42 CFR 475.1 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT ORGANIZATIONS General Provisions § 475.1 Definitions. For... than a self-insured employer, which makes payments directly or indirectly to health care practitioners...), in which the CMS contract directs the QIO to perform. Quality improvement initiative has the same...

Incentives and control in primary health care: findings from English pay-for-performance case studies.

PubMed

McDonald, Ruth; Harrison, Stephen; Checkland, Kath

2008-01-01

The authors' aim was to investigate mechanisms and perceptions of control following the implementation of a new "pay-for-performance" contract (the new General Medical Services, or GMS, contract) in general practice. This article was based on an in-depth qualitative case study approach in two general practices in England. A distinction is emerging amongst ostensibly equal partners between those general practitioners conducting and those subject to surveillance. Attitudes towards the contract were largely positive, although discontent was higher in the practice which employed a more intensive surveillance regime and greater amongst nurses than doctors. The sample was small and opportunistic. Further research is required to examine the longer-term effects as new contractual arrangements evolve. Increased surveillance and feedback mechanisms associated with new pay-for-performance schemes have the potential to constrain and shape clinical practice. The paper highlights the emergence of new tensions within and between existing professional groupings.

Legal responsibilities when fitting minors with contact lenses.

PubMed

Harris, M G

2000-02-01

Practitioners must understand their legal responsibilities in fitting minors with contact lenses, which include informed consent, contractual obligations, and the Statute of Limitations. Minors are children and teenagers who have not yet reached voting age in their state--generally 18 years of age. Informed consent requires permission from the patient before a practitioner performs any treatment. For these young people, this consent generally can only be given by a parent or legal guardian. Minors can repudiate contracts made with them; therefore, the contractual obligation to pay for a contact lens fitting should be established with a parent or legal guardian. In most states, minors have additional time beyond the usual Statute of Limitations to bring a lawsuit. If practitioners recognize their legal responsibilities in caring for these special patients, fitting youngsters with contact lenses can be a rewarding part of practice.

Demand and Signing of General Practitioner Contract Service among the Urban Elderly: A Population-Based Analysis in Zhejiang Province, China.

PubMed

Zhao, Yanrong; Lin, Junfen; Qiu, Yinwei; Yang, Qing; Wang, Xinyi; Shang, Xiaopeng; Xu, Xiaoping

2017-03-29

This study aims to examine whether the urban elderly in the Zhejiang Province of China signed contracts with their general practitioner (GP) based on their health service needs, and to further identify the determinants of their demand and signing decisions. A community-based cross-sectional study was conducted in 16 community health service (CHS) institutions in Zhejiang Province, China. The urban elderly over 60 years of age were enrolled when visiting the sampled CHS. Baseline characteristics were compared between participants using Chi-Square tests for categorical variables. Univariate and multivariable logistic regression analyses were used to identify determinants of the GP contract service demand and signing decisions, respectively. Among the 1440 urban elderly, 56.67% had signed contracts with their GP, and 55.35% had a demand of the GP contract service. The influencing factors of demand were a history of diabetes or cardiovascular disease (OR = 1.33, 95% CI, 1.05-1.68); urban resident basic medical insurance (URBMI) vs. urban employee basic medical insurance (UEBMI) (OR = 1.96, 95% CI, 1.46-2.61); and middle-income vs. low-income (OR = 0.67, 95% CI, 0.50-0.90 for RMB 1001-3000; OR = 0.59, 95% CI, 0.39-0.90 for RMB 3001-5000). Having a demand for the GP contract service was the strongest determinant of signing decisions (OR = 13.20, 95% CI, 10.09-17.27). Other factors also contributed to these decisions, including gender, caregiver, and income. The urban elderly who had signed contracts with GPs were mainly based on their health care needs. Elderly people with a history of diabetes or cardiovascular disease, as well as those with URBMI, were found to have stronger needs of a GP contract service. It is believed that the high-income elderly should be given equal priority to those of low-income.

Learning from contract change in primary care dentistry: A qualitative study of stakeholders in the north of England.

PubMed

Holmes, Richard D; Steele, Jimmy G; Donaldson, Cam; Exley, Catherine

2015-09-01

The aim of this research was to explore and synthesise learning from stakeholders (NHS dentists, commissioners and patients) approximately five years on from the introduction of a new NHS dental contract in England. The case study involved a purposive sample of stakeholders associated with a former NHS Primary Care Trust (PCT) in the north of England. Semi-structured interviews were conducted with 8 commissioners of NHS dental services and 5 NHS general dental practitioners. Three focus group meetings were held with 14 NHS dental patients. All focus groups and interviews were audio recorded and transcribed verbatim. The data were analysed using a framework approach. Four themes were identified: 'commissioners' views of managing local NHS dental services'; 'the risks of commissioning for patient access'; 'costs, contract currency and commissioning constraints'; and 'local decision-making and future priorities'. Commissioners reported that much of their time was spent managing existing contracts rather than commissioning services. Patients were unclear about the NHS dental charge bands and dentists strongly criticised the contract's target-driven approach which was centred upon them generating 'units of dental activity'. NHS commissioners remained relatively constrained in their abilities to reallocate dental resources amongst contracts. The national focus upon practitioners achieving their units of dental activity appeared to outweigh interest in the quality of dental care provided. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Learning from contract change in primary care dentistry: A qualitative study of stakeholders in the north of England

PubMed Central

Holmes, Richard D.; Steele, Jimmy G.; Donaldson, Cam; Exley, Catherine

2015-01-01

The aim of this research was to explore and synthesise learning from stakeholders (NHS dentists, commissioners and patients) approximately five years on from the introduction of a new NHS dental contract in England. The case study involved a purposive sample of stakeholders associated with a former NHS Primary Care Trust (PCT) in the north of England. Semi-structured interviews were conducted with 8 commissioners of NHS dental services and 5 NHS general dental practitioners. Three focus group meetings were held with 14 NHS dental patients. All focus groups and interviews were audio recorded and transcribed verbatim. The data were analysed using a framework approach. Four themes were identified: ‘commissioners’ views of managing local NHS dental services’; ‘the risks of commissioning for patient access’; ‘costs, contract currency and commissioning constraints’; and ‘local decision-making and future priorities’. Commissioners reported that much of their time was spent managing existing contracts rather than commissioning services. Patients were unclear about the NHS dental charge bands and dentists strongly criticised the contract's target-driven approach which was centred upon them generating ‘units of dental activity’. NHS commissioners remained relatively constrained in their abilities to reallocate dental resources amongst contracts. The national focus upon practitioners achieving their units of dental activity appeared to outweigh interest in the quality of dental care provided. PMID:25765782

General practitioner fundholding: experience in Grampian.

PubMed

Wisely, I C

1993-03-13

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

The role of counsellors in general practice. A qualitative study.

PubMed Central

Sibbald, B.; Addington-Hall, J.; Brenneman, D.; Obe, P. F.

1996-01-01

Counselling services in general practice are now widespread but little is known about their nature or role. We therefore carried out in-depth telephone interviews with a representative sample of 72 general practitioners and 60 of their counsellors who had participated in a previous national survey of counselling services in England and Wales. Our aim was to gain greater insight into the functioning of these services in order to determine the most appropriate focus for future research and development. Interviews were semi-structured and focused on service initiation and duration; counsellors' background and training; working arrangements including sources of funding; types of clients; communication between general practitioners and counsellors; perceived advantages and disadvantages to general practitioners, counsellors, and clients; goals, barriers, and proposed changes. Approximately two thirds of counsellors were employed by district health authorities and attached to practices. One third were employed by the practice with the financial assistance of family health services authorities. Practice-employed counsellors appeared a relatively new service innovation whose growth was facilitated by the general practitioner contract of 1991. Practice-employed counsellors were preferred to practice-attached staff in that general practitioners had greater control over the selection of counsellors and their working arrangements. Problems with interprofessional communication were noted in relation to counsellors' wishes to maintain patient confidentiality by not exchanging information about patients with general practitioners. Counsellors received referrals principally from general practitioners and occasionally from other primary health care staff. Self-referral by patients was rare. The problems for which patients were most commonly referred were: stress/anxiety, relationship problems, depression, and bereavement. The principal therapeutic styles were Rogerian counselling, behavioural therapy, and psychodynamic psychotherapy. A quarter described their style as 'eclectic'. Individual, not group, therapy was the norm. Sessions were usually 50 minutes in duration. However, waiting list times, the frequency of sessions, and overall duration of therapy varied enormously. Overall 28% of counsellors held no formal qualification in counselling or in any of the psychotherapies. Counsellors and general practitioners were generally satisfied with the service and identified a wide range of benefits with few disadvantages. The principal problem was said to be that demand exceeded capacity and the principal change proposed was expansion of the service. The findings provide the most comprehensive account to date of the present state and likely future direction of counselling services in general practice and point to the need to: 1. Evaluate the cost-effectiveness of counselling in the management of common psychiatric disorders such as anxiety and depression 2. Establish a national policy for the training and accreditation of counsellors working in general practice settings 3. Educate general practitioners about the organization and role of counselling services with particular attention to interprofessional communication and the maintenance of patient confidentiality. PMID:9080766

[Health insurance discount contracts: problems and risks for the general practitioner in the medical care of patients with chronic illness].

PubMed

Leutgeb, R; Mahler, C; Laux, G; Weschnetz, Artenetz; Szecsenyi, J

2009-01-01

The German federal Health Insurance law to strengthen competition between the pharmaceutical companies commits pharmacies to hand out drugs from discount contract drug suppliers of a patient's health insurance company. Thus patients are confronted with constantly changing drug packets. This study aimed at exploring whether patients have been properly informed about the new discount contracts and if they have experienced changes and problems in their long- term medications. Between May and June 2008 male and female patients older than 50 years who had a statutory health insurance and had been diagnosed with coronary heart disease for at least one year answered a standardized questionnaire filled in by doctors' assistants or general practitioners in the doctors' network "Weschnitztal". Of the 188 patients participated in this study 63,8% were informed about health insurance discount contracts. 31,3% of the patients reported that a positive effect due to the discount contracts was that they were discharged from paying the drug prescription fee, 22,2% mentioned that cost saving for the health insurance could also be positive. 120 patients (63,8%) knew that the names of their long-term drugs could change.101 of the questioned patients (53,7%) identified a change in their long-term drugs, 51,5% felt insecure about the permanent changes. 21,7% experienced adverse e effects due to the new drugs. 19% of the patients had serious problems regarding medication intake. This study demonstrates that the information which patients have on the new health insurance law is not adequate enough. Many of them felt insecure because of the changes of long-term medications. One fifth of the patients reported errors in their drug intake or their confusion about their drugs. There is a high risk that these circumstances may trigger further diseases or complications. The cost savings as intended by the health insurance companies may therefore not be achieved by discount contracts.

Duration of general practitioner contracts.

PubMed

Abelsen, Birgit; Gaski, Margrete; Brandstorp, Helen

2015-12-01

The regular GP scheme is intended to promote continuity in the relationship between doctor and patient. The duration of GP contracts is therefore a key factor in the success of the scheme. This study examines how long the GP contracts last and whether their duration varies according to doctors' gender and age, municipality size and list size. The study encompasses 7,359 GP contracts throughout Norway, entered into between municipalities and doctors in the period 1 May 2001 - 1 May 2014. Duration is measured as the time from which the contract was signed until its expiry or the end of the study period. The material was analysed with measures of central tendencies and dispersion, Kaplan-Meier survival curve analysis and Cox proportional hazards regression. Median duration of a GP contract at the time of the study was 5.91 years. It varied between 2.75 years in the smallest municipalities and 8.37 years in the largest ones. The duration of a GP contract increased significantly if the doctor was a woman, or with the doctor's age at the start of the contract, increased municipality size and increased list size. If it is assumed that continuity in the doctor-patient relationship provides a qualitatively better GP service, the results indicate that patients in small municipalities are generally offered a lower-quality service than patients in large municipalities.

Organization and financing of the Danish health care system.

PubMed

Christiansen, Terkel

2002-02-01

The present paper aims at giving a short overview of the organization and financing of the Danish health care system as of 1997-1998 when the SWOT panel evaluated the system. The overview follows the triangular model of a health care system. The Danish system is characterized by being decentralized and single-funded. The hospital sector is public, and hospitals are financed and run by the counties (with only a very small private hospital sector alongside). General practitioners are private entrepreneurs but work under contract for the counties. Hospitals are financed by global budgets, while general practitioners are paid by a mixed remuneration system of capitation fees and fee-for-service. During the past 20 years, the government has repeatedly imposed budget ceilings on the counties which has limited growth in the health care sector.

Salaried contracts in UK general practice: a study of job satisfaction and stress.

PubMed

Gosden, Toby; Williams, Jacky; Petchey, Roland; Leese, Brenda; Sibbald, Bonnie

2002-01-01

To compare job satisfaction and stress levels of general practitioners (GPs) employed on salaried contracts with GPs on a 'standard' performance-related contract paid by fee-for-service and capitation. Job satisfaction and stress levels were assessed using data from two postal surveys of GPs: a national survey of 'standard' contract GPs carried out in 1998; and a survey of salaried GPs and their non-salaried GP employers in 1999. Differences in satisfaction and stress scores were assessed by t-tests; regression analysis was used to control for confounding factors and possible selection bias. We achieved a response rate of 77% in the 1999 survey of salaried and non-salaried GPs; 48% of 'standard' contract GPs responded in the 1998 survey. We found that salaried GPs were as satisfied overall as both non-salaried GP employers and GPs on the 'standard' contract, even after controlling for confounding factors and selection bias. Salaried GPs were more satisfied with their remuneration, working hours and the recognition they got for their work. They experienced more stress with two factors but less stress with 19 factors compared with the 'standard' contract GPs. Overall job satisfaction levels among salaried doctors were similar to those of doctors on contracts paid by mixed fee-for-service and capitation. Future studies of job satisfaction levels under different doctor payment systems need to take account of the extent to which doctors have preferences for different types of contract if they are to derive unbiased results.

Antecedents and Consequences of Federal Bid Protests

DTIC Science & Technology

2015-04-30

contractor performance. While these effects have been anecdotally espoused by practitioners, this research is the first to quantitatively test the... Research design : Qualitative, quantitative , and mixed methods approaches (2nd ed.). Thousand Oaks, CA: Sage. DoD Inspector General (DoDIG). (2009a, April...contracting personnel, this research tests a model of antecedents to and consequences of the fear of a protest. Survey data was obtained from a sample of 350

The use of standard contracts in the English National Health Service: a case study analysis.

PubMed

Petsoulas, Christina; Allen, Pauline; Hughes, David; Vincent-Jones, Peter; Roberts, Jennifer

2011-07-01

The use of contracts is vital to market transactions. The introduction of market reforms in health care in the U.K. and other developed countries twenty years ago meant greater use of contracts. In the U.K., health care contracting was widely researched in the 1990s. Yet, despite the changing policy context, the subject has attracted less interest in recent years. This paper seeks to fill a gap by reporting findings from a study of contracting in the English National Health Service (NHS) after the introduction of the national standard contract in 2007. By using economic and socio-legal theories and two case studies we examine the way in which the new contract was implemented in practice and the extent to which implementation conformed to policy intentions and to our theoretical predictions. Data were collected using non-participant observation of 36 contracting meetings, 24 semi-structured interviews, and analysis of documents. We found that despite efforts to introduce a more detailed ('complete') contract, in practice, purchasers and providers often reverted to a more relational style of contracting. Frequently reliance on the NHS hierarchy proved to be indispensable; in particular, formal dispute resolution was avoided and financial risk was re-allocated in compromises that sometimes ignored contractual provisions. Serious data deficiencies and shortages of skilled personnel still caused major difficulties. We conclude that contracting for health care continues to raise serious problems, which may be exacerbated by the impending transfer of responsibility to groups of general practitioners (GPs) who generally lack experience and expertise in large-scale, secondary care contracting. Copyright © 2011 Elsevier Ltd. All rights reserved.

Dual job holding general practitioners: the effect of patient shortage.

PubMed

Godager, Geir; Lurås, Hilde

2009-10-01

In 2001, a listpatient system with capitation payment was introduced in Norwegian general practice. After an allocation process where each inhabitant was listed with a general practitioner (GP), a considerable share of the GPs got fewer persons listed than they would have preferred. We examine whether GPs who experience a shortage of patients to a larger extent than other GPs seek to hold a second job in the community health service even though the wage rate is low compared with the wage rate in general practice. Assuming utility maximization, we model the effect of patient shortage on a GP's decision to contract for a second job in the community health service. The model predicts a positive relationship between patient shortage and participation in the community health service. This prediction is tested by means of censored regression analyses, taking account of labour supply as a censored variable. We find a significant effect of patient shortage on the number of hours the GPs supply to community health service. The estimated marginal effect is 1.72 hours per week.

A survey of job satisfaction, sources of stress and psychological symptoms among general practitioners in Leeds.

PubMed Central

Appleton, K; House, A; Dowell, A

1998-01-01

BACKGROUND: The past seven years have seen rapid changes in general practice in the United Kingdom (UK), commencing with the 1990 contract. During the same period, concern about the health and morale of general practitioners (GPs) has increased and a recruitment crisis has developed. AIM: To determine levels of psychological symptoms, job satisfaction, and subjective ill health in GPs and their relationship to practice characteristics, and to compare levels of job satisfaction since the introduction of the 1990 GP contract with those found before 1990. METHOD: Postal questionnaire survey of all GP principals on the Leeds Health Authority list. The main outcome measures included quantitative measures of practice characteristics, job satisfaction, mental health (General Health Questionnaire), and general physical health. Qualitative statements about work conditions, job satisfaction, and mental health were collected. RESULTS: A total of 285/406 GPs (70%) returned the questionnaires. One hundred and forty-eight (52%) scored 3 or more on the General Health Questionnaire (GHQ-12), which indicates a high level of psychological symptoms. One hundred and sixty GPs (56%) felt that work had affected their recent physical health. Significant associations were found between GHQ-12 scores, total job satisfaction scores, and GPs' perceptions that work had affected their physical health. Problems with physical and mental health were associated with several aspects of workload, including list size, number of sessions worked per week, amount of time spent on call, and use of deputizing services. In the qualitative part of the survey, GPs reported overwork and excessive hours, paperwork and administration, recent National Health Service (NHS) changes, and the 1990 GP contract as the most stressful aspects of their work. CONCLUSIONS: Fifty-two per cent of GPs in Leeds who responded showed high levels of psychological symptoms. Job satisfaction was lower than in a national survey conducted in 1987, and GPs expressed the least satisfaction with their hours, recognition for their work, and rates of pay. Nearly 60% felt that their physical health had been affected by their work. These results point to a need to improve working conditions in primary care and for further research to determine the effect of any such changes. PMID:9624747

The impact of pay-for-performance on professional boundaries in UK general practice: an ethnographic study.

PubMed

Grant, Suzanne; Huby, Guro; Watkins, Francis; Checkland, Kath; McDonald, Ruth; Davies, Huw; Guthrie, Bruce

2009-03-01

The 2004 new General Medical Services (nGMS) contract exemplifies trends across the public services towards increased definition, measurement and regulation of professional work, with general practice income now largely dependent on the quality of care provided across a range of clinical and organisational indicators known collectively as the 'Quality and Outcomes Framework' (QOF). This paper reports an ethnographically based study of the impact of the new contract and the financial incentives contained within it on professional boundaries in UK general practice. The distribution of clinical and administrative work has changed significantly and there has been a new concentration of authority, with QOF decision making and monitoring being led by an internal QOF team of clinical and managerial staff who make the major practice-level decisions about QOF, monitor progress against targets, and intervene to resolve areas or indicators at risk of missing targets. General practitioners and nurses, however, appear to have accommodated these changes by re-creating long established narratives on professional boundaries and clinical hierarchies. This paper is concerned with the impact of these new arrangements on existing clinical hierarchies.

Management in general practice: the challenge of the new General Medical Services contract.

PubMed

Checkland, Kath

2004-10-01

Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. Three general practices in England, chosen using purposeful sampling. Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the management of performance in this role.

Management in general practice: the challenge of the new General Medical Services contract

PubMed Central

Checkland, Kath

2004-01-01

Background: Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. Aim: To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. Design of study: In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. Setting: Three general practices in England, chosen using purposeful sampling. Method: Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Results: Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. Conclusion: The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the management of performance in this role. PMID:15469672

Facets of job satisfaction of dental practitioners working in different organisational settings in England.

PubMed

Harris, R V; Ashcroft, A; Burnside, G; Dancer, J M; Smith, D; Grieveson, B

2008-01-12

Before April 2006, English dentists were either working as an NHS general dental service (GDS) practitioner (fee-per-item, no local contractual obligations); an NHS personal dental service (PDS) practitioner (block contract with the primary care trust (PCT)); a private practitioner (either fee-per-item or capitation-based, independent of the PCT); or in a situation where they were mixing their NHS work (either under the GDS or PDS arrangements) with private work. To a) investigate the extent of the mix of NHS and private work in English dentists working in the GDS and PDS, b) to compare global job satisfaction, and c) to compare facets of job satisfaction for practitioners working in the different organisational settings of PDS practices, GDS practices and practices where there is a mix of NHS and private provision. Method A questionnaire was sent to 684 practitioners, containing 83 attitudinal statements relating to job facets, a global job satisfaction score and questions concerning workload. Response rate was 65.2%. More PDS than GDS dentists were found to treat the majority of their patients under the NHS. GDS dentists working fully in the NHS were least likely to be satisfied with their job, followed by PDS practitioners and then GDS dentists working in mixed NHS/private practices. Private practitioners were the most satisfied. Differences between GDS, PDS and private practitioners were found in global job satisfaction and in the facets of job satisfaction related to restriction in being able to provide quality care, control of work and developing clinical skills.

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

What factors influence the use of contracts in the context of NHS dental practice? A systematic review of theory and logic model

PubMed Central

Harris, Rebecca; Mosedale, Sarah; Garner, Jayne; Perkins, Elizabeth

2014-01-01

UK NHS contracts mediate the relationship between dental and medical practitioners as independent contractors, and the state which reimburses them for their services to patients. There have been successive revisions of dental and medical contracts since the 1990s alongside a change in the levels of professional dominance and accountability. Unintended consequences of the 2006 dental contract have led to plans for further reform. We set out to identify the factors which facilitate and hinder the use of contracts in this area. Previous reviews of theory have been narrative, and based on macro-theory arising from various disciplines such as economics, sociology and political science. This paper presents a systematic review and aggregative synthesis of the theories of contracting for publicly funded health care. A logic map conveys internal pathways linking competition for contracts to opportunism. We identify that whilst practitioners' responses to contract rules is a result of micro-level bargaining clarifying patients' and providers' interests, responses are also influenced by relationships with commissioners and wider personal, professional and political networks. PMID:24608120

What factors influence the use of contracts in the context of NHS dental practice? A systematic review of theory and logic model.

PubMed

Harris, Rebecca; Mosedale, Sarah; Garner, Jayne; Perkins, Elizabeth

2014-05-01

UK NHS contracts mediate the relationship between dental and medical practitioners as independent contractors, and the state which reimburses them for their services to patients. There have been successive revisions of dental and medical contracts since the 1990s alongside a change in the levels of professional dominance and accountability. Unintended consequences of the 2006 dental contract have led to plans for further reform. We set out to identify the factors which facilitate and hinder the use of contracts in this area. Previous reviews of theory have been narrative, and based on macro-theory arising from various disciplines such as economics, sociology and political science. This paper presents a systematic review and aggregative synthesis of the theories of contracting for publicly funded health care. A logic map conveys internal pathways linking competition for contracts to opportunism. We identify that whilst practitioners' responses to contract rules is a result of micro-level bargaining clarifying patients' and providers' interests, responses are also influenced by relationships with commissioners and wider personal, professional and political networks. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

21 CFR 1301.76 - Other security controls for practitioners.

Code of Federal Regulations, 2014 CFR

2014-04-01

... nonpractitioners in § 1301.74 (a), (b), and (e). (d) Central fill pharmacies must comply with § 1301.74(e) when selecting private, common or contract carriers to transport filled prescriptions to a retail pharmacy for delivery to the ultimate user. When central fill pharmacies contract with private, common or contract...

21 CFR 1301.76 - Other security controls for practitioners.

Code of Federal Regulations, 2013 CFR

2013-04-01

... nonpractitioners in § 1301.74 (a), (b), and (e). (d) Central fill pharmacies must comply with § 1301.74(e) when selecting private, common or contract carriers to transport filled prescriptions to a retail pharmacy for delivery to the ultimate user. When central fill pharmacies contract with private, common or contract...

21 CFR 1301.76 - Other security controls for practitioners.

Code of Federal Regulations, 2012 CFR

2012-04-01

... nonpractitioners in § 1301.74 (a), (b), and (e). (d) Central fill pharmacies must comply with § 1301.74(e) when selecting private, common or contract carriers to transport filled prescriptions to a retail pharmacy for delivery to the ultimate user. When central fill pharmacies contract with private, common or contract...

Turnover intention and related factors among general practitioners in Hubei, China: a cross-sectional study.

PubMed

Gan, Yong; Gong, Yanhong; Chen, Yawen; Cao, Shiyi; Li, Liqing; Zhou, Yanfeng; Herath, Chulani; Li, Wenzhen; Song, Xingyue; Li, Jing; Yang, Tingting; Yin, Xiaoxv; Lu, Zuxun

2018-05-24

High turnover among general practitioners (GPs) is a significant challenge in China's efforts to build a sustainable, effective primary care system, but little data is available to help understand and address this issue. The study was aiming at assessing the intention to leave their posts among a sample of GPs and investigating associated factors. A cross-sectional survey was conducted between December 12, 2014 and March 10, 2015 in Hubei Province, Central China. A total of 1016 GPs (response rate, 85.67%) were investigated by using a structured self-administered questionnaire. A generalized linear regression model was used to identify the associated factors with turnover intention among GPs. Based on a full score of 24, the average score for GPs' turnover intention was 15.40 (SD = 3.43). 78.35% of the GPs had a moderate or higher level of turnover intention. Six hundred and thirty one (62.37%) GPs had ever been exposed to abuse of any kind (physical assault, 18.92%; verbal abuse, 54.38%; threat, 33.79%; verbal sexual harassment, 22.66%; and physical sexual harassment, 7.59%). Generalized linear regression analysis indicated that GPs who were male; who had a vocational school or higher; who had a temporary work contract; who were with lower level of job satisfaction; who reported higher scores on emotional exhaustion; who had been exposed to higher frequency of workplace violence were expressed higher intention to leave their present positions. This study shows that GP's intention to leave general practices is high in Hubei, China. In addition, the prevalence of workplace violence is high among GPs, particularly in the verbal abuse and threat. Measures such as offering permanent contract status, increasing overall job satisfaction, and improving doctor-patient relationship, are needed to moderate GP's turnover intention in order to maintain the foundation of China's three-tier health system.

General practice and the New Zealand health reforms – lessons for Australia?

PubMed Central

McAvoy, Brian R; Coster, Gregor D

2005-01-01

New Zealand's health sector has undergone three significant restructures within 10 years. The most recent has involved a Primary Health Care Strategy, launched in 2001. Primary Health Organisations (PHOs), administered by 21 District Health Boards, are the local structures for implementing the Primary Health Care Strategy. Ninety-three percent of the New Zealand population is now enrolled within 79 PHOs, which pose a challenge to the well-established Independent Practitioner Associations (IPAs). Although there was initial widespread support for the philosophy underlying the Primary Health Care Strategy, there are concerns amongst general practitioners (GPs) and their professional organisations relating to its implementation. These centre around 6 main issues: 1. Loss of autonomy 2. Inadequate management funding and support 3. Inconsistency and variations in contracting processes 4. Lack of publicity and advice around enrolment issues 5. Workforce and workload issues 6. Financial risks On the other hand, many GPs are feeling positive regarding the opportunities for PHOs, particularly for being involved in the provision of a wider range of community health services. Australia has much to learn from New Zealand's latest health sector and primary health care reforms. The key lessons concern: • the need for a national primary health care strategy • active engagement of general practitioners and their professional organisations • recognition of implementation costs • the need for infrastructural support, including information technology and quality systems • robust management and governance arrangements • issues related to critical mass and population/distance trade offs in service delivery models PMID:16262908

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. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Fundholders' referral patterns and perceptions of service quality in hospital provision of elective general surgery.

PubMed Central

Whynes, D K; Reed, G

1994-01-01

BACKGROUND. The introduction of fundholding established an internal market in public sector health care, involving purchasers and providers contracting for the supply of health care. AIM. This study set out to examine fundholders' hospital referral patterns, and to evaluate the quality of the service provided to patients undergoing elective general surgery, as perceived by fundholding general practitioners. METHOD. A questionnaire was posted to the senior partners of all fundholding practices in the Trent Regional Health Authority area. This questionnaire requested assessments of the importance of 13 specified aspects of service quality and the quality of provision by general practitioners' most frequently-used hospitals. Five-point scales were employed in each case. Respondents were asked to provide additional details about their practice. RESULTS. A 67% response rate was achieved. Confidence in the consultant's ability, short waiting times and informative feedback from the providers emerged as the most important elements in referral decisions, while the cost of treatment and patient convenience received lower importance ratings. In terms of how well their providers were seen to perform, fundholders ranked confidence in the consultant and patient convenience highest, and style of hospital management lowest. The majority of referrals seemed to be local. CONCLUSION. Judged in terms of fundholders' perceptions, sizeable variations in service quality between hospital providers of general surgery are evident. PMID:7748666

Regional Educational Laboratory Researcher-Practitioner Partnerships: Documenting the Research Alliance Experience. REL 2018-291

ERIC Educational Resources Information Center

Scher, Lauren; McCowan, Ronald; Castaldo-Walsh, Cynthia

2018-01-01

This report provides a detailed account of the Regional Educational Laboratory (REL) Program's experience establishing and supporting research-practice partnerships (called "research alliances") during its 2012-17 contract cycle. The report adds to the growing literature base on researcher-practitioner partnerships by sharing how the…

Clinical decision making by dentists working in the NHS General Dental Services since April 2006.

PubMed

Davies, B J B; Macfarlane, F

2010-11-27

In April 2006 a new contract was introduced that governed how NHS General Dental Practitioners would be funded for the services they provide. This study looks at the impact that the contract has had in the three years since its introduction, evaluating its influence on the clinical care that patients receive and the clinical decisions that dentists are making. This qualitative service evaluation involved interviewing 12 dentists representative of a range of NHS dentists involved with the new NHS dental contract using a semi-structured approach. We found evidence that the new contract has led to dentists making different decisions in their daily practice and sometimes altering their treatment plans and referral patterns to ensure that their business is not disadvantaged. Access to care for some patients without a regular dentist can be compromised by the new contract as it can be financially challenging for a dentist to accept to care for a new patient who has an unknown and potentially large need for treatment. Cherry-picking of potentially more profitable patients may be common. The incentive is to watch borderline problems rather than to treat if a treatment band threshold has already been crossed and treatment may be delayed until a later course of treatment for the same reason. Dentists often feel that complex treatments (for example, endodontic treatments) are financially unviable. Some dentists are referring difficult cases that might previously have been treated 'in house', such as extractions, to another provider, as this enables offloading of costs while potentially retaining full fees. Younger and less experienced dentists may be further pressured.

