Background The Netherlands was the first country in the world to implement a Euthanasia Act in 2002. It is unknown whether legalising euthanasia under strict conditions influences the number and nature of euthanasia requests. Aim To investigate changes in the number of, and reasons for, requests for euthanasia in Dutch general practice after implementation of the Euthanasia Act. Design of study Retrospective dynamic cohort study comparing 5 years before (1998–2002) and 5 years after (2003–2007) implementation of the Act. Method Standardised registration forms were used to collect data on requests for euthanasia via the Dutch Sentinel Practice Network. This network of 45 general practices is nationally representative by age, sex, geographic distribution, and population density. Results The mean annual incidence of requests before implementation amounted to 3.1/10 000 and thereafter to 2.8/10 000 patients. However, trends differed by sex. The number of requests by males decreased significantly from 3.7/10 000 to 2.6/10 000 (P = 0.008); the requests by females increased non-significantly from 2.6/10 000 to 3.1/10 000. Before and after implementation, cancer remained the major underlying disease for requesting euthanasia: 82% versus 77% for men; 73% versus 75% for females. Pain was a major reason for a request, increasing in the period before implementation (mean 27%), but declining in the period thereafter (mean 22%). Loss of dignity became a less important reason after implementation (from 18% to 10%, P = 0.04), predominantly due to a marked decrease in the number of females citing it as a reason (from 17% to 6%, P = 0.02). Conclusion There was no increase in demand for euthanasia after implementation of the Euthanasia Act. Pain as a reason for requesting euthanasia showed an increasing trend before implementation, but declined thereafter. Loss of dignity as a reason declined, especially in females. PMID:20353671

  16. Feasibility of improving identification of familial hypercholesterolaemia in general practice: intervention development study

    PubMed Central

    Qureshi, Nadeem; Weng, Stephen; Tranter, Jennifer; El-Kadiki, Alia; Kai, Joe

    2016-01-01

    Objectives To assess the feasibility of improving identification of familial hypercholesterolaemia (FH) in primary care, and of collecting outcome measures to inform a future trial. Design Feasibility intervention study. Setting 6 general practices (GPs) in central England. Participants 831 eligible patients with elevated cholesterol >7.5 mmol/L were identified, by search of electronic health records, for recruitment to the intervention. Intervention Educational session in practice; use of opportunistic computer reminders in consultations or universal postal invitation over 6 months to eligible patients invited to complete a family history questionnaire. Those fulfilling the Simon-Broome criteria for possible FH were invited for GP assessment and referred for specialist definitive diagnosis. Outcome measures Rates of recruitment of eligible patients, identification of patients with possible FH, referral to specialist care, diagnosis of confirmed FH in specialist care; and feasibility of collecting relevant outcome measures for a future trial. Results Of 173 general practices, 18 were interested in participating and 6 were recruited. From 831 eligible patients, 127 (15.3%) were recruited and completed family history questionnaires: 86 (10.7%) through postal invitation and 41 (4.9%) opportunistically. Among the 127 patients, 32 (25.6%) had a possible diagnosis of FH in primary care. Within 6 months of completing recruitment, 7 patients had had specialist assessment confirming 2 patients with definite FH (28.6%), and 5 patients with possible FH (71.4%). Potential trial outcome measures for lipid tests, statin prescribing and secondary causes of hypercholesterolaemia were extracted using automated data extraction from electronic records alone without recourse to other methods. Conclusions The intervention is feasible to implement in GP, and facilitates recruitment of patients with raised cholesterol for targeted assessment and identification of FH. Extracting

  17. Long-Term Patterns of Online Evidence Retrieval Use in General Practice: A 12-Month Study

    PubMed Central

    Westbrook, Johanna I; Kidd, Michael R; Day, Richard O; Coiera, Enrico

    2008-01-01

    Background Provision of online evidence at the point of care is one strategy that could provide clinicians with easy access to up-to-date evidence in clinical settings in order to support evidence-based decision making. Objective The aim was to determine long-term use of an online evidence system in routine clinical practice. Methods This was a prospective cohort study. 59 clinicians who had a computer with Internet access in their consulting room participated in a 12-month trial of Quick Clinical, an online evidence system specifically designed around the needs of general practitioners (GPs). Patterns of use were determined by examination of computer logs and survey analysis. Results On average, 9.9 searches were conducted by each GP in the first 2 months of the study. After this, usage dropped to 4.4 searches per GP in the third month and then levelled off to between 0.4 and 2.6 searches per GP per month. The majority of searches (79.2%, 2013/2543) were conducted during practice hours (between 9 am and 5 pm) and on weekdays (90.7%, 2315/2543). The most frequent searches related to diagnosis (33.6%, 821/2291) and treatment (34.5%, 844/2291). Conclusion GPs will use an online evidence retrieval system in routine practice; however, usage rates drop significantly after initial introduction of the system. Long-term studies are required to determine the extent to which GPs will integrate the use of such technologies into their everyday clinical practice and how this will affect the satisfaction and health outcomes of their patients. PMID:18353750

  18. Evaluation of features to support safety and quality in general practice clinical software

    PubMed Central

    2011-01-01

    Background Electronic prescribing is now the norm in many countries. We wished to find out if clinical software systems used by general practitioners in Australia include features (functional capabilities and other characteristics) that facilitate improved patient safety and care, with a focus on quality use of medicines. Methods Seven clinical software systems used in general practice were evaluated. Fifty software features that were previously rated as likely to have a high impact on safety and/or quality of care in general practice were tested and are reported here. Results The range of results for the implementation of 50 features across the 7 clinical software systems was as follows: 17-31 features (34-62%) were fully implemented, 9-13 (18-26%) partially implemented, and 9-20 (18-40%) not implemented. Key findings included: Access to evidence based drug and therapeutic information was limited. Decision support for prescribing was available but varied markedly between systems. During prescribing there was potential for medicine mis-selection in some systems, and linking a medicine with its indication was optional. The definition of 'current medicines' versus 'past medicines' was not always clear. There were limited resources for patients, and some medicines lists for patients were suboptimal. Results were provided to the software vendors, who were keen to improve their systems. Conclusions The clinical systems tested lack some of the features expected to support patient safety and quality of care. Standards and certification for clinical software would ensure that safety features are present and that there is a minimum level of clinical functionality that clinicians could expect to find in any system.

  19. Skin lesions suspected of malignancy: an increasing burden on general practice

    PubMed Central

    2014-01-01

    Background Skin cancer is believed to impose a heavy burden on healthcare services, but the burden of skin lesions suspected of malignancy on primary healthcare has never been evaluated. Therefore the aim of this study was to determine the demand for care in general practice due to these suspected skin lesions (i.e. lesions that are suspected of malignancy by either the patient or the GP). Methods Registry study based on data (2001–2010) from the Registration Network Groningen. This is a general practice registration network in the northern part of the Netherlands with an average annual population of approximately 30,000 patients. All patient contacts are coded according to the International Classification of Primary Care (ICPC). Consultations for skin lesions suspected of malignancy were selected according to the assigned ICPC codes. Subsequently, the number of consultations per year and the annual percent change in number of contacts (using the JoinPoint regression program) were calculated and analysed. Additionally, the percentage of patients referred to secondary care or receiving minor surgery within one year after the first contact were calculated. Results From 2001 onwards we found an annual increase in demand for care due to skin lesions suspected of malignancy of 7.3% (p < 0.01) and in 2010 the benign:malignant ratio was 10:1. In total 13.0% of the patients were referred and after 2006, minor surgery was performed on 31.2% of the patients. Most surgeries and referrals took place within 30 days. Conclusions Suspected skin lesions impose an increasing burden on primary healthcare and most likely on healthcare costs as well. General practitioners should therefore be trained in diagnosing skin lesions suspected of malignancy, as a high diagnostic accuracy can save lives in the case of melanoma, and may also prevent unnecessary, costly, excisions and referrals to secondary healthcare. PMID:24517098

  20. A survey of resilience, burnout, and tolerance of uncertainty in Australian general practice registrars

    PubMed Central

    2013-01-01

    Background Burnout and intolerance of uncertainty have been linked to low job satisfaction and lower quality patient care. While resilience is related to these concepts, no study has examined these three concepts in a cohort of doctors. The objective of this study was to measure resilience, burnout, compassion satisfaction, personal meaning in patient care and intolerance of uncertainty in Australian general practice (GP) registrars. Methods We conducted a paper-based cross-sectional survey of GP registrars in Australia from June to July 2010, recruited from a newsletter item or registrar education events. Survey measures included the Resilience Scale-14, a single-item scale for burnout, Professional Quality of Life (ProQOL) scale, Personal Meaning in Patient Care scale, Intolerance of Uncertainty-12 scale, and Physician Response to Uncertainty scale. Results 128 GP registrars responded (response rate 90%). Fourteen percent of registrars were found to be at risk of burnout using the single-item scale for burnout, but none met the criteria for burnout using the ProQOL scale. Secondary traumatic stress, general intolerance of uncertainty, anxiety due to clinical uncertainty and reluctance to disclose uncertainty to patients were associated with being at higher risk of burnout, but sex, age, practice location, training duration, years since graduation, and reluctance to disclose uncertainty to physicians were not. Only ten percent of registrars had high resilience scores. Resilience was positively associated with compassion satisfaction and personal meaning in patient care. Resilience was negatively associated with burnout, secondary traumatic stress, inhibitory anxiety, general intolerance to uncertainty, concern about bad outcomes and reluctance to disclose uncertainty to patients. Conclusions GP registrars in this survey showed a lower level of burnout than in other recent surveys of the broader junior doctor population in both Australia and overseas. Resilience

  1. Don't ask, sometimes tell. A survey of men who have sex with men sexual orientation disclosure in general practice.

    PubMed

    Metcalfe, Rebecca; Laird, George; Nandwani, Rak

    2015-12-01

    Despite advances in lesbian, gay, bisexual and transgender equality in recent years, some men who have sex with men remain at increased risk of ill-health. Positive interventions in primary care include psychological support and strategies for risk reduction. It is important that men who have sex with men can disclose sexual orientation in primary care. To quantify disclosure of sexual orientation by men who have sex with men attending general practice and identify barriers to disclosure we surveyed a group of Scottish men. A questionnaire was distributed by voluntary organisations and the National Health Service in the West of Scotland, to rural and urban populations. Two hundred and four gave evaluable responses, with all ages represented. A total of 199 (98%) were registered with a General Practitioner and 167 (83%) attended in the previous year. A total of 81 (40%) stated staff were aware of their sexual orientation. A total of 93/121 (75%) men who have sex with men whose GP was unaware stated this was because they had never been asked. A total of 36/81(44%) men who have sex with men rated support from practices since disclosure as 'excellent' and qualitative responses were positive. It is reassuring that almost all respondents were registered with GPs and attending primary care services. However, only 40% had disclosed sexual orientation. This was not because of fear of negative impact on care but because men who have sex with men felt it was irrelevant to their attendance. GPs appear to be reluctant to raise the issue of sexual orientation without prompting. PMID:25527656

  2. [Formalized dietary advice in hypercholesterolemia. Results in 110 men diagnosed by selective screening in general practice].