Treating body, treating mind: The experiences of people with psychotic disorders and their general practitioners - Findings from the Australian National Survey of High Impact Psychosis.

PubMed

Waterreus, Anna; Morgan, Vera A

2018-06-01

To describe from the perspective of people living with psychotic illness their use of general practitioner services over a 12-month period and the experiences, attitudes and challenges general practitioners face providing health care to this population. A two-phase design was used. Phase 1, screening for psychosis, occurred in public specialised mental health services and non-government organisations within seven catchment sites across Australia. In Phase 2, 1825 people who were screened positive for psychosis were randomly selected for interview which included questions about frequency and reason for general practitioner contact in the 12 months prior to interview. General practitioners (1473) of consenting participants were also surveyed. Almost all (90.3%) survey participants had consulted a general practitioner in the 12-month period, on average 8.9 times, and 28.8% of attenders had consulted 12 times or more. The majority (83.5%) attended one general practitioner practice. Most (77.6%) general practitioners wanted to be involved in the mental health care of their patient. Although 69.1% said the management of their patient was not problematic for their practice, one in five general practitioners reported issues related to patient non-compliance with treatment and non-attendance at scheduled appointments; time constraints; and lack of feedback from treating mental health services. People with psychotic disorders consult general practitioners, some very frequently. Most Australian general practitioners believe they have a responsibility to review the physical and mental health of their patients. Improved communication between general practitioners and mental health services, and easier access to mental health support, may help general practitioners manage the complex mental, physical and social problems of their patients.

Improving Grievance Arbitration: The Practitioners Speak. Working Paper 1973-07.

ERIC Educational Resources Information Center

Davey, Harold W.

Grievance arbitration is utilized on a nearly universal basis, but the process is malfunctioning in several ways. The study was based on a review of the literature, in field interviews, and in-depth correspondence with knowledgeable management and union practitioners; findings are limited to the arbitration step in contract administration. Twenty…

Do patients with unexplained physical symptoms pressurise general practitioners for somatic treatment? A qualitative study.

PubMed

Ring, Adele; Dowrick, Christopher; Humphris, Gerry; Salmon, Peter

2004-05-01

To identify the ways in which patients with medically unexplained symptoms present their problems and needs to general practitioners and to identify the forms of presentation that might lead general practitioners to feel pressurised to deliver somatic interventions. Qualitative analysis of audiorecorded consultations between patients and general practitioners. 7 general practices in Merseyside, England. 36 patients selected consecutively from 21 general practices, in whom doctors considered that patients' symptoms were medically unexplained. Inductive qualitative analysis of ways in which patients presented their symptoms to general practitioners. Although 34 patients received somatic interventions (27 received drug prescriptions, 12 underwent investigations, and four were referred), only 10 requested them. However, patients presented in other ways that had the potential to pressurise general practitioners, including: graphic and emotional language; complex patterns of symptoms that resisted explanation; description of emotional and social effects of symptoms; reference to other individuals as authority for the severity of symptoms; and biomedical explanations. Most patients with unexplained symptoms received somatic interventions from their general practitioners but had not requested them. Though such patients apparently seek to engage the general practitioner by conveying the reality of their suffering, general practitioners respond symptomatically.

Comparison of two scores for allocating resources to doctors in deprived areas.

PubMed

Hutchinson, A; Foy, C; Sandhu, B

1989-11-04

Current proposals in the general practitioner contract include additional payments to doctors working among deprived populations. The underprivileged area score will be used to identify local authority wards with the greatest levels of deprivation, thus acting as the basis for distributing considerable resources. Two methods of identifying deprived populations--the underprivileged area score and the material deprivation score--were compared to determine whether they result in similar allocation of resources to regions. Financial allocations to regions based on figures derived from the contract differed considerably if the material deprivation score was used instead of the underprivileged area score: Northern and Mersey regions gained over 50% of their allocation whereas East Anglia, Oxford, and South West Thames regions lost more than 30% of theirs. Such differences have considerable implications for doctors working among deprived populations as up to 60m pounds each year might be distributed by these payments.

Framework for Quality Professional Development for Practitioners Working with Adult English Language Learners. Revised

ERIC Educational Resources Information Center

Center for Adult English Language Acquisition, 2010

2010-01-01

The Center for Adult English Language Acquisition (CAELA) Network, under contract with the Office of Vocational and Adult Education (OVAE), has created a framework that can be used to plan, implement, and evaluate professional development for practitioners working with adult English language learners at the state, regional, and program levels. The…

A case study of nurse practitioner care compared to general practitioner care for children with respiratory tract infections.

PubMed

van Vugt, Saskia F; van de Pol, Alma C; Cleveringa, Frits G W; Stellato, Rebecca K; Kappers, Marieke P; de Wit, Niek J; Damoiseaux, Roger A M J

2018-05-13

To compare quality of care provided by nurse practitioners with care provided by general practitioners for children with respiratory tract infections in the Netherlands. Nurse practitioners increasingly manage acute conditions in general practice, with opportunities for more protocolled care. Studies on quality of nurse practitioners' care for children with respiratory tract infections are limited to the US health care system and do not take into account baseline differences in illness severity. Retrospective observational cohort study. Data were extracted from electronic healthcare records of children 0-6 years presenting with respiratory tract infection between January-December 2013. Primary outcomes were antibiotic prescriptions and early return visits. Generalized estimating equations were used to correct for potential confounders. A total of 899 respiratory tract infection consultations were assessed (168 seen by nurse practitioner; 731 by general practitioners). Baseline characteristics differed between these groups. Overall antibiotic prescription and early return visit rates were 21% and 24%, respectively. Adjusted odds ratio for antibiotic prescription after nurse practitioner vs. general practitioner delivered care was 1.40 (95% confidence interval 0.89-2.22) and for early return visits 1.53 (95% confidence interval 1.01-2.31). Important confounder for antibiotic prescription was illness severity. Presence of wheezing was a confounder for return visits. Complication and referral rates did not differ. Antibiotic prescription, complication and referral rates for paediatric respiratory tract infection consultations did not differ significantly between nurse practitioner and general practitioner consultations, after correction for potential confounders. General practitioners, however, see more severely ill children and have a lower return visit rate. A randomised controlled study is needed to determine whether nurse practitioner care quality is truly non-inferior. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Jazzing up the Psychological Contract

ERIC Educational Resources Information Center

Hartley, Nell Tabor

2010-01-01

Helping students and practitioners to understand and utilize the Psychological Contract is often a difficult task. Unlike fault-finding research, this paper presents the PC as a positive, vibrant and valuable tool. In an effort to make the concept less elusive, the paper draws upon the metaphor of jazz. The metaphor is an accepted tool of…

[The image of general practitioners' profession in a changing society].

PubMed

Natanzon, Iris; Szecsenyi, Joachim; Götz, Katja; Joos, Stefanie

2009-08-01

Due to a--depending on the region--already existent or predicted lack of general practitioners, the German health care is confronted with a serious problem. Besides the political general conditions and problems regarding the vocational training, social changes can influence the attractiveness of general practitioners' profession, thereby possibly also effecting a lack of young general practitioners. The aim of this study was to explore, which image exists of general practitioners' profession from their viewpoint and which social developments influence their image. A qualitative study was undertaken by interviewing 16 general practitioners in their practices or in the Department of General Practice and Health Service Research, University Hospital of Heidelberg, Germany. From the general practitioners' point of view, the image they have is positive in people from rural districts and the elder generation, but negative in younger people and urbanites. The image is influenced by the following social changes: declining social competencies, obligation and responsibility, an increasing distance to illness and sick persons as well as an increasing flexibility. Since particularly younger people have a negative opinion of general practitioners and young physicians belong to that target group, the subject general medicine might be less attractive to trainees. That is why the general practitioner is not perceived as a professional future perspective. Social changes influencing the choice of career should increasingly be considered as a starting point for the development of approaches directed against the lack of trainees in general medicine.

A survey of general dental practitioners in the North West of England concerning the dental care of patients following head and neck radiotherapy.

PubMed

Husein, Adam B; Butterworth, Chris J; Ranka, Meena S; Kwasnicki, Andrew; Rogers, Simon N

2011-04-01

The aim of this survey was to investigate the views of general dental practitioners (GDPs) on their perceived roles and the barriers regarding dental care of patients following head and neck radio-therapy. From a total of 1163 GDPs on the Mersey Postgraduate Dental Deanery mailing list, 369 were selected at random. Questionnaires were sent out in February 2010 followed by reminders a month later. A study-specific questionnaire was piloted prior to the survey. One hundred and ninety-eight of the potential 336 respondents returned valid questionnaires, a response rate of 59%. They did not respond to all questions. Of those who responded, 99/188 (53%) were either 'not at all' or 'little' happy about managing these patients and 118/183 (64%) and 100/173 (58%), respectively, perceived that complex management and the new General Dental Services (nGDS) contract introduced in 2006 were 'quite a bit' or 'very much' barriers to treatment. The majority of the respondents felt that they were 'quite a bit' or 'very much' happy to carry out routine fillings (177/195; 90%), periodontal treatment (166/195; 85%), removable dentures (161/195; 83%), crown and bridge work (123/192; 64%), and root canal therapy (114/195; 58%) but only 53/191 (28%) to perform dental extractions. Over half of the respondents felt that they had 'quite a bit' or a 'main role' in managing radiotherapy caries, xerostomia, detecting recurrence and offering smoking-cessation advice. The majority of the GDPs who responded had been involved in the management of patients who had undergone radio-therapy to the head and neck. A substantial number perceived barriers to care, such as the complexity of the treatment and the nGDS contract. These findings need further investigation. Continuing professional development would be helpful to improve GDPs' confidence in dealing with this group of patients.

Management of arterial hypertension in Cotonou city, Benin: general practitioners' knowledge, attitudes and practice.

PubMed

Houenassi, Martin Dèdonougbo; Codjo, Léopold Houétondji; Dokoui, David; Dohou, Serge Hugues Mahougnon; Wanvoegbe, Armand; Agbodande, Anthelme; Attinsounon, Angelo Cossi; Alassani, Adebayo; Ahoui, Séraphin; Dovonou, Albert Comlan; Adoukonou, Thierry Armel

2016-08-23

We aimed to assess the management of hypertensive patients by general practitioners in Cotonou city. This was a cross-sectional study based on a multicentre survey conducted from 1 May to 31 July 2011. We recruited all consenting general practitioners who worked in public and private centres in Cotonou city. We used the 7th report of the Joint National Committee to assess the management of hypertension by general practitioners. A tested and validated self-questionnaire was used to collect the data on hypertension management by general practitioners. In eight centres that approved the study, 41 general practitioners were included. The definition of hypertension was known by 20 (48.8%) practitioners. Only 25 (61.0%) could describe the conditions for blood pressure measurement. Ten of them were unable to list half of the minimum recommended tests for hypertension, and the majority (92.7%) did not have any idea of global cardiovascular risk. The blood pressure goal was known by only 18 (43.9%) practitioners. Lifestyle (82.9%) and monotherapy (70.7%) were the therapeutic modalities most prescribed. Antihypertensive agents commonly used by practitioners were calcium channel blockers (82.9%), angiotensin converting enzyme inhibitors (53.7%) and diuretics (36.6%). The general practitioners referred their patients to cardiologists mainly for uncontrolled hypertension (63.4%) and the onset of acute complications (56.1%). The general practitioners' knowledge of hypertension was insufficient and their management did not reflect international guidelines.

Specialization in general practice *

PubMed Central

Hart, Julian Tudor

1980-01-01

Ideas about general practitioner specialism may have been hampered in the past because of the three models of general practitioner specialism — in the hospital service, the fee-earning specialoid or the general practitioner obstetrician — none of which is satisfactory. However, general practitioner specialism can be justified in guaranteeing standards by concentrating groups of patients, accepting responsibility, and planning care. Medico-political changes may be needed to achieve improvement in clinical standards. PMID:7411511

Prevalence of burnout among Irish general practitioners: a cross-sectional study.

PubMed

O'Dea, B; O'Connor, P; Lydon, S; Murphy, A W

2017-05-01

Burnout constitutes a significant problem among physicians which impacts negatively upon both the doctor and their patients. Previous research has indicated that burnout is prevalent among primary care physicians in other European countries and North America. However, there is a paucity of research assessing burnout among Irish general practitioners and examining predictive factors. To report the findings of a survey of burnout among Irish general practitioners, and assess variables related to burnout in this population. An online, anonymous questionnaire was distributed to general practitioners working in the Republic of Ireland. In total, 683 general practitioners (27.3 % of practising Irish general practitioners) completed the survey. Of these, 52.7 % reported high levels of emotional exhaustion, 31.6 % scored high on depersonalisation and 16.3 % presented with low levels of personal accomplishment. In total, 6.6 % presented with all three symptoms, fulfilling the criteria for burnout. Emotional exhaustion was higher among this sample than that reported in European and UK studies of burnout in general practitioners. Personal accomplishment was, however, higher in this sample than in other studies. Multiple regression analyses revealed that younger age, non-principal status role, and male gender were related to increased risk of burnout symptoms. The symptoms of burnout appear prevalent among Irish general practitioners. This is likely to have a detrimental impact both upon the individual general practitioners and the patients that they serve. Research investigating the factors contributing to burnout in this population, and evaluating interventions to improve general practitioner well-being, is, therefore, essential.

Information needs of oncologists, general practitioners and other professionals caring for patients with cancer.

PubMed

Ciarlo, G; Liebl, P; Zell, J; Fessler, J; Koester, M J; Ruetters, D; Mugele, K; Huebner, J

2016-11-01

Oncology is a rapidly developing field with a growing number of publications every year. The main goal of this survey was to learn more about the information needs of oncologists and general practitioners. Data were collected using a standardised questionnaire developed in collaboration with the German Cancer Society (Deutsche Krebsgesellschaft) and the German Association of General Practitioners (Deutscher Hausärzteverband). A total of 495 questionnaires could be evaluated. Medical congresses were the preferred source of information for all participants. General practitioners preferred textbooks, while oncologists preferred journals and the Internet (all p < .001). Reasons for a lack of confidence during patient consultation were lack of time (60% of participants), lack of knowledge (61% of general practitioners and 26% of oncologists) and lack of data (>50%). Oncologists felt more confident in searching scientific databases than general practitioners did. Both groups required rapid access to transparent information. For general practitioners, reviews and comments by experts helped to put new information in the context of cancer treatment. Oncologists and general practitioners showed significantly different information needs and different ways to access specific information. In order to better integrate general practitioners while simultaneously serving the needs of oncologists, a database that is up to date, rapidly accessible and does not incur high costs would be helpful. © 2016 John Wiley & Sons Ltd.

Paediatric oncology information pack for general practitioners

PubMed Central

James, J A; Harris, D J; Mott, M G; Oakhill, A

1988-01-01

An information pack covering important aspects of paediatric oncology has been developed for general practitioners. Sixty general practitioners who received the information pack found that it helped them in managing children with neoplastic disease and their families. The pack has also improved communications between the oncology unit and general practitioners. Similar packs could be produced by paediatricians working in other specialties. PMID:3122972

[Patient expectations about decision-making for various health problems].

PubMed

Delgado, Ana; López-Fernández, Luis Andrés; de Dios Luna, Juan; Saletti Cuesta, Lorena; Gil Garrido, Natalia; Puga González, Almudena

2010-01-01

To identify patient expectations of clinical decision-making at consultations with their general practitioners for distinct health problems and to determine the patient and general practitioner characteristics related to these expectations, with special focus on gender. We performed a multicenter cross-sectional study in 360 patients who were interviewed at home. Data on patients' sociodemographic, clinical characteristics and satisfaction were gathered. General practitioners supplied information on their gender and postgraduate training in family medicine. A questionnaire was used to collect data on patients' expectations that their general practitioner at consultations with their general practitioner for five problems or hypothetical clinical scenarios (strong chest pain/cold with fever/abnormal discharge/depression or sadness/severe family problem). Patients were asked to indicate their preference that decisions on diagnosis and treatment be taken by: a) the general practitioner alone; b) the general practitioner, taking account of the patient's opinion; c) the patient, taking account of the general practitioner's opinion and d) the patient alone. A logistic regression was performed for clinical decision-making. The response rate was 90%. The mean age was 47.3 + or - 16.5 years and 51% were female. Patients' expectations that their general practitioner listen, explain and take account of their opinions were higher than their expectations of participating in decision-making, depending on the problem in question: 32% wished to participate in chest pain and 49% in family problems. Women had lower expectations of participating in depression and family problems. Patients with female general practitioners had higher expectations of participating in family problems and colds. Most patients wished to be listened to, informed and taken into account by their general practitioners and, to a lesser extent, wished to take decisions autonomously, especially for biomedical problems. Copyright 2009 SESPAS. Published by Elsevier Espana. All rights reserved.

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

PubMed Central

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

2014-01-01

Background: Although communicating effectively with patients receiving palliative care can be difficult, it may contribute to maintaining or enhancing patients’ quality of life. Little is known about the effect of training general practitioners in palliative care–specific communication. We hypothesized that palliative care patients of general practitioners exposed to the ‘Availability, Current issues and Anticipation’ communication training programme would report better outcomes than patients of control general practitioners. Aim: To evaluate the effectiveness of the Availability, Current issues and Anticipation training programme for general practitioners on patient-reported outcomes. Design: In a controlled trial, general practitioners followed the Availability, Current issues and Anticipation programme or were part of the control group. Patients receiving palliative care of participating general practitioners completed the Palliative Care Outcome Scale, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative, the Rest & Peace Scale, the Patient Satisfaction Questionnaire–III and the Availability, Current issues and Anticipation Scale, at baseline and 12 months follow-up. We analysed differences between groups using linear mixed models. Trial registration: ISRCTN56722368. Setting/participants: General practitioners who attended a 2-year Palliative Care Training Course in the Netherlands. Results: Questionnaire data were available for 145 patients (89 in intervention and 56 in control group). We found no significant differences over time between the intervention and control groups in any of the five outcome measures. Ceiling effects were observed for the Rest & Peace Scale, Patient Satisfaction Questionnaire–III and Availability, Current issues and Anticipation Scale. Conclusion: General practitioner participation in the Availability, Current issues and Anticipation training programme did not have a measurable effect on any of the outcomes investigated. Patients reported high levels of satisfaction with general practitioner care, regardless of group assignment. Future research might focus on general practitioners without special interest in palliative care. PMID:24951633

Job satisfaction of dental practitioners before and after a change in incentives and governance: a longitudinal study.

PubMed

Harris, R; Burnside, G; Ashcroft, A; Grieveson, B

2009-07-25

to measure changes in dental practitioners' job satisfaction following a contractual change, and compare differences between those transferring from a fee-per-item system (general dental service, GDS) and those previously working under a block contract with the primary care trust (personal dental service, PDS). Analysis of postal questionnaires conducted in 2006 and 2007. Four hundred and forty dental practitioners responding to the 2006 baseline questionnaire. Although perceived workload was unchanged, global job satisfaction had decreased for 24.7% (31) of GDS dentists and 49.0% (95) of PDS dentists comparing their scores given before and after the contractual change. PDS dentists showed a significant change in attitudes towards feeling restricted in providing quality care (change in factor mean [SD] = -2.88 [0.82]; p < 0.001). They also showed less positive attitudes towards 'respect' (change in factor mean [SD] = -3.70 [0.48]; p < 0.001). The 2006 contractual change appears to have had a negative impact on dentists' job satisfaction and has not addressed concerns which have led dentists to move into the private sector. The study indicates that the fall in job satisfaction is more a result of a perceived erosion of professional autonomy than a reaction to the change in the system of remuneration.

General practitioners and mental health staff sharing patient care: working model.

PubMed

Horner, Deborah; Asher, Kim

2005-06-01

The paper describes a shared care programme developed by mental health services and general practitioners for shifting patients with chronic psychiatric disorders to the care of a general practitioner. The programme is characterized by: (i) a dedicated mental health service general practitioner liaison position to manage the programme and provide support to both patients and doctors; (ii) a multidisciplinary care planning meeting that includes mental health staff, the patient, the general practitioner and a carer; and (iii) a jointly developed individual management plan that specifies patient issues, strategies to deal with these issues, persons responsible for monitoring and a review date. The shared care protocol, the results of a review of patient mental health indicators and general practitioner satisfaction with the programme are described. Outcomes to date suggest that patients' mental health is not compromised and may be enhanced by transfer to general practitioners within the shared care model. Indicators of mental health outcomes (Health of the Nation Outcome Scale and Life Skills Profile scores) show improved patient symptomatology and functioning in most cases. The programme fits the model of recovery-based mental health services and complies with current local, state and Commonwealth policies that encourage integrated and collaborative approaches by mental health services and general practitioners in delivering mental health care to persons with chronic mental illness.

An instrument for assessment of videotapes of general practitioners' performance.

PubMed Central

Cox, J; Mulholland, H

1993-01-01

OBJECTIVES--To identify those important characteristics of doctors' and patients' behaviour that distinguish between "good" and "bad" consultations when viewed on videotape; to use these characteristics to develop a reliable instrument for assessing general practitioners' performance in their own consultations. DESIGN--Questionnaires completed by patients, general practitioner trainers, and general practitioner trainees. Reliability of draft instrument tested by general practitioner trainers. SETTING--All vocational training schemes for general practice in the Northern region of England. SUBJECTS--First stage: 76 patients in seven groups, 108 general practice trainers in 12 groups, and 122 general practice trainees in 10 groups. Second stage: 85 general practice trainers in 12 groups. MAIN OUTCOME MEASURES--Trainers' ratings of importance; alpha coefficients of draft instrument by trainee, group, and consultation. RESULTS--6890 characteristics of good and bad consultations were consolidated into a draft assessment instrument consisting of 46 pairs of definitions separated by six point bipolar scales. Nine statement pairs given low importance ratings by trainers were eliminated, reducing the instrument to 37 statement pairs. To test reliability, general practitioner trainers used the instrument to assess three consultations. With the exception of one group of trainers, all alpha coefficients exceeded the acceptable level of 0.80. CONCLUSION--The instrument produced is reliable for assessing general practitioners' performance in their own consultations. PMID:8490501

Potential difficulties in applying the Pay for Safety Scheme (PFSS) in construction projects.

PubMed

Choi, Tracy N Y; Chan, Daniel W M; Chan, Albert P C

2012-09-01

Since 1996, the Government of the Hong Kong Special Administrative Region (HKSAR) has introduced the Pay for Safety Scheme (PFSS) to the public works construction contracts to uplift their safety performance. However, the adoption of PFSS has also encountered some difficulties that merit considerable attention. This paper purports to provide a concise review of the prevailing application of PFSS in Hong Kong in general, and to explore the potential difficulties associated with PFSS in particular. By means of an empirical questionnaire survey geared towards industrial practitioners with extensive direct hands-on PFSS experience, their opinions were solicited, analyzed and compared between the client group and contractor group of respondents. The three most significant difficulties in implementing PFSS were found to be: (1) "Plenty of paperwork required for certifying payment to contractor"; (2) "Complicated contract documents and lengthy assessment process"; and (3) "Over-tight project schedule requiring rush jobs". The output of this research study is particularly essential in assisting the contracting parties to mitigate the avoidable hindrances when embarking on PFSS. It has also generated valuable insights into developing effective recommendations for alleviating the barriers to PFSS success for future construction projects. Copyright © 2011 Elsevier Ltd. All rights reserved.

Professional relationships between general practitioners and pharmacists in health centres.

PubMed Central

Harding, G; Taylor, K M

1990-01-01

The inclusion of pharmacies in health centres has created opportunities for general practitioners to become better acquainted with the potential contribution of pharmacists to health care. A qualitative study has been made to explore the extent to which this potential has been realized. Ten health centres with an integral pharmacy were selected, one from each of the regional health authorities in England which had at least one such health centre. Interviews were conducted with 13 general practitioners and 10 pharmacists working in the health centres. Nine general practitioners working in health centres without pharmacies and 10 community pharmacists were also interviewed. General practitioners' attitudes towards health centre pharmacists appeared to differ markedly from the attitudes of colleagues working in relative isolation from pharmacists. It appears that general practitioners working closely with the pharmacist develop a collaborative approach to health care. PMID:2271280

A retrospective study on anthropometrical, physical fitness, and motor coordination characteristics that influence dropout, contract status, and first-team playing time in high-level soccer players aged eight to eighteen years.

PubMed

Deprez, Dieter N; Fransen, Job; Lenoir, Matthieu; Philippaerts, Renaat M; Vaeyens, Roel

2015-06-01

The goal of this article was twofold, and a 2-study approach was conducted. The first study aimed to expose the anthropometrical, physical performance, and motor coordination characteristics that influence dropout from a high-level soccer training program in players aged 8-16 years. The mixed-longitudinal sample included 388 Belgian youth soccer players who were assigned to either a "club group" or a "dropout group." In the second study, cross-sectional data of anthropometry, physical performance, and motor coordination were retrospectively explored to investigate which characteristics influence future contract status (contract vs. no contract group) and first-team playing time for 72 high-level youth soccer players (mean age = 16.2 years). Generally, club players outperformed their dropout peers for motor coordination, soccer-specific aerobic endurance, and speed. Anthropometry and estimated maturity status did not discriminate between club and dropout players. Contract players jumped further (p = 0.011) and had faster times for a 5-m sprint (p = 0.041) than no contract players. The following prediction equation explains 16.7% of the variance in future playing minutes in adolescent youth male soccer players: -2,869.3 + 14.6 × standing broad jump. Practitioners should include the evaluation of motor coordination, aerobic endurance, and speed performances to distinguish high-level soccer players further succeeding a talent development program and future dropout players, between 8 and 16 years. From the age of 16 years, measures of explosivity are supportive when selecting players into a future professional soccer career.

Electrocardiogram interpretation in general practice: relevance to prehospital thrombolysis.

PubMed Central

McCrea, W A; Saltissi, S

1993-01-01

OBJECTIVE--To assess, in the context of their possible role in prehospital thrombolysis, the ability of general practitioners to recognise acute transmural myocardial ischaemia/infarction on an electrocardiogram. DESIGN--150 doctors (every fifth name) were selected from the alphabetical list of 750 on Merseyside general practitioner register and without prior warning were asked to interpret a series of six 12 lead electrocardiograms. Three of these showed acute transmural ischaemia/infarction, one was normal, and two showed non-acute abnormalities. Details of doctors' ages, postgraduate training, and clinical practice were sought. SETTING--General practitioners' surgeries and postgraduate centres within the Merseyside area. PARTICIPANTS--106 general practitioners (mean age 45 years) agreed to participate. MAIN OUTCOME MEASURE--Accuracy of general practitioners' interpretations of the six electrocardiograms. RESULTS--82% of general practitioners correctly recognised a normal electrocardiogram. Recognition of acute abnormalities was less reliable. Between 33% and 61% correctly identified acute transmural ischaemia/infarction depending on the specific trace presented. Accurate localisation of the site of the infarct was achieved only by between 8% and 30% of participants, while between 22% and 25% correctly interpreted non-acute abnormalities. Neither routine use of electrocardiography nor postgraduate hospital experience in general medicine was associated with significantly greater expertise. CONCLUSION--The current level of proficiency of a sample of general practitioners in the Merseyside area in recognising acute transmural ischaemia/infarction on an electrocardiogram suggests that refresher training is needed if general practitioners are to give prehospital thrombolysis. Images PMID:8398491

Primary health-care teams as adaptive organizations: exploring and explaining work variation using case studies in rural and urban Scotland.

PubMed

Farmer, Jane; West, Christina; Whyte, Bruce; Maclean, Margaret

2005-08-01

It is acknowledged, internationally, that health-care practitioners' work differs between and urban areas. While several factors affect individual teams' activities, there is little understanding about how patterns of work evolve. Consideration of work in relation to local circumstances is important for training, devising contracts and redesigning services. Six case studies centred on Scottish rural and urban general practices were used to examine, in-depth, the activity of primary health-care teams. Quantitative workload data about patient contacts were collected over 24 months. Interviews and diaries revealed insightful qualitative data. Findings revealed that rural general practitioners and district nurses tended to conduct more consultations per practice patient compared with their urban counterparts. Conditions seen and work tasks varied between case study teams. Qualitative data suggested that the key reasons for variation were: local needs and circumstances; choices made about deployment of available time, team composition and the extent of access to other services. Primary care teams might be viewed as adaptive organization, with co-evolution of services produced by health professionals and local people. The study highlights limitations in the application of workload data and suggests that understanding the nature of work in relation to local circumstances is important in service redesign.

General practitioners' views on (long-term) prescription and use of problematic and potentially inappropriate medication for oldest-old patients-A qualitative interview study with GPs (CIM-TRIAD study).

PubMed

Pohontsch, Nadine Janis; Heser, Kathrin; Löffler, Antje; Haenisch, Britta; Parker, Debora; Luck, Tobias; Riedel-Heller, Steffi G; Maier, Wolfgang; Jessen, Frank; Scherer, Martin

2017-02-17

Potentially inappropriate medication (PIM) is defined as medication with uncertain therapeutic effects and/or potential adverse drug reactions outweighing the clinical benefits. The prescription rate of PIM for oldest-old patients is high despite the existence of lists of PIM (e.g. the PRISCUS list) and efforts to raise awareness. This study aims at identifying general practitioners' views on PIM and aspects affecting the (long-term) use of PIM. As part of the CIM-TRIAD study, we conducted semi-structured, qualitative interviews with 47 general practitioners, discussing 25 patients with and 22 without PIM (according to the PRISCUS list). The interview guideline included generic and patient-specific questions. Interviews were digitally recorded and transcribed verbatim. We content analyzed the interviews using deductive and inductive category development. The majority of the general practitioners were not aware of the PRISCUS list. Agents deemed potentially inappropriate from the general practitioners' point of view and the PRISCUS list are not completely superimposable. General practitioners named their criteria to identify appropriate medication for elderly patients (e.g. renal function, cognitive state) and emphasized the importance of monitoring. We identified prescription- (e.g. benzodiazepines on alternative private prescription), medication- (e.g. subjective perception that PIM has no alternative), general practitioner- (e.g. general practitioner relies on specialists), patient- (e.g. "demanding high-user", positive subjective benefit-risk-ratio) and system-related aspects (e.g. specialists lacking holistic view, interface problems) related to the (long term) use of PIM. While the PRISCUS list does not seem to play a decisive role in general practice, general practitioners are well aware of risks associated with PIM. Our study identifies some starting points for a safer handling of PIM, e.g. stronger dissemination of the PRISCUS list, better compensation of medication reviews, "positive lists", adequate patient information, multifaceted interventions and improved communication between general practitioners and specialists.

Factors influencing the decision to use nurse practitioners in the emergency department.

PubMed

McGee, Laurie A; Kaplan, Louise

2007-10-01

Emergency department overcrowding is a serious problem nationwide. Of an estimated 14 million visits to hospital emergency departments, only 12.9% are considered emergent. Many emergency departments, however, employ only physicians despite the fact that nurse practitioners have a proven record of providing high quality, cost-effective care in the emergency department. The purpose of the study was to determine factors that influence the decision to use nurse practitioners in the emergency department. Interviews were conducted with ED managers in hospitals that both employ and do not employ nurse practitioners in the emergency department. In this study, the primary reason that nurse practitioners were not employed by emergency departments was that physician groups with whom the hospitals contract refuse to use nurse practitioners. Emergency department managers of facilities with nurse practitioners reported high levels of satisfaction with the nurse practitioners performance. The 2 ED managers without nurse practitioners in their facility were highly supportive of having nurse practitioners in the emergency department and have advocated for hiring nurse practitioners. Education needs to occur with emergency departments regarding the value of the nurse practitioner's role to the facility. Research is needed to investigate why emergency department physician groups resist hiring nurse practitioners. Increased staffing with nurse practitioners in the emergency department can serve to reduce overcrowding, reduce waiting times, and increase patient satisfaction.

Influence on general practitioners of teaching undergraduates: qualitative study of London general practitioner teachers

PubMed Central

Hartley, Sarah; Macfarlane, Fraser; Gantley, Madeleine; Murray, Elizabeth

1999-01-01

Objective To examine the perceived effect of teaching clinical skills and associated teacher training programmes on general practitioners' morale and clinical practice. Design Qualitative semistructured interview study. Setting General practices throughout north London. Subjects 30 general practitioners who taught clinical skills were asked about the effect of teaching and teacher training on their morale, confidence in clinical and teaching skills, and clinical practice. Results The main theme was a positive effect on morale. Within teacher training this was attributed to developing peer and professional support; improved teaching skills; and revision of clinical knowledge and skills. Within teaching this was attributed to a broadening of horizons; contact with enthusiastic students; increased time with patients; improved clinical practice; improved teaching skills; and an improved image of the practice. Problems with teaching were due to external factors such as lack of time and space and anxieties about adequacy of clinical cover while teaching. Conclusions Teaching clinical skills can have a positive effect on the morale of general practitioner teachers as a result of contact with students and peers, as long as logistic and funding issues are adequately dealt with. Key messagesThe increase in community based teaching of clinical skills requires an increase in the number of general practitioner teachersLittle evidence is available about the effect of teaching of clinical skills and teacher training on general practitioner teachers and practicesGeneral practitioner teachers reported an increase in morale, improvements in clinical skills, and changes in clinical practice and in practice infrastructure as a result of teaching and trainingGeneral practitioner teachers reported problems because of pressure on time, lack of space, problems recruiting patients, and unsupportive practice partnersPositive effects on morale and clinical practice may be important for sustainable teaching and continuing medical education PMID:10541508

Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial

PubMed Central

Bos, Ingeborg B C Korthals-de; Hoving, Jan L; van Tulder, Maurits W; Mölken, Maureen P M H Rutten-van; Adèr, Herman J; de Vet, Henrica C W; Koes, Bart W; Vondeling, Hindrik; Bouter, Lex M

2003-01-01

Objective To evaluate the cost effectiveness of physiotherapy, manual therapy, and care by a general practitioner for patients with neck pain. Design Economic evaluation alongside a randomised controlled trial. Setting Primary care. Participants 183 patients with neck pain for at least two weeks recruited by 42 general practitioners and randomly allocated to manual therapy (n=60, spinal mobilisation), physiotherapy (n=59, mainly exercise), or general practitioner care (n=64, counselling, education, and drugs). Main outcome measures Clinical outcomes were perceived recovery, intensity of pain, functional disability, and quality of life. Direct and indirect costs were measured by means of cost diaries that were kept by patients for one year. Differences in mean costs between groups, cost effectiveness, and cost utility ratios were evaluated by applying non-parametric bootstrapping techniques. Results The manual therapy group showed a faster improvement than the physiotherapy group and the general practitioner care group up to 26 weeks, but differences were negligible by follow up at 52 weeks. The total costs of manual therapy (€447; £273; $402) were around one third of the costs of physiotherapy (€1297) and general practitioner care (€1379). These differences were significant: P<0.01 for manual therapy versus physiotherapy and manual therapy versus general practitioner care and P=0.55 for general practitioner care versus physiotherapy. The cost effectiveness ratios and the cost utility ratios showed that manual therapy was less costly and more effective than physiotherapy or general practitioner care. Conclusions Manual therapy (spinal mobilisation) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner. What is already known on this topicThe cost of treating neck pain is considerableMany conservative interventions are available, such as prescription drugs, yet their cost effectiveness has not been evaluatedNo randomised trials of conservative treatment for neck pain have so far included an economic evaluationWhat this study addsManual therapy is more effective and less costly than physiotherapy or care by a general practitioner for treating neck painPatients undergoing manual therapy recovered more quickly than those undergoing the other interventions PMID:12714472

Process-related factors associated with disciplinary board decisions.

PubMed

Birkeland, Søren; Christensen, Rene dePont; Damsbo, Niels; Kragstrup, Jakob

2013-01-07

In most health care systems disciplinary boards have been organised in order to process patients' complaints about health professionals. Although, the safe-guarding of the legal rights of the involved parties is a crucial concern, there is limited knowledge about what role the complaint process plays with regard to board decision outcomes. Using complaint cases towards general practitioners, the aim of this study was to identify what process factors are statistically associated with disciplinary actions as seen from the party of the complainant and the defendant general practitioner, respectively. Danish Patient Complaints Board decisions concerning general practitioners completed in 2007 were examined. Information on process factors was extracted from the case files and included complaint delay, complainant's lawyer involvement, the number of general practitioners involved, event duration, expert witness involvement, case management duration and decision outcome (discipline or no discipline). Multiple logistic regression analyses were performed on compound case decisions eventually involving more general practitioners (as seen from the complainant's side) and on separated decisions (as seen from the defendant general practitioner's side). From the general practitioner's side, when the number of general practitioners involved in a complaint case increased, odds of being disciplined significantly decreased (OR=0.661 per additional general practitioner involved, p<0.001). Contrarily, from the complainant's side, no association could be detected between complaining against a plurality of general practitioners and the odds of at least one general practitioner being disciplined. From both sides, longer case management duration was associated with higher odds of discipline (OR=1.038 per additional month, p=0.010). No association could be demonstrated with regard to complaint delay, lawyer involvement, event duration, or expert witness involvement. There was lawyer involvement in 5% of cases and expert witness involvement in 92% of cases. The mean complaint delay was 3 months and 18 days and the mean case management duration was 14 months and 7 days. Certain complaint process factors might be statistically associated with decision outcomes. However, the impact diverges as seen from the different parties. Future studies are merited in order to uncover the judicial mechanisms lying behind.

Collaboration of general practitioners and exercise providers in promotion of physical activity a written survey among general practitioners.

PubMed

Leemrijse, C J; de Bakker, D H; Ooms, L; Veenhof, C

2015-08-06

General practitioners have an ideal position to motivate inactive patients to increase their physical activity. Most patients are able to exercise in regular local facilities outside the health care setting. The purpose of this study was to get insight into general practitioners perceptions and current practices regarding referral of patients to local exercise facilities. Furthermore, collaboration with exercise providers in the community was investigated, and motivators and barriers for referral. A written questionnaire sent to a representative random sample of 800 Dutch general practitioners. Descriptive statistics and Chi(2) tests were used. All responding general practitioners (340) recommend their patients to take more exercise when necessary and 87 % say to refer patients sometimes. Limited motivation of the patient (44 %) and reduced health status (34 %) are the most mentioned barriers for advising patients to increase physical activity. When referred, most patients are send to a physical therapist (69 %) but also local exercise facilities were mentioned (54 %). The most important barrier for referring patients to local exercise activities are patients limited financial possibilities (46 %). Restricted knowledge of local exercise- or sport facilities was an additional barrier (19 %). There is little structural collaboration between general practitioners and exercise providers, but when collaboration exists general practitioners refer more often. Positive experiences of patients (67 %), affordable offers (59 %) and information of local exercise facilities (46 %) are seen as important promoting factors for referral. Although 32 % of the general practitioners think that good collaboration would be stimulating, regular meetings with sports and exercise providers were considered the least important for increasing referral (3 %). Dutch physicians have a positive attitude towards stimulating physical activity but referral to local exercise facilities is low. Referral is partly hindered by restricted knowledge of local exercise facilities. Although general practitioners think that collaboration is important for physical activity promotion, it should not cost them much extra time. A coordinator with knowledge of the local situation can facilitate contacts between GP practices and sports providers.

Determinants of Service Contract Outcomes

DTIC Science & Technology

2011-04-30

requiring researchers to brief sponsors on project findings as a condition of funding award; “pushing” potentially high- impact research reports (e.g...allocate resources towards those factors that have greater impacts and avoid the inefficient use of resources on those factors that have little or no... impacts . The objective of this research, therefore, is to address existing gaps in the literature and offer service contract practitioners a

45 CFR 60.1 - The National Practitioner Data Bank.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false The National Practitioner Data Bank. 60.1 Section 60.1 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS General...

[Antipsychotic prescription assessment in general practice: metabolic effects].

PubMed

Gignoux-Froment, F; de Montleau, F; Saravane, D; Verret, C

2012-12-01

Second-generation antipsychotics have improved living conditions of patients affected by severe mental illness. Some of them can induce weight gain with metabolic complications. Furthermore, they are prescribed to vulnerable patients, with comorbidity and high cardiovascular mortality rate. Prevention of a metabolic syndrome by simple measures improves patient's physical health. General practitioners are privileged partners for psychiatrists. This study was conducted to assess the prevention and management of a metabolic syndrome in patients treated with antipsychotics in general practice. With this in mind, at first we needed to explore how general practitioners prescribe antipsychotics. To assess the general practice, we interviewed 204 general practitioners in the Hauts-de-Seine. Our database was the yellow pages of this area (September 2007). We then conducted a random draw using random digits. We called 507 general practitioners, 410 of whom were sent a questionnaire. We received the return of 204 questionnaires. Each questionnaire consisted of four parts: the general practitioner's profile, psychiatry in his/her practice, the prescription of antipsychotics and the management of metabolic syndromes in patients treated with antipsychotics. The general practitioner's response rate was 49.7%. The results show that although they prescribe antipsychotics, general practitioners need more information on these molecules and on their side effects. Indeed 57% of them feel they are not given enough information on antipsychotics, but 69% have already initiated antipsychotic treatment and 17% do so regularly. Furthermore, a metabolic syndrome is insufficiently detected by general practitioners, although they know of its prevalence after the introduction of antipsychotic treatment. Thus, 81% reported having been confronted with this problem, but only 54% of them calculated the body mass index of patients taking antipsychotics, and 26% measured waist circumference. These results are consistent with studies tracking metabolic syndrome performed in all patients, so, general practitioners do not conduct specific monitoring of patients on antipsychotics. However, they are faced with difficulties related to adherence to treatment because of weight gain. In such cases, 16% of respondents start a new treatment, without a psychiatrist's opinion. These results confirm the results of previous studies on the risks of such prescriptions in general practice, when not supervised. In conclusion, we suggest that information of general practitioners about their role in prevention of metabolic syndromes should be improved, and psychiatrists and general practitioners should be informed on the necessity of joint care of patients affected by severe mental illness. Copyright © 2011 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

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

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 8 2010-10-01 2010-10-01 false The practitioner's duty to clients, generally... Practitioner's Duties and Responsibilities Toward A Client § 1103.15 The practitioner's duty to clients... all clients to observe the statutory law to the best of his knowledge or as interpreted by competent...

Roles, risks, and responsibilities in maternity care: trainees' beliefs and the effects of practice obstetric training.

PubMed Central

Smith, L. F.

1992-01-01

OBJECTIVES--To document the content of practice obstetric vocational training, the beliefs of general practitioner trainees about the roles of midwives and general practitioners in maternity care, and the risks of providing such care; and to ascertain if undergoing such training affects their beliefs. DESIGN--Confidential postal questionnaire survey. SUBJECTS--Random one in four sample of all general practitioner trainees in the United Kingdom on vocational training schemes or in training practices in autumn 1990. MAIN OUTCOME MEASURES--Beliefs scored on seven point Likert scales and characteristics of trainer and training practice. RESULTS--Of 1019 trainees sent questionnaires, 765 (75.1% response rate) replied; 638 (83.3%) had done some part of their practice year. Of their trainers, 224 (35.1%) provided full obstetric care. 749 (99%) and 364 (48%) trainees believed that midwives and general practitioners respectively have an important role in normal labour; 681 (91.7%) trainees believed that general practice intrapartum care is a high risk "specialty." Those trainees whose trainers provide full obstetric care were significantly more likely to believe that both midwives and general practitioners have an important role in abnormal labour and to see the provision of intrapartum care as an incentive to join a practice. CONCLUSION--In this series most general practitioner trainees believed that both midwives and general practitioners have important roles in maternity care. Exposure of trainees to the provision of full obstetric care while in their training practice resulted in a more positive attitude towards the provision of such care by general practitioners. PMID:1628091

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.

Complementary medicine for cancer patients in general practice: qualitative interviews with german general practitioners.

PubMed

Dahlhaus, Anne; Siebenhofer, Andrea; Guethlin, Corina

2015-01-01

The aim of this study was to investigate how general practitioners react when their cancer patients show interest in complementary medicine, and how their reaction is related to their knowledge in the field. We conducted semi-structured interviews with 10 German general practitioners. Interviewees came from 5 different federal states and varied in terms of urban/rural setting, single/joint practice, additional certifications, gender and length of professional experience. Interviews were electronically recorded, transcribed and then analysed using qualitative content analysis according to Mayring. General practitioners feel largely responsible for providing information on complementary medicine to their cancer patients. However, uncertainty and a lack of knowledge concerning CAM lead mainly to reactive responses to patients' needs, and the general practitioners base their recommendations on personal experiences and attitudes. They wish to support their cancer patients and thus, in order to keep their patients' hopes up and maintain a trusting relationship, sometimes support complementary medicine, regardless of their own convictions. Although general practitioners see themselves as an important source of information on complementary medicine for their cancer patients, they also speak of their uncertainties and lack of knowledge. General practitioners would profit from training in complementary medicine enabling them to discuss this topic with their cancer patients in a proactive, open and honest manner. © 2015 S. Karger GmbH, Freiburg

Pathways to Lung Cancer Diagnosis: A Qualitative Study of Patients and General Practitioners about Diagnostic and Pretreatment Intervals.

PubMed

Rankin, Nicole M; York, Sarah; Stone, Emily; Barnes, David; McGregor, Deborah; Lai, Michelle; Shaw, Tim; Butow, Phyllis N

2017-05-01

Pathways to lung cancer diagnosis and treatment are complex. International evidence shows significant variations in pathways. Qualitative research investigating pathways to lung cancer diagnosis rarely considers both patient and general practitioner views simultaneously. To describe the lung cancer diagnostic pathway, focusing on the perspective of patients and general practitioners about diagnostic and pretreatment intervals. This qualitative study of patients with lung cancer and general practitioners in Australia used qualitative interviews or a focus group in which participants responded to a semistructured questionnaire designed to explore experiences of the diagnostic pathway. The Model of Pathways to Treatment (the Model) was used as a framework for analysis, with data organized into (1) events, (2) processes, and (3) contributing factors for variations in diagnostic and pretreatment intervals. Thirty participants (19 patients with lung cancer and 11 general practitioners) took part. Nine themes were identified during analysis. For the diagnostic interval, these were: (1) taking patient concerns seriously, (2) a sense of urgency, (3) advocacy that is doctor-driven or self-motivated, and (4) referral: "knowing who to refer to." For the pretreatment interval, themes were: (5) uncertainty, (6) psychosocial support for the patient and family before treatment, and (7) communication among the multidisciplinary team and general practitioners. Two cross-cutting themes were: (8) coordination of care and "handing over" the patient, and (9) general practitioner knowledge about lung cancer. Events were perceived as complex, with diagnosis often being revealed over time, rather than as a single event. Contributing factors at patient, system, and disease levels are described for both intervals. Patients and general practitioners expressed similar themes across the diagnostic and pretreatment intervals. Significant improvements could be made to health systems to facilitate better patient and general practitioner experiences of the diagnostic pathway. This novel presentation of patient and general practitioner perspectives indicates that systemic interventions have a role in timely and appropriate referrals to specialist care and coordination of investigations. Systemic interventions may alleviate concerns about urgency of diagnostic workup, communication, and coordination of care as patients transition from primary to specialist care.

The effectiveness of Nurse Practitioners working at a GP cooperative: a study protocol

PubMed Central

2012-01-01

Background In many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high) accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting. Design A quasi experimental study is undertaken at one “general practitioner cooperative” to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012. Methods Data will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals) and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes are: patient satisfaction; general practitioners workload; quality and safety of care and barriers and facilitators. Discussion The study will provide evidence whether substitution of care in out-of-hours setting is safe and efficient and give insight into barriers and facilitators related to the introduction of nurse practitioners in out-of-hours setting. Trial registration ClinicalTrials.gov ID NCT01388374 PMID:22870898

The effectiveness of nurse practitioners working at a GP cooperative: a study protocol.

PubMed

Wijers, Nancy; Schoonhoven, Lisette; Giesen, Paul; Vrijhoef, Hubertus; van der Burgt, Regi; Mintjes, Joke; Wensing, Michel; Laurant, Miranda

2012-08-07

In many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high) accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting. A quasi experimental study is undertaken at one "general practitioner cooperative" to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012. Data will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals) and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes are: patient satisfaction; general practitioners workload; quality and safety of care and barriers and facilitators. The study will provide evidence whether substitution of care in out-of-hours setting is safe and efficient and give insight into barriers and facilitators related to the introduction of nurse practitioners in out-of-hours setting. ClinicalTrials.gov ID NCT01388374.

Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

PubMed

van der Plas, Annicka G M; Onwuteaka-Philipsen, Bregje D; Vissers, Kris C; Deliens, Luc; Jansen, Wim J J; Francke, Anneke L

2016-01-01

To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for complex situations. Acceptance of and cooperation with specialist palliative care providers by the general practitioner and community nurse is pivotal. Cross-sectional questionnaire study. Questionnaire data from 168 general practitioners and 125 community nurses were analysed using chi-square tests, univariate and multivariate logistic regression. Data were gathered between March 2011-December 2013. Of general practitioners, 46% rated the case manager as helpful in realizing care that is appropriate for the patient; for community nurses this was 49%. The case manager did not hinder the process of care and had added value for patients, according to the general practitioners and community nurses. The tasks of the case manager were associated with whether or not the case manager was helpful in realizing appropriate care, whereas patient characteristics and the number of contacts with the case manager were not. General practitioners and community nurses are moderately positive about the support from the case manager. To improve cooperation further, case managers should invest in contact with general practitioners and community nurses. © 2015 John Wiley & Sons Ltd.

Importance-performance analysis as a guide for hospitals in improving their provision of services.

PubMed

Whynes, D K; Reed, G

1995-11-01

As a result of the 1990 National Health Services Act, hospitals now compete with one another to win service contracts. A high level of service quality represents an important ingredient of a successful competitive strategy, yet, in general, hospitals have little external information on which to base quality decisions. Specifically, in their efforts to win contracts from fundholding general practitioners, hospitals require information on that which these purchasers deem important with respect to quality, and on how these purchasers assess the quality of their current service performance. The problem is complicated by the fact that hospital service quality, in itself, is multi-dimensional. In other areas of economic activity, the information problem has been resolved by importance-performance analysis and this paper reports the findings of such an analysis conducted for hosptials in the Trent region. The importance and performance service quality ratings of fundholders were obtained from a questionnaire survey and used in a particular variant of importance-performance analysis, which possesses certain advantages over more conventional approaches. In addition to providing empirical data on the determinants of service quality, as perceived by the purchasers of hospital services, this paper demonstrates how such information can be successfully employed in a quality enhancement strategy.

The Role of Labor Unions in Creating Working Conditions That Promote Public Health

PubMed Central

Paras, Claudia Alexandra; Greenwich, Howard; Hagopian, Amy

2016-01-01

We sought to portray how collective bargaining contracts promote public health, beyond their known effect on individual, family, and community well-being. In November 2014, we created an abstraction tool to identify health-related elements in 16 union contracts from industries in the Pacific Northwest. After enumerating the contract-protected benefits and working conditions, we interviewed union organizers and members to learn how these promoted health. Labor union contracts create higher wage and benefit standards, working hours limits, workplace hazards protections, and other factors. Unions also promote well-being by encouraging democratic participation and a sense of community among workers. Labor union contracts are largely underutilized, but a potentially fertile ground for public health innovation. Public health practitioners and labor unions would benefit by partnering to create sophisticated contracts to address social determinants of health. PMID:27077343

Referral patterns to an ophthalmic outpatient clinic by general practitioners and ophthalmic opticians and the role of these professionals in screening for ocular disease.

PubMed

Harrison, R J; Wild, J M; Hobley, A J

1988-11-05

Case notes of 1113 consecutive new patients referred to a consultant ophthalmologist at a district general hospital were reviewed to determine the source and efficacy of referrals and the current screening practices of general practitioners and ophthalmic opticians. General practitioners initiated referral in 546 cases (49%) and ophthalmic opticians referral in 439 (39%). Visual loss or visual disturbance was the most important single reason for referral (345 cases; 31%), followed by suspected glaucoma (145 cases; 13%), abnormalities of binocular vision (140; 12.5%), disorders of eyelids or ocular adnexa (127; 11%), and red eye (86; 8%). General practitioners referred many more patients with disorders of the eyelids and adnexa and ophthalmic opticians many more patients with suspected glaucoma. Ophthalmic opticians were far more likely than general practitioners to refer patients with suspected glaucoma correctly. A total of 180 patients (16%) were referred from ocular screening, in 149 cases by ophthalmic opticians and in 10 by general practitioners. Seventy patients had glaucoma or incomplete features of glaucoma, all of them referred by ophthalmic opticians. Of eight diabetic patients referred by ophthalmic opticians, three had asymptomatic disease and in two diabetes was diagnosed as a result of ocular screening. No patient was referred for asymptomatic diabetic retinopathy from screening by general practitioners. Ophthalmic opticians were more likely than general practitioners to diagnose retinopathy requiring photocoagulation. Use of a community based service to screen for glaucoma could save unnecessary consultant outpatient appointments. A similar service could facilitate detection of diabetic retinopathy at a stage when treatment is most effective.

Referral patterns to an ophthalmic outpatient clinic by general practitioners and ophthalmic opticians and the role of these professionals in screening for ocular disease.

PubMed Central

Harrison, R. J.; Wild, J. M.; Hobley, A. J.

1988-01-01

Case notes of 1113 consecutive new patients referred to a consultant ophthalmologist at a district general hospital were reviewed to determine the source and efficacy of referrals and the current screening practices of general practitioners and ophthalmic opticians. General practitioners initiated referral in 546 cases (49%) and ophthalmic opticians referral in 439 (39%). Visual loss or visual disturbance was the most important single reason for referral (345 cases; 31%), followed by suspected glaucoma (145 cases; 13%), abnormalities of binocular vision (140; 12.5%), disorders of eyelids or ocular adnexa (127; 11%), and red eye (86; 8%). General practitioners referred many more patients with disorders of the eyelids and adnexa and ophthalmic opticians many more patients with suspected glaucoma. Ophthalmic opticians were far more likely than general practitioners to refer patients with suspected glaucoma correctly. A total of 180 patients (16%) were referred from ocular screening, in 149 cases by ophthalmic opticians and in 10 by general practitioners. Seventy patients had glaucoma or incomplete features of glaucoma, all of them referred by ophthalmic opticians. Of eight diabetic patients referred by ophthalmic opticians, three had asymptomatic disease and in two diabetes was diagnosed as a result of ocular screening. No patient was referred for asymptomatic diabetic retinopathy from screening by general practitioners. Ophthalmic opticians were more likely than general practitioners to diagnose retinopathy requiring photocoagulation. Use of a community based service to screen for glaucoma could save unnecessary consultant outpatient appointments. A similar service could facilitate detection of diabetic retinopathy at a stage when treatment is most effective. PMID:3144331

[The image of general practitioners from the perspective of patients with and without a Turkish migration background - a qualitative study].

PubMed

Uslu, S; Natanzon, I; Joos, S

2014-06-01

In order to improve the medical care of people with migration background, the existing specialties in medical understanding must be taken into account. The aim of this study was to explore the image of general practitioners from the viewpoint of patients and to evaluate possible differences in the perception of patients with and without a Turkish migration background. 5 focus groups with participants with and without migration background were assessed in German language. In addition to a predefined interview guideline, the collage technique was used in order to explore the image of the practitioners through pictures. The content analysis was conducted according to Mayring using the software program ATLAS.ti. The patients revealed a highly positive image about the general practitioners. By means of the collage technique some negative aspects could be identified which were not discussed in the focus groups. Only minimal differences in the opinions of participants with and without Turkish migration background could be observed. These were a strongly negative attribution to the general practitioners with regard to financial aspects by the participants without migration background on the one hand and a rather paternalistic viewpoint by the participants with Turkish migration background on the other hand. Asked about an image change of general practitioners, the overall opinion has changed over the years from doctors being considered to be "powerful" and "unapproachable" to a "normal" level. Major reasons for this image change were attributed to the fact that patients are becoming increasingly informed about medical issues through the internet and the high work pressure of general practitioners. The image of general practitioners in Turkey was perceived more negative as compared to Germany. The image of general practitioners from the perspective of patients is predominantly positive. Altogether, only minor differences in the perception of German speaking patients with and without Turkish migration background could be identified. Therefore, specific ways of proceeding or qualification measures for general practitioners do not seem necessary in this context. © Georg Thieme Verlag KG Stuttgart · New York.

Nutrition Counselling Practices among General Practitioners in Croatia.

PubMed

Dumic, Albina; Miskulin, Ivan; Matic Licanin, Matea; Mujkic, Aida; Cacic Kenjeric, Daniela; Miskulin, Maja

2017-12-04

Chronic non-communicable diseases are a significant public health problem and imbalanced nutrition is one of the most significant risk factor for them. The objective of this study was to examine Croatia's general practitioners' nutrition counselling practice and determine the factors that influence such practice. A cross-sectional study was conducted among 444 (17.0%) randomly selected general practitioners (GPs) in Croatia from May to July 2013 via a 32-item anonymous questionnaire. Study showed that 77.0% of participants had provided nutrition counselling exclusively to patients with specific health risks; 18.7% participants had provided nutrition counselling for all patients, regardless of their individual risks, while 4.3% had not provide nutrition counselling. As the most significant stimulating factor for implementing nutrition counselling in their daily work with patients, 55.6% of the participants identified personal interest regarding nutrition and the effects it has on health. The latter factor was more frequently emphasized among female general practitioners ( p < 0.001) and general practitioners without chronic diseases ( p < 0.001). The most significant barrier for nutrition counselling was lack of time (81.6%). It is necessary to make additional efforts to increase the frequency of nutrition counselling provided by general practitioners in Croatia. The majority of Croatian general practitioners could increase their nutrition counselling practice in order to promote balanced nutrition and improve the overall health status of their patients.

Process-related factors associated with disciplinary board decisions

PubMed Central

2013-01-01

Background In most health care systems disciplinary boards have been organised in order to process patients’ complaints about health professionals. Although, the safe-guarding of the legal rights of the involved parties is a crucial concern, there is limited knowledge about what role the complaint process plays with regard to board decision outcomes. Using complaint cases towards general practitioners, the aim of this study was to identify what process factors are statistically associated with disciplinary actions as seen from the party of the complainant and the defendant general practitioner, respectively. Methods Danish Patient Complaints Board decisions concerning general practitioners completed in 2007 were examined. Information on process factors was extracted from the case files and included complaint delay, complainant’s lawyer involvement, the number of general practitioners involved, event duration, expert witness involvement, case management duration and decision outcome (discipline or no discipline). Multiple logistic regression analyses were performed on compound case decisions eventually involving more general practitioners (as seen from the complainant’s side) and on separated decisions (as seen from the defendant general practitioner’s side). Results From the general practitioner’s side, when the number of general practitioners involved in a complaint case increased, odds of being disciplined significantly decreased (OR=0.661 per additional general practitioner involved, p<0.001). Contrarily, from the complainant’s side, no association could be detected between complaining against a plurality of general practitioners and the odds of at least one general practitioner being disciplined. From both sides, longer case management duration was associated with higher odds of discipline (OR=1.038 per additional month, p=0.010). No association could be demonstrated with regard to complaint delay, lawyer involvement, event duration, or expert witness involvement. There was lawyer involvement in 5% of cases and expert witness involvement in 92% of cases. The mean complaint delay was 3 months and 18 days and the mean case management duration was 14 months and 7 days. Conclusions Certain complaint process factors might be statistically associated with decision outcomes. However, the impact diverges as seen from the different parties. Future studies are merited in order to uncover the judicial mechanisms lying behind. PMID:23294599

Private or salaried practice: how do young general practitioners make their career choice? A qualitative study.

PubMed

Kinouani, Shérazade; Boukhors, Gary; Luaces, Baptiste; Durieux, William; Cadwallader, Jean-Sébastien; Aubin-Auger, Isabelle; Gay, Bernard

2016-09-01

Young French postgraduates in general practice increasingly prefer salaried practice to private practice in spite of the financial incentives offered by the French government or local communities to encourage the latter. This study aimed to explore the determinants of choice between private or salaried practice among young general practitioners. A qualitative study was conducted in the South West of France. Semi-structured interviews of young general practitioners were audio-recorded until data saturation. Recordings were transcribed and then analyzed according to Grounded Theory by three researchers working independently. Sixteen general practitioners participated in this study. For salaried and private doctors, the main factors governing their choice were occupational factors: working conditions, need of varied scope of practice, quality of the doctor-patient relationship or career flexibility. Other factors such as postgraduate training, having worked as a locum or self-interest were also determining. Young general practitioners all expected a work-life balance. The fee-for-service scheme or home visits may have discouraged young general practitioners from choosing private practice. National health policies should increase the attractiveness of ambulatory general practice by promoting the diversification of modes of remuneration and encouraging the organization of group exercises in multidisciplinary medical homes and community health centers.

Characteristics of complaints resulting in disciplinary actions against Danish GPs.

PubMed

Birkeland, Søren; Depont Christensen, Rene; Damsbo, Niels; Kragstrup, Jakob

2013-09-01

The risk of being disciplined in connection with a complaint case causes distress to most general practitioners. The present study examined the characteristics of complaint cases resulting in disciplinary action. The Danish Patients' Complaints Board's decisions concerning general practice in 2007 were examined. Information on the motives for complaining, as well as patient and general practitioner characteristics, was extracted and the association with case outcome (disciplinary or no disciplinary action) was analysed. Variables included complaint motives, patient gender and age, urgency of illness, cancer diagnosis, healthcare settings (daytime or out-of-hours services), and general practitioner gender and professional seniority. Cases where the complaint motives involved a wish for placement of responsibility (OR = 2.35, p = 0.01) or a wish for a review of the general practitioner's competence (OR = 1.95, p = 0.02) were associated with increased odds of the general practitioner being disciplined. The odds of discipline decreased when the complaint was motivated by a feeling of being devalued (OR = 0.39, p = 0.02) or a request for an explanation (OR = 0.46, p = 0.01). With regard to patient and general practitioner characteristics, higher general practitioner professional seniority was associated with increased odds of discipline (OR = 1.97 per 20 additional years of professional seniority, p = 0.01). None of the other characteristics was statistically significantly associated with discipline in the multiple logistic regression model. Complaint motives and professional seniority were associated with decision outcomes. Further research is needed on the impact of professional seniority on performance.