    PubMed

    Agner, E; Christensen, T E; Jacobsen, K; Baastrup, A; Mahnfeldt, M S; Jensen, S E

    1990-11-01

    In connection with a screening investigation for high blood cholesterol in middle-aged men in general practice in the Municipality of Copenhagen, all participants with cholesterol values greater than or equal to 7.5 mmol/l were given brief advice by their own general practitioner and were invited to come for fasting blood lipid tests approximately ten days later. In cases with continued cholesterol greater than or equal to 6.8 mmol/l, the participants together with wives or partners were invited to formalized dietary advice in small groups. Already before the formalized dietary advice, an average decrease in serum cholesterol of 10% was observed. This was attributed to biological variation, absence of fasting, the degree of error between the measuring methods and also a genuine decrease on the basis of the brief dietary advice by the general practitioner. On control after dietary advice, a further decrease in cholesterol of 15% was observed while low density lipoprotein cholesterol fell by 20% and triglycerides by 23%. These decreases must be considered to result mainly from the dietary advice. It is concluded that a single but professional session of dietary advice in small groups and with involvement of the wives or partners is an effective method of treatment in hypercholesterolaemia. If the decrease in cholesterol obtained can be maintained, the literature suggests that the risk of development of ischaemic heart disease during the subsequent 5-7 years is reduced by 20-30%. PMID:2238224

  3. Too much information? A document analysis of sport safety resources from key organisations

    PubMed Central

    Finch, Caroline F

    2016-01-01

    Objectives The field of sport injury prevention has seen a marked increase in published research in recent years, with concomitant proliferation of lay sport safety resources, such as policies, fact sheets and posters. The aim of this study was to catalogue and categorise the number, type and topic focus of sport safety resources from a representative set of key organisations. Design Cataloguing and qualitative document analysis of resources available from the websites of six stakeholder organisations in Australia. Setting This study was part of a larger investigation, the National Guidance for Australian Football Partnerships and Safety (NoGAPS) project. Participants The NoGAPS study provided the context for a purposive sampling of six organisations involved in the promotion of safety in Australian football. These partners are recognised as being highly representative of organisations at national and state level that reflect similarly in their goals around sport safety promotion in Australia. Results The catalogue comprised 284 resources. More of the practical and less prescriptive types of resources, such as fact sheets, than formal policies were found. Resources for the prevention of physical injuries were the predominant sport safety issue addressed, with risk management, environmental issues and social behaviours comprising other categories. Duplication of resources for specific safety issues, within and across organisations, was found. Conclusions People working within sport settings have access to a proliferation of resources, which creates a potential rivalry for sourcing of injury prevention information. Important issues that are likely to influence the uptake of safety advice by the general sporting public include the sheer number of resources available, and the overlap and duplication of resources addressing the same issues. The existence of a large number of resources from reputable organisations does not mean that they are necessarily evidence based

  4. Musical Practices and Methods in Music Lessons: A Comparative Study of Estonian and Finnish General Music Education

    ERIC Educational Resources Information Center

    Sepp, Anu; Ruokonen, Inkeri; Ruismäki, Heikki

    2015-01-01

    This article reveals the results of a comparative study of Estonian and Finnish general music education. The aim was to find out what music teaching practices and approaches/methods were mostly used, what music education perspectives supported those practices. The data were collected using questionnaires and the results of 107 Estonian and 50…

  5. 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

  6. A policy of introducing a new contract and funding system of general practice in Estonia.

    PubMed

    Lember, Margus

    2002-01-01

    The socialist bloc of post-war Europe was obliged to follow the Soviet example with a hierarchical, centrally controlled health care system based on polyclinics and other facilities providing extensive specialist services at the first level of contact. All the countries of Central and Eastern Europe have now expressed their wish to totally change their health care systems. Changes in these countries include: the introduction of market economy mechanisms in health care, an increased focus on population health needs in guiding health care systems, and the possibility of introducing a more general type of care at primary level. Patient expectations of access, choice and convenience are factors in shaping new models of health care delivery. Appropriate timing is the key determinant of the success of reforms. In Estonia the beginning of the 1990s was the time when several interest groups in society supported changes in the health care system. The first step after regaining independence was the reintroduction of a Bismarck-type insurance system. In the late 1990s the primary care reforms have changed the initial plans and elements of a National Health Service were introduced, especially general practitioners' lists, capitation payment and gate-keeping principles. The family medicine reform in Estonia has two main objectives: introduction of general practice as a specialty into Estonian health care and changing the remuneration system of primary care doctors. The specific tasks are: to provide practising primary care doctors with opportunities for retraining to gain the specialty status of a general practitioner, to create a list system for the population to register with a primary care doctor, to introduce a partial gate-keeping system and to give the status of the independent contractor to primary care doctors. PMID:11963443

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

    PubMed

    Kurz, X; Scuvée-Moreau, J; Salmon, E; Pepin, J L; Ventura, M; Dresse, A

    2001-12-01

    Early detection of dementia is an important element for the efficacy of therapies currently proposed to slow down disease progression. This detection mainly relies on general practitioners. In order to estimate the impact of dementia on health services, we have estimated from the data of the NAtional Dementia Economic Study (NADES) the prevalence rate of dementia in patients aged > or = 65 years living at home and consulting in general practice. The study population was based on the sampling of consecutive patients consulting a general practitioner, irrespective of the reason and location of the consultation. The diagnosis of dementia was based on the CAMDEX performed at home in patients presenting > or = 3 warning signs of dementia. The prevalence rate of dementia among 2.234 registered patients living at home was 14.3% (CI95: 12.6-16.0). In age groups 65-74, 75-84 and > or = 85 years, it was 7.0%, 17.5% and 18.5%, respectively, in men, and 6.1%, 15.8% and 25.2%, respectively, in women. The percentage of demented with mild, mild to moderate, moderate and severe dementia was 35.0%, 38.8%, 13.1% and 13.1%, respectively. After adjusting for the age and sex distribution of the Belgian population, the prevalence rate in patients aged > or = 65 years was estimated at 11.3%. A diagnosis of dementia had already been made by a specialist in 41.5% of patients with dementia, with figures of 19.3%, 34.3%, 41.9% and 60.9% according to the severity of disease (mild, mild to moderate, moderate, severe). The onset of first symptoms had preceded the diagnosis by an average of 1 year. Our results show a high prevalence rate of dementia in the elderly living at home consulting in general practice, and less than half of the patients had previously been diagnosed. It is possible that a systematic detection will not be performed as long as specific treatments are not made widely available. PMID:11820036

  8. Screening for Chlamydia is acceptable and feasible during Cervical Screening in General Practice.

    PubMed

    Hassan, S J; Dunphy, E; Navin, E; Marron, L; Fitzsimmons, C; Loy, A; O'Shea, B

    2016-01-01

    The incidence of Chlamydia trachomatis (CT) & Neisseria gonorrhoeae (NG) are rising in Ireland. Both are often undiagnosed and may cause infertility amongst other complications. CT/NG screening is not routinely offered during cervical cancer screening. This study aimed to ascertain the feasibility and acceptability of screening for CT/NG at time of smear and to measure the diagnostic yield. Screening was offered to women aged 25-40 years attending four participating general practices as part of Cervical Check. A retrospective review of the three months preceding the study period, indicated that out of 138 smears, CT/NG testing was performed in 10 (7%) of cases. 236 (93%) patients consented to screening for CT/NG. The detection rate for Chlamydia was 6 (2.4%), with no positive results for NG. Feedback from patients was positive. Interestingly, 42 (18%) of participants who completed the questionnaire believed STI screening was already part of the routine smear. PMID:26904785

  9. [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

  10. A qualitative study exploring medicines use pattern and practice among general public in Malaysia

    PubMed Central

    2016-01-01

    Objective: The objective of this study is to explore the pattern and practice of medicine use among the general public; and to explore the key factors influencing medicine use among medicine users. Methods: A qualitative approach using focus group discussions was conducted to get in-depth information about medicines use pattern and practice from the general public. Adult people who reported using medicines at the time of study or in the previous month were approached. Two focus group discussions were audio-recorded and transcribed verbatim. The obtained data were analysed using thematic content analysis. Results: This study found that there are some misunderstanding about the appropriate use of medicines. The majority of the participants reported that they were complying with their medication regimen. However, forgetting to take medicines was stated by 4 participants while 2 participants stopped taking medicines when they felt better. In addition, 10 participants reporting using medicines according to their own knowledge and past experience. Whereas 4 participants took medicines according to other informal resources such as family, friends or the media. Seven participants have experienced side effects with using medicines, 4 of them informed their doctor while 3 participants stopped taking medicines without informing their doctor. Conclusion: There was a misunderstanding about medicines use in terms of medication compliance, self-management of the illness and the resources of information about using medicines. Many efforts are still needed from health care professionals to provide sufficient information about medicines use in order to decrease the risk of inappropriate use of medicines and to achieve better therapeutic outcome. PMID:27382428

  11. Management Decisions in Nontraumatic Complaints of Arm, Neck, and Shoulder in General Practice

    PubMed Central

    Feleus, Anita; Bierma-Zeinstra, Sita M. A.; Bernsen, Roos M. D.; Miedema, Harald S.; Verhaar, Jan A. N.; Koes, Bart W.

    2009-01-01

    OBJECTIVE We wanted to evaluate associations between diagnosis and characteristics of the patient, complaint, and general practitioner (GP), as well as 6 common management decisions, in patients with nontraumatic arm, neck, and shoulder complaints at the time of the first consultation with their physician. METHODS We undertook an observational cohort study set in 21 Dutch general practices, including 682 patients with nontraumatic complaints of arm, neck, and shoulder. The outcome measure was application (yes/no) of a specific management option: watchful waiting, additional diagnostic tests, prescription of medication, corticosteroid injection, referral for physiotherapy, and referral for medical specialist care. RESULTS Separate multilevel analyses showed that overall, the diagnostic category, having long duration of complaints, and reporting many functional limitations were most frequently associated with the choice of a management option. For watchful waiting, only complaint variables played a role (long duration of complaints, high complaint severity, many functional limitations, recurrent complaint). All these variables were negatively associated with watchful waiting. When opting for 1 of the 5 other management options, several physician characteristics played a role as well. Less clinical experience was associated with additional diagnostic tests and referral to a medical specialist. GPs working in a solo practice more frequently referred to a medical specialist. GPs working in a rural area more frequently referred for physiotherapy. Female GPs prescribed medication less frequently. Physicians with special interest in musculoskeletal complaints gave corticosteroid injections more frequently. CONCLUSIONS Diagnostic category, long duration of complaints, and high functional limitations were key variables in management decisions with these complaints. In addition, several physician characteristics played a role as well. PMID:19752473

  12. Effectiveness of ear syringing in general practice: a randomised controlled trial and patients' experiences.

    PubMed Central

    Memel, David; Langley, Carole; Watkins, Chris; Laue, Barbara; Birchall, Martin; Bachmann, Max

    2002-01-01

    BACKGROUND: Ear syringing is a common procedure performed for a variety of symptoms in primary care. Reports of its effectiveness vary considerably and no randomised controlled trials (RCTs) have been performed. AIM: To estimate the effect of ear syringing on hearing thresholds and on symptoms leading to ear syringing in general practice. DESIGN OF STUDY: Randomised single-blind controlled trial. Before-and-after self-assessments of symptoms. SETTING: Patients from three general practices in the Bristol area attending twice-weekly clinics dedicated to ear syringing over a 12-week period. METHOD: Patients were randomly assigned to have their hearing tested before and after ear syringing, or twice before ear syringing. Changes in hearing threshold were measured by pure tone audiometry (PTA). All patients completed sef-assessment forms of symptoms using Likert scales before, and one week after, ear syringing. RESULTS: Hearing threshold improved by 10 dB or more in 34% (95% confidence interval [CI] = 21% to 47%) of the intervention group and 1.6% of control group (number needed to treat = 3.1, 95% CI = 2.2 to 5.2, P<0.001). The levels of improvement in the intervention group ranged between 15 dB and 36 dB. The symptoms that most commonly improved included hearing on the phone, pain, a feeling of blocked ears, and hearing one-to-one. There was a strong relationship between the change thresholds, as measure using PTA, and self-reports of hearing improvement. Secondary analysis was unable to identify predictors of objectively measured improvement. CONCLUSION: Ear syringing improved hearing threshold in a substantial proportion of patients. An even larger proportion reported an improvement in symptoms. It was not possible to predict which patients would benefit. PMID:12434959

  13. Hypnosis as a treatment of chronic widespread pain in general practice: A randomized controlled pilot trial

    PubMed Central

    Grøndahl, Jan Robert; Rosvold, Elin Olaug

    2008-01-01

    Background Hypnosis treatment in general practice is a rather new concept. This pilot study was performed to evaluate the effect of a standardized hypnosis treatment used in general practice for patients with chronic widespread pain (CWP). Methods The study was designed as a randomized control group-controlled study. Sixteen patients were randomized into a treatment group or a control group, each constituting eight patients. Seven patients in the treatment group completed the schedule. After the control period, five of the patients in the control group also received treatment, making a total of 12 patients having completed the treatment sessions. The intervention group went through a standardized hypnosis treatment with ten consecutive therapeutic sessions once a week, each lasting for about 30 minutes, focusing on ego-strengthening, relaxation, releasing muscular tension and increasing self-efficacy. A questionnaire was developed in order to calibrate the symptoms before and after the 10 weeks period, and the results were interpolated into a scale from 0 to 100, increasing numbers representing increasing suffering. Data were analyzed by means of T-tests. Results The treatment group improved from their symptoms, (change from 62.5 to 55.4), while the control group deteriorated, (change from 37.2 to 45.1), (p = 0,045). The 12 patients who completed the treatment showed a mean improvement from 51.5 to 41.6. (p = 0,046). One year later the corresponding result was 41.3, indicating a persisting improvement. Conclusion The study indicates that hypnosis treatment may have a positive effect on pain and quality of life for patients with chronic muscular pain. Considering the limited number of patients, more studies should be conducted to confirm the results. Trial Registration The study was registered in ClinicalTrials.gov and released 27.08.07 Reg nr NCT00521807 Approval Number: 05032001. PMID:18801190

  14. Natural course of 500 consecutive cases of whooping cough: a general practice population study.

    PubMed Central

    Jenkinson, D.

    1995-01-01

    OBJECTIVE--To describe the natural course of whooping cough. DESIGN--Observational study of a general practice population. SETTING--Discrete semirural East Midlands practice of 11,500 patients. SUBJECTS--500 consecutive cases of whooping cough diagnosed clinically during 1977-92. MAIN OUTCOME MEASURES--Incidence of vomiting, whooping, apnoea, admission to hospital, and complications; duration and frequency of paroxysms. Pattern of spread. RESULTS--The incidence in the practice population was 4347/100,000 population compared with a notification rate for England and Wales of 717/100,000. Most cases were relatively mild. 284 patients vomited after paroxysms, 242 whooped, and 57 had apnoea. Duration and frequency of paroxysms varied widely. Female and unimmunised patients suffered more severe disease. Bordetella was isolated from fewer immunised patients (24/96 v 63/122 unimmunised). Infection was usually spread through contacts with someone with clinical whooping cough. Five patients developed pneumonia, three of whom had been immunised. Three patients required hospital admission. CONCLUSIONS--Most cases of whooping cough are relatively mild. Such cases are difficult to diagnose without a high index of suspicion because doctors are unlikely to hear the characteristic cough, which may be the only symptom. Parents can be reassured that a serious outcome is unlikely. Adults also get whooping cough, especially from their children, and get the same symptoms as children. The difficulty of early diagnosis and probability of missed cases reinforces the need to keep the incidence low through immunisation in order to protect infants, who are the most vulnerable. PMID:7866173

  15. 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

  16. Weigh Forward: a clinical audit of weight management in Australian general practice.

    PubMed

    Hemmes, R A; Adam, N; Dixon, J B

    2016-06-01

    Weigh Forward was a prospective clinical audit, aimed to assess the use and efficacy of 12-week weight management program in general practice. Twenty-eight practitioners participated in the audit, with a total of 258 patients observed. Of these, 147 (57%) were retained to 24 weeks. Practices were asked to implement a structured 12-week weight loss program, and encouraged to utilize relevant weight management guidelines as necessary. Patients were followed up regularly, and comprehensively assessed at baseline, 12 and 24 weeks. Evaluations were made of patient weight loss, practitioner willingness to utilize available weight loss interventions, practitioner set weight loss goals and the appropriateness of such goals. Overall, the 57% of completing patients lost an average of 6.1% ± 0.5% body weight, with 27.2% losing ≥10% body weight. Practitioners were hesitant to intensify treatment, and those with comorbidities were less likely (odds ratio 1.8; 95% CI 1.4-2.4) to receive intensified treatment than those without. Practitioners also tended to set high weight loss goals, with a mean goal of 17.3% body-weight loss. The clinically significant mean weight loss demonstrates that practitioners are able to generate meaningful weight loss in primary care settings, however, could benefit from increased use of available interventions. PMID:27166135

  17. Instructional and behavior management practices implemented by elementary general education teachers.

    PubMed

    Reddy, Linda A; Fabiano, Gregory A; Dudek, Christopher M; Hsu, Louis

    2013-12-01

    This investigation examined 317 general education kindergarten through fifth-grade teachers' use of instructional and behavioral management strategies as measured by the Classroom Strategy Scale (CSS)-Observer Form, a multidimensional tool for assessing classroom practices. The CSS generates frequency of strategy use and discrepancy scores reflecting the difference between recommended and actual frequencies of strategy use. Hierarchical linear models (HLMs) suggested that teachers' grade-level assignment was related to their frequency of using instructional and behavioral management strategies: Lower grade teachers utilized more clear 1 to 2 step commands, praise statements, and behavioral corrective feedback strategies than upper grade teachers, whereas upper grade teachers utilized more academic monitoring and feedback strategies, content/concept summaries, student focused learning and engagement, and student thinking strategies than lower grade teachers. Except for the use of praise statements, teachers' usage of instructional and behavioral management strategies was not found to be related to years of teaching experience or to the interaction of years of teaching experience and grade-level assignment. HLMs suggested that teachers' grade level was related to their discrepancy scores of some instructional and behavioral management strategies: Upper grade teachers had higher discrepancy scores in academic performance feedback, behavioral feedback, and praise than lower grade teachers. Teachers' discrepancy scores of instructional and behavioral management strategies were not found to be related to years of teaching experience or to the interaction of years of teaching experience and grade-level assignment. Implications of results for school psychology practice are outlined. PMID:24295143

  18. An Outcomes Study of 40 Years of Graduates of a General Practice Dental Residency.

    PubMed

    Lau, Agnes; Dodson, Thomas B; Sonis, Stephen T; Kaban, Leonard B

    2015-08-01

    Assessing program quality and outcomes is essential to improve postgraduate dental education. This study's aims were to document career direction and practice patterns of graduates of the Brigham and Women's Hospital (BWH) General Practice Residency (GPR), to compare BWH GPR outcomes to those of other American GPRs, and to identify characteristics of the BWH GPR program that trainees valued. This was a retrospective cohort study with a sample comprised of BWH GPR graduates between 1973 and 2013. Outcomes examined included pursuit of specialty training and positions on academic or hospital staff. Data sources were a survey of BWH GPR graduates and published national surveys. Of the 190 BWH graduates (95% of total) who were located and contacted, 133 (70% response rate) completed the survey. Compared to national survey data, BWH GPR graduates were significantly more likely to be specialists, full-time hospital staff, or full-time or part-time dental school faculty. Most BWH graduates (96.2%) ranked the program as outstanding or good. Faculty characteristics were considered by BWH graduates to be the most important factors in judging program quality. Since faculty characteristics were the most important factors in residents' judgment of program quality, GPR programs should recruit, maintain, and develop a quality faculty in order to attract students. PMID:26246526

  19. [General practice consultation in a hospital emergency department. History, evaluation and prospects].

    PubMed

    Lafay, Vincent; Giraud, Christiane; Bel, Corinne; Giovannetti, Olivier

    2002-10-26

    INSTALLATION OF A GENERAL MEDICINE CONSULTATION: In 1995, in reaction to an increase of more than 35% over three years, related essentially to out-patient consultations, the installation of a general medicine consultation (GMC) near the emergency unit reception area (EUR) was envisaged. The project, developed over 5 years and based on an epidemiological study, was finally set-up in January 2000. The aims of the GMC are to supply information to the patients, help them in their administrative rights, and their subsequent follow-up by an external physician; the benefits expected by the EUR is the re-concentration on heavier and more urgent pathologies. THE FUNCTION OF THE GMC: Exclusively reserved for CCMU 1 patients (level 1 of the clinical classification of emergency unit patients), the GMC relies on general practice, with the presence of general practitioners installed in the SAU (emergency unit) sector, a double admission method (either via the emergency unit, or directly), a means of payment for the consultation and the absence of priority access to the technical network of the hospital. A social services worker is present. RECRUITMENT: After 18 months of activity, the GMC had managed more than 4500 patients and the method of referral via the SAU, almost exclusive at the beginning, has been reduced to a minority. The patients are generally young; socially close to the underprivileged population surrounding the SAU, but not in a situation of precariousness. The four principle motives for consultation are benign traumas, ENT infections, dermatological affections and pain. A DYNAMIC STRUCTURE: The rapid progress in the context of general medicine, and the observations of the physicians and non-physicians participating in this experience, has progressively modified the aim and mission of this GMC, which is gradually becoming a real structure of permanent care. Its originality is its close link between the town and the hospital, whilst permitting the various actors to

  20. Data quality and fitness for purpose of routinely collected data--a general practice case study from an electronic practice-based research network (ePBRN).

    PubMed

    Liaw, Siaw-Teng; Taggart, Jane; Dennis, Sarah; Yeo, Anthony

    2011-01-01

    The practice-based research network (PBRN) is a resource to recruit research participants; conduct developmental and pilot studies; and coordinate multicentre research, teaching, clinical care and quality assurance programs. It is a community-based laboratory for translational, clinical and health services research. The mining of clinical information systems of PBRNs can be used to monitor performance at the service unit level. However, are the routinely collected data of ePBRNs fit for the abovementioned purposes? We describe the establishment and governance of an ePBRN which included general practice and community health and hospital units, The general practice data quality was examined, using diabetes as the context, for completeness, correctness and consistency and assessed on its fitness for research, audit and quality assurance purposes. The quality of social determinants data was generally good while risk factors data were variable. Issues and strategies for improving data quality are discussed. PMID:22195136

  1. [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

  2. Radiation dosage reduction in general dental practice using digital intraoral radiographic systems.

    PubMed

    Hayakawa, Y; Shibuya, H; Ota, Y; Kuroyanagi, K

    1997-02-01

    This report describes the radiation dosage reduction possible in the general dental practice with two CCD (charge-coupled device)-based intraoral radiographic systems: the RVG-S (Trophy Radiologie, Vincennes, France) and the Sens-A-Ray (Regam Medical Systems, Sundsvall, Sweden). Radiation dosages (air-kerma; Gy) necessary for obtaining clinically acceptable images were measured at the cone tip using an ionization chamber type 660-1 (Nuclear Associates, Victoreen, Inc., Carle Place, New York, USA). When the RVG-S was used with an Oramatic 70 (Trophy Radiologie) X-ray generator, dosages at the cone tip ranged from 322 to 612 microGy. These corresponded to 40-60% of the dosages necessary when using Ektaspeed dental X-ray film (Eastman Kodak, Rochester, New York, USA) with a Heliodent 70 (Siemens, Erlangen, Germany) X-ray generator. At 60 kVp, the Sens-A-Ray reduced the dosage in the order of 30% compared with Ektaspeed dental X-ray film. Reduction in radiation dosage is one of the benefits of digital intraoral radiographic systems in general dental clinics. The RVG-S provides greater dose savings than does the Sens-A-Ray. PMID:9566150

  3. [Clinical practice guidelines for systemic lupus erythematosus: Recommendations for general clinical management].

    PubMed

    Trujillo-Martín, María M; Rúa-Figueroa Fernández de Larrinoa, Iñigo; Ruíz-Irastorza, Guillermo; Pego-Reigosa, José María; Sabio Sánchez, José Mario; Serrano-Aguilar, Pedro

    2016-05-01

    Systemic lupus erythematosus (SLE) is a complex rheumatic multisystemic disease of autoimmune origin with significant potential morbidity and mortality. It is one of the most common autoimmune diseases with an estimated prevalence of 20-150 cases per 100,000 inhabitants. The clinical spectrum of SLE is wide and variable both in clinical manifestations and severity. This prompted the Spanish Ministry of Health, Social Services and Equality to promote and fund the development of a clinical practice guideline (CPG) for the clinical care of SLE patients within the Programme of CPG in the National Health System which coordinates GuiaSalud. This CPG is is intended as the reference tool in the Spanish National Health System in order to support the comprehensive clinical management of people with SLE by all health professionals involved, regardless of specialty and level of care, helping to standardize and improve the quality of clinical decisions in our context in order to improve the health outcomes of the people affected. The purpose of this document is to present and discuss the rationale of the recommendations on the general management of SLE, specifically, clinical follow-up, general therapeutic approach, healthy lifestyles, photoprotection, and training programmes for patients. These recommendations are based on the best available scientific evidence, on discussion and the consensus of expert groups. PMID:26975887

  4. A systematic review of empirical research into ethics in general practice.

    PubMed Central

    Rogers, W A

    1997-01-01

    Much of the bioethical literature addresses the problems of tertiary medicine, with little attention to the daily concerns of general practitioners (GPs). The present review assesses the current state of research into the range and nature of ethical issues for GPs, looking specifically at the content of the research, the methods employed, and the philosophical framework of the research. A systematic search of MEDLINE, CINAHL, and Sociofile identified nine articles which form the basis for this review. The majority of the research reviewed here is quantitative in nature, using hypothetical cases with closed questions and categorical responses. No consistently significant variables were identified. Decisions appear to be inconsistent in terms of theoretical models and moral psychology. Ethical issues of concern to GPs differed from those commonly reported in the bioethical literature. There is a paucity of research into the ethical concerns of general practice. The existing body of research is quantitative in nature, leaving many unanswered questions concerning the reasons behind the decisions of GPs. There is a need for qualitative studies to further our understanding of this area. PMID:9519523

  5. Consultations conducted in languages other than English in Australian general practice.

    PubMed

    Bayram, Clare; Ryan, Rowena; Harrison, Christopher; Gardiner, Joanne; Bailes, Marion Jean; Obeyesekere, Nayantara; Miller, Graeme; Britt, Helena