When the group practice breaks up: a qualitative study

PubMed Central

2013-01-01

Background Group practices are increasingly common for primary care physicians worldwide. Although breakups are likely to happen frequently within group practices, their process has not been studied to date. The aims of this study were therefore to explore the reasons for breakups of group practices of general practitioners and to describe the associated feelings. Methods We conducted a qualitative study consisting of in-depth interviews of 21 general practitioners and one secretary from past group practices in the Rhône-Alpes region, France, who experienced a breakup. Results When getting started in group practice for the first time, young doctors did not feel ready and supported, and did not necessarily share the same expectations as their partners. The reasons for the breakups involved imbalances within the groups, contrasting working and management styles, and breakdowns in communication. The breakup process often generated long-persistent feelings of suffering and failure for almost every partner who experienced a breakup, particularly for the partner who was leaving. Conclusions Weakening factors exist from the very beginning of a partnership, and problems are likely to increase at every change or event occurring in the group. We provide several recommendations, including fair management, a shared project based on a precise contract, the consultation of third parties as necessary and, in the worst case scenario, leaving the group practice in time. PMID:23642277

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

PubMed

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

2006-09-13

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

Advising vaccinations for the elderly: a cross-sectional survey on differences between general practitioners and physician assistants in Germany.

PubMed

Klett-Tammen, Carolina Judith; Krause, Gérard; von Lengerke, Thomas; Castell, Stefanie

2016-07-29

In Germany, the coverage of officially recommended vaccinations for the elderly is below a desirable level. It is known that advice provided by General Practitioners and Physician Assistants influences the uptake in patients ≥60 years. Therefore, the predictors of advice-giving behavior by these professions should be investigated to develop recommendations for possible actions for improvement. We conducted a postal cross-sectional survey on knowledge, attitudes and advice - giving behavior regarding vaccinations in the elderly among General Practitioners and Physician Assistants in 4995 practices in Germany. To find specific predictors, we performed logistic regressions with non-advising on any officially recommended vaccination or on three specific vaccinations as four separate outcomes, first using all participants, then only General Practitioners and lastly only Physician Assistants as our study population. Participants consisted of 774 General Practitioners and 563 Physician Assistants, of whom overall 21 % stated to have not advised an officially recommended vaccination in elderly patients. The most frequent explanation was having forgotten about it. The habit of not counselling on vaccinations at regular intervals was associated with not advising any vaccination (OR: 2.8), influenza vaccination (OR: 2.3), and pneumococcal vaccination (OR: 3.1). While more General Practitioners than Physician Assistants felt sufficiently informed (90 % vs. 79 %, p < 0.001), General Practitioners displayed higher odds to not advise specific vaccinations (ORs: 1.8-2.8). To reduce the high risk of forgetting to advice on vaccinations, we recommend improving and promoting standing recall-systems, encouraging General Practitioners and Physician Assistants to counsel routinely at regular intervals regarding vaccinations, and providing Physician Assistants with better, tailor-made information on official recommendations and their changes.

Who joins the network? Physicians' resistance to take budgetary co-responsibility.

PubMed

Rischatsch, Maurus

2015-03-01

Managed Care (MC) is expected to provide health care at a lower cost than conventional provision. Therefore, Switzerland intends to promote MC by forcing health insurers to write MC contracts and introducing budgetary co-responsibility for ambulatory care physicians. A discrete choice experiment conducted in 2011 including 872 physicians reveals a strong preference heterogeneity with respect to network participation and alternative remuneration schemes. The number of physicians working in networks is unlikely to rise on a voluntary basis, while general practitioners are more likely to join networks than specialists with surgical activities. For physicians considering joining networks, cost savings are predicted to be higher than the estimated willingness-to-accept payments. Copyright © 2014 Elsevier B.V. All rights reserved.

Patients' and carers' perspectives of palliative care in general practice: A systematic review with narrative synthesis.

PubMed

Green, Emilie; Knight, Selena; Gott, Merryn; Barclay, Stephen; White, Patrick

2018-04-01

General practitioners have overall responsibility for community care, including towards end of life. Current policy places generalists at the centre of palliative care provision. However, little is known about how patients and carers understand the general practitioner's role. To explore patient and carer perspectives of (1) the role of the general practitioner in providing palliative care to adult patients and (2) the facilitators and barriers to the general practitioner's capacity to fulfil this perceived role. Systematic literature review and narrative synthesis. Seven electronic databases (MEDLINE, Embase, PsycINFO, BNI, CINAHL, Cochrane and HMIC) were searched from inception to May 2017. Two reviewers independently screened papers at title, abstract and full-text stages. Grey literature, guideline, hand searches of five journals and reference list/citation searches of included papers were undertaken. Data were extracted, tabulated and synthesised using narrative, thematic analysis. A total of 25 studies were included: 14 employed qualitative methods, 8 quantitative survey methods and 3 mixed-methods. Five key themes were identified: continuity of care, communication between primary and secondary care, contact and accessibility, communication between general practitioner and patient, and knowledge and competence. Although the terminology and context of general practice vary internationally, themes relating to the perceived role of general practitioners were consistent. General practitioners are considered well placed to provide palliative care due to their breadth of clinical responsibility, ongoing relationships with patients and families, and duty to visit patients at home and coordinate healthcare resources. These factors, valued by service users, should influence future practice and policy development.

Use of the consultation satisfaction questionnaire to examine patients' satisfaction with general practitioners and community nurses: reliability, replicability and discriminant validity.

PubMed Central

Poulton, B C

1996-01-01

BACKGROUND: Primary health care services are the most frequently used in the health care system. Consumer feedback on these services is important. Research in this area relates mainly to doctor-patient relationships which fails to reflect the multidisciplinary nature of primary health care. AIM: A pilot study aimed to examine the feasibility of using a patient satisfaction questionnaire designed for use with general practitioner consultations as an instrument for measuring patient satisfaction with community nurses. METHOD: The questionnaire measuring patient satisfaction with general practitioner consultations was adapted for measuring satisfaction with contacts with a nurse practitioner, district nurses, practice nurses and health visitors. A total of 1575 patients in three practices consulting general practitioners or community nurses were invited to complete a questionnaire. Data were subjected to principal components analysis and the dimensions identified were tested for internal reliability and replicability. To establish discriminant validity, patients' mean satisfaction scores for consultations with general practitioners, the nurse practitioner, health visitors and nurses (district and practice nurses) were compared. RESULTS: Questionnaires were returned relating to 400 general practitioner, 54 nurse practitioner, 191 district/practice nurse and 83 health visitor consultations (overall response rate 46%). Principal components analysis demonstrated a factor structure similar to that found in an earlier study of the consultation satisfaction questionnaire. Three dimensions of patient satisfaction were identified: professional care, depth of relationship and perceived time spent with the health professional. The dimensions were found to have acceptable levels of reliability. Factor structures obtained from data relating to general practitioner and community nurse consultations were found to correlate significantly. Comparison between health professionals showed that patients rated satisfaction with professional care significantly more highly for nurses than for general practitioners and health visitors. Patients' rating of satisfaction with the depth of relationships with health visitors was significantly lower than their ratings of this relationship with the other groups of health professionals. There were so significant differences between health professional groups regarding patients' ratings of satisfaction with the perceived amount of time spent with health professionals. CONCLUSION: The pilot study showed that it is possible to use the consultation satisfaction questionnaire for both general practitioners and community nurses. Comparison between health professional groups should be undertaken with caution as data were available for only a small number of consultations with some of the groups of health professionals studied. PMID:8745848

Legal issues of the electronic dental record: security and confidentiality.

PubMed

Szekely, D G; Milam, S; Khademi, J A

1996-01-01

Computer-based, electronic dental record keeping involves complex issues of patient privacy and the dental practitioner's ethical duty of confidentiality. Federal and state law is responding to the new legal issues presented by computer technology. Authenticating the electronic record in terms of ensuring its reliability and accuracy is essential in order to protect its admissibility as evidence in legal actions. Security systems must be carefully planned to limit access and provide for back-up and storage of dental records. Carefully planned security systems protect the patient from disclosure without the patient's consent and also protect the practitioner from the liability that would arise from such disclosure. Human errors account for the majority of data security problems. Personnel security is assured through pre-employment screening, employment contracts, policies, and staff education. Contracts for health information systems should include provisions for indemnification and ensure the confidentiality of the system by the vendor.

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

PubMed Central

2013-01-01

Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. Methods The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. Results One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. Conclusion General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this study suggest that the development of conversational models for general practitioners including points to be aware of in the treatment of refugee patients may serve as a support in the management of refugee patients in primary care. PMID:23356401

Content Development for 72,000 Learners: An Online Learning Environment for General Practitioners: A Case Study

ERIC Educational Resources Information Center

Pilat, Dirk

2016-01-01

Increasing workload due to reduced numbers of general practitioners, a population boom and an aging population has increased the need for accessible distance learning for the UK's primary care doctors. The Royal College of General Practitioners is now in its eighth year of delivering high quality e-learning to 72,000 registered users via its…

Role of the General Practitioner in the Care of Patients Recently Discharged From the Hospital After a First Psychotic Episode: Influence of Length of Stay

PubMed Central

Rivoiron-Besset, Emmanuelle; David, Michel; Jaussent, Isabelle; Prudhomme, Cindy; Boulenger, Jean-Philippe; Mann, Anthony H.; Ritchie, Karen A.; Capdevielle, Delphine

2011-01-01

Objective: It is unclear to what extent general practitioners are involved in the postdischarge care of patients hospitalized for a first psychotic episode and whether this involvement is influenced by length of stay in the hospital. The objectives of this study were to describe the role of the general practitioner in providing postdischarge care to patients with first-episode psychosis in terms of frequency and type of consultation and the extent of collaboration with hospital-based specialist services and to determine whether decreasing length of stay was accompanied by a modification in this role. Method: Six months after hospital discharge, a postal questionnaire was sent to the general practitioners of patients recruited to the French STEP cohort (Schizophrenie et son Traitement: une Evaluation de la Prize en charge), a prospective study of the clinical and social determinants of care pathways and prognosis for patients hospitalized for a first psychotic episode (DSM-IV criteria) in 5 services of the La Colombière Psychiatric Hospital, Montpellier, France. Length of stay in the hospital was dichotomized according to the median value of 35 days. Data collection took place from February 2008 to March 2009. Results: Of the 121 STEP patients, 65% (n=79) had a regular general practitioner. The general practitioners had been informed by the hospital of the admission of their patient in only 17.9% (7/39) of cases. Of the general practitioners, 78.3% (47/60) had seen the patient at least once since discharge, with a median number of visits standardized over 6 months of 0.86 (range, 0–8.6). General practitioners were better informed with regard to diagnosis, date of discharge, name of psychiatrist, treatment, and community follow-up at discharge for patients with a short length of stay in the hospital, who were also more likely than those with a long length of stay to be consulting for mental health problems. Conclusions: Our findings suggest a low level of implication of general practitioners in providing postdischarge care to first-episode psychotic patients, irrespective of their length of hospital stay. Yet, the general practitioner has a role to play in coordinating and providing care for somatic health problems as well as psychiatric symptoms, specifically in the case of early discharge. PMID:22295272

Primary care perceptions of neurology and neurology services.

PubMed

Loftus, Angela M; Wade, Carrie; McCarron, Mark O

2016-06-01

Neurophobia (fear of neural sciences) and evaluation of independent sector contracts in neurology have seldom been examined among general practitioners (GPs). A questionnaire determined GPs' perceptions of neurology compared with other medical specialties. GP experiences of neurology services with independent sector companies and the local National Health Service (NHS) were compared. Areas of potential improvement in NHS neurology services were recorded from thematic analyses. Among 76 GPs neurology was perceived to be as interesting as other medical specialties. GPs reported less knowledge, more difficulty and less confidence in neurology compared with other medical specialties. There was a preference for a local NHS neurology service (p<0.001), which was easier to contact (p<0.001) and provided better follow-up. GPs reported that local neurology services provided better patient satisfaction. GPs prefer local NHS neurology services to independent sector contracts. GPs' evaluations should inform commissioning of neurology services. Combating neurophobia should be an integral part of responsive commissioning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

WestREN: a description of an Irish academic general practice research network

PubMed Central

2010-01-01

Background Primary care research networks have been established internationally since the 1960s to enable diverse practitioners to engage in and develop research and education and implement research evidence. The newly established Western Research and Education Network (WestREN) is one such network consisting of a collaboration between the Discipline of General Practice at NUI Galway and 71 West of Ireland general practices. In September 2009 all member practices were issued with a questionnaire with two objectives: to describe the structure and characteristics of the member practices and to compare the results to the national profile of Irish general practice. Methods A postal survey was used followed by one written and one email reminder. Results A response rate of 73% (52/71) was achieved after two reminders. Half of practices were in a rural location, one quarter located in an urban setting and another quarter in a mixed location. Ninety-four per cent of general practitioners practice from purpose-built or adapted premises with under 6% of practices being attached to the general practitioner's residence. Over 96% of general practitioners use appointment systems with 58% using appointment only. All practices surveyed were computerised, with 80% describing their practices as 'fully computerised'. Almost 60% of general practitioners are coding chronic diagnoses with 20% coding individual consultations. Twenty-five per cent of general practitioners were single-handed with the majority of practices having at least two general practitioners, and a mean number of general practitioners of 2.4. Ninety-two per cent of practices employed a practice nurse with 30% employing more than one nurse. Compared to the national profile, WestREN practices appear somewhat larger, and more likely to be purpose-built and in rural areas. National trends apparent between 1982 and 1992, such as increasing computerisation and practice nurse availability, appear to be continuing. Conclusions WestREN is a new university-affiliated general practice research network in Ireland. Survey of its initial membership confirms WestREN practices to be broadly representative of the national profile and has provided us with valuable information on the current and changing structure of Irish general practice. PMID:20925958

Private dentists assess treatment required as more extensive, demanding and costly, than public sector dentists.

PubMed

Tuominen, Risto; Eriksson, Anna-Leena; Vahlberg, Tero

2012-08-01

The aim was to evaluate whether contracted private practitioners assess required treatment more extensive, demanding and economically more rewarding than mainly salaried public sector dentists and to estimate the cost consequences of using these alternative providers. All dental services included in comprehensive treatments funded by the city of Turku and provided to adult patients during the year 2009 were recorded. Patients were distributed randomly without any determination of treatment needs before appointing them to different dentists. Treatment courses for 7432 patients in public clinics included 63 906 procedures and for 2932 patients assigned to treatment by contracted private practitioners included 21 194 procedures. Public sector dentists were mainly salaried with production incentives, and private practitioners worked purely on a fee-for-service basis. The cost estimates were based on the distributions of competence classifications recorded by the providers, which also formed the basis for reimbursement. For each studied treatment category with more than one competence classification, private contractors were less likely than their public sector counterparts to give an assessment of simple or less demanding: 8% versus 29% of examinations, 46% versus 69% of periodontal treatments, 63% versus 85% of extractions, 31% versus 46% of fillings, 18% versus 35% of root canals. The excess cost to society varied from 7.0% for root canal treatments to 21.3% for extractions, causing on average 14.4% higher cost level from use of private practitioners compared with public sector dentists. Private practitioners systematically classified the treatment procedures they provided as more demanding, and therefore more economically rewarding, than their public sector counterparts. The findings indicate that the costs of publicly funded dental care may be increased by the use of private dental contractors. © 2012 John Wiley & Sons A/S.

The importance of social support for people with type 2 diabetes - a qualitative study with general practitioners, practice nurses and patients.

PubMed

Goetz, Katja; Szecsenyi, Joachim; Campbell, Stephen; Rosemann, Thomas; Rueter, Gernot; Raum, Elke; Brenner, Herrmann; Miksch, Antje

2012-01-01

Social support is an important element of family medicine within a primary care setting, delivered by general practitioners and practice nurses in addition to usual clinical care. The aim of the study was to explore general practitioner's, practice nurse's and people with type 2 diabetes' views, experiences and perspectives of the importance of social support in caring for people with type 2 diabetes and their role in providing social support. Interviews with general practitioners (n=10) and focus groups with practice nurses (n=10) and people with diabetes (n=9). All data were audio-recorded, fully transcribed and thematically analysed using qualitative content analysis by Mayring. All participants emphasized the importance of the concept of social support and its impacts on well-being of people with type 2 diabetes. Social support is perceived helpful for people with diabetes in order to improve diabetes control and give support for changes in lifestyle habits (physical activity and dietary changes). General practitioners identified a lack of information about facilities in the community like sports or self-help groups. Practice nurses emphasized that they need more training, such as in dietary counselling. Social support given by general practitioners and practice nurses plays a crucial role for people with type 2 diabetes and is an additional component of social care. However there is a need for an increased awareness by general practitioners and practice nurses about the influence social support could have on the individual's diabetes management.

High spatial resolution pressure distribution of the vaginal canal in Pompoir practitioners: A biomechanical approach for assessing the pelvic floor.

PubMed

Cacciari, Licia P; Pássaro, Anice C; Amorim, Amanda C; Sacco, Isabel C N

2017-08-01

Pompoir is a technique poorly studied in the literature that claims to improve pelvic floor strength and coordination. This study aims to investigate the pelvic floor muscles' coordination throughout the vaginal canal among Pompoir practitioners and non-practitioners by describing a high resolution map of pressure distribution. This cross-sectional, study included 40 healthy women in two groups: control and Pompoir. While these women performed both sustained and "waveform" pelvic floor muscle contractions, the spatiotemporal pressure distribution in their vaginal canals was evaluated by a non-deformable probe fully instrumented with a 10×10 matrix of capacitive transducers. Pompoir group was able to sustain the pressure levels achieved for a longer period (40% longer, moderate effect, P=0.04). During the "waveform" contraction task, Pompoir group achieved lower, earlier peak pressures (moderate effect, P=0.05) and decreased rates of contraction (small effect, P=0.04) and relaxation (large effect, P=0.01). During both tasks, Pompoir group had smaller relative contributions by the mid-region and the anteroposterior planes and greater contributions by the caudal and cranial regions and the latero-lateral planes. Results suggest that specific coordination training of the pelvic floor muscles alters the pressure distribution profile, promoting a more-symmetric distribution of pressure throughout the vaginal canal. Therefore, this study suggests that pelvic floor muscles can be trained to a degree beyond strengthening by focusing on coordination, which results in changes in symmetry of the spatiotemporal pressure distribution in the vaginal canal. Copyright © 2017 Elsevier Ltd. All rights reserved.

[General practitioners, community physicians and hospital physicians--how different are they?].

PubMed

Førde, R; Aasland, O G; Akre, V

1996-09-30

In 1993, 9,226 practising physicians in Norway received extensive questionnaires about their health, working and living conditions. In this article we compare municipality employed community physicians (n = 972), general practitioners in private practice (n = 869), and hospital physicians (n = 3,160) with regard to demographic variables and their experience of stress, professional autonomy and job satisfaction. General practitioners report higher job satisfaction and more autonomy than community and hospital physicians, whereas community physicians seem to have a somewhat higher stress level than the two other categories. The experience of general well being, however, is the same in the three groups. General practitioners also spend more time with patients, and are much more satisfied with their income.

Professional attitudes to patient participation groups: an exploratory study

PubMed Central

Wood, J.; Metcalfe, D. H. H.

1980-01-01

An exploratory study of the development of patient participation groups in general practice and general practitioners' attitudes towards them suggests that many general practitioners may not yet be aware of this innovation and may at first react negatively to the idea. This response stems in part from misconceptions about the origins and functions of these groups, a failure to see their relevance to professional objectives, and a fear that they will threaten general practitioners' autonomy and status. In contrast, general practitioners who have formed groups believe they have an important contribution to make to their developing role and have been encouraged by their experience so far. Therefore, at present, patient participation groups should neither be rejected out of hand, nor welcomed as a panacea. PMID:7452590

Referrals from general practitioners to a social services department

PubMed Central

Sheppard, M. G.

1983-01-01

One year's referrals from general practitioners to a social services department were studied. There was a low referral rate and a bias towards women, the elderly and the less affluent. The referrals were predominantly made for practical help with problems of ill health. A high proportion of clients were allocated to non-social work staff, and the social service intervention, generally of short duration, showed a sympathetic response to the practical requests of general practitioners. The limited use of social workers by doctors is considered to be the result of ignorance or scepticism about psychodynamic social work skills. Closer liaison between general practitioners and social workers, and a clearer presentation by social workers of their professional skills, are suggested solutions to this problem. PMID:6854536

A survey of general practitioners' views on autopsy reports.

PubMed Central

Karunaratne, S; Benbow, E W

1997-01-01

AIMS: To study the views of general practitioners on the quality and utility of autopsy reports, and on autopsies in general. METHODS: For a period of six months, a questionnaire was enclosed with each autopsy report sent to a general practitioner from the mortuary at Manchester Royal Infirmary. RESULTS: Most (93.3%) general practitioners found the autopsy report useful, and many (66.7%) thought the bereaved relatives would do so too. However, only a minority (25.2%) would discuss the report with the relatives. A considerable proportion (20.0%) found the cause of death surprising, and a significant number (10.4%) felt the report would modify their future clinical practice. There was approval of autopsies in general, with most (88.6%) agreeing that autopsies reveal lesions not detected in life, and many (74.4%) indicating that loss of the autopsy would impair severely the monitoring of clinical standards. CONCLUSIONS: General practitioners appreciate autopsy reports, which may have a significant impact on clinical practice. Autopsy reports provide both case audit and information for relatives. PMID:9306932

The procurement of NHS dental services--a guide.

PubMed

Jones, C L; Rooney, E

2009-05-23

This paper gives an overview of the strategic background for procurement of NHS primary care dental services and an outline of the processes involved in procurement. The main aim is to bring procurement to the attention of a wider audience of dental practitioners and provide advice for potential primary care dental service providers. The move towards local procurement of healthcare services, including primary care dental services, has been shaped by a number of strategic Government publications and is supported by law. In line with other public bodies, the NHS is subject to the European Union and international rules regarding procurement and awarding contracts. Primary Care Trust (PCT) Dental Service Commissioners have to ensure that their procurement strategy is transparent and non-discriminatory so that all providers have an equal opportunity to compete for contracts. In order to successfully tender for future service provision contracts, dental practitioners not only need to be aware of the process of procurement and its associated legal requirements. It is also important that they have a grasp of the expectations of PCTs. Commissioning services via procurement is set to become more commonplace and it is likely, in time, that competition for some contracts will increase in intensity. The importance of researching proposals thoroughly and adopting a professional, businesslike approach to tendering cannot be understated as this maximises chance of success in the new commissioning environment.

Characteristics of complaints resulting in disciplinary actions against Danish GPs

PubMed Central

2013-01-01

Abstract Objective The risk of being disciplined in connection with a complaint case causes distress to most general practitioners. The present study examined the characteristics of complaint cases resulting in disciplinary action. Material and methods The Danish Patients’ Complaints Board's decisions concerning general practice in 2007 were examined. Information on the motives for complaining, as well as patient and general practitioner characteristics, was extracted and the association with case outcome (disciplinary or no disciplinary action) was analysed. Variables included complaint motives, patient gender and age, urgency of illness, cancer diagnosis, healthcare settings (daytime or out-of-hours services), and general practitioner gender and professional seniority. Results Cases where the complaint motives involved a wish for placement of responsibility (OR = 2.35, p = 0.01) or a wish for a review of the general practitioner's competence (OR = 1.95, p = 0.02) were associated with increased odds of the general practitioner being disciplined. The odds of discipline decreased when the complaint was motivated by a feeling of being devalued (OR = 0.39, p = 0.02) or a request for an explanation (OR = 0.46, p = 0.01). With regard to patient and general practitioner characteristics, higher general practitioner professional seniority was associated with increased odds of discipline (OR = 1.97 per 20 additional years of professional seniority, p = 0.01). None of the other characteristics was statistically significantly associated with discipline in the multiple logistic regression model. Conclusion Complaint motives and professional seniority were associated with decision outcomes. Further research is needed on the impact of professional seniority on performance. PMID:23906082

Associations between degrees of task delegation and job satisfaction of general practitioners and their staff: a cross-sectional study.

PubMed

Riisgaard, Helle; Søndergaard, Jens; Munch, Maria; Le, Jette V; Ledderer, Loni; Pedersen, Line B; Nexøe, Jørgen

2017-01-17

In recent years, the healthcare system in the western world has undergone a structural development caused by changes in demography and pattern of disease. In order to maintain the healthcare system cost-effective, new tasks are placed in general practice urging the general practitioners to rethink the working structure without compromising the quality of care. However, there is a substantial variation in the degree to which general practitioners delegate tasks to their staff, and it is not known how these various degrees of task delegation influence the job satisfaction of general practitioners and their staff. We performed a cross-sectional study based on two electronic questionnaires, one for general practitioners and one for their staff. Both questionnaires were divided into two parts, a part exploring the degree of task delegation regarding management of patients with chronic obstructive pulmonary disease in general practice and a part concerning the general job satisfaction and motivation to work. We found a significant association between perceived "maximal degree" of task delegation in management of patients with chronic obstructive pulmonary disease and the staff's overall job satisfaction. The odds ratio of the staff's satisfaction with the working environment displayed a tendency that there is also an association with "maximal degree" of task delegation. In the analysis of the general practitioners, the odds ratios of the results indicate that there is a tendency that "maximal degree" of task delegation is associated with overall job satisfaction, satisfaction with the challenges in work, and satisfaction with the working environment. We conclude that a high degree of task delegation is significantly associated with overall job satisfaction of the staff, and that there is a tendency that a high degree of task delegation is associated with the general practitioners' and the staff's satisfaction with the working environment as well as with general practitioners' overall job satisfaction and satisfaction with challenges in work. To qualify future delegation processes within general practice, further research could explore the reasons for our findings.

The limits of market-based reforms in the NHS: the case of alternative providers in primary care.

PubMed

Coleman, Anna; Checkland, Kath; McDermott, Imelda; Harrison, Stephen

2013-01-01

Historically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as 'Alternative Provider Medical Services', were encouraged by two centrally-driven rounds of procurement (2007/8 and 2008/9). This research investigated the commissioning and operation of such Alternative Providers of Primary Care (APPCs). Two qualitative case studies were undertaken in purposively sampled English Primary Care Trusts (PCTs) and their associated APPCs over 14 months (2009-10). We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation. We found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was 'transactional', in marked contrast to the 'relational' contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services. The Coalition Government elected in 2010 is committed to 'Any Qualified Provider' of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market in primary care provision, including the trade-offs between transparent processes, fair procurement, performance assurance and cost.

The limits of market-based reforms in the NHS: the case of alternative providers in primary care

PubMed Central

2013-01-01

Background Historically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as ‘Alternative Provider Medical Services’, were encouraged by two centrally-driven rounds of procurement (2007/8 and 2008/9). This research investigated the commissioning and operation of such Alternative Providers of Primary Care (APPCs). Methods Two qualitative case studies were undertaken in purposively sampled English Primary Care Trusts (PCTs) and their associated APPCs over 14 months (2009-10). We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation. Results and conclusions We found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was ‘transactional’, in marked contrast to the ‘relational’ contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services. The Coalition Government elected in 2010 is committed to ‘Any Qualified Provider’ of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market in primary care provision, including the trade-offs between transparent processes, fair procurement, performance assurance and cost. PMID:23735051

Accessing remote data bases using microcomputers

PubMed Central

Saul, Peter D.

1985-01-01

General practitioners' access to remote data bases using microcomputers is increasing, making even the most obscure information readily available. Some of the systems available to general practitioners in the UK are described and the methods of access are outlined. General practitioners should be aware of the advances in technology; data bases are increasing in size, the cost of access is falling and their use is becoming easier. PMID:4020756

42 CFR 440.166 - Nurse practitioner services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Nurse practitioner services. 440.166 Section 440... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.166 Nurse practitioner services. (a) Definition of nurse practitioner services. Nurse practitioner services means services that...

42 CFR 440.166 - Nurse practitioner services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Nurse practitioner services. 440.166 Section 440... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.166 Nurse practitioner services. (a) Definition of nurse practitioner services. Nurse practitioner services means services that...

General dental practitioner's views on dental general anaesthesia services.

PubMed

Threlfall, A G; King, D; Milsom, K M; Blinkhom, A S; Tickle, M

2007-06-01

Policy has recently changed on provision of dental general anaesthetic services in England. The aim of this study was to investigate general dental practitioners' views about dental general anaesthetics, the reduction in its availability and the impact on care of children with toothache. Qualitative study using semi-structured interviews and clinical case scenarios. General dental practitioners providing NHS services in the North West of England. 93 general dental practitioners were interviewed and 91 answered a clinical case scenario about the care they would provide for a 7-year-old child with multiple decayed teeth presenting with toothache. Scenario responses showed variation; 8% would immediately refer for general anaesthesia, 25% would initially prescribe antibiotics, but the majority would attempt to either restore or extract the tooth causing pain. Interview responses also demonstrated variation in care, however most dentists agree general anaesthesia has a role for nervous children but only refer as a last resort. The responses indicated an increase in inequalities, and that access to services did not match population needs, leaving some children waiting in pain. Most general dental practitioners support moving dental general anaesthesia into hospitals but some believe that it has widened health inequalities and there is also a problem associated with variation in treatment provision. Additional general anaesthetic services in some areas with high levels of tooth decay are needed and evidence based guidelines about caring for children with toothache are required.

Ethnic Disparities in Diabetes Management and Pay-for-Performance in the UK: The Wandsworth Prospective Diabetes Study

PubMed Central

Millett, Christopher; Gray, Jeremy; Saxena, Sonia; Netuveli, Gopalakrishnan; Khunti, Kamlesh; Majeed, Azeem

2007-01-01

Background Pay-for-performance rewards health-care providers by paying them more if they succeed in meeting performance targets. A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay-for-performance seen in any health-care system. The contract provides an important opportunity to address disparities in chronic disease management between ethnic and socioeconomic groups. We examined disparities in management of people with diabetes and intermediate clinical outcomes within a multiethnic population in primary care before and after the introduction of the new contract in April 2004. Methods and Findings We conducted a population-based longitudinal survey, using electronic general practice records, in an ethnically diverse part of southwest London. Outcome measures were prescribing levels and achievement of national treatment targets (HbA1c ≤ 7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol ≤ 5 mmol/l or 193 mg/dl). The proportion of patients reaching treatment targets for HbA1c, BP, and total cholesterol increased significantly after the implementation of the new contract. The extents of these increases were broadly uniform across ethnic groups, with the exception of the black Caribbean patient group, which had a significantly lower improvement in HbA1c (adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.57–0.97) and BP control (AOR 0.65, 95% CI 0.53–0.81) relative to the white British patient group. Variations in prescribing and achievement of treatment targets between ethnic groups present in 2003 were not attenuated in 2005. Conclusions Pay-for-performance incentives have not addressed disparities in the management and control of diabetes between ethnic groups. Quality improvement initiatives must place greater emphasis on minority communities to avoid continued disparities in mortality from cardiovascular disease and the other major complications of diabetes. PMID:17564486

Ethnic disparities in diabetes management and pay-for-performance in the UK: the Wandsworth Prospective Diabetes Study.