    2016-01-01

    This study sought to determine the need for, and use of, professional interpreters in general practice. This is a sub-study of the Bettering the Evaluation and Care of Health (BEACH) program - a continuous, national, cross-sectional survey of Australian general practitioner (GP) activity. Data were provided by 206 randomly sampled GPs between December 2013 and March 2014. Of 6074 patients sampled, there were 986 (16.2%; 95% confidence interval [CI]: 13.2-19.3) who reported speaking a language other than English (LOTE) at home. Five per cent of all GP consultations involved communicating in a LOTE. Of these, 1% involved professional interpreters, 82.3% were conducted by multilingual GPs who spoke the patient's language, and 17.7% involved a family member or friend. GPs thought a professional interpreter would/may have improved the quality of 27.8% of these consultations. Our study suggests that GPs see the opportunity to improve the quality of LOTE consultations by using professional interpreters to replace family member/friend interpreters. PMID:27051980

  6. Lifestyle variables and the risk of myocardial infarction in the General Practice Research Database

    PubMed Central

    Delaney, Joseph AC; Daskalopoulou, Stella S; Brophy, James M; Steele, Russell J; Opatrny, Lucie; Suissa, Samy

    2007-01-01

    Background The primary objective of this study is to estimate the association between body mass index (BMI) and the risk of first acute myocardial infarction (AMI). As a secondary objective, we considered the association between other lifestyle variables, smoking and heavy alcohol use, and AMI risk. Methods This study was conducted in the general practice research database (GPRD) which is a database based on general practitioner records and is a representative sample of the United Kingdom population. We matched cases of first AMI as identified by diagnostic codes with up to 10 controls between January 1st, 2001 and December 31st, 2005 using incidence density sampling. We used multiple imputation to account for missing data. Results We identified 19,353 cases of first AMI which were matched on index date, GPRD practice and age to 192,821 controls. There was a modest amount of missing data in the database, and the patients with missing data had different risks than those with recorded values. We adjusted our analysis for each lifestyle variable jointly and also for age, sex, and number of hospitalizations in the past year. Although a record of underweight (BMI <18.0 kg/m2) did not alter the risk for AMI (adjusted odds ratio (OR): 1.00; 95% confidence interval (CI): 0.87–1.11) when compared with normal BMI (18.0–24.9 kg/m2), obesity (BMI ≥30 kg/m2) predicted an increased risk (adjusted OR: 1.41; 95% CI: 1.35–1.47). A history of smoking also predicted an increased risk of AMI (adjusted OR: 1.81; 95% CI: 1.75–1.87) as did heavy alcohol use (adjusted OR: 1.15; 95% CI: 1.06–1.26). Conclusion This study illustrates that obesity, smoking and heavy alcohol use, as recorded during routine care by a general practitioner, are important predictors of an increased risk of a first AMI. In contrast, low BMI does not increase the risk of a first AMI. PMID:18088433

  7. Trends in suicidal behaviour in Dutch general practice 1983–2013: a retrospective observational study

    PubMed Central

    Hooiveld, Mariette; Korevaar, Joke C; Donker, Gé A

    2016-01-01

    Objectives To analyse trends in suicidal behaviour as reported by the Dutch sentinel general practices from 1983 to 2013. Second, to examine the relationship between suicidal behaviour and several patient characteristics. Finally, to compare the relationship between suicidal behaviour and patient characteristics before (1983–2007) and after (2008–2013) the start of the crisis. Setting 40 general practices in the Netherlands during the period 1983–2013. Participants Patients with an ICPC code of P77 (suicide attempt). Primary and secondary outcomes Primary outcomes were age-adjusted and gender-specific trends in reported suicides (342) and suicide attempts (1614). Secondary outcomes were the relationship between suicidal behaviour and age, household composition, history of depression, recognition of suicide ideation, treatment before the suicidal behaviour and contact within the past month before suicidal behaviour for the period 1983–2013. Additionally, separate frequencies for the periods 1983–2007 and 2008–2013 were presented. Results Join-point analyses revealed a significant rise in male suicides from 2008 (b=0.32, SE=0.1, p=0.008), and an increase in male suicide attempts since 2009 (b=0.19, SE=0.04, p<0.001). Female suicidal behaviour showed a steady decrease from 1989 to 2013(b=−0.03, SE=0.007, p<0.0001 for female suicide, b=−0.02, SE=0.002, p<0.001 for female attempts). Before 2007, a history of depression was reported in 65% (168/257) of the suicides. After the start of the recession, a depression was recognised in 44% (22/50) of the patients who died by suicide. Conclusions Since 2008, there was a rise in the male suicide rate while female suicide behaviour has continued to decline. General practitioners less often reported a history of depression within patients who died due to suicide after 2007 than before. Training in the early recognition of suicide ideation in depressive patients might improve suicide prevention in primary care. PMID

  8. 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

  9. 40 years of biannual family medicine research meetings – The European General Practice Research Network (EGPRN)

    PubMed Central

    2013-01-01

    Abstract Objective To document family medicine research in the 25 EGPRN member countries in 2010. Design Semi-structured survey with open-ended questions. Setting Academic family medicine in 23 European countries, Israel, and Turkey. Subjects 25 EGPRN national representatives. Main outcome measures Demographics of the general population and family medicine. Assessments, opinions, and suggestions. Results EGPRN has represented family medicine for almost half a billion people and > 300 000 general practitioners (GPs). Turkey had the largest number of family medicine departments and highest density of GPs, 2.1/1000 people, Belgium had 1.7, Austria 1.6, and France 1.5. Lowest GP density was reported from Israel 0.17, Greece 0.18, and Slovenia 0.4 GPs per 1000 people. Family medicine research networks were reported by 22 of 25 and undergraduate family medicine research education in 20 of the 25 member countries, and in 10 countries students were required to do research projects. Postgraduate family medicine research was reported by 18 of the member countries. Open-ended responses showed that EGPRN meetings promoted stimulating and interesting research questions such as comparative studies of chronic pain management, sleep disorders, elderly care, healthy lifestyle promotion, mental health, clinical competence, and appropriateness of specialist referrals. Many respondents reported a lack of interest in family medicine research related to poor incentives and low family medicine status in general and among medical students in particular. It was suggested that EGPRN exert political lobbying for family medicine research. Conclusion Since 1974, EGPRN organizes biannual conferences that unite and promote primary care practice, clinical research and academic family medicine in 25 member countries. PMID:24191874

  10. Relationships between job organisational factors, biomechanical and psychosocial exposures.

    PubMed

    Bao, Stephen S; Kapellusch, Jay M; Merryweather, Andrew S; Thiese, Matthew S; Garg, Arun; Hegmann, Kurt T; Silverstein, Barbara A

    2016-02-01

    The relationships between work organisational, biomechanical and psychosocial factors were studied using cross-sectional data from a pooled dataset of 1834 participants. The work organisational factors included: job rotation, overtime work, having second jobs and work pace. Task and job level biomechanical variables were obtained through sub-task data collected in the field or analysed in the laboratory. Psychosocial variables were collected based on responses to 10 questions. The results showed that job rotations had significant effects on all biomechanical and most psychosocial measures. Those with job rotations generally had higher job biomechanical stressors, and lower job satisfaction. Overtime work was associated with higher job biomechanical stressors, and possibly self-reported physical exhaustion. Those having second jobs reported getting along with co-workers well. Work pace had significant influences on all biomechanical stressors, but its impact on job biomechanical stressors and psychosocial effects are complicated. Practitioner Summary: The findings are based on a large number of subjects collected by three research teams in diverse US workplaces. Job rotation practices used in many workplaces may not be effective in reducing job biomechanical stressors for work-related musculoskeletal disorders. Overtime work is also associated with higher biomechanical stressors. PMID:26102483

  11. Interpersonal psychotherapy (IPT) for late-life depression in general practice: uptake and satisfaction by patients, therapists and physicians

    PubMed Central

    van Schaik, Digna JF; van Marwijk, Harm WJ; Beekman, Aartjan TF; de Haan, Marten; van Dyck, Richard

    2007-01-01

    Background Interpersonal Psychotherapy (IPT) is recommended in most depression treatment guidelines and proved to be a suitable treatment for elderly depressed patients. Despite the favorable results of IPT in research populations, the dissemination to general practice is surprisingly limited. Little is known about uptake and satisfaction when this therapy is introduced into real-life general practice. Methods Motivation and evaluation of patients, GPs and therapists were recorded and organizational barriers described alongside a randomized controlled trial. IPT, given by mental health workers, was compared with usual general practitioner (GP) care. Included were patients (≥55 years) who met the DSM-IV criteria for major depressive disorder. Results Patients were motivated for the psychotherapy intervention: of the 205 eligible patients, 143 (70%) entered the study, and of the 69 patients who were offered IPT, 77% complied with the treatment. IPT proved to be an attractive therapy for patients as well as for therapists from mental health organizations. General practitioners evaluated the intervention positively afterwards, mainly because of the time-limited and structured approach. Organizational barriers: no IPT therapists were available; an IPT trainer and supervisor had to be trained and training materials had to be developed and translated. Additionally, there was a lack of office space in some general practices; for therapists from private practices it was not feasible to participate because of financial reasons. IPT was superior to usual care in patients with moderate to severe depression. Conclusion As we succeeded in delivering IPT in primary care practice, and as IPT was superior to usual care, there are grounds to support the implementation of IPT for depressed elderly patients within general practice, as long as the practices have room for the therapists and financial barriers can be overcome. Consolidation may be achieved by making this intervention

  12. Average recovery time from a standardized intravenous sedation protocol and standardized discharge criteria in the general dental practice setting.

    PubMed Central

    Lepere, A. J.; Slack-Smith, L. M.

    2002-01-01

    Intravenous sedation has been used in dentistry for many years because of its perceived advantages over general anesthesia, including shorter recovery times. However, there is limited literature available on recovery from intravenous dental sedation, particularly in the private general practice setting. The aim of this study was to describe the recovery times when sedation was conducted in private dental practice and to consider this in relation to age, weight, procedure type, and procedure time. The data were extracted from the intravenous sedation records available with 1 general anesthesia-trained dental practitioner who provides ambulatory sedation services to a number of private general dental practices in the Perth, Western Australia Metropolitan Area. Standardized intravenous sedation techniques as well as clear standardized discharge criteria were utilized. The sedatives used were fentanyl, midazolam, and propofol. Results from 85 patients produced an average recovery time of 19 minutes. Recovery time was not associated with the type or length of dental procedures performed. PMID:15384295

  13. Determining organisation-specific factors for developing health interventions in companies by a Delphi procedure: Organisational Mapping.

    PubMed

    van Scheppingen, Arjella R; ten Have, Kristin C J M; Zwetsloot, Gerard J I M; Kok, Gerjo; van Mechelen, Willem

    2015-12-01

    Companies, seen as social communities, are major health promotion contexts. However, health promotion in the work setting is often less successful than intended. An optimal adjustment to the organisational context is required. Knowledge of which organisation-specific factors are relevant to health promotion is scarce. A Delphi procedure is used to identify these factors. The aim is to contribute to more effective workplace health promotion. The identified factors are described and embedded into a practical methodology (Intervention Mapping). A systematic use of these factors (called 'Organisational Mapping') is likely to contribute to more effective health promotion in the work setting. PMID:26573181

  14. Organising, Educating... Changing the World

    ERIC Educational Resources Information Center

    Grayson, John

    2005-01-01

    Over the past few years a constellation of social movements and organisations concerned with issues of globalisation and world poverty have exploded onto the world stage. They have mobilised demonstrations, organised mass gatherings and conferences, created e-networks and websites and become major players in international political lobbying and…

  15. Perceived wellbeing of patients one year post stroke in general practice - recommendations for quality aftercare

    PubMed Central

    2011-01-01

    improvements in mental functioning can be envisaged. In addition, more attention should be paid to maintaining the patients' activities. The wellbeing of these stroke patients could be increased further if greater attention is paid to these aspects of life. This seems to be applicable to general practice. PMID:21453512

  16. The usefulness of a clinical 'scorecard' in managing patients with sore throat in general practice

    PubMed Central

    2010-01-01

    Background Objective: To evaluate the usefulness of a clinical scorecard in managing sore throat in general practice. Design: Validation study of scorecard for sore throat with a throat swab culture used as the 'gold standard'. Setting: A solo family practice in rural New South Wales, Australia Participants: Patients attending with sore throat. Methods Patients from the age of 5 years and above presenting with the main symptom of a sore throat, and who have not had any antibiotic treatment in the previous two weeks, were invited to participate in the study. The doctor completed a scorecard for each patient participating and took a throat swab for culture. Adult patients (> 16 yrs) were asked to complete a patient satisfaction questionnaire, while guardians accompanying children (5 yr to < 16 yrs old) were asked to complete a similar, guardian questionnaire. Main outcome measures: 1. Ability of a new scorecard to differentiate between bacterial and non-bacterial sore throat. 2. Patients' trust in the scorecard. Results The scorecard has a sensitivity of 93.33%, a specificity of 63.16%, a positive predictive value of 50% and a negative predictive value of 96%. The sensitivity is better than other sore throat scorecards that have been published but with a slightly lower specificity. There was a high level of patient trust in the scorecard was (85.8% agreement). Patients also trusted their doctor's judgement based on the scorecard (90.6% agreement). Conclusions As the scorecard has a high sensitivity but only a moderate specificity, this means that it is more reliable for negative results, i.e. when the result suggests a viral infection. When the result favours a bacterial sore throat, then a high sensitivity can mean that there are a number of false positives. GPs can be confident in withholding antibiotics when the scorecard indicates a viral infection. PMID:20670439

  17. Acute rhinosinusitis (ARS). Diagnosis and treatment of adults in general practice.

    PubMed

    Hansen, Jens Georg

    2014-02-01

    The idea behind this thesis is to present how ARS and especially acute maxillary sinusitis in adults is diagnosed and treated in general practice. The study extends over many years, beginning with the first survey in 1991. Based on doctors' answers, we then investigated the diagnostic values ​​of the symptoms, signs and examinations which the doctors reported using. All patients over 18 years suspected of acute maxillary sinusitis were included consecutively and only once and, after a clinical examination with the GP, they were offered the opportunity to enter into the prospective study referred to acute CT scan and by changes in the CT, immediately referred to sinus puncture. Both examinations were conducted at Aalborg Hospital. The disease was found most frequently in younger and 2/3 were women. The reason for this gender difference is unknown. We have assessed the diagnostic values of the symptoms, objective findings and investigations ​​using 3 different reference standards: sinus puncture, microbiological diagnosis and CT scan described in three articles. In all examinations, it appeared that the usual signs and symptoms of acute maxillary sinusitis occur almost equally often and with a few exceptions in patients, with and without pus in the sinus cavities. Pain in the sinus cavities occurring in 95% of patients, and only elevated levels of CRP and ESR are significantly and independently associated with pus in the sinus cavities. This finding is surprising, because they are two nonspecific markers. CRP tested by near-patient testing has, within the investigations period, been introduced in general practice, and from 1999 the doctors also get reimbursed for performing the test. We have on this background originally defined a clinical criterion with pain over the sinuses accompanied by elevated values ​​of CRP and/or ESR giving a sensitivity of 0.82, specificity 0.57, ppv 0.68 and npv 0.74. But looking at the ROC curve we suggest that a more clinical

  18. Analgesia dose prescribing and estimated glomerular filtration rate decline: a general practice database linkage cohort study

    PubMed Central

    Nderitu, Paul; Doos, Lucy; Strauss, Vicky Y; Lambie, Mark; Davies, Simon J; Kadam, Umesh T

    2014-01-01

    Objective We aimed to quantify the short-term effect of non-steroidal anti-inflammatory drugs (NSAIDs), aspirin and paracetamol analgesia dose prescribing on estimated glomerular filtration rate (eGFR) decline in the general practice population. Design A population-based longitudinal clinical data linkage cohort study. Setting Two large general practices in North Staffordshire, UK. Participants Patients aged 40 years and over with ≥2 eGFR measurements spaced ≥90 days apart between 1 January 2009 and 31 December 2010 were selected. Exposure Using WHO Defined Daily Dose standardised cumulative analgesia prescribing, patients were categorised into non-user, normal and high-dose groups. Outcome measure The primary outcome was defined as a >5 mL/min/1.73 m2/year eGFR decrease between the first and last eGFR. Logistic regression analyses were used to estimate risk, adjusting for sociodemographics, comorbidity, baseline chronic kidney disease (CKD) status, renin-angiotensin-system inhibitors and other analgesia prescribing. Results There were 4145 patients (mean age 66 years, 55% female) with an analgesia prescribing prevalence of 17.2% for NSAIDs, 39% for aspirin and 22% for paracetamol and stage 3–5 CKD prevalence was 16.1% (n=667). Normal or high-dose NSAID and paracetamol prescribing was not significantly associated with eGFR decline. High-dose aspirin prescribing was associated with a reduced risk of eGFR decline in patients with a baseline (first) eGFR ≥60 mL/min/1.73 m2; OR=0.52 (95% CI 0.35 to 0.77). Conclusions NSAID, aspirin and paracetamol prescribing over 2 years did not significantly affect eGFR decline with a reduced risk of eGFR decline in high-dose aspirin users with well-preserved renal function. However, the long-term effects of analgesia use on eGFR decline remain to be determined. PMID:25138808

  19. Practical prediction model for the risk of 2-year mortality of individuals in the general population.

    PubMed

    Goldfarb-Rumyantzev, Alexander; Gautam, Shiva; Brown, Robert S

    2016-04-01

    This study proposed to validate a prediction model and risk-stratification tool of 2-year mortality rates of individuals in the general population suitable for office practice use. A risk indicator (R) derived from data in the literature was based on only 6 variables: to calculate R for an individual, starting with 0, for each year of age above 60, add 0.14; for a male, add 0.9; for diabetes mellitus, add 0.7; for albuminuria >30 mg/g of creatinine, add 0.7; for stage ≥3 chronic kidney disease (CKD), add 0.9; for cardiovascular disease (CVD), add 1.4; or for both CKD and CVD, add 1.7. We developed a univariate logistic regression model predicting 2-year individual mortality rates. The National Health and Nutrition Examination Survey (NHANES) data set (1999-2004 with deaths through 2006) was used as the target for validation. These 12,515 subjects had a mean age of 48.9±18.1 years, 48% males, 9.5% diabetes, 11.7% albuminuria, 6.8% CVD, 5.4% CKD, and 2.8% both CKD and CVD. Using the risk indicator R alone to predict mortality demonstrated good performance with area under the receiver operating characteristic (ROC) curve of 0.84. Dividing subjects into low-risk (R=0-1.0), low intermediate risk (R>1.0-3.0), high intermediate risk (R>3.0-5.0) or high-risk (R>5.0) categories predicted 2-year mortality rates of 0.52%, 1.44%, 5.19% and 15.24%, respectively, by the prediction model compared with actual mortality rates of 0.29%, 2.48%, 5.13% and 13.40%, respectively. We have validated a model of risk stratification using easily identified clinical characteristics to predict 2-year mortality rates of individuals in the general population. The model demonstrated performance adequate for its potential use for clinical practice and research decisions. PMID:26951378

  20. The Frankfurt Patient Safety Climate Questionnaire for General Practices (FraSiK): analysis of psychometric properties.

    PubMed

    Hoffmann, Barbara; Domanska, Olga Maria; Albay, Zeycan; Mueller, Vera; Guethlin, Corina; Thomas, Eric J; Gerlach, Ferdinand M

    2011-09-01

    BACKGROUND Safety culture has been identified as having a major impact on how safety is managed in healthcare. However, it has not received much attention in general practices. Hence, no instrument yet exists to assess safety climate-the measurable artefact of safety culture-in this setting. This study aims to evaluate psychometric properties of a newly developed safety climate questionnaire for use in German general practices. METHODS The existing Safety Attitudes Questionnaire, Ambulatory Version, was considerably modified and enhanced in order to be applicable in general practice. After pilot tests and its application in a random sample of 400 German practices, a first psychometric analysis led to modifications in several items. A further psychometric analysis was conducted with an additional sample of 60 practices and a response rate of 97.08%. Exploratory factor analysis with orthogonal varimax rotation was carried out and the internal consistency of the identified factors was calculated. RESULTS Nine factors emerged, representing a wide range of dimensions associated with safety culture: teamwork climate, error management, safety of clinical processes, perception of causes of errors, job satisfaction, safety of office structure, receptiveness to healthcare assistants and patients, staff perception of management, and quality and safety of medical care. Internal consistency of factors is moderate to good. CONCLUSIONS This study demonstrates the development of a patient safety climate instrument. The questionnaire displays established features of safety climate and additionally contains features that might be specific to small-scale general practices. PMID:21571753

  1. 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

  2. Building Organisational Capability the Private Provider Way

    ERIC Educational Resources Information Center

    Guthrie, Hugh

    2008-01-01

    Organisational capability is recognised as a key to organisational success. The combination of human capital (peoples' skills and knowledge), social capital (relationships between people) and organisational capital (the organisation's processes), is central to building an organisation's capability. This paper, presented at the 2008 annual…

  3. Frequent attenders in general practice and immigrant status in Norway: A nationwide cross-sectional study

    PubMed Central

    Gimeno-Feliu, Luis-Andrés; Calderón-Larrañaga, Amaia; Prados-Torres, Alexandra

    2014-01-01

    Abstract Objective. To compare the likelihood of being a frequent attender (FA) to general practice among native Norwegians and immigrants, and to study socioeconomic and morbidity factors associated with being a FA for natives and immigrants. Design, setting and subjects. Linked register data for all inhabitants in Norway with at least one visit to the general practitioner (GP) in 2008 (2 967 933 persons). Immigrants were grouped according to their country of origin into low- (LIC), middle- (MIC), and high-income countries (HIC). FAs were defined as patients whose attendance rate ranked in the top 10% (cut-off point > 7 visits). Main outcome measures. FAs were compared with other GP users by means of multivariate binary logistic analyses adjusting for socioeconomic and morbidity factors. Results. Among GP users during the daytime, immigrants had a higher likelihood of being a FA compared with natives (OR (95% CI): 1.13 (1.09–1.17) and 1.15 (1.12–1.18) for HIC, 1.84 (1.78–1.89) and 1.66 (1.63–1.70) for MIC, and 1.77 (1.67–1.89) and 1.65 (1.57–1.74) for LIC for men and women respectively). Pregnancy, middle income earned in Norway, and having cardiologic and psychiatric problems were the main factors associated with being a FA. Among immigrants, labour immigrants and the elderly used GPs less often, while refugees were overrepresented among FAs. Psychiatric, gastroenterological, endocrine, and non-specific drug morbidity were relatively more prevalent among immigrant FA compared with natives. Conclusion. Although immigrants account for a small percentage of all FAs, GPs and policy-makers should be aware of differences in socioeconomic and morbidity profiles to provide equality of health care. PMID:25421090

  4. [Promotion of community-based care in Africa: example of community general practice in Benin].

    PubMed

    Caplain, Roland; Yacoubou, Ismaïl; Adedemy, Didier; Sani, Alidou; Takam, Sandrine; Desplats, Dominique

    2014-01-01

    Considerable effort has been made to provide rural African populations with basic health care, but the quality of this care remains unsatisfactory due to the absence of first-line GPs. This is a paradoxical situation in view of the large number of physicians trained in medical schools in French-speaking Africa and Madagascar. of the lack of GPs working in rural areas is a real concern, as many young doctors remain unemployed in cities. For more than 20 years, the NGO Santé Sud has proposed a Community General Medicine concept, which, combined with a support system, has allowed the installation of more than 200 community GPs in Mali and Madagascar. The advantage of this concept is that it provides family medicine and primary health care in the same practice. Since 2009, Santé Sud supports an installation project in rural areas of northern Benin, where community GPs work independently, as a complementary partner of the public sector. Since 2013, the installation process comprises a university degree created with the University of Parakou Faculty of Medicine. Based on this experience in Benin, the authors show that the presence of a first-line general practitioner is an original strategy that provides a major contribution to health promotion : reducing health inequalities between rural and urban populations, allowing women to receive medically assisted childbirth close to home, developing family planning activities, education and health care for chronic diseases, strengthening health coverage by participating in vaccination campaigns, etc. Due to their functions and proximity, community GPs represent an added value for health promotion. PMID:25380378

  5. The Identity Crisis of Osteoarthritis in General Practice: A Qualitative Study Using Video-Stimulated Recall

    PubMed Central

    Paskins, Zoe; Sanders, Tom; Croft, Peter R.; Hassell, Andrew B.