PubMed

Millett, Christopher; Gray, Jeremy; Saxena, Sonia; Netuveli, Gopalakrishnan; Khunti, Kamlesh; Majeed, Azeem

2007-06-01

Pay-for-performance rewards health-care providers by paying them more if they succeed in meeting performance targets. A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay-for-performance seen in any health-care system. The contract provides an important opportunity to address disparities in chronic disease management between ethnic and socioeconomic groups. We examined disparities in management of people with diabetes and intermediate clinical outcomes within a multiethnic population in primary care before and after the introduction of the new contract in April 2004. We conducted a population-based longitudinal survey, using electronic general practice records, in an ethnically diverse part of southwest London. Outcome measures were prescribing levels and achievement of national treatment targets (HbA1c < or = 7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol < or = 5 mmol/l or 193 mg/dl). The proportion of patients reaching treatment targets for HbA1c, BP, and total cholesterol increased significantly after the implementation of the new contract. The extents of these increases were broadly uniform across ethnic groups, with the exception of the black Caribbean patient group, which had a significantly lower improvement in HbA1c (adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.57-0.97) and BP control (AOR 0.65, 95% CI 0.53-0.81) relative to the white British patient group. Variations in prescribing and achievement of treatment targets between ethnic groups present in 2003 were not attenuated in 2005. Pay-for-performance incentives have not addressed disparities in the management and control of diabetes between ethnic groups. Quality improvement initiatives must place greater emphasis on minority communities to avoid continued disparities in mortality from cardiovascular disease and the other major complications of diabetes.

General practitioners' competence and confidentiality determinations with a minor who requests the oral contraceptive pill.

PubMed

Bartholomew, Terence P; Carvalho, Tatiana

2005-11-01

The right of minors to make medical treatment decisions is an issue that is not explicitly addressed in the legislation of most Australian jurisdictions. While recent common law decisions allow competent minors to consent to treatment, current legislation in Victoria does not provide adequate guidelines on how competence is to be measured. It is also unclear whether the duty of confidentiality is extended to competent minors. The current study explored general practitioners' competence and confidentiality decisions with a hypothetical 14-year-old patient who requests the oral contraceptive pill (OCP). Questionnaires were sent to 1,000 Victorian general practitioners, 305 of whom responded. General practitioners were asked to determine whether "Liz" was competent to request the OCP, and whether they would maintain her confidentiality. A total of 81% of respondents found the patient competent, while 91% would have maintained her confidentiality. Results indicate that the majority of general practitioners used rationales that generally did not conform to current legal principles when making competence and confidentiality determinations regarding this patient.

Nutrition Counselling Practices among General Practitioners in Croatia

PubMed Central

Dumic, Albina; Mujkic, Aida; Miskulin, Maja

2017-01-01

Chronic non-communicable diseases are a significant public health problem and imbalanced nutrition is one of the most significant risk factor for them. The objective of this study was to examine Croatia’s general practitioners’ nutrition counselling practice and determine the factors that influence such practice. A cross-sectional study was conducted among 444 (17.0%) randomly selected general practitioners (GPs) in Croatia from May to July 2013 via a 32-item anonymous questionnaire. Study showed that 77.0% of participants had provided nutrition counselling exclusively to patients with specific health risks; 18.7% participants had provided nutrition counselling for all patients, regardless of their individual risks, while 4.3% had not provide nutrition counselling. As the most significant stimulating factor for implementing nutrition counselling in their daily work with patients, 55.6% of the participants identified personal interest regarding nutrition and the effects it has on health. The latter factor was more frequently emphasized among female general practitioners (p < 0.001) and general practitioners without chronic diseases (p < 0.001). The most significant barrier for nutrition counselling was lack of time (81.6%). It is necessary to make additional efforts to increase the frequency of nutrition counselling provided by general practitioners in Croatia. The majority of Croatian general practitioners could increase their nutrition counselling practice in order to promote balanced nutrition and improve the overall health status of their patients. PMID:29207514

Women with urinary incontinence: self-perceived worries and general practitioners' knowledge of problem.

PubMed Central

Lagro-Janssen, T L; Smits, A J; Van Weel, C

1990-01-01

In the context of a large scale survey of health problems in women aged 50 to 65 years, a study was undertaken on the effects of incontinence on daily life. For this purpose 1442 women randomly selected from the practice files of 75 general practitioners in the eastern part of the Netherlands were interviewed at home (response rate 60%). In cases of moderate or severe incontinence the general practitioner of the woman concerned was asked whether this problem had been diagnosed in general practice. Incontinence was reported in 22.5% of the women. Overall, 77.8% of the women did not feel worried about it and 75.4% did not feel restricted in their activities; even for women with severe incontinence (daily frequency and needing protective pads) only 15.6% experienced much worry and 15.7% much restriction. About a third of the women with incontinence (32.0%) had been identified by their general practitioner. The greater the worries and restrictions owing to incontinence, the greater the chance that the incontinence was known to the general practitioner concerned. Only a small minority of the women who felt severely restricted were not identified by their general practitioner. There was a positive relation between recognized incontinence and a history of hysterectomy. This study contradicts the image of the incontinent woman as isolated and helpless; most women in this study seemed able to cope. PMID:2121179

[Violence for educational purpose: Representations of general practitioners in the Paris area, France. A qualitative study].

PubMed

de Brie, Claire; Piet, Emmanuelle; Chariot, Patrick

2018-03-01

Violence for educational purpose refers to a modality of education that includes threats, verbal abuse, physical abuse and humiliations. Twenty European countries, not including France, have abolished corporal punishment through explicit laws and regulations. The position of general practitioners in the screening and care of violence for educational purpose in France is unknown. In this study, we aimed to assess the representations of this form of violence among general practitioners. We have performed semi-directed interviews of general practitioners in the Paris, France region (Île-de-France). Interviews were conducted until data saturation was achieved. Interviews were recorded, transcribed and analysed by two investigators. Interviews were conducted with 20 physicians (November 2015-January 2016). General practitioners considered that physical, verbal or psychological abuse had possible negative consequences on children. Uncertainty regarding the consequences of violence was a cause of tolerance towards violence for educational purpose, depending on the act committed and the context, as perceived by nearly all practitioners. General practitioners expressed interest in the field. They cited their own education and experience as the main obstacles to action. Most of them expressed a feeling of failure when they screened or took care of violence for educational purpose. This study suggests that doctors can participate in supporting the parents in the prevention of violence for educational purpose. Support to parents would need specific medical training as well as a societal change. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Home care by general practitioners for cancer patients in the last 3 months of life: An epidemiological study of quality and associated factors

PubMed Central

Pivodic, Lara; Harding, Richard; Calanzani, Natalia; McCrone, Paul; Hall, Sue; Deliens, Luc; Higginson, Irene J; Gomes, Barbara

2016-01-01

Background: Stronger generalist end-of-life care at home for people with cancer is called for but the quality of end-of-life care delivered by general practitioners has been questioned. Aim: To determine the degree of and factors associated with bereaved relatives’ satisfaction with home end-of-life care delivered by general practitioners to cancer patients. Design: Population-based mortality followback survey. Setting/participants: Bereaved relatives of people who died of cancer in London, United Kingdom (identified from death registrations in 2009–2010), were invited to complete a postal questionnaire surveying the deceased’s final 3 months of life. Results: Questionnaires were completed for 596 decedents of whom 548 spent at least 1 day at home in the last 3 months of life. Of the respondents, 55% (95% confidence interval: 51%–59%) reported excellent/very good home care by general practitioners, compared with 78% (95% confidence interval: 74%–82%) for specialist palliative care providers and 68% (95% confidence interval: 64%–73%) for district/community/private nurses. The odds of high satisfaction (excellent/very good) with end-of-life care by general practitioners doubled if general practitioners made three or more compared with one or no home visits in the patient’s last 3 months of life (adjusted odds ratio: 2.54 (95% confidence interval: 1.52–4.24)) and halved if the patient died at hospital rather than at home (adjusted odds ratio: 0.55 (95% confidence interval: 0.31–0.998)). Conclusion: There is considerable room for improvement in the satisfaction with home care provided by general practitioners to terminally ill cancer patients. Ensuring an adequate offer of home visits by general practitioners may help to achieve this goal. PMID:26036688

Prevalence of anal symptoms in general practice: a prospective study.

PubMed

Tournu, Géraldine; Abramowitz, Laurent; Couffignal, Camille; Juguet, Frédéric; Sénéjoux, Agnès; Berger, Stéphane; Wiart, Anne-Laure; Bernard, Marc; Provost, Françoise; Pillant-Le Moult, Hélène; Bouchard, Dominique; Aubert, Jean-Pierre

2017-08-03

Anal disorders are largely underestimated in general practice. Studies have shown patients conceal anal symptoms leading to late diagnosis and treatment. Management by general practitioners is poorly described. The aim of this study is to assess the prevalence of anal symptoms and their management in general practice. In this prospective, observational, national study set in France, all adult patients consulting their general practitioner during 2 days of consultation were included. Anal symptoms, whether spontaneously revealed or not, were systematically collected and assessed. For symptomatic patients, the obstacles to anal examination were evaluated. The general practitioner's diagnosis was collected and a proctologist visit was systematically proposed in case of anal symptoms. If the proctologist was consulted, his or her diagnosis was collected. From October 2014 to April 2015, 1061 patients were included by 57 general practitioners. The prevalence of anal symptoms was 15.6% (95% CI: 14-18). However, 85% of these patients did not spontaneously share their symptoms with their doctors, despite a discomfort rating of 3 out of 10 (range 1-5). Although 65% of patients agreed to an anal examination, it was not proposed in 45% of cases with anal symptoms. Performing the examination was associated with a significantly higher diagnosis rate of 76% versus 20% (p < 0.001). Proctologist and general practitioner diagnoses were consistent in 14 out of 17 cases. Patients' concealed anal symptoms are significant in general practice despite the impact on quality of life. Anal examination is seldom done. Improved training of general practitioners is required to break the taboo.

Retrospective analysis of census data on general practitioners who qualified in South Asia: who will replace them as they retire?

PubMed Central

Taylor, Donald H; Esmail, Aneez

1999-01-01

Objectives To determine the number and geographical distribution of general practitioners in the NHS who qualified medically in South Asia and to project their numbers as they retire. Design Retrospective analysis of yearly data and projection of future trends. Setting England and Wales. Subjects General practitioners who qualified medically in the countries of Bangladesh, India, Pakistan, and Sri Lanka and who were practising in the NHS on 1 October 1992. Main outcome measures Proportion and age of general practitioners who qualified in South Asia by health authority; the Benzeval and Judge measure of population need at the health authority level. Results 4192 of 25 333 (16.5%) of all unrestricted general practitioners practising full time on 1 October 1992 qualified in South Asian medical schools. The proportion varied by health authority from 0.007% to 56.5%. Roughly two thirds who were practising in 1992 will have retired by 2007; in some health authorities this will represent a loss of one in four general practitioners. The practices that these doctors will leave seem to be in relatively deprived areas as measured by deprivation payments and a health authority measure of population need. Conclusion Many general practitioners who qualified in South Asian medical schools will retire within the next decade. The impact will vary greatly by health authority. Those health authorities with the greatest number of such doctors are in some of the most deprived areas in the United Kingdom and have experienced the most difficulty in filling vacancies. Various responses will be required by workforce planners to mitigate the impact of these retirements. Key messagesCurrently, one in six general practitioners practising full time in the NHS qualified medically in a South Asian medical school; two thirds are likely to retire by 2007It is unlikely that doctors who qualify in South Asia will be a source of general practice recruitment in the futureThe posts from which South Asian qualifiers are retiring may be more difficult to fill because they are often in practices in areas of higher needThere is extreme variation in the proportion of total general practitioners who are South Asian qualifiers; flexibility for policy responses should be maintained PMID:9924060

Explaining outputs of primary health care: population and practice factors.

PubMed Central

Baker, D; Klein, R

1991-01-01

OBJECTIVE--To examine whether variations in the activities of general practice among family health service authorities can be explained by the populations characteristics and the organisation and resourcing of general practice. DESIGN--The family health services authorities were treated as discrete primary health care systems. Nineteen performance indicators reflecting the size, distribution, and characteristics of the population served; the organisation of general practice (inputs); and the activities generated by general practitioners and their staff (output) were analysed by stepwise regression. SETTING--90 family health services authorities in England. MAIN OUTCOME MEASURES--Rates of cervical smear testing, immunisation, prescribing, and night visiting. RESULTS--53% of the variation in uptake of cervical cytology was accounted for by Jarman score (t = -3.3), list inflation (-0.41), the proportion of practitioners over 65 (-0.64), the number of ancillary staff per practitioner (2.5), and 70% of the variation in immunisation rates by standardised mortality ratios (-6.6), the proportion of practitioners aged over 65 (-4.8), and the number of practice nurses per practitioner (3.5). Standardised mortality ratios (8.4), the number of practitioners (2.3), and the proportion over 65 (2.2), and the number of ancillary staff per practitioner (-3.1) accounted for 69% of variation in prescribing rates. 54% of the variation in night visiting was explained by standardised mortality ratios (7.1), the proportion of practitioners with lists sizes below 1000 (-2.2), the proportion aged over 65 (-0.4), and the number of practice nurses per practitioner (-2.5). CONCLUSIONS--Family health services authorities are appropriate systems for studying output of general practice. Their performance indicators need to be refined and to be linked to other relevant factors, notably the performance of hospital, community, and social services. PMID:1653065

[Informed diagnosis and psycho-education on psychiatric illnesses by primary care physicians--a result from pathway to psychiatric care in Japan study].

PubMed

Koizumi, Yayoi; Fujisawa, Daisuke; Hashimoto, Naoki; Otsuka, Kotaro

2007-01-01

On the path to psychiatric care, many patients who experience their first episode of mental disorder consult general practitioners or physicians of general hospitals before consulting psychiatrists. Some patients receive proper care promptly while others experience a delay in treatment. We investigated treatments and psycho-education given to patients by general practitioners or physicians of general hospitals, particularly focusing on informed diagnosis. We conducted a multi-center collaborative study in Japan. In this study, 15 facilities participated, including 4 university hospitals, 3 general hospitals, and 8 psychiatric hospitals. A total of 382 patients experiencing their first episode of mental disorder were enrolled. Among them, 157 patients primarily consulted general practitioners or general hospitals. We divided the 157 patients into 3 groups according to the kind of psycho-education given by general practitioners or physicians of general hospitals: those who were told nothing about their diagnosis nor mental condition (N = 74, 47.1%), those who were not given a direct diagnosis but were informed about their condition in some way (N = 55, 35.0%), and those who were directly informed of their diagnosis (N = 28, 17.8%). We found that almost half of the patients were told nothing about their diagnosis nor mental condition by general practitioners or physicians of general hospitals. Patients who were likely to be directly informed of their diagnosis were those who were recommended to see a doctor by someone, or those with a lower global psychosocial function. The patients who were told nothing about their diagnosis nor mental condition were mainly covered by national health insurance, and had decided to go to hospitals or clinics under their own volition. Sorted by ICD-10 F code, patients diagnosed as F0, F3, or F4 accounted for 89.9% of all subjects. We compared treatment delays among these 3 categories. The median treatment delay in patients diagnosed correctly as F0 by general practitioners or physicians of general hospitals was 50 weeks, that in patients diagnosed as F3 was 4 weeks, and that in patients diagnosed as F4 was 5 weeks. These findings suggest that patients might be treated in different ways according to their diagnosis by general practitioners or physicians in general hospitals. Our results suggest the importance of further educating general practitioners and physicians of general hospitals about mental disorders, in order to not only shorten the duration of untreated psychosis, but also for patients to be given proper primary care.

42 CFR 441.22 - Nurse practitioner services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Nurse practitioner services. 441.22 Section 441.22... General Provisions § 441.22 Nurse practitioner services. With respect to nurse practitioner services that... State plan must meet the following requirements: (a) Provide that nurse practitioner services are...

42 CFR 441.22 - Nurse practitioner services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Nurse practitioner services. 441.22 Section 441.22... General Provisions § 441.22 Nurse practitioner services. With respect to nurse practitioner services that... State plan must meet the following requirements: (a) Provide that nurse practitioner services are...

Dependence and caring in clinical communication: the relevance of attachment and other theories.

PubMed

Salmon, Peter; Young, Bridget

2009-03-01

Clinical relationships are usually asymmetric, being defined by patients' dependence and practitioners' care. Our aims are to: (i) identify literature that can contribute to theory for researching and teaching clinical communication from this perspective; (ii) highlight where theoretical development is needed; and (iii) test the utility of the emerging theory by identifying whether it leads to implications for educational practice. Selective and critical review of research concerned with dependence and caring in clinical and non-clinical relationships. Attachment theory helps to understand patients' need to seek safety in relationships with expert and authoritative practitioners but is of limited help in understanding practitioners' caring. Different theories that formulate practitioners' care as altruistic, rewarded by personal connection or as a contract indicate the potential importance of practitioners' emotions, values and sense of role in understanding their clinical communication. Extending the theoretical grounding of clinical communication can accommodate patients' dependence and practitioners' caring without return to medical paternalism. A broader theoretical base will help educators to address the inherent subjectivity of clinical relationships, and researchers to distinguish scientific questions about how patients and clinicians are from normative questions about how they should be.

45 CFR 60.18 - Requesting information from the National Practitioner Data Bank.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Practitioner Data Bank. 60.18 Section 60.18 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK Disclosure of Information by the National Practitioner Data Bank § 60.18 Requesting information from the National Practitioner Data Bank. (a) Who may request...

45 CFR 60.18 - Requesting information from the National Practitioner Data Bank.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Practitioner Data Bank. 60.18 Section 60.18 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK Disclosure of Information by the National Practitioner Data Bank § 60.18 Requesting information from the National Practitioner Data Bank. (a) Who may request...

General practitioners' perceptions of the current status and pharmacists' contribution to primary care in Iceland.

PubMed

Blondal, Anna Bryndis; Jonsson, Jon Steinar; Sporrong, Sofia Kälvemark; Almarsdottir, Anna Birna

2017-08-01

Background For the past several years pharmacists' responsibilities have expanded globally from traditional tasks of dispensing medications to collaborating with other health care professionals in patient care. Similar developments have not occurred in outpatient settings in Iceland. Objective The aim of this study was to explore Icelandic general practitioners' views on the current status of primary care, their perceptions of pharmacists as a health care profession, and their attitudes towards future GP-pharmacist collaboration in primary care in Iceland. Setting Twelve primary care clinics in Iceland. Methods Semi-structured in-depth interviews were conducted with general practitioners from different primary care clinics in Iceland. A purposive and snowball sampling technique was used to select participants. All interviews were recorded and transcribed verbatim. The transcripts were categorized by themes and then analyzed using conventional content analysis. Main outcome measure General practitioners' attitudes towards pharmacists. Results Twenty general practitioners from twelve different primary care clinics in Iceland were interviewed. There are several unmet needs regarding medicines and patient monitoring in the Icelandic health care system. General practitioners suggested ways in which these gaps may be addressed and pharmacist-led clinical service was one of the suggestions. Currently, their communication with pharmacists in the primary sector solely surrounds practical non-clinical issues. Due to increasing polypharmacy and multimorbidity, they suggested that pharmacists should be more involved in patient care. Conclusions General practitioners believe that pharmacist-led clinical service can increase the quality of patient therapy. To improve communication between these health care providers, pharmacists must also re-professionalize (strengthening the profession´s status through new responsibilities and tasks), not having a conflict of interest and showing that they have expertise in patient care.

[Four years of specialized outpatient palliative care in a rural area : Cooperation and acceptability from general practitioners' view].

PubMed

Kaiser, Florian; Sohm, Michael; Illig, Daniela; Vehling-Kaiser, Ursula; Haas, Michael

2016-07-01

In 2011, a specialized palliative home care was introduced in the counties of Landshut and Dingolfing. The aim of the current survey was to evaluate the cooperation, acceptance and need of palliative measures for patients particulary from the general practitioner's perspective. From January to March 2015, 198 general practitioners from the counties of Landshut and Dingolfing were contacted with questionnaires. The questionnaires consisted of 16 questions covering five different issues, and drew upon the practical experiences of the authors and earlier surveys from the literature. The questionnaires were sent by post containing a self-addressed and postpaid envelope. Completed questionnaires from 40 out of 198 contacted general practitioners (33 % female and 53 % male). Of these 85 % had cooperated with a SAPV team, 23 % had taken part in training for palliative medicine, 10 % intended to acquire a qualification and 10 % could imagine working in a SAPV team. In addition, 75 % stated that hospitalizations were avoided through the use of SAPV while 73 % felt that time and costs were saved for their own practices. The majority of general practitioners were satisfied with the work provided by the SAPV and the cooperation. Regarding additional palliative care for geriatric patients, 60 % believed that this was sensible. One main critique was that the information about including a patient in the SAPV program was transferred to the general practitioner too late. The current data show that general practitioners recognize the need for palliative medicine skills and predominately welcome the work of a specialized palliative care team in treating their patients. However, close cooperation and communication is necessary for a successful network between generalists and specialists in palliative care.

Urban public attitudes to the treatment of psychological problems and depression in general practice.

PubMed

Gavigan, P; Carr, A; McKeon, P

2000-10-01

A previous national study of public attitudes to depression indicated that only 17% spontaneously mentioned their general practitioner as someone who could help with depression, in contrast to 79% of respondents being willing to consult their G.P. in a similar U.K. survey. The present study undertook to examine the public perception of an urban sample to the treatment of depression in general practice and the factors associated with expressed unwillingness to consult. A random sample from the electoral register was drawn and 54 (89%) of 61 subjects selected were interviewed. While 85% of respondents were satisfied with their general practice care, only 24% to 52%, depending on the context and wording of the question, said that they would seek help from their general practitioner for depression. Factors associated with an expressed reluctance to consult were being male, dissatisfied with general practitioner care and believing that general practitioners were not qualified to treat depression.

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…

Two case reports of orofacial paraesthesia demonstrating the role of the general dental practitioner in identifying patients with intracranial tumours.

PubMed

Barber, Andrew J; Lawson, David D A; Field, E Anne

2009-04-01

The following case reports describe the clinical features, diagnosis and management of two patients who presented to their general dental practitioner with a complaint of orofacial paraesthesia. After appropriate investigations, both patients were diagnosed as having benign intracranial tumours and were managed by a neurosurgeon. These cases illustrate the important role the general dental practitioner has in the early recognition of potentially life-threatening conditions.

[A competency model of rural general practitioners: theory construction and empirical study].

PubMed

Yang, Xiu-Mu; Qi, Yu-Long; Shne, Zheng-Fu; Han, Bu-Xin; Meng, Bei

2015-04-01

To perform theory construction and empirical study of the competency model of rural general practitioners. Through literature study, job analysis, interviews, and expert team discussion, the questionnaire of rural general practitioners competency was constructed. A total of 1458 rural general practitioners were surveyed by the questionnaire in 6 central provinces. The common factors were constructed using the principal component method of exploratory factor analysis and confirmatory factor analysis. The influence of the competency characteristics on the working performance was analyzed using regression equation analysis. The Cronbach 's alpha coefficient of the questionnaire was 0.974. The model consisted of 9 dimensions and 59 items. The 9 competency dimensions included basic public health service ability, basic clinical skills, system analysis capability, information management capability, communication and cooperation ability, occupational moral ability, non-medical professional knowledge, personal traits and psychological adaptability. The rate of explained cumulative total variance was 76.855%. The model fitting index were Χ(2)/df 1.88, GFI=0.94, NFI=0.96, NNFI=0.98, PNFI=0.91, RMSEA=0.068, CFI=0.97, IFI=0.97, RFI=0.96, suggesting good model fitting. Regression analysis showed that the competency characteristics had a significant effect on job performance. The rural general practitioners competency model provides reference for rural doctor training, rural order directional cultivation of medical students, and competency performance management of the rural general practitioners.

Determinants of non-compliance with herpes zoster vaccination in the community-dwelling elderly.

PubMed

Opstelten, Wim; van Essen, Gerrit A; Hak, Eelko

2009-01-07

As part of a series of studies on vaccine acceptance, we assessed determinants of compliance of the community-dwelling elderly with herpes zoster (HZ) vaccination in an existing influenza vaccination program. General practitioners (GPs) sent out a questionnaire to 1778 patients aged > or =65 years, and offered them free HZ vaccination simultaneously with the yearly influenza vaccination. In all, 690 patients (39%) were vaccinated against HZ; 1349 patients (76%) accepted influenza vaccination. Determinants of non-compliance with HZ vaccination were perceived lack of recommendation by the GP, unwillingness to comply with the doctor's advice, perception of low risk of contracting HZ, perception of short pain duration of HZ, and the opinion that vaccinations weaken one's natural defenses. The same determinants were associated with non-compliance with both vaccinations, but objections in general towards vaccination, a high education and difficulties to visit GPs were also important. Uptake of HZ vaccination was rather low and more data on (cost-)effectiveness might encourage GPs to offer HZ vaccination to their patients.

Where have all the doctors gone? (2). Intraurban trends: changes in the geographic distribution of general practitioners in Auckland, 1980-7.

PubMed

Barnett, J R

1991-08-14

During the 1980s the Auckland metropolitan area increased its share of all general practitioners in New Zealand at a much faster rate than its share of the population, resulting in a high level of availability by 1987. In the light of such trends, neoclassical theory would predict a diffusion of general practitioners into areas with fewer doctors where there is less competition for patients. Data for 1980-7, however, indicates that for every FTE general practitioner who located in doctor poor areas of the city, 1.87 general practitioners continued to open practices in areas already well provided for. Or, for every extra consultation that took place in low income suburbs, 1.51 extra consultations occurred in more affluent localities. These results do not provide strong support for a market led diffusion of doctors into areas of need and any gains in increased equity appear to have been achieved at the expense of considerable inefficiency given the likely presence of induced demand.

"Saying no is no easy matter" A qualitative study of competing concerns in rationing decisions in general practice

PubMed Central

Carlsen, Benedicte; Norheim, Ole Frithjof

2005-01-01

Background The general practitioner in Norway is expected to ensure equity and effectiveness through fair rationing. At the same time, due to recent reforms of the Norwegian health care sector, both the role of economic incentives and patient autonomy have been strengthened. Studies indicate that modern general practitioners, both in Norway and in other countries are uncomfortable with the gatekeeper role, but there is little knowledge about how general practitioners experience rationing in practice. Methods Through focus group interviews with Norwegian general practitioners, we explore physicians' attitudes toward factors of influence on medical decision making and how rationing dilemmas are experienced in everyday practice. Results Four major concerns appeared in the group discussions: The obligation to ration health care, professional autonomy, patient autonomy, and competition. A central finding was that the physicians find rationing difficult because saying no in face to face relations often is felt uncomfortable and in conflict with other important objectives for the general practitioner. Conclusion It is important to understand the association between using economic incentives in the management of health care, increasing patient autonomy, and the willingness among physicians to contribute to efficient, fair and legitimate resource allocation. PMID:16281967

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

PubMed

Adam, Rachel

2007-08-31

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. 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. 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. 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 quality care. As it is mainly conceptualised and experienced as care within the context of a continuing relationship, policies and organisational arrangements that support and give incentives to this must be in place. These preferences are not strongly reflected in the QOF. Specific questions need to be addressed by future audit and research on the impact of the contract on these aspects of service.

Financial viability, benefits and challenges of employing a nurse practitioner in general practice.

PubMed

Helms, Christopher; Crookes, Jo; Bailey, David

2015-04-01

This case study examines the financial viability, benefits and challenges of employing a primary healthcare (PHC) nurse practitioner (NP) in a bulk-billing healthcare cooperative in the Australian Capital Territory. There are few empirical case reports in the Australian literature that demonstrate financial sustainability of this type of healthcare professional in primary healthcare. This case study demonstrates that the costs of employing a PHC-NP in general practice are offset by direct and indirect Medicare billings generated by the PHC-NP, resulting in a cost-neutral healthcare practitioner. The success of this model relies on bidirectional collaborative working relationships amongst general practitioners and NPs. PHC-NPs should have a generalist scope of practice and specialist expertise in order to maximise their utility within the general practice environment.

5 CFR 890.702 - Payment to any licensed practitioner.

Code of Federal Regulations, 2011 CFR

2011-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits in Medically Underserved Areas..., if a contract between the Office of Personnel Management and a group health insurance carrier offering a health benefits plan subject to this subpart provides for payment or reimbursement of the cost...

5 CFR 890.702 - Payment to any licensed practitioner.

Code of Federal Regulations, 2014 CFR

2014-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits in Medically Underserved Areas..., if a contract between the Office of Personnel Management and a group health insurance carrier offering a health benefits plan subject to this subpart provides for payment or reimbursement of the cost...

5 CFR 890.702 - Payment to any licensed practitioner.

Code of Federal Regulations, 2010 CFR

2010-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits in Medically Underserved Areas..., if a contract between the Office of Personnel Management and a group health insurance carrier offering a health benefits plan subject to this subpart provides for payment or reimbursement of the cost...

5 CFR 890.702 - Payment to any licensed practitioner.

Code of Federal Regulations, 2013 CFR

2013-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Benefits in Medically Underserved Areas..., if a contract between the Office of Personnel Management and a group health insurance carrier offering a health benefits plan subject to this subpart provides for payment or reimbursement of the cost...

The payment for performance model and its influence on British general practitioners' principles and practice.

PubMed

Norman, Armando Henrique; Russell, Andrew J; Macnaughton, Jane

2014-01-01

This article explores some effects of the British payment for performance model on general practitioners' principles and practice, which may contribute to issues related to financial incentive modalities and quality of primary healthcare services in low and middle-income countries. Aiming to investigate what general practitioners have to say about the effect of the British payment for performance on their professional ethos we carried out semi-structured interviews with 13 general practitioner educators and leaders working in academic medicine across the UK. The results show a shift towards a more biomedical practice model and fragmented care with nurse practitioners and other health care staff focused more on specific disease conditions. There has also been an increased medicalisation of the patient experience both through labelling and the tendency to prescribe medications rather than non-pharmacological interventions. Thus, the British payment for performance has gradually strengthened a scientific-bureaucratic model of medical practice which has had profound effects on the way family medicine is practiced in the UK.

45 CFR 60.21 - How to dispute the accuracy of National Practitioner Data Bank information.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Practitioner Data Bank information. 60.21 Section 60.21 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK Disclosure of Information by the National Practitioner Data Bank § 60.21 How to dispute the accuracy of National Practitioner Data Bank information. (a...

45 CFR 60.17 - Information which hospitals must request from the National Practitioner Data Bank.

Code of Federal Regulations, 2013 CFR

2013-10-01

... National Practitioner Data Bank. 60.17 Section 60.17 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK Disclosure of Information by the National Practitioner Data Bank § 60.17 Information which hospitals must request from the National Practitioner Data...

45 CFR 60.21 - How to dispute the accuracy of National Practitioner Data Bank information.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Practitioner Data Bank information. 60.21 Section 60.21 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK Disclosure of Information by the National Practitioner Data Bank § 60.21 How to dispute the accuracy of National Practitioner Data Bank information. (a...

45 CFR 60.17 - Information which hospitals must request from the National Practitioner Data Bank.

Code of Federal Regulations, 2014 CFR

2014-10-01

... National Practitioner Data Bank. 60.17 Section 60.17 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK Disclosure of Information by the National Practitioner Data Bank § 60.17 Information which hospitals must request from the National Practitioner Data...

The contribution of an asthma diagnostic consultation service in obtaining an accurate asthma diagnosis for primary care patients: results of a real-life study.

PubMed

Gillis, R M E; van Litsenburg, W; van Balkom, R H; Muris, J W; Smeenk, F W

2017-05-19

Previous studies showed that general practitioners have problems in diagnosing asthma accurately, resulting in both under and overdiagnosis. To support general practitioners in their diagnostic process, an asthma diagnostic consultation service was set up. We evaluated the performance of this asthma diagnostic consultation service by analysing the (dis)concordance between the general practitioners working hypotheses and the asthma diagnostic consultation service diagnoses and possible consequences this had on the patients' pharmacotherapy. In total 659 patients were included in this study. At this service the patients' medical history was taken and a physical examination and a histamine challenge test were carried out. We compared the general practitioners working hypotheses with the asthma diagnostic consultation service diagnoses and the change in medication that was incurred. In 52% (n = 340) an asthma diagnosis was excluded. The diagnosis was confirmed in 42% (n = 275). Furthermore, chronic rhinitis was diagnosed in 40% (n = 261) of the patients whereas this was noted in 25% (n = 163) by their general practitioner. The adjusted diagnosis resulted in a change of medication for more than half of all patients. In 10% (n = 63) medication was started because of a new asthma diagnosis. The 'one-stop-shop' principle was met with 53% of patients and 91% (n = 599) were referred back to their general practitioner, mostly within 6 months. Only 6% (n = 41) remained under control of the asthma diagnostic consultation service because of severe unstable asthma. In conclusion, the asthma diagnostic consultation service helped general practitioners significantly in setting accurate diagnoses for their patients with an asthma hypothesis. This may contribute to diminish the problem of over and underdiagnosis and may result in more appropriate treatment regimens. SERVICE HELPS GENERAL PRACTITIONERS MAKE ACCURATE DIAGNOSES: A consultation service can help general practitioners more accurately diagnose asthma and select the appropriate treatments for their patients. Researchers in The Netherlands, led by Frank Smeenk from Catharina Hospital in Eindhoven, describe an asthma diagnostic consultation service they created to support GPs in their diagnostic process for patients suspected of having asthma. Over a four-year period, the service received a total of 659 referrals and only confirmed the diagnosis of asthma in 275 cases. Another 20 patients had asthma overlapping with chronic obstructive pulmonary syndrome. The service also picked up other diseases, such as rhinitis, that general practitioners had missed. Overall, because of the consultation service and its revised diagnoses, more than half of all patients adjusted their medications. Most patients required only a single consultation and could then be referred back to their physicians.

Computers in general practice: the patient's voice

PubMed Central

Potter, A. R.

1981-01-01

Analysis of answers to a questionnaire on the use of computers in general practice showed that 19 per cent of patients in two practices in Staffordshire would be worried if their general practitioner used a computer to store medical records. Twenty-seven per cent of patients would be unwilling to speak frankly about personal matters to their general practitioner if he or she used a computer and 7 per cent said that they would change to another doctor. Fifteen per cent stated that their general practitioner already had information about them that they would not want to be included in a computerized record of their medical history. PMID:7328555

48 CFR 32.601 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... costs related to defaults in performance. (10) Breach of contract obligations concerning progress....601 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Debts 32.601 General. (a) Contract debts are amounts that— (1) Have...

Attitude and awareness of general dental practitioners toward radiation hazards and safety.

PubMed

Aravind, B S; Joy, E Tatu; Kiran, M Shashi; Sherubin, J Eugenia; Sajesh, S; Manchil, P Redwin Dhas

2016-10-01

The aim and objective is to evaluate the level of awareness and attitude about radiation hazards and safety practices among general dental practitioners in Trivandrum District, Kerala, India. A questionnaire-based cross-sectional study was conducted among 300 general dental practitioners in Trivandrum District, Kerala, India. Postanswering the questions, a handout regarding radiation safety and related preventive measures was distributed to encourage radiation understanding and protection. Statistical analysis were done by assessing the results using Chi-square statistical test, t -test, and other software (Microsoft excel + SPSS 20.0 trail version). Among 300 general practitioners (247 females and 53 males), 80.3% of the practitioners were found to have a separate section for radiographic examination in their clinics. Intraoral radiographic machines were found to be the most commonly (63.3%) used radiographic equipment while osteoprotegerin was the least (2%). Regarding the practitioner's safety measures, only 11.7% of them were following all the necessary steps while 6.7% clinicians were not using any safety measure in their clinic, and with respect to patient safety, only 9.7% of practitioners were following the protocol. The level of awareness of practitioners regarding radiation hazards and safety was found to be acceptable. However, implementation of their knowledge with respect to patient and personnel safety was found wanting. Insisting that they follow the protocols and take necessary safety measures by means of continuing medical education programs, pamphlets, articles, and workshops is strongly recommended.

Addressing the problems associated with general practitioners' workload in nursing and residential homes: findings from a qualitative study.

PubMed Central

Jacobs, Sally

2003-01-01

BACKGROUND: Caring for older people in residential and nursing homes makes major demands on general practitioners (GPs). AIM: To investigate the perceptions and experiences of home managers and GPs of the provision of general medical services for older residents. DESIGN OF STUDY: In-depth qualitative study. SETTING: Forty-two nursing and residential homes in five locations in England, interviewing home managers and eight of their residents' GPs. METHOD: Semi-structured face-to-face and telephone interviews. RESULTS: Most homes endorse principles of continuity of care and patient choice. Although many homes therefore deal with a large number of GPs, with the inherent difficulties of coordinating care and duplication of GP effort, limitations in residents' choice of GP result in the majority of residents in many homes being registered with only one or two practices. Contracts between homes and GPs may provide opportunities for improving medical care but do not guarantee additional services and have implications for patient choice and residents' fees. Visits on request form the bulk of GPs' workload in homes but can be hard to obtain for residents and may not be appropriate. Regular weekly surgeries are preferred by many homes but may have additional workload implications for GPs. CONCLUSION: The assumption that patient choice and continuity in medical care are paramount for older people in nursing and residential homes is questioned. While recognition of the additional workload for GPs working in these settings is necessary, this should be accompanied by additional NHS remuneration. Further research is urgently required to identify which models of GP provision would most benefit both residents and GPs. PMID:12817356

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

PubMed

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

2003-09-01

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

48 CFR 43.201 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

....201 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT CONTRACT MODIFICATIONS Change Orders 43.201 General. (a) Generally, Government contracts contain a changes clause that permits the contracting officer to make unilateral changes, in designated areas, within the general scope...

48 CFR 43.201 - General.

Code of Federal Regulations, 2011 CFR

2011-10-01

....201 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT CONTRACT MODIFICATIONS Change Orders 43.201 General. (a) Generally, Government contracts contain a changes clause that permits the contracting officer to make unilateral changes, in designated areas, within the general scope...

Practice Research: General practitioners' awareness of colorectal cancer

PubMed Central

Nichols, Sally

1986-01-01

A survey was carried out in Portsmouth to find out what general practitioners knew about colorectal cancer and what their views were on screening. A random sample of general practitioners was interviewed by questionnaire and the remainder asked to complete the questionnaire themselves. The overall response rate was 62%. There was a higher response rate from women doctors and from the group that was interviewed. For some questions there was a difference in the pattern of responses given by the interview group and the group who completed the questionnaire themselves. The level of knowledge of colorectal cancer varied according to which aspect was questioned. The general practitioners knew the symptoms well but were less aware of the vital statistics and risk factors. Most doctors were not in favour of screening by testing for faecal occult blood. PMID:3080150

What does locality commissioning in Avon offer? Retrospective descriptive evaluation.

PubMed Central

Hine, C. E.; Bachmann, M. O.

1997-01-01

OBJECTIVE: To describe the impact, direct costs of, and participants' attitudes to the first two years and eight months of locality commissioning in Avon. DESIGN: Retrospective description of programme. SETTING: Thirteen localities in Avon Health Authority area, covering 982000 population and 147 general practices. METHODS: Postal questionnaire survey of 147 general practitioners (one per practice); interviews with and questionnaire survey of 13 lead general practitioners and 13 so called link staff from the health authority. MAIN OUTCOME MEASURES: Locality initiatives, perceived influence, general practitioners' attitudes, management costs. RESULTS: Twenty initiatives were identified that had changed services to patients, and another nine were planned. The commonest initiatives concerned primary mental health care (seven), nurse specialists for primary care of chronic diseases (three), referral and clinical practice guidelines (seven), and access to hospital outpatient departments (one, with two others planned). Localities were more likely to have influenced the authority, trust managers, and consultants than social services, community health councils, and voluntary organisations. Activity varied between localities, lead general practitioners estimating that 120/147 (82%) of practices had been involved in locality meetings (range 44-100% in different localities). The authority had spent 6 p per capita on running the scheme, and the total time used by general practitioners for locality commissioning was estimated at 1.5 whole time equivalents. CONCLUSION: Locality commissioning has selectively changes services with limited extra funding and without delegation of hospital and community health service budgets. General practitioners wanted more policy and financial support. Further development should be based on evidence of costs, benefits, and limitations of locality commissioning schemes. PMID:9154029

A qualitative study of the barriers and enablers to fertility-awareness education in general practice.

PubMed

Hampton, Kerry D; Newton, Jennifer M; Parker, Rhian; Mazza, Danielle

2016-07-01

To understand the barriers and enablers to fertility-awareness education in general practice. Most women along with their primary care practitioners - general practitioners and practice nurses - believe that women should be educated about fertility-awareness when first reporting trouble conceiving. To date, no in-depth study has examined the enablers and challenges of this type of education in general practice. A descriptive exploratory qualitative study using deductive content analysis. General practitioners (N = 11) and practice nurses (N = 20) were recruited from general practices in three socioculturally diverse areas in Victoria, Australia. Data were collected through semistructured interviews based on the 12 domains of a theoretical behaviour change framework from April-August 2012. The participants' responses were organized into themes that fall under the framework domains. The biggest barriers to fertility-awareness education in general practice were short consultations and time constraints faced by general practitioners together with a lack of patient educational materials and remuneration to support its delivery. The biggest enablers were a greater use of nurses trained in fertility-awareness in a collaborative team care arrangement with general practitioners. This study has identified several important barriers and enablers to fertility-awareness education in general practice. Translation into practice of our findings is imperative as the first step in establishing a primary care model in fertility-awareness. This would fill an important gap in the primary care of infertile women and build capacity in general practice to reduce infertility through women's enhanced fertility knowledge. © 2016 John Wiley & Sons Ltd.

Should general practitioners call patients by their first names?

PubMed

McKinstry, B

1990-10-06

To assess the acceptability to patients of the use of patients' first names by doctors and doctors' first names by patients in general practice. An administered questionnaire survey. 5 General practices in Lothian. 475 Patients consulting 30 general practitioners. Response by patients to questionnaire on attitude to use of first names. Most of the patients either liked (223) or did not mind (175) being called by their first names. Only 77 disliked it, most of whom were aged over 65. Most patients (324) did not, however, want to call the doctor by his or her first name. General practitioners should consider using patients' first names more often, particularly with younger patients.

General practitioners' experiences as nursing home medical consultants.

PubMed

Kirsebom, Marie; Hedström, Mariann; Pöder, Ulrika; Wadensten, Barbro

2017-03-01

To describe general practitioners' experiences of being the principal physician responsible for a nursing home. Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation. Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety. The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems. © 2016 Nordic College of Caring Science.

Contemporary machine learning: techniques for practitioners in the physical sciences

NASA Astrophysics Data System (ADS)

Spears, Brian

2017-10-01

Machine learning is the science of using computers to find relationships in data without explicitly knowing or programming those relationships in advance. Often without realizing it, we employ machine learning every day as we use our phones or drive our cars. Over the last few years, machine learning has found increasingly broad application in the physical sciences. This most often involves building a model relationship between a dependent, measurable output and an associated set of controllable, but complicated, independent inputs. The methods are applicable both to experimental observations and to databases of simulated output from large, detailed numerical simulations. In this tutorial, we will present an overview of current tools and techniques in machine learning - a jumping-off point for researchers interested in using machine learning to advance their work. We will discuss supervised learning techniques for modeling complicated functions, beginning with familiar regression schemes, then advancing to more sophisticated decision trees, modern neural networks, and deep learning methods. Next, we will cover unsupervised learning and techniques for reducing the dimensionality of input spaces and for clustering data. We'll show example applications from both magnetic and inertial confinement fusion. Along the way, we will describe methods for practitioners to help ensure that their models generalize from their training data to as-yet-unseen test data. We will finally point out some limitations to modern machine learning and speculate on some ways that practitioners from the physical sciences may be particularly suited to help. This work was performed by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344.

48 CFR 32.703-1 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false General. 32.703-1 Section 32.703-1 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 32.703-1 General. (a) If the contract is fully funded, funds...

Implications of Job Rotation Literature for Performance Improvement Practitioners

ERIC Educational Resources Information Center

Casad, Scott

2012-01-01

Job rotations have existed as a means of developing individual knowledge and skills since the industrial revolution, and in today's dynamic global workplace, they afford organizations an opportunity to manage changing psychological work contracts and employee desires for self-managed careers. Through the systematic mining of psychology, business,…

Career orientation and burnout in French general practitioners.

PubMed

Truchot, Didier

2008-12-01

This study among 259 French general practitioners examined how Cherniss's four career orientations, Artisan, Social Activist, Careerist, and Self-investor, as recalled by these physicians, are related to their burnout scores. Data were collected using anonymous questionnaires. Initial and present career orientations were related to depersonalization and personal accomplishment. Those whose career orientation changed to Self-investor reported the highest despersonalization, while those who changed to the Artisan orientation reported the lowest depersonalization. Results are discussed regarding the fit between career orientation and the work setting of general practitioners, a professional group with high burnout.

General practice and the provision of information and services for physically disabled people aged 16 to 65 years.

PubMed Central

Chesson, R A; Sutherland, A M

1992-01-01

The study reported here was part of a larger survey investigating the nature and extent of disability in the Grampian region. Interviews with 212 people aged between 16 and 65 years who had a wide range of physical disabilities elicited perceptions of current and past service provision. Respondents expressed a strong need for information on disability services and reported difficulty in knowing whom to approach for this. General practitioners were the most commonly reported source of such information and low usage of the Department of Social Security, social work departments and voluntary organizations was identified. No significant relationship was found between degree of disability and frequency of consultation with a general practitioner. However, the more severe the disability the more likely it was that the general practitioner initiated contact rather than the patient. Although in general those interviewed were satisfied with medical information given regarding their diagnosis, they were more critical of information provided in relation to coping with the disorder, including that concerning benefits and services. The study confirmed the pivotal role of the general practitioner in the care of physically disabled people in the community aged between 16 and 65 years. The need to re-evaluate the role of the general practitioner in the provision of information and services is discussed. PMID:1472395

General practice on-the-job training in Chinese urban community: a qualitative study on needs and challenges.

PubMed

Zhao, Yali; Chen, Rui; Wang, Bo; Wu, Tao; Huang, Yafang; Guo, Aimin

2014-01-01

On-the-job training is an important strategy for general practitioners to deliver appropriately community health services in China. The development of basic professional competence for general practitioners is the main goal of on-the-job training program. The aim of this study was to explore the needs of and the challenges to on-the-job training for general practitioners, and to provide advices for policy-makers to carry out this program more effectively. We conducted 3 nominal group techniques, 17 in-depth interviews and 3 focus groups to identify the status of, needs of and challenges to on-the-job training for general practitioners in Liaoning, Ningxia, and Fujian provinces from September 2011 until December 2011. Audiotapes and transcripts were analyzed to identify major themes. Content analysis of the data was completed from January 2012 to March 2012. Basic theoretical knowledge and clinical skills were the main needs for general practitioners during on-the-job training. The challenges during training included the time contradiction between work and training, deficiencies of qualified preceptors, and lack of training funds. Participants gave recommendations how to resolve the above problems. In order to improve the outcomes of general practice on-the-job training, it is necessary for government officials to resolve the contradiction between work and training, train preceptors continuously, and increase financial support in the training program.

Slow Scan Telemedicine

NASA Technical Reports Server (NTRS)

1984-01-01

Originally developed under contract for NASA by Ball Bros. Research Corporation for acquiring visual information from lunar and planetary spacecraft, system uses standard closed circuit camera connected to a device called a scan converter, which slows the stream of images to match an audio circuit, such as a telephone line. Transmitted to its destination, the image is reconverted by another scan converter and displayed on a monitor. In addition to assist scans, technique allows transmission of x-rays, nuclear scans, ultrasonic imagery, thermograms, electrocardiograms or live views of patient. Also allows conferencing and consultation among medical centers, general practitioners, specialists and disease control centers. Commercialized by Colorado Video, Inc., major employment is in business and industry for teleconferencing, cable TV news, transmission of scientific/engineering data, security, information retrieval, insurance claim adjustment, instructional programs, and remote viewing of advertising layouts, real estate, construction sites or products.

General practitioner non-principals benefit from flexible working.

PubMed

French, Fiona; Andrew, Jane; Awramenko, Morag; Coutts, Helen; Leighton-Beck, Linda; Mollison, Jill; Needham, Gillian; Scott, Anthony; Walker, Kim

2005-01-01

The purpose of this study is to explore non-principals' working patterns and attitudes to work. The article is based on data provided by a questionnaire survey. Findings - Gender division was apparent among the non-principals. Males were more likely to work full-time, because their spouses modified their working hours. It was impossible to identify all non-principals in Scotland or to compare responders and non-responders, due to the lack of official data. Hence, the results might not be representative. More flexible posts would enable GPs to more easily combine paid work with family commitments. It is anticipated that the new GP contract should deliver this. This was the first time a study of all non-principals in Scotland had been attempted. The findings provide a more comprehensive picture of GPs in Scotland and provide valuable information for policymakers.

The influence of an academic representative on prescribing by general practitioners.

PubMed Central

Newton-Syms, F A; Dawson, P H; Cooke, J; Feely, M; Booth, T G; Jerwood, D; Calvert, R T

1992-01-01

1. The effect of providing information about medicines by a short 'sales' interview between individual general practitioners and an 'academic representative' on prescribing was investigated. 2. The promotional campaign was designed to encourage a rational approach to prescribing of non-steroidal anti-inflammatory agents in an intervention group of 101 general practitioners selected at random from the Leeds Family Practitioner Committee (FPC). The remaining general practitioners in the Leeds FPC acted as a reference group. 3. The prescribing data for each group for 5 months immediately prior to and 5 months following intervention were compared. 4. Intervention produced a significant increase (P less than 0.005) in the prescribing cost of ibuprofen, the non-steroidal promoted as first choice agent, which was sustained for at least 5 months. 5. Prescribing of the second choice agent, piroxicam, decreased in the reference group but not in the intervention group. 6. There was a decrease in the average prescribing cost of pounds 6.60 per doctor per month in the intervention group compared with the reference group. PMID:1540493

Continuing education for general practice. 2. Systematic learning from experience.

PubMed Central

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

1993-01-01

Prompted by evidence that the recently-adopted arrangements for ongoing education among established general practitioners are unsatisfactory, the first of a pair of papers examined the theoretical basis of continuing education for general practice and proposed a model of self-directed learning in which the experience of established practitioners is connected, through the media of reading, reflection and audit, with competence for the role. In this paper a practical, systematic approach to self-directed learning by general practitioners is described based on the model. The contribution which appropriate participation in continuing medical education can make to enhancing learning from experience is outlined. PMID:8373649

42 CFR 418.304 - Payment for physician and nurse practitioner services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for physician and nurse practitioner... Payment for physician and nurse practitioner services. (a) The following services performed by hospice physicians and nurse practitioners are included in the rates described in § 418.302: (1) General supervisory...

45 CFR 60.15 - Confidentiality of National Practitioner Data Bank information.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Confidentiality of National Practitioner Data Bank information. 60.15 Section 60.15 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS...

Therapeutic management of orally treated type 2 diabetic patients, by French general practitioners in 2010: the DIAttitude Study.

PubMed

Halimi, S; Balkau, B; Attali, C; Detournay, B; Amelineau, E; Blickle, J-F

2012-03-01

To describe the behaviour of French general practitioners (GP) regarding intensification of hypoglycaemic agents in orally treated type 2 diabetic (T2D) patients, according to their HbA(1c) level. General practitioners were recruited from a panel of office-based general practitioners. T2D patients who had been orally treated for at least 6 months were included in the study; their characteristics were recorded, and their HbA(1c) values and hypoglycaemic treatments over the previous 24 months extracted from electronic records The major reasons for intensification (or no intensification) of hypoglycaemic agents were recorded at the inclusion visit. A total of 236 general practitioners recruited 2109 T2D patients: 1732 had at least one HbA(1c) value recorded in the previous 6 months, and 52%, 33% and 14% had been treated, with oral hypoglycaemic agents in monotherapy, bitherapy or tri-or quadritherapy, respectively. Of these patients, 702 (41%) remained uncontrolled (47%, 39% and 20% respectively) and according to the current French guidelines needed treatment intensification. Only 46 (7%) had their treatment intensified at inclusion. Of those without intensified treatment, 60% were treated with monotherapy; the main reason given by the general practitioners for not intensifying treatment was a satisfactory HbA(1c) level (53%), although 32% had an HbA(1c)>7%. Other reasons were: lifestyle advice had greater priority (20%); decision was postponed until the next visit (11%); HbA(1c) had decreased since last visit (7%; not confirmed by available data in 58% of cases); a medical priority other than diabetes (6%) and other reasons related to the patient (3%). For T2D patients managed by French general practitioners, guidelines are not consistently followed: HbA(1c) should be monitored more frequently and treatment adjusted according to HbA(1c) levels. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

[Diagnosis of a systolic murmur among young asymptomatic patient: An assessment of professional practices for the expertise in military medicine].

PubMed

Boeuf, M-C; Rohel, G; Lamour, G; Piquemal, M; Paleiron, N; Fouilland, X; Le Nestour, C; Vinsonneau, U; Paez, S; Paule, P

2015-11-01

The finding of a systolic heart murmur is common in medical military practice. Albeit often benign among young healthy adults, it can reveal a valvular or a cardiac disease, which could worsen during workout or expose to risk of a sudden death. This study aims to evaluate the diagnostic efficiency of the military general practitioner when discovering a systolic murmur among young asymptomatic patients. During one year, this study involved all the general practitioners of the medical military centres of Brittany and the cardiologists of the military hospital in Brest. It prospectively enrolled a cohort of all military asymptomatic patients under 40, without any underlying known heart condition. Military general practitioners listed, thanks to an anonymous form, the main features of the systolic murmur and of the ECG and proposed an auscultatory diagnosis: innocent or organic murmur. Then cardiologists did the same and finally performed a transthoracic echocardiography giving the diagnosis. Fifty-eight patients were referred, 5 not meeting the inclusion criteria. Of the 53 patients included, military general practitioners found 46 innocent murmurs and 7 organic ones. Cardiologists found 51 innocent murmurs and 2 organic. Transthoracic echocardiography just took on one organic murmur (linked with a bicuspid aortic valve), spotted by the specialist, though judged innocent by the general practitioner. Most of innocent murmurs diagnosed by general practitioners (45/46) were confirmed. Regarding the seven organic murmurs, the main selected criteria (intensity over 3, orthostatic persistence, diffuse irradiation) are mostly in accordance with the literature, proving right medical instincts. Authors propose a practical management of systolic murmurs among asymptomatic young patients. Military general practitioners seem to master symptoms of organic murmur. This assessment argues for a promotion of a holistic clinical examination, which will help not only to rationalize the use of transthoracic echocardiography in economic terms but also to value the medical expertise. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Toys are a potential source of cross-infection in general practitioners' waiting rooms.

PubMed Central

Merriman, Eileen; Corwin, Paul; Ikram, Rosemary

2002-01-01

The waiting rooms of general practitioners' surgeries usually have toys provided for children. The level of contamination of these toys and the effectiveness of toy decontamination was investigated in this study. Hard toys from general practitioners' waiting rooms had relatively low levels of contamination, with only 13.5% of toys showing any coliform counts. There were no hard toys with heavy contamination by coliforms or other bacteria. Soft toys were far more likely to be contaminated, with 20% of toys showing moderate to heavy coliform contamination and 90% showing moderate to heavy bacterial contamination. Many waiting-room toys are not cleaned routinely. Soft toys are hard to disinfect and tend to rapidly become recontaminated after cleaning. Conversely, hard toys can be cleaned and disinfected easily. Soft toys in general practitioners' waiting rooms pose an infectious risk and it is therefore recommended that soft toys are unsuitable for doctors' waiting rooms. PMID:11885823

Recruiting for success--the potential for using occupational personality questionnaires for the assessment of doctors.

PubMed

Chambers, R; Wright, D; Taylor, H

1995-05-01

to evaluate the Saville and Holdsworth Occupational Personality Questionnaire (OPQ) to assess its potential and validity as a tool in the recruitment of doctors. To determine the range of personality characteristics in a group of general practitioners. an administered commercially available questionnaire. general practitioners in North and Mid. Stafftordshire. 133 general practitioners or trainees. 44% of general practitioners agreed to participate. The majority found it useful and recognised its potential to increase self-awareness, highlight weaknesses that might be improved and for future recruitment of others to their teams. Doctors' personality traits were similar to those of managerial/professional norms. The validity of the OPQ was supported by (a) significant associations with subjects' previously reported mental health problems and (b) 83% of respondents confirming that their reports correctly described their personalities at work. OPQs have a place in the recruitment of doctors by identifying appropriate people to strengthen the team.

Models of clinical reasoning with a focus on general practice: A critical review.

PubMed

Yazdani, Shahram; Hosseinzadeh, Mohammad; Hosseini, Fakhrolsadat

2017-10-01

Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings. A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized. Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed.

'Management is a black art'--professional ideologies with respect to temporomandibular disorders.

PubMed

Durham, J; Exley, C; Wassell, R; Steele, J G

2007-06-09

To gain a deeper understanding of the range of influences on the full range of dental professionals who provide treatment for temporomandibular disorders (TMD). Qualitative semi-structured interviews. Primary and secondary care in the North and South of the United Kingdom. A criterion-based purposive sample was taken of dental practitioners, comprising primary and secondary care practitioners. In-depth interviews were conducted and data collection and analysis occurred concurrently until data saturation was achieved. DATA AND DISCUSSION: There was a reported lack of adequate remuneration for provision of treatment for TMD within primary care. This alongside the primary care practitioners' reported uncertainty in diagnosis of TMD appeared to lead to a propensity for referral to secondary care. Practitioners recognised a poor and scanty evidence base on which to base their care, and this allowed for idiosyncratic practice. Often the outcome measure for treatment was a subjective questioning of the patient focussing mainly on relief of pain. There is a need for better quality evidence on which to base TMD treatment, more continuing professional development and improvement in contracting arrangements to enable primary practitioners to feel confident in managing TMD.

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

PubMed

Vanagas, Giedrius; Bihari-Axelsson, Susanna

2005-06-10

There are number of studies showing that general practice is one of the most stressful workplace among health care workers. Since Baltic States regained independence in 1990, the reform of the health care system took place in which new role and more responsibilities were allocated to general practitioners' in Lithuania. This study aimed to explore the psychosocial stress level among Lithuanian general practitioner's and examine the relationship between psychosocial stress and work characteristics. The cross-sectional study of 300 Lithuanian General practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the R. Karasek scale. The analysis included descriptive statistics; interrelationship analysis between characteristics and multivariate logistic regression to estimate odds ratios for each of the independent variables in the model. Response rate 66% (N = 197). Our study highlighted highest prevalence of psychosocial stress among widowed, single and female general practitioners. Lowest prevalence of psychosocial stress was among males and older age general practitioners. Psychosocial stress occurs when job demands are high and job decision latitude is low (chi2 = 18,9; p < 0,01). The multivariate analysis shows that high job demands (OR 4,128; CI 2,102-8,104; p < 0,001), patient load more than 18 patients per day (OR 5,863; CI 1,549-22,188; p < 0,01) and young age of GP's (OR 6,874; CI 1,292-36,582; p < 0,05) can be assigned as significant predictors for psychosocial stress. One half of respondents suffering from work related psychosocial stress. High psychological workload demands combined with low decision latitude has the greatest impact to stress caseness among GP's. High job demands, high patient load and young age of GP's can be assigned as significant predictors of psychosocial stress among GP's.

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

PubMed

Mørk, Trine; Andersen, Pernille Tanggaard; Taket, Ann

2014-06-03

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

Paediatric consultation patterns in general practice and the accident and emergency department.

PubMed

Bradley, T; McCann, B; Glasgow, J F; Patterson, C C

1995-04-01

The age, sex, source of referral and diagnosis of children brought to a paediatric accident and emergency department by their parents were compared to those consulting their general practitioner. A simultaneous, prospective review of these consultations was carried out over a six-week period in an inner-city paediatric teaching hospital and a group practice in a socially deprived urban area. 730 children less than 13 years of age who presented for a new consultation were seen. 629 (86%) presented initially to the general practitioner, who dealt with all but 25 (4.0%) without onward referral to the accident and emergency department. 127 consultations took place at the accident and emergency department, of which 104 (82%) were parental referrals. There was no sex difference in children seen by the general practitioner. There was a decreasing trend with increasing age in the proportion of children who consulted the general practitioner, perhaps due to the higher frequency of injury in the older children. Over three quarters (77%) of injured children were brought directly to the accident and emergency department, compared with only 4% of children without injuries (p < 0.001). Of 22 children with injuries who presented to the general practitioner, only 4 (18%) required onward referral. General practitioners met the great majority of the paediatric workload generated by the practice. Audit between primary and secondary care gives a more reliable picture than data from only one source. Injured children are more likely to be taken to the accident and emergency department. Further study of the severity of injury in children is required to determine if there is potential to reduce parental referrals to accident and emergency departments.

General practitioners' perceptions of the stigma of dementia and the role of reciprocity.

PubMed

Gove, Dianne; Small, Neil; Downs, Murna; Vernooij-Dassen, Myrra

2017-10-01

A qualitative exploration of the stigma of dementia reported that general practitioners described lack of reciprocity as one way in which people with dementia are perceived within society. This was closely linked to their perception of dementia as a stigma. In this article, we explore whether general practitioners perceive people with dementia as lacking reciprocity and, if so, if this is linked with societal opinions about dementia as a stigma. The implications of both perceptions of people with dementia failing to reciprocate and of stigma for timely diagnosis are explored. Our approach is to follow the thread of reciprocity in the data from our initial study. In this follow-up study, general practitioners' perceptions of societal views of people with dementia included a perception of a lack of reciprocity specifically linked with; failing to respond to human contact, the absence of an appropriate return on social investment and failing to contribute to, or being a burden on, society. General practitioners reported a link between societal perceptions of lack of reciprocity and stereotypes about advanced dementia, difficulties communicating with people with dementia, and lack of opportunities for people with dementia to reciprocate. General practitioners occupy a key position, they can challenge stereotypes and, with support and targeted training about communicating with people living with dementia, can emphasize the ways in which people with dementia can communicate, thereby enhancing their potential to reciprocate. Such changes have implications for improved care and quality of life through the continued maintenance of social inclusion and perceptions of personhood.