    2015-01-01

    PURPOSE Patients and doctors report marked disenchantment with primary care consultation experiences relating to osteoarthritis. This study aimed to observe and analyze interactions between general practitioners (GPs) and patients presenting with osteoarthritis (OA) to identify how to improve care for OA. METHODS We conducted an observational study in general practices in the United Kingdom using video-recorded real-life consultations of unselected patients and their GPs. Postconsultation interviews were conducted using video-stimulated recall. Both consultations and interviews were analyzed thematically. RESULTS Three key themes were identified in an analysis of 19 OA consultations and the matched GP and patient interviews: complexity, dissonance, and prioritization. The topic of osteoarthritis arises in the consultation in complex contexts of multimorbidity and multiple, often not explicit, patient agendas. Dissonance between patient and doctor was frequently observed and reported; this occurred when GPs normalized symptoms of OA as part of life and reassured patients who were not seeking reassurance. GPs used wear and tear in preference to osteoarthritis or didn’t name the condition at all. GPs subconsciously made assumptions that patients did not consider OA a priority and that symptoms raised late in the consultation were not troublesome. CONCLUSIONS The lack of a clear illness profile results in confusion between patients and doctors about what OA is and its priority in the context of multimorbidity. This study highlights generic communication issues regarding the potential negative consequences of unsought reassurance and the importance of validation of symptoms and raises new arguments for tackling OA’s identity crisis by developing a clearer medical language with which to explain OA. PMID:26553893

  6. The experience and management of neck pain in general practice: the patients’ perspective

    PubMed Central

    Schaefer, Helene; Blozik, Eva; Chenot, Jean-François; Himmel, Wolfgang

    2010-01-01

    The objective of this study is to investigate the perspective and expectation of patients presenting with neck pain in general practice. The study design is a qualitative analysis of patient interviews and was conducted in a primary care setting in Germany. Twenty patients aged 20–78, according to theoretical sampling were included in the study. Patients tried to cope autonomously with the situation and consulted GPs only if their self-help had failed. When patients asked for external help, they usually focused on somatic treatment options such as massage, physiotherapy or injections. Most patients reported to have experiences with somatic therapies; however, they felt that some or all of these treatments were inefficient or led only to short-time improvements. Patients often avoided psychosocial themes when talking to doctors for fear of being branded as ‘neurotic’. Although neck pain is difficult to manage and a burden for patients, they have obviously found a way of both living with their pain and a pragmatic approach of talking about their symptoms with their doctor. According to the patients’ statements, the interaction between doctor and patient seems to be rather distant, ensuring that both sides avoid any issues that might touch upon psychological aspects of neck pain. PMID:20151163

  7. Prevalence of chronic diseases among older patients in German general practices

    PubMed Central

    Jacob, Louis; Breuer, Jessica; Kostev, Karel

    2016-01-01

    Aims: To evaluate the prevalence of chronic diseases (CDs) among older patients in German general practices (GPs). Methods: A total of 840,319 patients older than 65 years (359,289 male and 481,030 female) who consulted a GP between January and December 2014 were selected. Ten different CDs were considered: hypertension, lipid metabolism, diabetes, coronary heart disease, cancer, chronic obstructive pulmonary disease, heart failure, stroke, chronic kidney disease and osteoporosis. The prevalence, defined as the proportion of patients diagnosed with these disorders, was estimated. Results: All CDs were very common in older subjects. Hypertension was the most common CD, affecting 65.7% of men and 66.1% of women. Stroke was the least frequent CD, with 6.6% of men and 5.1% of women displaying this condition. More than one out of two subjects had between one and three CDs (men: 57.7% and women: 59.3%). Approximately 25% of subjects had four or more CDs (men: 26.6% and women: 23.6%). Conclusions: Our study showed that the prevalence of CDs is high in the German elderly population. Hypertension was the most frequent chronic condition and around 25% of patients displayed at least four CDs. PMID:26977142

  8. Patient-initiated camera phone images in general practice: a qualitative study of illustrated narratives

    PubMed Central

    Tan, Lawrence; Hu, Wendy; Brooker, Ron

    2014-01-01

    Background Camera phones have become ubiquitous in the digital age. Patients are beginning to bring images recorded on their mobile phones to share with their GP during medical consultations. Aim To explore GP perceptions about the effect of patient-initiated camera phone images on the consultation. Design and setting An interview study of GPs based in rural and urban locations in Australia. Methods Semi-structured telephone interviews with nine GPs about their experiences with patient-initiated camera phone images. Results GPs described how patient-initiated camera phone photos and videos contributed to the diagnostic process, management and continuity of care. These images gave GPs in the study additional insight into the patient’s world. Potential harm resulting from inappropriate use of camera phones by patients was also identified. Conclusion Patient-initiated camera phone images can empower patients by illustrating their narratives, thus contributing to improved communication in general practice. Potential harm could result from inappropriate use of these images. GPs shown images on patients’ camera phones should make the most of this opportunity for improved understanding of the patient’s world. There are however, potential medicolegal implications such as informed consent, protection of patient and doctor privacy, and the risk of misdiagnosis. PMID:24771843

  9. Falls prevention within the Australian general practice data model: methodology, information model, and terminology issues.

    PubMed

    Liaw, Siaw-Teng; Sulaiman, Nabil; Pearce, Christopher; Sims, Jane; Hill, Keith; Grain, Heather; Tse, Justin; Ng, Choon-Kiat

    2003-01-01

    The iterative development of the Falls Risk Assessment and Management System (FRAMS) drew upon research evidence and early consumer and clinician input through focus groups, interviews, direct observations, and an online questionnaire. Clinical vignettes were used to validate the clinical model and program logic, input, and output. The information model was developed within the Australian General Practice Data Model (GPDM) framework. The online FRAMS implementation used available Internet (TCP/IP), messaging (HL7, XML), knowledge representation (Arden Syntax), and classification (ICD10-AM, ICPC2) standards. Although it could accommodate most of the falls prevention information elements, the GPDM required extension for prevention and prescribing risk management. Existing classifications could not classify all falls prevention concepts. The lack of explicit rules for terminology and data definitions allowed multiple concept representations across the terminology-architecture interface. Patients were more enthusiastic than clinicians. A usable standards-based online-distributed decision support system for falls prevention can be implemented within the GPDM, but a comprehensive terminology is required. The conceptual interface between terminology and architecture requires standardization, preferably within a reference information model. Developments in electronic decision support must be guided by evidence-based clinical and information models and knowledge ontologies. The safety and quality of knowledge-based decision support systems must be monitored. Further examination of falls and other clinical domains within the GPDM is needed. PMID:12807809

  10. Information retrieval patterns and needs among practicing general surgeons: a statewide experience.

    PubMed

    Shelstad, K R; Clevenger, F W

    1996-10-01

    Information retrieval has progressed from a reliance on traditional print sources to the modern era of computer databases and online networks. Surgeons, many from remote areas not served by professional medical libraries, must develop and maintain skills in information retrieval and management in both electronic and standard formats. One hundred thirty-three New Mexico general surgeons were surveyed to identify their information-seeking patterns in five areas: retrieval purposes, retrieval sources, barriers to access, techniques used, and continuing education needs. Ninety-nine (74.4%) surgeons responded to the survey. Ninety-five percent utilize professional meetings, the medical literature, and physician colleagues as information sources. Only 17% utilize the outreach services of the state's only medical school library. Common retrieval barriers were practice demands (71%), isolation from medical schools (30%), computer illiteracy (28%), and rural environment (25%). Continuing education topics related to information management would be valuable to 61% of the surgeons. Sixty-nine percent believe their current ability to access biomedical information is adequate, despite most frequently accessing their personal libraries for information related to decision-making or patient management. These data suggest that, despite significant information needs, surgeons have not embraced newer forms of information retrieval. It is imperative that surgeons acquire and maintain modern information retrieval skills as a means of remaining up-to-date in their profession. Professional surgical organizations and medical librarians should collaborate on these continuing education ventures. PMID:8913551

  11. Moral hazard and supplier-induced demand: empirical evidence in general practice.

    PubMed

    van Dijk, Christel E; van den Berg, Bernard; Verheij, Robert A; Spreeuwenberg, Peter; Groenewegen, Peter P; de Bakker, Dinny H

    2013-03-01

    Changes in cost sharing and remuneration system in the Netherlands in 2006 led to clear changes in financial incentives faced by both consumers and general practitioner (GPs). For privately insured consumers, cost sharing was abolished, whereas those socially insured never faced cost sharing. The separate remuneration systems for socially insured consumers (capitation) and privately insured consumers (fee-for-service) changed to a combined system of capitation and fee-for-service for both groups. Our first hypothesis was that privately insured consumers had a higher increase in patient-initiated GP contact rates compared with socially insured consumers. Our second hypothesis was that socially insured consumers had a higher increase in physician-initiated contact rates. Data were used from electronic medical records from 32 GP-practices and 35336 consumers in 2005-2007. A difference-in-differences approach was applied to study the effect of changes in cost sharing and remuneration system on contact rates. Abolition of cost sharing led to a higher increase in patient-initiated utilisation for privately insured consumers in persons aged 65 and older. Introduction of fee-for-service for socially insured consumers led to a higher increase in physician-initiated utilisation. This was most apparent in persons aged 25 to 54. Differences in the trend in physician-initiated utilisation point to an effect of supplier-induced demand. Differences in patient-initiated utilisation indicate limited evidence for moral hazard. PMID:22344712

  12. Feasibility of HIV Universal Voluntary Counseling and Testing in a Thai General Practice Clinic.

    PubMed

    Khawcharoenporn, Thana; Apisarnthanarak, Anucha; Chunloy, Krongtip; Smith, Kimberly

    2016-05-01

    An HIV transmission prevention program incorporating universal voluntary counseling and testing (UVCT) was conducted in a general practice (GP) clinic of a Thai hospital. Of the 494 participating patients, 356 (72%) accepted HIV-UVCT. Independent factors associated with HIV-UVCT acceptance included participating in the program after office hours (4-8 pm; P < .001), living with domestic partner with no marriage (P = .01), and having primary school education or less (P = .02). The main reasons for declining HIV-UVCT were time constraint (38%) and perceiving self as no risk (35%). Among the 356 patients undergoing HIV-UVCT, having moderate to high HIV risk (P < .001) and male sex (P = .01) were independently associated with low HIV risk perception. By HIV-UVCT, the rate of new HIV infection was 4 (1.1%) of 356 patients. Of these 4 newly diagnosed HIV-infected patients, 3 (75%) were homosexual men. The findings suggest feasibility of HIV-UVCT in our GP clinic and factors to be considered for improving the program. PMID:24759448

  13. Ethical principles and the rationing of health care: a qualitative study in general practice

    PubMed Central

    Berney, Lee; Kelly, Moira; Doyal, Len; Feder, Gene; Griffiths, Chris; Jones, Ian Rees

    2005-01-01

    Background Researching sensitive topics, such as the rationing of treatments and denial of care, raises a number of ethical and methodological problems. Aim To describe the methods and findings from a number of focus group discussions that examined how GPs apply ethical principles when allocating scarce resources. Design of study A small-scale qualitative study involving purposive sampling, semi-structured interviews and focus groups. Setting Twenty-four GPs from two contrasting areas of London: one relatively affluent and one relatively deprived. Method Initial interviews asked GPs to identify key resource allocation issues. The interviews were transcribed and themes were identified. A number of case studies, each illustrative of an ethical issue related to rationing, were written up in the form of vignettes. In focus group discussions, GPs were given a number of these vignettes to debate. Results With respect to the ethical basis for decision making, the findings from this part of the study emphasised the role of social and psychological factors, the influence of the quality of the relationship between GPs and patients and confusion among GPs about their role in decision making. Conclusion The use of vignettes developed from prior interviews with GPs creates a non-threatening environment to discuss sensitive or controversial issues. The acceptance by GPs of general moral principles does not entail clarity of coherence of the application of these principles in practice. PMID:16105371

  14. Community Cardiovascular Disease Risk From Cross-Sectional General Practice Clinical Data: A Spatial Analysis

    PubMed Central

    Gilmour, Bridget; McRae, Ian; Konings, Paul; Dawda, Paresh; Del Fante, Peter; van Weel, Chris

    2015-01-01

    Introduction Cardiovascular disease (CVD) continues to be a leading cause of illness and death among adults worldwide. The objective of this study was to calculate a CVD risk score from general practice (GP) clinical records and assess spatial variations of CVD risk in communities. Methods We used GP clinical data for 4,740 men and women aged 30 to 74 years with no history of CVD. A 10-year absolute CVD risk score was calculated based on the Framingham risk equation. The individual risk scores were aggregated within each Statistical Area Level One (SA1) to predict the level of CVD risk in that area. Finally, the pattern of CVD risk was visualized to highlight communities with high and low risk of CVD. Results The overall 10-year risk of CVD in our sample population was 14.6% (95% confidence interval [CI], 14.3%–14.9%). Of the 4,740 patients in our study, 26.7% were at high risk, 29.8% were at moderate risk, and 43.5% were at low risk for CVD over 10 years. The proportion of patients at high risk for CVD was significantly higher in the communities of low socioeconomic status. Conclusion This study illustrates methods to further explore prevalence, location, and correlates of CVD to identify communities of high levels of unmet need for cardiovascular care and to enable geographic targeting of effective interventions for enhancing early and timely detection and management of CVD in those communities. PMID:25719216

  15. Appropriate use of serum troponin testing in general practice: a narrative review.

    PubMed

    Aroney, Constantine N; Cullen, Louise

    2016-07-18

    The troponin assay was designed to assist in diagnosis and improve risk stratification for people presenting to the emergency setting with symptoms suggestive of an acute coronary syndrome. Newly developed high sensitivity assays provide reliable detection of very low concentrations of troponin and offer earlier risk stratification of patients with possible acute coronary syndrome. Cardiac troponin testing in general practice should be limited to patients presenting with ischaemic symptoms that occurred more than 24 hours previously. If these patients have no high risk clinical features and a normal electrocardiogram (ECG), they may be assessed with a single troponin assay but should be referred urgently to hospital if the result is elevated. In patients presenting with symptoms of possible acute coronary syndrome within the preceding 24 hours, or if they otherwise have symptoms consistent with unstable angina, high risk clinical features or ECG abnormalities, a serum troponin test should not be ordered and patients should be referred immediately to an emergency department. When a single troponin assay is appropriate, the test should be labelled as urgent and systems must be in place to ensure the result is conveyed immediately to the medical practitioner, as it has prognostic implications and may require an urgent action plan. PMID:27456451

  16. Patient organisations and the reimbursement process for medicines: an exploratory study in eight European countries

    PubMed Central

    2010-01-01

    Background Little is known about the role European patient organisations play in the process of deciding on reimbursement for medicines. Therefore we explore the current role of patient organisations in the process of reimbursement for medicines in Western Europe. We focus in particular on collaboration between patient organisations and the pharmaceutical industry in this respect. Methods Sixty-eight patient organisations representing seven medical conditions, from ten Western European countries, were asked to participate in the study. The participating organisations reported their experiences in a web-based questionnaire. Results Twenty-one patient organisations completed the questionnaire (response rate: 31%), of which ten (47.6%) demanded reimbursement for medicines. Organisations demanding reimbursement were larger than those not demanding reimbursement. The main aim of these organisations was to create better accessibility of medicines for patients. Most organisations limited themselves to single actions. Only two engaged in multiple actions. Almost all organisations had general policies on cooperation with the pharmaceutical industry, with autonomy as the key feature. The patient organisations said they were reasonably successful and almost always satisfied with their own role in the reimbursement process. Conclusion Our study has found that the role of European patient organisations in the reimbursement process still seems limited, especially for small patient organisations. PMID:20170557

  17. Perceptions of Interns and General Medicine Examiners Regarding Cardiovascular Case Presentation in Practical Exams of General Medicine in Final MBBS Summative Examinations

    PubMed Central

    Nimbal, Naren; Rekha, M C; Patil, Giridhar; Padaki, Samata; Dambal, Amrut; Pise, Gajanan; Kalsad, S T

    2015-01-01

    Introduction Assessment of cardiovascular cases in practical exit exam is limited to simple history taking and physical examination. Standards of assessment are not uniform. This makes assessment less valid and reliable. Aim To explore the perceptions of Internees and General Medicine Examiners about current practices in Cardio Vascular system (CVS) case presentation in final MBBS exit exams and the necessity to change some of the practices. Materials and Methods A set questions pertaining to the preparation for exams, validity, reliability, feasibility and educational impact were prepared to guide in obtaining the perceptions of internees and internal medicine examiners. Focus group discussions were conducted. Data Analysis was done by immersion-crystallization process. Results Most of the internees admitted to feeling concerned because of difficulty in diagnosing murmurs by auscultation. Most of the examiners felt concerned about the logistics involved in arranging practical exams. Both admitted to the lack of uniform standards in assessment. Both agreed that the present system thrived as it was relatively feasible. Some internees suggested that the exam may be conducted in two parts by splitting the syllabus instead of once. Some internees suggested incorporating a student-doctor program to improve practical skills just like the on-going student nurse program. Conclusion There is a need for overhauling the assessment of cardiovascular system in final MBBS summative exams towards one aligned to the competencies as required in an Indian Medical Graduate. Blueprinting of practical assessment with due weightage assigned to epidemiologically important topics is the need of the hour. PMID:26816933

  18. Qualification and assessment of work organisation in livestock farms.

    PubMed

    Madelrieux, S; Dedieu, B

    2008-03-01

    Farmers have to cope with both society and market pressures in their working practices, as well as with the enlargement of farms, off-farm opportunities and profound changes in the workforce. Expectations in terms of working duration and rhythms are increasingly expressed by farmers, meaning that working conditions and the efficiency of work organisation are critical issues nowadays. The bibliography shows that work organisation is mainly discussed by social scientists, but that livestock scientists make a significant contribution to the debate. Indeed, technical changes modify working calendars, priorities between tasks and interchangeability among workers; technical adaptations are levers to solving problems of work with equipment, buildings and the workforce. We present here French approaches to work organisation that take into account livestock management and its implications in work organisation. The 'Work Assessment' method represents the work organisation and evaluates work durations and time flexibility for farmers. The ATELAGE model describes and qualifies work organisation with its various regulations and time scales, integrating the other activities - economic or private - that farmers can carry on. Three principles underpin them: not all workers are interchangeable; tasks have different temporal characteristics (rhythms, postponement, etc.); and the year is a succession of work periods that differ in their daily form of organisation. We illustrate with concrete examples how these approaches contribute to helping and guiding farmers in their thoughts about change. PMID:22445047

  19. Building the backbone for organisational research in public health systems: development of measures of organisational capacity for chronic disease prevention

    PubMed Central

    Hanusaik, Nancy; O'Loughlin, Jennifer L; Kishchuk, Natalie; Eyles, John; Robinson, Kerry; Cameron, Roy

    2007-01-01

    Background : Research to investigate levels of organisational capacity in public health systems to reduce the burden of chronic disease is challenged by the need for an integrative conceptual model and valid quantitative organisational level measures. Objective To develop measures of organisational capacity for chronic disease prevention/healthy lifestyle promotion (CDP/HLP), its determinants, and its outcomes, based on a new integrative conceptual model. Methods Items measuring each component of the model were developed or adapted from existing instruments, tested for content validity, and pilot tested. Cross sectional data were collected in a national telephone survey of all 216 national, provincial, and regional organisations that implement CDP/HLP programmes in Canada. Psychometric properties of the measures were tested using principal components analysis (PCA) and by examining inter‐rater reliability. Results PCA based scales showed generally excellent internal consistency (Cronbach's α = 0.70 to 0.88). Reliability coefficients for selected measures were variable (weighted κ(κw) = 0.11 to 0.77). Indicators of organisational determinants were generally positively correlated with organisational capacity (rs = 0.14–0.45, p<0.05). Conclusions This study developed psychometrically sound measures of organisational capacity for CDP/HLP, its determinants, and its outcomes based on an integrative conceptual model. Such measures are needed to support evidence based decision making and investment in preventive health care systems. PMID:17630377

  20. Isolated rural general practice as the focus for teaching core clinical rotations to pre-registration medical students

    PubMed Central

    Margolis, Stephen A; Davies, Llewellyn M; Ypinazar, Valmae

    2005-01-01

    Background Earlier studies have successfully demonstrated that medical students can achieve success in core clinical rotations with long term attachments in small groups to rural general / family practices. Methods In this study, three students from a class of 226 volunteered for this 1-year pilot program, conducted by the University of Queensland in 2004, for medical students in the 3rd year of a 4-year graduate entry medical course. Each student was based with a private solo general practitioner in a different rural town between 170 and 270 km from the nearest teaching hospital. Each was in a relatively isolated rural setting, rated 5 or 6 on the RRMA scale (Rural, Remote, Metropolitan Classification: capital city = 1, other metropolitan = 2, large regional city = 3, most remote community = 7). The rural towns had populations respectively of 500, 2000 and 10,000. One practice also had a General Practice registrar. Only one of the locations had doctors in the same town but outside the teaching practice, while all had other doctors within the same area. All 3 supervisors had hospital admitting rights to a hospital within their town. The core clinical rotations of medicine, surgery, mental health, general practice and rural health were primarily conducted within these rural communities, with the student based in their own consulting room at the general practitioner (GP) supervisor's surgery. The primary teacher was the GP supervisor, with additional learning opportunities provided by visiting specialists, teleconferences and university websites. At times, especially during medicine and surgery terms, each student would return to the teaching hospital for additional learning opportunities. Results All students successfully completed the year. There were no statistical differences in marks at summative assessment in each of the five core rotations between the students in this pilot and their peers at the metropolitan or rural hospital based clinical schools

  1. Consultations in general practices with and without mental health nurses: an observational study from 2010 to 2014

    PubMed Central

    Magnée, Tessa; de Beurs, Derek P; de Bakker, Dinny H; Verhaak, Peter F

    2016-01-01

    Objectives To investigate care for patients with psychological or social problems provided by mental health nurses (MHNs), and by general practitioners (GPs) with and without MHNs. Design An observational study with consultations recorded by GPs and MHNs. Setting Data were routinely recorded in 161–338 Dutch general practices between 2010 and 2014. Participants All patients registered at participating general practices were included: 624 477 patients in 2010 to 1 392 187 patients in 2014. Outcome measures We used logistic and Poisson multilevel regression models to test whether GPs recorded more patients with at least one consultation for psychological or social problems and to analyse the number of consultations over a 5-year time period. We examined the additional effect of an MHN in a practice, and tested which patient characteristics predicted transferral from GPs to MHNs. Results Increasing numbers of patients with psychological or social problems visit general practices. Increasing numbers of GPs collaborate with an MHN. GPs working in practices with an MHN record as many consultations per patient as GPs without an MHN, but they record slightly more patients with psychological or social problems (OR=1.05; 95% CI 1.02 to 1.08). MHNs most often treat adult female patients with common psychological symptoms such as depressive feelings. Conclusions MHNs do not seem to replace GP care, but mainly provide additional long consultations. Future research should study to what extent collaboration with an MHN prevents patients from needing specialised mental healthcare. PMID:27431902

  2. Computer templates in chronic disease management: ethnographic case study in general practice

    PubMed Central

    Swinglehurst, Deborah; Greenhalgh, Trisha; Roberts, Celia

    2012-01-01

    Objective To investigate how electronic templates shape, enable and constrain consultations about chronic diseases. Design Ethnographic case study, combining field notes, video-recording, screen capture with a microanalysis of talk, body language and data entry—an approach called linguistic ethnography. Setting Two general practices in England. Participants and methods Ethnographic observation of administrative areas and 36 nurse-led consultations was done. Twenty-four consultations were directly observed and 12 consultations were video-recorded alongside computer screen capture. Consultations were transcribed using conversation analysis conventions, with notes on body language and the electronic record. The analysis involved repeated rounds of viewing video, annotating field notes, transcription and microanalysis to identify themes. The data was interpreted using discourse analysis, with attention to the sociotechnical theory. Results Consultations centred explicitly or implicitly on evidence-based protocols inscribed in templates. Templates did not simply identify tasks for completion, but contributed to defining what chronic diseases were, how care was being delivered and what it meant to be a patient or professional in this context. Patients’ stories morphed into data bytes; the particular became generalised; the complex was made discrete, simple and manageable; and uncertainty became categorised and contained. Many consultations resembled bureaucratic encounters, primarily oriented to completing data fields. We identified a tension, sharpened by the template, between different framings of the patient—as ‘individual’ or as ‘one of a population’. Some clinicians overcame this tension, responding creatively to prompts within a dialogue constructed around the patient's narrative. Conclusions Despite their widespread implementation, little previous research has examined how templates are actually used in practice. Templates do not simply document the

  3. Attitudes towards General Practice: a comparative cross-sectional survey of 1st and 5th year medical students

    PubMed Central

    Kruschinski, Carsten; Wiese, Birgitt; Hummers-Pradier, Eva

    2012-01-01

    Objective: Positive attitudes towards General Practice can be understood as a prerequisite for becoming a General Practitioner (GP) and for collaboration with GPs later on. This study aimed to assess attitudes of medical students at the beginning and the end of medical school. Methods: A total of 160 1st year students at Hannover Medical School were surveyed. Their attitudes were compared to those of 287 5th year students. Descriptive, bi- and multivariate analyses were performed to investigate influences of year of study and gender. Results: Year of study and gender both were associated with the attitudes towards General Practice. The interest in General Practice and patient-orientation (communication, care of older patients with chronic diseases) was higher in 1st year students compared to more advanced students. Female students valued such requirements more than male students, the differences in attitudes between the years of study being more pronounced in male students. Conclusion: Despite some limitations caused by the cross-sectional design, the attitudes towards General Practice competencies changed to their disadvantage during medical school. This suggests a formative influence of the strategies used in medical education. Educational strategies, however, could be used to bring about a change of attitudes in the other direction. PMID:23255966