[Need for information concerning medical rehabilitation of the federal german pension fund--findings of an online survey of general practitioners].

PubMed

Walther, A L; Pohontsch, N J; Deck, R

2015-05-01

General practitioners complain about information deficits, uncertainties and unclear requirements associated with medical rehabilitation. In this study General practitioners' specific information needs are identified and the preferred form for the presentation of information is determined. In a secondary analysis of several focus groups with different stakeholders, rehabilitation specific aspects were identified for which General practitioners could have further information needs. Those were transferred into an online-questionnaire. GPs in Schleswig-Holstein were invited to the online-survey via E-Mail by different medical associations. A total of 194 questionnaires were available for analysis. In general, high information needs covering all rehabilitation topics in the questionnaire are evident. The highest information need is recognised for the following aspects: in which cases it makes sense to file an objection, which measures have to take place before it makes sense to file an objection and what the term "ambulant measures have been exhausted" exactly means. GPs clearly prefer a website as a means of informational source. Under the option of multiple replies 74.2% prefer a website, followed by the option of a brochure (44.8%) and further education (22.2%). General practitioners have high information needs regarding different aspects of rehabilitation which are not satisfied with existing sources of information. The development of a user-friendly website with comprehensible information on the required aspects seems necessary to increase the acceptance and understanding of medical rehabilitation among practitioners and therefore to optimise rehabilitation processes. © Georg Thieme Verlag KG Stuttgart · New York.

General practitioners: Between integration and co-location. The case of primary care centers in Tuscany, Italy.

PubMed

Barsanti, Sara; Bonciani, Manila

2018-01-01

Healthcare systems have followed several strategies aimed at integrating primary care services and professionals. Medical homes in the USA and Canada, and primary care centres across Europe have collocated general practitioners and other health and social professionals in the same building in order to boost coordination among services and the continuity of care for patients. However, in the literature, the impact of co-location on primary care has led to controversial results. This article analyses the possible benefits of the co-location of services in primary care focusing on the Italian model of primary care centres (Case della Salute) in terms of general practitioners' perception. We used the results of a web survey of general practitioners in Tuscany to compare the experiences and satisfaction of those general practitioners involved and not involved in a primary care centre, performed a MONAVA and ANOVA analysis. Our case study highlights the positive impact of co-location on the integration of professionals, especially with nurses and social workers, and on organizational integration, in terms of frequency of meeting to discuss about quality of care. Conversely, no significant differences were found in terms of either clinical or system integration. Furthermore, the collaboration with specialists is still weak. Considering the general practitioners' perspective in terms of experience and satisfaction towards primary care, co-location strategies is a necessary step in order to facilitate the collaboration among professionals and to prevent unintended consequences in terms of an even possible isolation of primary care as an involuntary 'disintegration of the integration'.

[Prostate cancer screening using prostate-specific antigen: The views of general and laboratory physicians].

PubMed

Giménez, N; Filella, X; Gavagnach, M; Allué, J A; Pedrazas, D; Ferrer, F

2018-03-21

It is currently recommended to provide individualised information on benefit-risk balance and shared decision-making in prostate cancer screening using prostate-specific antigen (PSA). To determine the usual practice and the views of general and laboratory practitioners in the screening of prostate cancer using PSA. A cross-sectional study based on a questionnaire and on PSA screening requests from Primary Health Care (PHC) in men older than 49 years with no prostatic symptoms. In 2015, PHC in Catalonia requested PSA on 15.2% of males. A total of 114 general practitioners and 227 laboratory practitioners participated in the questionnaire. The mean age of those who responded was 43 years with a mean of 17 years' experience, and included 64% women. According to general practitioners, 61% of PSA was performed at the patient's request. The uncertainty score when requesting PSA was 5 points for general practitioners and 5.7 for laboratory professionals. Interest in having clinical recommendations received 7.2 points in PHC, and 8.8 in the laboratory. Knowledge about the different clinical practice guidelines received was less than 5 points overall. General practitioners requested PSA screening in almost one-sixth of men over the age of 49 without prostate disease, often at the patient's request, and after informing them of the benefits and risks. PHC and laboratory physicians were interested in having recommendations and information, although they did not usually consult clinical practice guidelines immediately. Copyright © 2018 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Measuring the ambiguity tolerance of medical students: a cross-sectional study from the first to sixth academic years

PubMed Central

2014-01-01

Background Tolerance of ambiguity, or the extent to which ambiguous situations are perceived as desirable, is an important component of the attitudes and behaviors of medical students. However, few studies have compared this trait across the years of medical school. General practitioners are considered to have a higher ambiguity tolerance than specialists. We compared ambiguity tolerance between general practitioners and medical students. Methods We designed a cross-sectional study to evaluate the ambiguity tolerance of 622 medical students in the first to sixth academic years. We compared this with the ambiguity tolerance of 30 general practitioners. We used the inventory for measuring ambiguity tolerance (IMA) developed by Reis (1997), which includes three measures of ambiguity tolerance: openness to new experiences, social conflicts, and perception of insoluble problems. Results We obtained a total of 564 complete data sets (return rate 90.1%) from medical students and 29 questionnaires (return rate 96.7%) from general practitioners. In relation to the reference groups defined by Reis (1997), medical students had poor ambiguity tolerance on all three scales. No differences were found between those in the first and the sixth academic years, although we did observe gender-specific differences in ambiguity tolerance. We found no differences in ambiguity tolerance between general practitioners and medical students. Conclusions The ambiguity tolerance of the students that we assessed was below average, and appeared to be stable throughout the course of their studies. In contrast to our expectations, the general practitioners did not have a higher level of ambiguity tolerance than the students did. PMID:24405525

Measuring the ambiguity tolerance of medical students: a cross-sectional study from the first to sixth academic years.

PubMed

Weissenstein, Anne; Ligges, Sandra; Brouwer, Britta; Marschall, Bernhard; Friederichs, Hendrik

2014-01-09

Tolerance of ambiguity, or the extent to which ambiguous situations are perceived as desirable, is an important component of the attitudes and behaviors of medical students. However, few studies have compared this trait across the years of medical school. General practitioners are considered to have a higher ambiguity tolerance than specialists. We compared ambiguity tolerance between general practitioners and medical students. We designed a cross-sectional study to evaluate the ambiguity tolerance of 622 medical students in the first to sixth academic years. We compared this with the ambiguity tolerance of 30 general practitioners. We used the inventory for measuring ambiguity tolerance (IMA) developed by Reis (1997), which includes three measures of ambiguity tolerance: openness to new experiences, social conflicts, and perception of insoluble problems. We obtained a total of 564 complete data sets (return rate 90.1%) from medical students and 29 questionnaires (return rate 96.7%) from general practitioners. In relation to the reference groups defined by Reis (1997), medical students had poor ambiguity tolerance on all three scales. No differences were found between those in the first and the sixth academic years, although we did observe gender-specific differences in ambiguity tolerance. We found no differences in ambiguity tolerance between general practitioners and medical students. The ambiguity tolerance of the students that we assessed was below average, and appeared to be stable throughout the course of their studies. In contrast to our expectations, the general practitioners did not have a higher level of ambiguity tolerance than the students did.

Postnatal gestational diabetes mellitus follow-up: Perspectives of Australian hospital clinicians and general practitioners.

PubMed

Kilgour, Catherine; Bogossian, Fiona Elizabeth; Callaway, Leonie; Gallois, Cindy

2018-05-04

The reasons for low postnatal screening rates for women with gestational diabetes mellitus are not well understood. Multiple care providers, settings and changes to diagnostic criteria, may contribute to confusion over postnatal care. Quality of communication between clinicians may be an important influence for the completion of postnatal gestational diabetes mellitus follow-up. Describe and analyse communication processes between hospital clinicians (midwives, medical, allied staff) and general practitioners who provide postnatal gestational diabetes mellitus care. Purposive sampling and convergent interviews explored participants' communication experiences providing gestational diabetes mellitus postnatal follow-up. Data were analysed with Leximancer automated content analysis software; interpretation was undertaken using Communication Accommodation Theory. Clinicians who provided maternity care at a tertiary referral hospital (n=13) in Queensland, Australia, and general practitioners (n=16) who provided maternity shared care with that hospital between December 2012 and July 2013. Thematic analysis identified very different perspectives between the experiences of General Practitioners and hospital clinicians; six themes emerged. General practitioners were concerned about themes relating to discharge summaries and follow-up guidelines. In contrast, hospital clinicians were more concerned about themes relating to gestational diabetes mellitus antenatal care and specialist clinics. Two themes, gestational diabetes mellitus women and postnatal checks were shared. Gestational diabetes mellitus follow-up is characterised by communication where general practitioners appear to be information seekers whose communication needs are not met by hospital clinicians. Midwives are ideally placed to assist in improving communication and postnatal gestational diabetes mellitus follow-up. Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Attitude of dental hygienists, general practitioners and periodontists towards preventive oral care: an exploratory study.

PubMed

Thevissen, Eric; De Bruyn, Hugo; Colman, Roos; Koole, Sebastiaan

2017-08-01

Promoting oral hygiene and stimulating patient's responsibility for his/her personal health remain challenging objectives. The presence of dental hygienists has led to delegation of preventive tasks. However, in some countries, such as Belgium, this profession is not yet legalized. The aim of this exploratory study was to compare the attitude towards oral-hygiene instructions and patient motivational actions by dental hygienists and by general practitioners/periodontists in a context without dental hygienists. A questionnaire on demographics (six items), oral-hygiene instructions (eight items) and patient motivational actions (six items) was distributed to 241 Dutch dental hygienists, 692 general practitioners and 32 periodontists in Flanders/Belgium. Statistical analysis included Fisher's exact-test, Pearson's chi-square test and multiple (multinomial) logistic regression analysis to observe the influence of profession, age, workload, practice area and chair-assistance. Significant variance was found between general practitioners and dental hygienists (in 13 of 14 items), between general practitioners and periodontists (in nine of 14 items) and between dental hygienists and periodontists (in five of 14 items). In addition to qualification, chair-assistance was also identified as affecting the attitude towards preventive oral care. The present study identified divergence in the application of, and experienced barriers and opinions about, oral-hygiene instructions and patient motivational actions between dental hygienists and general practitioners/periodontists in a context without dental hygienists. In response to the barriers reported it is suggested that preventive oriented care may benefit from the deployment of dental hygienists to increase access to qualified preventive oral care. © 2017 FDI World Dental Federation.

[MODERN EDUCATIONAL TECHNOLOGY MASTERING PRACTICAL SKILLS OF GENERAL PRACTITIONERS].

PubMed

Kovalchuk, L I; Prokopchuk, Y V; Naydyonova, O V

2015-01-01

The article presents the experience of postgraduate training of general practitioners--family medicine. Identified current trends, forms and methods of pedagogical innovations that enhance the quality of learning and mastering the practical skills of primary professionals providing care.

42 CFR 434.6 - General requirements for all contracts and subcontracts. P>(a) Contracts. All contracts under...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false General requirements for all contracts and subcontracts. P>(a) Contracts. All contracts under this part must include all of the following: 434.6 Section... contracts and subcontracts.P>(a) Contracts. All contracts under this part must include all of the following...

76 FR 10476 - (General Provisions) Contract Appeals and the Acquisition Regulation: General, Acquisition...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-25

... DEPARTMENT OF ENERGY 10 CFR Part 1023 48 CFR Parts 901, 902, 903, 904, 906, 907, 908, 909, 911, 914, 915, 916, 917, and 952 RIN 1991-AB81 (General Provisions) Contract Appeals and the Acquisition Regulation: General, Acquisition Planning, and Contracting Methods and Contract Types Correction In rule...

41 CFR 50-204.2 - General safety and health standards.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true General safety and health... Public Contracts PUBLIC CONTRACTS, DEPARTMENT OF LABOR 204-SAFETY AND HEALTH STANDARDS FOR FEDERAL SUPPLY CONTRACTS General Safety and Health Standards § 50-204.2 General safety and health standards. (a) Every...

[The dimensions of the organisational climate as seen by general practitioners].

PubMed

Delgado Sánchez, Ana; Bellón Saameño, Juan Angel; Martínez-Cañavate López-Montes, María Teresa; Luna del Castillo, Juan de Dios; López Fernández, Luis Andrés; Lardelli Claret, Pablo

2006-05-31

To create and validate a tool to assess the organizational climate (OC) perceived by general practitioners (GP). Descriptive, cross-sectional, and multi-site, study. Health centres (HC) in Jaén and Málaga province Spain. Random sample of 38 HCs and 387 GPs. A self-administered questionnaire in March 2001, with the personal variables of sex, age, graduation date, specialty, kind of contract, time worked in primary care teams, time in current job, list size, case load, tutor of residents and academic qualification. HC variables: urban/rural, team structure, accreditation for teaching residents, service portfolio, out-patient care, and an OC scale of 40 Likert-like questions. We analysed the content validity of the scale by factorial analysis; and its reliability, by Cronbach's alpha and corrected scale-item correlation coefficients. Reply rate was 89.8%, 71% of the GPs were male, mean age was 44, 76% had tenure, and 37% were specialists in family medicine and 28% tutors, 17% with 3rd-year residents, 9% with doctors; 50% of HCs were rural and the mean team structure had 13 GPs and 4 paediatricians. We obtained 12 factors that explained 60% of variance, and 7 factors with reliability coefficients >0.50. We made an OC-positive scale (alpha=.82) with the dimensions for team-work, cohesion and social life; and another OC-negative scale (alpha=.78) composed of team conflict, perceived team failure, excess autonomy, authoritarian management, and GP-nurse tension. We found a questionnaire with good validity and reliability, which was useful for evaluating the OC perceived by GPs.

48 CFR 232.007 - Contract financing payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Contract financing... SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING 232.007 Contract financing payments. (a) DoD policy is to make contract financing payments as quickly as possible. Generally...

Clinical guidelines in primary care: a survey of general practitioners' attitudes and behaviour.

PubMed Central

Siriwardena, A N

1995-01-01

BACKGROUND: In the United Kingdom little is known about general practitioners' attitudes to and behaviour concerning clinical guidelines. AIM: A study was performed to investigate these two under-researched areas. METHOD: In 1994 a postal questionnaire on clinical guidelines was sent to all 326 general practitioner principals on the list of Lincolnshire Family Health Services Authority. The questionnaire consisted of 20 attitude statements and an open question on clinical guidelines, as well as surveying characteristics and behaviour of respondents. RESULTS: Of the 326 general practitioners sent questionnaires, 213 (65%) replied. Most respondents (78%) reported having been involved in writing inhouse guidelines. An even greater proportion (92%) reported having participated in clinical audit. Respondents were generally in favour of clinical guidelines, with mean response scores indicating a positive attitude to guidelines in 15 of the 20 statements, a negative attitude in four and equivocation in one. The majority of respondents felt that guidelines were effective in improving patient care (69%). Members (or fellows) of the Royal College of General Practitioners had a more positive attitude than non-members towards guidelines. They were also significantly more likely than non-members to have written inhouse guidelines, as were those who had participated in audit compared with those who had not participated in audit. A substantial minority (over a quarter) of general practitioners were concerned that guidelines may be used for setting performance-related pay, or that they may lead to 'cookbook' medicine, reduce clinical freedom or stifle innovation. There was also concern that guidelines should be scientifically valid. CONCLUSION: This study suggests that many general practitioners in the Lincolnshire Family Health Services Authority area have produced written inhouse guidelines. This is largely sustained by positive attitudes about the effectiveness and benefits of clinical guidelines. The positive attitude of RCGP members supports it in its continuing role in developing, implementing and evaluating guidelines in primary care. The question of whether incorporation of guidelines into clinical audit is an effective means to disseminate systematic research-based guidelines warrants further study. PMID:8745861

Effectiveness of oncogenetics training on general practitioners' consultation skills: a randomized controlled trial

PubMed Central

Houwink, Elisa J.F.; Muijtjens, Arno M.M.; van Teeffelen, Sarah R.; Henneman, Lidewij; Rethans, Jan Joost; van der Jagt, Liesbeth E.J.; van Luijk, Scheltus J.; Dinant, Geert Jan; van der Vleuten, Cees; Cornel, Martina C.

2014-01-01

Purpose: General practitioners are increasingly called upon to deliver genetic services and could play a key role in translating potentially life-saving advancements in oncogenetic technologies to patient care. If general practitioners are to make an effective contribution in this area, their genetics competencies need to be upgraded. The aim of this study was to investigate whether oncogenetics training for general practitioners improves their genetic consultation skills. Methods: In this pragmatic, blinded, randomized controlled trial, the intervention consisted of a 4-h training (December 2011 and April 2012), covering oncogenetic consultation skills (family history, familial risk assessment, and efficient referral), attitude (medical ethical issues), and clinical knowledge required in primary-care consultations. Outcomes were measured using observation checklists by unannounced standardized patients and self-reported questionnaires. Results: Of 88 randomized general practitioners who initially agreed to participate, 56 completed all measurements. Key consultation skills significantly and substantially improved; regression coefficients after intervention were equivalent to 0.34 and 0.28 at 3-month follow-up, indicating a moderate effect size. Satisfaction and perceived applicability of newly learned skills were highly scored. Conclusion: The general practitioner–specific training proved to be a feasible, satisfactory, and clinically applicable method to improve oncogenetics consultation skills and could be used as an educational framework to inform future training activities with the ultimate aim of improving medical care. PMID:23722870

Hypertension control and management in Slovenia, Yugoslavia.

PubMed

Jezersek, P; Dolenc, P; Kralj, Z

1990-08-01

Data were collected from 413 questionnaires sent to general practitioners throughout Slovenia, accounting for half the physicians in this discipline. BP was measured most commonly in the sitting position (72%), mostly on the left arm. Most respondents (93%) used only one cuff size. Correction of BP readings according to the patient's arm circumference was used by 63% of the respondents. Seventy-eight percent of the general practitioners recorded phase V of the Korotkoff sounds for diastolic BP. BP was measured more than once at each examination by 55%. BP measurements were performed by nurses in 27% of cases. Mercury sphygmomanometers were used by 87%. Manometers were calibrated once a year by 73%. Complete diagnostic procedures for the definition of hypertension were conducted in approximately 50% of patients, predominantly in severe cases. Drug treatment was commenced in the range of 'mild hypertension' usually by 93% of the general practitioners. It was started at BP values of 165/99 mmHg and higher. In patients with other risk factors, it was instituted even earlier. General measures (non-drug therapy) were advised by only 30%. Beta-blockers were usually prescribed to younger patients as drug of choice (74%), and diuretic agents to the elderly (48%). General practitioners' sources of new information about hypertension were mainly medical literature, pharmaceutical industry information, and professional meetings. Prevalence of hypertensive BP values in the responding general practitioners themselves was 8%.

A survey on acquaintance, orientation and behavior of general medical practitioners toward periodontal diseases.

PubMed

Kaur, Supreet; Khurana, Pankaj; Kaur, Harjit

2015-01-01

An association between oral conditions such as periodontal diseases and systemic conditions is noted. As such, periodontal disease is associated with an increased risk of systemic illnesses such as cardiovascular disease, diabetes, adverse pregnancy outcome, atherosclerosis, stroke and hospital acquired pneumonia. The concept of diagnosing and treating a potential patient to minimize the deleterious effects of this chronic infectious and inflammatory condition on systemic conditions represents both an unprecedented challenge and opportunity to our profession. Keeping this in view, the present survey was designed to evaluate the acquaintance, orientation and behavior of general medical practitioners; concerning the effects of periodontal disease on systemic health. A typed questionnaire carrying four sets of questions was distributed among general medical practitioners of seven different government and private medical colleges and hospitals. Questionnaire was developed to assess the acquaintance, orientation and behavior of general medical practitioners toward periodontal disease. Most of the respondents have knowledge regarding the signs and symptoms of periodontal disease and its association with cardiovascular disease. However, majority of them do not know about the potential effect of periodontal disease on other organ systems. General medical practitioners have inadequate knowledge regarding periodontal diseases. Hence, oral health related training should be an integral part of the medical curriculum.

A survey on acquaintance, orientation and behavior of general medical practitioners toward periodontal diseases

PubMed Central

Kaur, Supreet; Khurana, Pankaj; Kaur, Harjit

2015-01-01

Background: An association between oral conditions such as periodontal diseases and systemic conditions is noted. As such, periodontal disease is associated with an increased risk of systemic illnesses such as cardiovascular disease, diabetes, adverse pregnancy outcome, atherosclerosis, stroke and hospital acquired pneumonia. The concept of diagnosing and treating a potential patient to minimize the deleterious effects of this chronic infectious and inflammatory condition on systemic conditions represents both an unprecedented challenge and opportunity to our profession. Keeping this in view, the present survey was designed to evaluate the acquaintance, orientation and behavior of general medical practitioners; concerning the effects of periodontal disease on systemic health. Materials and Methods: A typed questionnaire carrying four sets of questions was distributed among general medical practitioners of seven different government and private medical colleges and hospitals. Questionnaire was developed to assess the acquaintance, orientation and behavior of general medical practitioners toward periodontal disease. Results: Most of the respondents have knowledge regarding the signs and symptoms of periodontal disease and its association with cardiovascular disease. However, majority of them do not know about the potential effect of periodontal disease on other organ systems. Conclusion: General medical practitioners have inadequate knowledge regarding periodontal diseases. Hence, oral health related training should be an integral part of the medical curriculum. PMID:26229276

[Summary of the practice guideline 'Viral hepatitis and other liver diseases' (second revision) from the Dutch College of General Practitioners].

PubMed

Bouma, M; van Geldrop, W J; Numans, M E; Wiersma, Tj; Goudswaard, A N

2008-12-06

The revised Dutch College of General Practitioners' practice guideline 'Viral hepatitis and other liver diseases' offers advice in the diagnosis and management of viral hepatitis A, B and C and other liver diseases. The guideline is important for general practitioners as well as specialists in internal medicine and gastroenterology. The emphasis is on the management of chronic hepatitis B en C, because the prevalence of these diseases has increased in the Netherlands and, in addition, the treatment options for chronic hepatitis have improved. Consequently, timely recognition and adequate referral of patients with chronic hepatitis B or hepatitis C have become more important. However, many patients with a chronic liver disease have no symptoms. Therefore, the general practitioner should be aware that a patient visiting the practice with fatigue and malaise could have a liver disease if he or she belongs to a high-risk group or has had high-risk contacts. If the general practitioner repeatedly finds increased liver transaminase values during routine examination of asymptomatic patients, additional diagnostic tests should be performed. Further tests should focus on viral hepatitis as well as on non-alcoholic fatty liver disease and non-alcoholic steatohepatitis or, depending on the history-taking, liver damage due to excessive alcohol, medication or drug use.

[Initiatives to increase the efficiency of dermatological patient care].

PubMed

van de Kerkhof, P C M

2006-08-26

The number of tasks required of dermatologists has increased in the last decade. This article discusses potential ways to enhance the efficiency ofdermatological patient care and prevent problems of capacity. A study conducted in the UK found that, for the top 10 skin disorders, the accessibility of general practitioners with special expertise in dermatology was better than that of the dermatology clinic. Waiting times were considerably shorter with the general practitioners, but care was more expensive. Outcomes were similar for these skin disorders in terms of disease-specific quality of life. The study made no comment on the actual diagnostic ability of the specialised general practitioners. Teledermatology can reduce the number of referrals to a dermatologist by half. However, a considerable percentage of teledermatological consultations result in a different diagnosis than that obtained during a standard 'in vivo' consultation. Teledermatology can be a useful option for the follow-up of patients with ulcus cruris. The efficiency of dermatological care can be increased by working in teams. Dermatological nurses can be trained and conduct their own consultations under the supervision of a dermatologist. Dermatological care can also be organised in regional cooperative groups with general practitioners. Within these groups, teledermatology and specialised dermatology training for general practitioners can be useful innovations.

Impact of Training on General Practitioner's Knowledge, Attitude and Practices Regarding Emergency Contraception in Hyderabad.

PubMed

Bibi, Seema; Mustafa Abbasi, Razia; Awan, Shazia; Ara Qazi, Roshan; Ashfaque, Sanober

2013-09-01

To elaborate the impact of family planning training on general practitioners' knowledge, attitude and practices regarding emergency contraception. A cross sectional survey involving 270 general practitioners was conducted in Hyderabad from 1(st) Oct to 31(st) Dec 2010. Participants were divided into two groups on the basis of attending family planning training course after graduation and were interviewed face to face. Data was noted on questionnaire asking their knowledge, attitude and practices regarding emergency contraception. Data was analyzed on SPSS version 11. Student t-test was applied to compare the proportions among two groups. Out of 270 general practitioners, male & female participants were 132 (48.9%) and 138 (51.1%) respectively. Mean experience as private general practitioner was 7.48 + 7.6 years. One third of the participants 84 (31.1%) have attended five days training course on family planning in the past, while 186 (69.9%) did not have any training. Source of training was government institutes 46(17%) and non government organization in 38 (14.1%) cases. Significant positive difference was noted on emergency contraception knowledge, attitude and use in group who attended family planning training. Educational intervention has a positive impact on health care provider's knowledge, attitude and practices of emergency contraception.

A trial of a self-assessment tool of problems following treatment of colorectal cancer: a prospective study in Australia primary care.

PubMed

Ngune, I; Jiwa, M; McManus, A; Parsons, R; Hodder, R

2016-01-01

Patients treated for colorectal cancer (CRC) experience considerable physical, social and psychological morbidity. In this study, 66 participants with stages I-III CRC were enrolled in this study. Participants completed the self-assessment tool for patients (SATp) over a 5-month period and visited a general practitioner with a copy of their SATp to assist in the management of any problems associated with CRC treatment. General practitioners' notes were reviewed for management actions. Of the 66 participants, 57 visited a general practitioner over the 5-month study period. A total of 547 problems were identified (median 7; IQR: 3-12.25). Participants with physical problems were more likely to consult their general practitioner (OR: 1.84, CI: 1.05-3.21, P = 0.03) compared to those with psychological problems. The number of problems experienced by participants did not have any influence on the decision to visit a general practitioner. Psychological problems (P < 0.01) significantly reduced over the 5-month study period. Regular use of the SATp facilitates the identification of long-term CRC treatment-related problems. Some of these problems could then be addressed in primary care. © 2015 John Wiley & Sons Ltd.

[Vitamin D supplementation in the elderly: guidelines and practice].

PubMed

Chel, V G M; Elders, P J M; Tuijp, M L M; van den Berg, H H; van Drongelen, K I; Siedenburg, R C; Ooms, M E; Lips, P T A

2013-01-01

In 2008, the Health Council of the Netherlands published an advice on vitamin D supplementation for the elderly. Nevertheless, suspicion arose at the Ministry of Health, Welfare and Sport and the Netherlands Nutrition Centre that vitamin D supplementation in the elderly is still insufficient. We aimed to determine the extent to which general practitioners and elderly care physicians actually followed the advice of the Health Council. Questionnaire study. Brief questionnaires were sent to all elderly care physicians in the Netherlands. Some questions were also posed to general practitioners at a network meeting of the Academic Network of GP Practices of the VU University Medical Center in Amsterdam. More than two-thirds of the respondents, both elderly care physicians and general practitioners, are familiar with the guidelines of the Health Council of the Netherlands on vitamin D supplementation in the elderly, but about half do not prescribe vitamin D when the guideline advises to do so. When supplementation is prescribed, about half of the elderly care physicians and a fifth of the general practitioners uses an insufficient dose. The guidelines of the Health Council of the Netherlands on vitamin D supplementation in the elderly are not sufficiently followed by elderly care physicians and general practitioners. Awareness of and support for the vitamin D supplementation guidelines among health care providers is still limited.

General Practice On-the-Job Training in Chinese Urban Community: A Qualitative Study on Needs and Challenges

PubMed Central

Wang, Bo; Wu, Tao; Huang, Yafang; Guo, Aimin

2014-01-01

Background On-the-job training is an important strategy for general practitioners to deliver appropriately community health services in China. The development of basic professional competence for general practitioners is the main goal of on-the-job training program. The aim of this study was to explore the needs of and the challenges to on-the-job training for general practitioners, and to provide advices for policy-makers to carry out this program more effectively. Methods We conducted 3 nominal group techniques, 17 in-depth interviews and 3 focus groups to identify the status of, needs of and challenges to on-the-job training for general practitioners in Liaoning, Ningxia, and Fujian provinces from September 2011 until December 2011. Audiotapes and transcripts were analyzed to identify major themes. Content analysis of the data was completed from January 2012 to March 2012. Results Basic theoretical knowledge and clinical skills were the main needs for general practitioners during on-the-job training. The challenges during training included the time contradiction between work and training, deficiencies of qualified preceptors, and lack of training funds. Participants gave recommendations how to resolve the above problems. Conclusions In order to improve the outcomes of general practice on-the-job training, it is necessary for government officials to resolve the contradiction between work and training, train preceptors continuously, and increase financial support in the training program. PMID:24728399

42 CFR 418.106 - Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... direction of a qualified licensed pharmacist who is an employee of or under contract with the hospice. The provided pharmacist services must include evaluation of a patient's response to medication therapy... licensed nurse, nurse practitioner (where appropriate), pharmacist, or physician; and (ii) The individual...

42 CFR 418.106 - Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... direction of a qualified licensed pharmacist who is an employee of or under contract with the hospice. The provided pharmacist services must include evaluation of a patient's response to medication therapy... licensed nurse, nurse practitioner (where appropriate), pharmacist, or physician; and (ii) The individual...

42 CFR 418.106 - Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... direction of a qualified licensed pharmacist who is an employee of or under contract with the hospice. The provided pharmacist services must include evaluation of a patient's response to medication therapy... licensed nurse, nurse practitioner (where appropriate), pharmacist, or physician; and (ii) The individual...

42 CFR 418.106 - Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... direction of a qualified licensed pharmacist who is an employee of or under contract with the hospice. The provided pharmacist services must include evaluation of a patient's response to medication therapy... licensed nurse, nurse practitioner (where appropriate), pharmacist, or physician; and (ii) The individual...

42 CFR 418.106 - Condition of participation: Drugs and biologicals, medical supplies, and durable medical equipment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... direction of a qualified licensed pharmacist who is an employee of or under contract with the hospice. The provided pharmacist services must include evaluation of a patient's response to medication therapy... licensed nurse, nurse practitioner (where appropriate), pharmacist, or physician; and (ii) The individual...

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

ERIC Educational Resources Information Center

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

2008-01-01

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

48 CFR 46.201 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

....201 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Quality Requirements 46.201 General. (a) The contracting officer shall include in the solicitation and contract the appropriate quality requirements. The type and extent of contract quality...