  4. Acute red ear in children: controlled trial of non-antibiotic treatment in general practice.

    PubMed Central

    Burke, P; Bain, J; Robinson, D; Dunleavey, J

    1991-01-01

    OBJECTIVE--To examine the efficacy and safety of conservative management of mild otitis media ("the acute red ear") in children. DESIGN--Double blind placebo controlled trial. SETTING--17 group general practices (48 general practitioners) in Southampton, Bristol, and Portsmouth. PATIENTS--232 children aged 3-10 years with acute earache and at least one abnormal eardrum (114 allocated to receive antibiotic, 118 placebo). INTERVENTIONS--Amoxycillin 125 mg three times a day for seven days or matching placebo; 100 ml paracetamol 120 mg/5 ml. MAIN OUTCOME MEASURES--Diary records of pain and crying, use of analgesic, eardrum signs, failure of treatment, tympanometry at one and three months, recurrence rate, and ear, nose, and throat referral rate over one year. RESULTS--Treatment failure was eight times more likely in the placebo than the antibiotic group (14.4% v 1.7%, odds ratio 8.21, 95% confidence interval 1.94 to 34.7). Children in the placebo group showed a significantly higher incidence of fever on the day after entry (20% v 8%, p less than 0.05), mean analgesic consumption (0.36 ml/h v 0.21 ml/h, difference 0.14, 95% confidence interval 0.07 to 0.23; p = 0.0022), mean duration of crying (1.44 days v 0.50 days, 0.94; 0.50 to 1.38; p less than 0.001), and mean absence from school (1.96 days v 0.52 days, 1.45; 0.46 to 2.42; p = 0.0132). Differences in recorded pain were not significant. The prevalence of middle ear effusion at one or three months, as defined by tympanometry, was not significantly different, nor was there any difference in recurrence rate or in ear, nose, and throat referral rate in the follow up year. No characteristics could be identified which predicted an adverse outcome. CONCLUSIONS--Use of antibiotic improves short term outcome substantially and therefore continues to be an appropriate management policy. PMID:1912887

  5. Prevalence of metabolic syndrome in the clinical practice of general medicine in Italy

    PubMed Central

    Ferrucci, Andrea; Bruno, Graziella; Mannarino, Elmo; Nati, Giulio; Trimarco, Bruno; Volpe, Massimo

    2015-01-01

    Background Prevalence of metabolic syndrome (MS) in the clinical practice is still debated, due to different diagnostic criteria, target populations and clinical settings. Thus, the main purposes of the study were: (I) to evaluate prevalence of MS; (II) to estimate prevalence of additional cardiovascular (CV) risk factors and concomitant conditions in patients with MS followed by general practitioners (GPs) in Italy. Methods GPs from three different macro-areas were asked to evaluate the first and the last three outpatients, consecutively seen during 20 consecutive weeks in 2007, whatever the reason for clinical consultation. MS was defined according to Adult Treatment Panel (ATP) III definition. Clinical data were collected locally and centrally analysed. Results The overall population sample included 4,513 outpatients, among which 1,574 (34.9%) from Regione Lazio, 1,498 (33.2%) from Regione Piemonte, and 1,441 (31.9%) from Regione Umbria. The population analysis included 4,418 (97.9%) adult outpatients [52.1% females, (mean age, 58.0±11.8 years); mean body mass index (BMI), 26.7±4.7 kg/m2]. MS was diagnosed in 1,456 (33.0%) outpatients. High-normal blood pressure (BP) was the most common risk factor for MS (n=1,382; 94.9%), followed by abdominal obesity (n=1,229; 84.4%), hypertriglyceridemia (n=1,032; 70.9%), abnormal fasting glucose (n=819; 56.3%) and low high-density lipoprotein (HDL) cholesterol levels (n=730; 50.1%). Conclusions Using this sample of outpatients followed by GPs in Italy, our study reports a relatively high prevalence of MS and a high prevalence of associated CV and metabolic risk factors in patients with than in those without MS. PMID:26331111

  6. Management of acute neck pain in general practice: a prospective study

    PubMed Central

    Vos, Cees; Verhagen, Arianne; Passchier, Jan; Koes, Bart

    2007-01-01

    Background Research on neck pain in primary care is sparse. The role of GPs in taking care of patients with neck pain has not been described so far. This study focused on interested in the interaction between patients and GPs in their first contact on a new episode of neck pain. Aim To describe GPs' management of acute neck pain in patients and to detail the diagnostic and therapeutic procedures undertaken by GPs and self-care by patients. Design of study A prospective cohort study with 1-year follow up. Setting General practice in The Netherlands. Method Patients consulting their GP for non-specific acute neck pain lasting no longer than 6 weeks were invited to participate. Questionnaires were collected from patients at baseline and after 6, 12, 26, and 52 weeks. Patients rated their recovery on a 7-point ordinal scale. Results In total 187 patients were included. At baseline GPs prescribed medication for 42% of patients, mostly non-steroidal anti-inflammatory drugs (56%) or muscle relaxation medication (20%); 51% were referred to a physiotherapist. Seventy-four per cent of referred patients reported recovery at the end of the follow-up year, whereas 79% of non-referred patients reported recovery. Frequently-given advice by the GP was to ‘wait and see’ (23%), ‘improve posture’ and ‘stay active’ (22%) or to ‘take a rest’ (18%). Self-care by patients included different sources of heat application (79%) and exercises (57%). Complementary medicine was used in 12% of cases and 39% of patients visited their GP again during follow up. Consultation of a medical specialist and ordering of X-rays rarely occurred. Conclusion Management by GPs included a strategy to ‘wait and see’ for an expected favourable natural course supported by medication, or referral to a physiotherapist. PMID:17244420

  7. Investigating unexplained fatigue in general practice with a particular focus on CFS/ME.

    PubMed

    Bansal, Amolak S

    2016-01-01

    Unexplained fatigue is not infrequent in the community. It presents a number of challenges to the primary care physician and particularly if the clinical examination and routine investigations are normal. However, while fatigue is a feature of many common illnesses, it is the main problem in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). This is a poorly understood condition that is accompanied by several additional symptoms which suggest a subtle multisystem dysfunction. Not infrequently it is complicated by sleep disturbance and alterations in attention, memory and mood.Specialised services for the diagnosis and management of CFS/ME are markedly deficient in the UK and indeed in virtually all countries around the world. However, unexplained fatigue and CFS/ME may be confidently diagnosed on the basis of specific clinical criteria combined with the normality of routine blood tests. The latter include those that assess inflammation, autoimmunity, endocrine dysfunction and gluten sensitivity. Early diagnosis and intervention in general practice will do much to reduce patient anxiety, encourage improvement and prevent expensive unnecessary investigations.There is presently an on-going debate as to the precise criteria that best confirms CFS/ME to the exclusion of other medical and psychiatric/psychological causes of chronic fatigue. There is also some disagreement as to best means of investigating and managing this very challenging condition. Uncertainty here can contribute to patient stress which in some individuals can perpetuate and aggravate symptoms. A simple clinical scoring system and a short list of routine investigations should help discriminate CFS/ME from other causes of continued fatigue. PMID:27436349

  8. The complexity of managing COPD exacerbations: a grounded theory study of European general practice

    PubMed Central

    Risør, Mette Bech; Spigt, Mark; Iversen, R; Godycki-Cwirko, M; Francis, N; Altiner, A; Andreeva, E; Kung, K; Melbye, H

    2013-01-01

    Objectives To understand the concerns and challenges faced by general practitioners (GPs) and respiratory physicians about primary care management of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). Design 21 focus group discussions (FGDs) were performed in seven countries with a Grounded Theory approach. Each country performed three rounds of FGDs. Setting Primary and secondary care in Norway, Germany, Wales, Poland, Russia, The Netherlands, China (Hong Kong). Participants 142 GPs and respiratory physicians were chosen to include urban and rural GPs as well as hospital-based and out patient-clinic respiratory physicians. Results Management of acute COPD exacerbations is dealt with within a scope of concerns. These concerns range from ‘dealing with comorbidity’ through ‘having difficult patients’ to ‘confronting a hopeless disease’. The first concern displays medical uncertainty regarding diagnosis, medication and hospitalisation. These clinical processes become blurred by comorbidity and the social context of the patient. The second concern shows how patients receive the label ‘difficult’ exactly because they need complex attention, but even more because they are time consuming, do not take responsibility and are non-compliant. The third concern relates to the emotional reactions by the physicians when confronted with ‘a hopeless disease’ due to the fact that most of the patients do not improve and the treatment slows down the process at best. GPs and respiratory physicians balance these concerns with medical knowledge and practical, situational knowledge, trying to encompass the complexity of a medical condition. Conclusions Knowing the patient is essential when dealing with comorbidities as well as with difficult relations in the consultations on exacerbations. This study suggests that it is crucial to improve the collaboration between primary and secondary care, in terms of, for example, shared consultations

  9. Auditing the management of hypertension in British general practice: a critical literature review.

    PubMed Central

    Cranney, M; Barton, S; Walley, T

    1998-01-01

    Hypertension is a common condition almost exclusively managed by general practitioners (GPs), making it an ideal subject for practice-based audit. However, the conduct and interpretation of such audits is complex. Even minor variations in methodology can produce dramatic differences in results obtained. We used a focus group of seven GPs with a special interest in audit to establish a standardized method for the planning and reporting of audits for the management of hypertension. In order to enhance the reliability and comparability of hypertension audits, 13 key areas of audit methodology were produced by the focus group. Eleven audits were identified in a literature search using pre-determined selection criteria. These were then assessed to compare their methodology with the criteria produced by the focus group. None of the recently published audits in this subject covered all of the key areas (range: 27-65% of the areas covered). One key area, that of digit preference, was not mentioned by any. Other problematic key areas included the selection of patient records without bias, the determination of the prevalence of hypertension, the number of recordings used to determine the diagnosis of hypertension and its subsequent control, the time period examined by the audit, and the approach taken to notes containing an inadequate number of blood pressure recordings. Significant variability in the methods used by different authors in these key areas calls into question the reliability of their results and makes comparisons between them very difficult. We propose a standardized method for hypertension audits comprising 13 key areas, which will enhance the reliability of results and facilitate such comparisons. PMID:9800405

  10. Impact of organisation and management factors on infection control in hospitals: a scoping review.

    PubMed

    Griffiths, P; Renz, A; Hughes, J; Rafferty, A M

    2009-09-01

    This scoping review sought evidence about organisational and management factors affecting infection control in general hospital settings. A literature search yielded a wide range of studies, systematic reviews and reports, but high quality direct evidence was scant. The majority of studies were observational and the standard of reporting was generally inadequate. Positive leadership at ward level and above appears to be a prerequisite for effective action to control infection, although the benefits of good clinical leadership are diffused by supervision of large numbers of staff. Senior clinical leaders need a highly visible presence and clear role boundaries and responsibilities. Team stability and morale are linked to improved patient outcomes. Organisational mechanisms for supporting training, appraisal and clinical governance are important determinants of effective practice and successful change. Rates of infection have been linked to workload, in terms of nurse staffing, bed occupancy and patient turnover. The organisational characteristics identified in the review should be considered risk factors for infection. They cannot always be eliminated or avoided completely, but appropriate assessment will enable targeted action to protect patients. PMID:19647338

  11. In memoriam: Jean Blancou, DVM, 1936-2010. World authority on rabies, historian and former Director General of the World Organisation for Animal Health (Office International des Épizooties: OIE).

    PubMed

    2011-01-01

    Jean-Marie Blancou was born in Bangui on 28 August 1936 and passed away in Paris on 10 November 2010 at the age of 74. After studying at the Pierre de Fermat Lycée in Toulouse, Jean Blancou graduated from the Toulouse Veterinary School in 1960. He continued his studies in tropical veterinary medicine in Paris until 1963, extending his knowledge of immunology, microbiology, biochemistry and zoology, at the Institut Pasteur. He obtained his doctorate in biological sciences at the University of Nancy in 1982. Jean Blancou commenced his career as technical adviser to the Veterinary Services of Ethiopia where he directed a campaign against rinderpest in the south of the county. From 1965 to 1967 he was deputy director of the national veterinary laboratory in Niamey where he was responsible for the diagnosis of animal diseases and the production of veterinary vaccines. In 1967, he moved to the central livestock laboratory in Madagascar, where he commenced research on the diagnosis and control of dermatophilosis, bovine tuberculos