48 CFR 42.1601 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42.1601 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT CONTRACT ADMINISTRATION AND AUDIT SERVICES Small Business Contract Administration 42.1601 General. The... request to the contracting officer from a small business concern with respect to a contract administration...

Legal and ethical issues in telemedicine and robotics.

PubMed

Dickens, B M; Cook, R J

2006-07-01

Modern medical concerns with telemedicine and robotics practiced across national or other jurisdictional boundaries engage the historical, complex area of law called conflict of laws. An initial concern is whether a practitioner licensed only in jurisdiction A who treats a patient in jurisdiction B violates B's laws. Further concerns are whether a practitioner in A who violates a contract or treats a patient in B negligently incurs liability in B, A, or both, and, if treatment lawful in A is unlawful in B, whether the practitioner commits a crime. Judicial procedures are set by courts in which proceedings are initiated, but courts may decline jurisdiction due to inconvenience to parties. If courts accept jurisdiction, they may apply their own substantive legal rules, but may find that the rules of a conflicting jurisdiction should apply. Cross-border care should not change usual medical ethics, for instance on confidentiality, but may mitigate or aggravate migration of specialists.

Marine Corps Installations National Capital RegionRegional Contracting Office Generally Implemented Recommendations

DTIC Science & Technology

2016-07-29

Corps Installations National Capital Region–Regional Contracting Office Generally Implemented Recommendations J U LY 2 9 , 2 0 1 6 Report No...Installations National Capital Region–Regional Contracting Office Generally Implemented Recommendations Objective We determined whether the Marine...Corps Regional Contracting Office–National Capital Region implemented the recommendations in Report No. DODIG-2015-095, “Small Business Contracting

25 CFR 900.194 - Does FTCA coverage extend to services provided under a staff privileges agreement with a non-IHS...

Code of Federal Regulations, 2011 CFR

2011-04-01

... practitioner to provide reciprocal services to the general population? 900.194 Section 900.194 Indians BUREAU... health care practitioner to provide reciprocal services to the general population? Yes. Those services...

25 CFR 900.194 - Does FTCA coverage extend to services provided under a staff privileges agreement with a non-IHS...

Code of Federal Regulations, 2014 CFR

2014-04-01

... practitioner to provide reciprocal services to the general population? 900.194 Section 900.194 Indians BUREAU... health care practitioner to provide reciprocal services to the general population? Yes. Those services...

25 CFR 900.194 - Does FTCA coverage extend to services provided under a staff privileges agreement with a non-IHS...

Code of Federal Regulations, 2012 CFR

2012-04-01

... practitioner to provide reciprocal services to the general population? 900.194 Section 900.194 Indians BUREAU... health care practitioner to provide reciprocal services to the general population? Yes. Those services...

25 CFR 900.194 - Does FTCA coverage extend to services provided under a staff privileges agreement with a non-IHS...

Code of Federal Regulations, 2010 CFR

2010-04-01

... practitioner to provide reciprocal services to the general population? 900.194 Section 900.194 Indians BUREAU... health care practitioner to provide reciprocal services to the general population? Yes. Those services...

25 CFR 900.194 - Does FTCA coverage extend to services provided under a staff privileges agreement with a non-IHS...

Code of Federal Regulations, 2013 CFR

2013-04-01

... practitioner to provide reciprocal services to the general population? 900.194 Section 900.194 Indians BUREAU... health care practitioner to provide reciprocal services to the general population? Yes. Those services...

[How do general practitioners limit their prescriptions? A qualitative study based on a focus group].

PubMed

Duffaud, Sylvain; Liébart, Sandra

2014-01-01

There is no consensus on prescription of medicines in many situations in general medicine. The aim of this study was to identify the strategies used by general practitioners to limit prescriptions in order to make their prescriptions more effective. A mixed sample of general practitioners in terms of age and types of practice were interviewed using the focus group method until a sufficient number of data were obtained. Fourteen women and ten men aged between 32 and 64 years were interviewed by means of three group interviews. Various strategies were identified: the practitioner's attitude (rapid identification of the patient's needs, listening and evaluation of symptoms, support by physical examination) and the use of resources (reference tools and news) during the consultation; the importance of the conclusion of the consultation (written advice or visit report, review of the previous prescription) and explanation (reasons for limitation, reassurance, arguments, proposal of a follow-up visit). Limitation of prescriptions also depends on the practitioner's own reasons (initial and continued training, motivation and personal objectives, part of a peer group) but equally on the health care system (institutional, specialist support). The study highlights numerous approach to facilitate limitation of prescriptions: training and informing practitioners and patients, consultation management, promote communication at the heart of the health care system and policy-makers. Training organizations and health authorities could facilitate these strategies for the benefit of patients.

Near patient testing in general practice: a review.

PubMed Central

Hilton, S

1990-01-01

Until recently, technological advances in general practice have generally been thought of as the applications of microcomputers in practice organization and record keeping. Advances in miniaturization and versatility of diagnostic technology will have a similarly large impact on the way general practitioners practice medicine in the next decade. This article reviews some of the newer tests that are already available to general practitioners, particularly in diagnostic biochemistry and microbiology. Preliminary evaluative work and research studies in general practice are also described. PMID:2107838

Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers--a qualitative study.

PubMed

Espeland, Ansgar; Baerheim, Anders

2003-03-24

General practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors. Focus group interviews regarding factors affecting ordering decisions were carried out on a diverse sample of Norwegian general practitioners and were analysed qualitatively. Results of this study and two qualitative studies from the Netherlands and USA on use of spine radiography were interpreted for barriers to guideline adherence. These were compared with an existing barrier classification system described by Dr Cabana's group. The factors which Norwegian general practitioners considered might affect their decisions about ordering plain radiography for back pain concerned the following broader issues: clinical ordering criteria, patients' wishes for radiography and the general practitioner's response, uncertainty, professional dignity, access to radiology services, perception of whether the patient really was ill, sense of pressure from other health care providers/social security, and expectations about the consequences of ordering radiography. The three studies suggested several attitude-related and external barriers as classified in a previously reported system described by Dr Cabana in another study. Identified barriers not listed in this system were: lack of expectancy that guideline adherence will lead to desired health care process, emotional difficulty with adherence, improper access to actual/alternative health care services, and pressure from health care providers/organisations. Our findings may help implement spine radiography guidelines. They also indicate that Cabana et al.'s barrier classification system needs extending. A revised system is proposed.

Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers – a qualitative study

PubMed Central

Espeland, Ansgar; Baerheim, Anders

2003-01-01

Background General practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors. Methods Focus group interviews regarding factors affecting ordering decisions were carried out on a diverse sample of Norwegian general practitioners and were analysed qualitatively. Results of this study and two qualitative studies from the Netherlands and USA on use of spine radiography were interpreted for barriers to guideline adherence. These were compared with an existing barrier classification system described by Dr Cabana's group. Results The factors which Norwegian general practitioners considered might affect their decisions about ordering plain radiography for back pain concerned the following broader issues: clinical ordering criteria, patients' wishes for radiography and the general practitioner's response, uncertainty, professional dignity, access to radiology services, perception of whether the patient really was ill, sense of pressure from other health care providers/social security, and expectations about the consequences of ordering radiography. The three studies suggested several attitude-related and external barriers as classified in a previously reported system described by Dr Cabana in another study. Identified barriers not listed in this system were: lack of expectancy that guideline adherence will lead to desired health care process, emotional difficulty with adherence, improper access to actual/alternative health care services, and pressure from health care providers/organisations. Conclusions Our findings may help implement spine radiography guidelines. They also indicate that Cabana et al.'s barrier classification system needs extending. A revised system is proposed. PMID:12659640

Preventing Sexual Violence in Adolescence: Comparison of a Scientist-Practitioner Program and a Practitioner Program Using a Cluster-Randomized Design.

PubMed

Muck, Christoph; Schiller, Eva-Maria; Zimmermann, Maria; Kärtner, Joscha

2018-02-01

Numerous school-based prevention programs have been developed by scientists and practitioners to address sexual violence in adolescence. However, such programs struggle with two major challenges. First, the effectiveness of many well-established practitioner programs has not been rigorously evaluated. Second, effective scientific programs may be hard to implement into everyday school practice. Combining the knowledge of scientists and practitioners in a scientist-practitioner program could be a helpful compromise. The aim of the present study is to evaluate the effects of a scientist-practitioner program and a practitioner program using a cluster-randomized experimental design. Twenty-seven school classes were randomly assigned to either one of two programs or a control group. Outcome variables (knowledge, attitudes, behavior, and iatrogenic effects) were assessed at pretest, posttest, and a 6-month follow-up for 453 adolescents (55% female, Mage = 14.18). Short-term effects were found in both programs regarding general knowledge, knowledge of professional help, and victim-blaming attitudes. Long-term effects were found in both programs regarding general knowledge and knowledge of professional help and, in the practitioner program, in a reduction of victimization. No other effects were found on attitudes and behavior. No iatrogenic effects in the form of increased anxiety were found. Both the scientist-practitioner and the practitioner program show promise for the prevention of sexual violence in adolescence; in particular, the practitioner program may be a more cost-effective method.

The proposed general practice descriptors--will they influence preventive medicine?

PubMed

Moorhead, R G

1989-01-01

The proposed descriptor bill to change Medicare rebates to general practice patients could have a benefit to general practice preventive medicine. This seems possible through rewarding practitioners who spend more time with their patients and the positive effects of continuing medical education. However, the potential exists for whittling away any rewards for these practitioners by future governments and the audit of general practices could become a method of political control of Australian general practice.

Implementing standard setting into the Conjoint MAFP/FRACGP Part 1 examination - Process and issues.

PubMed

Chan, S C; Mohd Amin, S; Lee, T W

2016-01-01

The College of General Practitioners of Malaysia and the Royal Australian College of General Practitioners held the first Conjoint Member of the College of General Practitioners (MCGP)/Fellow of Royal Australian College of General Practitioners (FRACGP) examination in 1982, later renamed the Conjoint MAFP/FRACGP examinations. The examination assesses competency for safe independent general practice and as family medicine specialists in Malaysia. Therefore, a defensible standard set pass mark is imperative to separate the competent from the incompetent. This paper discusses the process and issues encountered in implementing standard setting to the Conjoint Part 1 examination. Critical to success in standard setting were judges' understanding of the process of the modified Angoff method, defining the borderline candidate's characteristics and the composition of judges. These were overcome by repeated hands-on training, provision of detailed guidelines and careful selection of judges. In December 2013, 16 judges successfully standard set the Part 1 Conjoint examinations, with high inter-rater reliability: Cronbach's alpha coefficient 0.926 (Applied Knowledge Test), 0.921 (Key Feature Problems).

49 CFR 1103.1 - Register of practitioners.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 8 2010-10-01 2010-10-01 false Register of practitioners. 1103.1 Section 1103.1 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT OF TRANSPORTATION RULES OF PRACTICE PRACTITIONERS General Information § 1103.1 Register of...

Osteopathic Medicine and Primary Care Practice: Plan or Serendipity?

ERIC Educational Resources Information Center

Melnick, Arnold

1990-01-01

General practitioners predominate in osteopathic as compared with allopathic medicine, perhaps because of the student selection process, features of osteopathic education, training in osteopathic hospitals, required rotating internship, and more high-quality general practitioner role models. Personality differences may account for differences in…

Vaginismus in peri- and postmenopausal women: a pragmatic approach for general practitioners and gynaecologists.

PubMed

Hope, Mairi E; Farmer, Laura; McAllister, Kay F; Cumming, Grant P

2010-06-01

Vaginismus is generally described as an involuntary contraction of the vaginal musculature, which usually results in the failure of penetration. Despite a lack of consensus as to the exact definition, prevalence rates vary between 4.2% and 42%. It is commonly diagnosed at both gynaecological and psychosexual clinics. The majority of studies and treatment options concentrate on the premenopausal age group. It is accepted that even within this age group, the diagnosis is often incorrect as symptoms can be confused with dyspareunia and other sexual pain disorders. There is no literature discussing vaginismus in the postmenopausal patient, despite evidence that an active sex life is important to the majority of women, irrespective of age. It is known that the majority of women do not report difficulties in their sex life and it may be that the older patient is more embarrassed at disclosing any such difficulties. This review aims to highlight the possible causes of vaginismus in this older age group and to aid the clinician in asking the appropriate questions, performing the appropriate examination and suggesting possible treatment options.

Casualty and surgical services in Perthshire general practitioner hospitals 1954-84

PubMed Central

Blair, J.S.G.; Grant, J.; McBride, H.; Martin, A.; Ross, R.T.A.

1986-01-01

The results are reported of a study of casualty and surgical services in five general practitioner hospitals in Perthshire — Aberfeldy, Auchterarder, Blairgowrie, Crieff and Pitlochry. Details of the total workload, the nature of the conditions treated and the referral rate to major hospitals are given. Figures for the Royal Infirmary, Perth, the main referral hospital for the county, are also given for comparison. The surgical service at one of the rural hospitals is described. Experience has demonstrated the usefulness of these hospitals in providing casualty and surgical services to both the local population and to visitors, and their superiority in providing these services over health centres because staff and beds are available 24 hours a day. Rural general practitioner hospitals merit a continuing share of resources and bed allocation as they spare major hospitals surgical and medical work. The general practitioners serving the hospitals studied here undertook almost 40% of the total accident and emergency workload in the Perth and Kinross area of Scotland. PMID:3735224

General practitioners' referrals to specialist outpatient clinics. II. Locations of specialist outpatient clinics to which general practitioners refer patients.

PubMed Central

Coulter, A.; Noone, A.; Goldacre, M.

1989-01-01

Although linkage by computer of hospital administration systems across all clinics in a health district is becoming a practical possibility, complete records of general practitioners' referrals to outpatient clinics will be difficult to achieve. Data from a large study of general practitioners' referrals to such clinics were used to calculate the proportion of referrals that crossed district boundaries, the proportion that were made to the private sector; and the number of locations that each practice referred patients to. Of the 17,601 referrals from practices in Oxford Regional Health Authority, 13,857 (78.7%) were made to NHS outpatient clinics within practices' own districts, 1524 (8.7%) to clinics in other districts in the same region, 420 (2.4%) to NHS clinics in other regions, and 1800 (10.2%) to the private sector; but these proportions varied considerably among the practices. The mean number of different NHS hospitals or clinics that each practice referred patients to was 15.8 (range 4-42). PMID:2504414

Psychological determinants of the intention to educate patients about benzodiazepines

PubMed Central

Dijkstra, A.; Van Empelen, P.; Knuistingh Neven, A.; Zitman, F. G.

2007-01-01

Objective General practitioners and pharmacists do not properly educate their patients about the disadvantages of benzodiazepines. In order to increase and improve education, this study will investigate which psychological factors (i.e., beliefs, outcome expectation, social norm and self-efficacy) predict the intention to educate. Methods A cross-sectional survey study was conducted in which 339 general practitioners and 149 pharmacists in the Netherlands completed a questionnaire. Results The Results show that the above-mentioned factors play an important role in forming intentions to educate. However, differences exist between general practitioners and pharmacists. Conclusion General practitioners and pharmacists intend to educate in cases where they think that benzodiazepines have well-defined disadvantages, when the education they undertake leads to success, when they feel pressure to educate from their surroundings and when they are capable of educating. Implications for practice These findings contribute to a better understanding of patient education and are of great value in developing new interventions to improve education. PMID:18095183

Meeting the needs of vulnerable patients: The need for team working across general practice and community nursing services

PubMed Central

While, Alison E

2014-01-01

General practitioners and district nurses have a long history of providing care outside the hospital setting. With health care increasingly moving out of the hospital setting, there are more opportunities for general practitioners and district nurses to work together to meet the health needs of the local population. However, the reduction in qualified specialist practitioner district nurses over the last decade is concerning. The need for an effective district nursing service has been recognised by the Department of Health in their own model – the nature of district nursing work, often over a long period, enables relationships to develop with the patient, family and informal carers as a basis for anticipatory care to manage long-term conditions. Communication and understanding of the role are central to enhance effective working between general practitioners and district nurses, which can be fostered by engagement in community-oriented integrated care and case management. PMID:25949736

41 CFR 50-204.2 - General safety and health standards.

Code of Federal Regulations, 2013 CFR

2013-07-01

... health standards. 50-204.2 Section 50-204.2 Public Contracts and Property Management Other Provisions Relating to Public Contracts PUBLIC CONTRACTS, DEPARTMENT OF LABOR 204-SAFETY AND HEALTH STANDARDS FOR FEDERAL SUPPLY CONTRACTS General Safety and Health Standards § 50-204.2 General safety and health...

48 CFR 732.111 - Contract clauses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Contract clauses. 732.111 Section 732.111 Federal Acquisition Regulations System AGENCY FOR INTERNATIONAL DEVELOPMENT GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING General 732.111 Contract clauses. (a) [Reserved] (b) USAID may...

48 CFR 732.111 - Contract clauses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Contract clauses. 732.111 Section 732.111 Federal Acquisition Regulations System AGENCY FOR INTERNATIONAL DEVELOPMENT GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING General 732.111 Contract clauses. (a) [Reserved] (b) USAID may...

An agenda for change in referral--consensus from general practice.

PubMed Central

McColl, E; Newton, J; Hutchinson, A

1994-01-01

BACKGROUND. Wide variations in rates of referral from primary to secondary care have been a matter of concern for many years. Effective strategies for optimizing referral depend on doctors being able to understand what the influences on their referral behaviour are, as well as having the ability to identify priority areas for action and to develop strategies for pushing through effective measures. AIM. This study set out to ascertain general practitioners' priorities for change with respect to the referral process, and to set an agenda for change to be tackled by general practitioners, providers, policy makers and educationalists. METHOD. Through the use of the Delphi technique and focused interviews, general practitioners throughout Northumberland contributed to the consensus view. RESULTS. The main themes to emerge related to hospital waiting lists, open access, flow of information between secondary and primary care and general practitioners' knowledge and training. Ideas for implementing change included the production of directories of hospital services and the development of guidelines for the use of the term 'urgent' in referral letters. CONCLUSION. All of the proposed changes are manageable and share the burden between general practice and other professionals with an interest in the referral process. PMID:8185989

Multi-factor energy price models and exotic derivatives pricing

NASA Astrophysics Data System (ADS)

Hikspoors, Samuel

The high pace at which many of the world's energy markets have gradually been opened to competition have generated a significant amount of new financial activity. Both academicians and practitioners alike recently started to develop the tools of energy derivatives pricing/hedging as a quantitative topic of its own. The energy contract structures as well as their underlying asset properties set the energy risk management industry apart from its more standard equity and fixed income counterparts. This thesis naturally contributes to these broad market developments in participating to the advances of the mathematical tools aiming at a better theory of energy contingent claim pricing/hedging. We propose many realistic two-factor and three-factor models for spot and forward price processes that generalize some well known and standard modeling assumptions. We develop the associated pricing methodologies and propose stable calibration algorithms that motivate the application of the relevant modeling schemes.

26 CFR 1.460-3 - Long-term construction contracts.

Code of Federal Regulations, 2010 CFR

2010-04-01

... construction contracts. (a) In general. Section 460 generally requires a taxpayer to determine the income from... not real property. (b) Exempt construction contracts—(1) In general. The general requirement to use...) of this section. (2) Home construction contract—(i) In general. A long-term construction contract is...

26 CFR 1.1402(e)(1)-1 - Election by ministers, members of religious orders, and Christian Science practitioners for self...

Code of Federal Regulations, 2010 CFR

2010-04-01

... orders, and Christian Science practitioners for self-employment coverage. 1.1402(e)(1)-1 Section 1.1402(e... religious orders, and Christian Science practitioners for self-employment coverage. (a) In general. Any... order) or (2) a Christian Science practitioner may elect to have the Federal old-age, survivors, and...

[General practitioners as gatekeepers: Better health care than in countries with self-referral to specialists?].

PubMed

Groenewegen, Peter

2016-01-01

In the Netherlands and a number of other European countries general practitioners are the gatekeepers for specialist and hospital care. European health care systems with gatekeeping general practitioners, i.e. those with comprehensive, strong primary care, perform better on a number of health indicators and on equity. However, it is less clear if gatekeeping health care systems have lower health expenditure. There is ongoing debate on whether gatekeeping plays a role in diagnostic delay of cancers. At health care system level research is being hampered by small numbers and should be combined with in-depth research into health care mechanisms.

Adding retinal photography to screening for diabetic retinopathy: a prospective study in primary care.

PubMed

O'Hare, J P; Hopper, A; Madhaven, C; Charny, M; Purewell, T S; Harney, B; Griffiths, J

1996-03-16

To evaluate whether adding retinal photography improved community screening for diabetic retinopathy. Mobile screening unit at rural and urban general practices in south west England. 1010 diabetic patients from primary care. Prospective study; patients were examined by ophthalmoscopy by general practitioners or opticians without fundal photographs and again with photographs, and assessments were compared to those of an ophthalmologist. Whether fundal photography improved the sensitivity of detection of retinopathy and referrable diabetic retinopathy, and whether this sensitivity could be improved by including a review of the films by the specialist. Diabetic retinopathy was detected by the ophthalmologist in 205 patients (20.5%) and referrable retinopathy in 49 (4.9%). The sensitivity of the general practitioners and opticians for referrable retinopathy with ophthalmoscopy was 65%, and improved to 84% with retinal photographs. General practitioners' sensitivity in detecting background retinopathy improved with photographs from 22% to 65%; opticians' sensitivity in detecting background retinopathy improved from 43% to 71%. The sensitivity of detecting referrable retinopathy by general practitioners improved from 56% to 80% with photographs; for opticians it improved from 75% to 88%. Combining modalities of screening by providing photography with specialist review of all films in addition to direct ophthalmoscopy through dilated pupils improves assessment and referral for diabetic retinopathy by general practitioners and opticians. With further training and experience, primary care screeners should be able to achieve a sensitivity that will achieve an effective, acceptable, and economical community based screening programme for this condition.

Guidance of eruption for general practitioners.

PubMed

Ngan, Peter W; Kao, Elizabeth C; Wei, Stephen H

2003-04-01

The principle of early treatment through well-planned extraction of primary teeth followed by removal of permanent teeth has stood the test of time. The objective of this article is to develop some simple guidelines for general dental practitioners to perform 'guidance of eruption' in malocclusion with severe crowding.

Personality Factors Related to Career Satisfaction among General Practitioners.

ERIC Educational Resources Information Center

Schwartz, Robert H.; Shenoy, Sunil

1994-01-01

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

Postgraduate training for general practice in the United Kingdom.

PubMed

Eisenberg, J M

1979-04-01

Although the role of general practice is well established in the United Kingdom's National Health Service, formal postgraduate training for primary care practice is a recent development. Trainees may enter three-year programs of coordinated inpatient and outpatient training or may select a series of independent posts. Programs have been developed to train general practitioners as teachers, and innovative courses have been established. Nevertheless, there is a curious emphasis on inpatient experiences, especially since British general practitioners seldom treat patients in the hospital. In their outpatient experiences trainees are provided with little variety in their instructors, practice settings, and medical problems. The demands on this already strained system will soon be increased due to recent legislation requiring postgraduate training for all new general practitioners. With a better understanding of training for primary care in the National Health Service, those planning American primary care training may avoid the problems and incorporate the attributes of British training for general practice.

Models of clinical reasoning with a focus on general practice: A critical review

PubMed Central

YAZDANI, SHAHRAM; HOSSEINZADEH, MOHAMMAD; HOSSEINI, FAKHROLSADAT

2017-01-01

Introduction: Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings. Methods: A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized. Results: Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. Conclusion: A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed. PMID:28979912

Periodontal Diseases and Systemic Disorders: What Do Our Doctors Know? A General Practitioner's Survey Conducted in Southern France.

PubMed

Alexia, Vinel; Chloé, Vachon; Pierre, Barthet; Sara, Laurencin-Dalicieux

2017-12-01

With 39,359 entries on PubMed, periodontal medicine has a prominent position in periodontal research. Good patient care requires well-advised physicians, and whereas the dental community is informed about the relationships between periodontal diseases (PDs) and an increasing number of systemic pathologies, we wondered whether general practitioners were too. Thus, we aimed to evaluate their knowledge of the links between periodontal and systemic diseases. To this end, we sent an electronic questionnaire to the 2350 general practitioners registered to the URPS (Union régionale des Professionnels de Santé) of Midi-Pyrénées, France. They were asked about their practice, their attitude during a medical examination, and their knowledge about PDs. The analysis of 222 properly answered questionnaires showed that while most general practitioners are aware of the relationships between PDs and diabetes or cardiovascular diseases, the majority of them are unaware that obesity and respiratory and joint diseases are also concerned. Indeed, 94% of the questioned subjects consider their insight of PDs to be insufficient. Nevertheless, more than half of the interrogated physicians cared about their patients' oral health and dental care. Education regarding relationships between periodontal and systemic diseases must be improved among general practitioners who are in the front line to refer high-risk patients to a periodontist. Copyright © 2017 Elsevier Inc. All rights reserved.

The evaluation of knowledge and activities of primary health care professionals in promoting breast-feeding.

PubMed

Leviniene, Giedra; Petrauskiene, Ausra; Tamuleviciene, Egle; Kudzyte, Jolanta; Labanauskas, Liutauras

2009-01-01

The objective of this study was to evaluate the knowledge and activities of Kaunas primary health care center professionals in promoting breast-feeding. A total of 84 general practitioners and 52 nurses participated in the survey, which was carried out in Kaunas primary health care centers in 2006. Data were gathered from the anonymous questionnaire. Less than half of general practitioners (45.1%) and 65% of nurses were convinced that baby must be exclusively breast-fed until the age of 6 months, but only 21.6% of general practitioners and 27.5% of nurses knew that breast-feeding with complementary feeding should be continued until the age of 2 years and longer. Still 15.7% of general practitioners and 25% of nurses recommended pacifiers; 7.8% of general practitioners advised to breast-feed according to hours. Half of the health professionals recommended additional drinks between meals; one-third of them--to give complementary food for the babies before the age of 6 months. One-third (29.6%) of the health professionals surveyed recommended mothers to feed their babies more frequently in case the amount of breast milk decreased. The survey showed that knowledge of medical personnel in primary health care centers about the advantages of breast-feeding, prophylaxis of hypogalactia, and duration of breast-feeding was still insufficient.

48 CFR 801.680 - Contracting authority of the Inspector General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Secretary's contracting authority. (For example, management controls and approvals specified in subpart 837... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Contracting authority of..., Contracting Authority, and Responsibilities 801.680 Contracting authority of the Inspector General. (a) Under...

48 CFR 801.680 - Contracting authority of the Inspector General.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Secretary's contracting authority. (For example, management controls and approvals specified in subpart 837... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Contracting authority of..., Contracting Authority, and Responsibilities 801.680 Contracting authority of the Inspector General. (a) Under...

What do plastic surgeons do?

PubMed

Park, A J; Scerri, G V; Benamore, R; McDiarmid, J G; Lamberty, B G

1998-06-01

The image of plastic surgery as portrayed by the media is of concern to all plastic surgeons. In order to assess knowledge about the specialty, a questionnaire was devised and given to five groups of participants: general practitioners, medical students, nurses, plastic surgical out-patient attendees, and the general public. The results revealed that general practitioners, nurses and medical students in the Cambridge area are, on the whole, knowledgeable about the role of plastic surgery. However, the general public are not so well educated and 23.7% of them could not think of five conditions treated by plastic surgeons, and felt that burns and cosmetic problems were the commonest conditions dealt with. Improved liaison with general practitioners, other specialties and more teaching of undergraduates, coupled with more effective promotion of the skills on offer might permit better use to be made of the specialty.

CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) Reform: Will It Work? An Analysis of the CHAMPUS Reform Initiative.

DTIC Science & Technology

1987-12-01

eterinarians, optometrists, podiatrists, pharmacists , psycologists, nurse practitioners, rhvsician assistants, and others. In addition, over 146,000 enlisted...and the uti -lization data needed for ood resource C. CONTROL OF HEALTH CARE COSTS 1-,- la c ot- regional fixed-price contracts is set forth by the fram

Access to Specialty Health Care for Rural American Indians in Two States

ERIC Educational Resources Information Center

Baldwin, Laura-Mae; Hollow, Walter B.; Casey, Susan; Hart, L. Gary; Larson, Eric H.; Moore, Kelly; Lewis, Ervin; Andrilla, C. Holly A.; Grossman, David C.

2008-01-01

Context: The Indian Health Service (IHS), whose per capita expenditure for American Indian and Alaska Native (AI/AN) health services is about half that of the US civilian population, is the only source of health care funding for many rural AI/ANs. Specialty services, largely funded through contracts with outside practitioners, may be limited by…

Teaching and Assessment of Mathematical Principles for Software Correctness Using a Reasoning Concept Inventory

ERIC Educational Resources Information Center

Drachova-Strang, Svetlana V.

2013-01-01

As computing becomes ubiquitous, software correctness has a fundamental role in ensuring the safety and security of the systems we build. To design and develop software correctly according to their formal contracts, CS students, the future software practitioners, need to learn a critical set of skills that are necessary and sufficient for…

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

PubMed Central

Vanagas, Giedrius; Bihari-Axelsson, Susanna

2005-01-01

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

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

PubMed Central

2014-01-01

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

Violence against General Practitioners in Turkey

ERIC Educational Resources Information Center

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

2009-01-01

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

An Evaluation of a Clerkship In Cardiology

ERIC Educational Resources Information Center

Edson, John N.; and others

1969-01-01

Evaluation of the clinical clerkship in Cardiology for general practitioners proves there is an urgent need for continuing post graduate medical education for general practitioners. Clerkship was offered jointly by the Long Island College Hospital and the State University of New York Downstate Medical Center, Brooklyn, New York. (IR)

Informal and Formal Learning of General Practitioners

ERIC Educational Resources Information Center

Spaan, Nadia Roos; Dekker, Anne R. J.; van der Velden, Alike W.; de Groot, Esther

2016-01-01

Purpose: The purpose of this study is to understand the influence of formal learning from a web-based training and informal (workplace) learning afterwards on the behaviour of general practitioners (GPs) with respect to prescription of antibiotics. Design/methodology/approach: To obtain insight in various learning processes, semi-structured…

Danish physicians' preferences for prescribing escitalopram over citalopram and sertraline to treatment-naïve patients: a national, register-based study.

PubMed

Poulsen, Karen Killerup; Glintborg, Dorte; Moreno, Søren Ilsøe; Thirstrup, Steffen; Aagaard, Lise; Andersen, Stig Ejdrup

2013-05-01

To investigate whether general practitioners, hospital physicians and specialized practitioners in psychiatry have similar preferences for initiating treatment with expensive serotonin-specific reuptake inhibitors (SSRIs). All first-time prescriptions for the SSRIs escitalopram, citalopram and sertraline reported to the Danish National Register of Medicinal Product Statistics from April 1, 2009 until March 31, 2010 were analysed with regard to treatment naivety and type of prescriber. A prescription was considered as first time if the patient had not received a prescription for the same drug within the last 2 years. Patients who had not received a prescription for an antidepressant within 6 months prior to the date of redemption were classified as treatment-naïve. We included 82,702 first-time prescriptions, 65,313 (79 %) of which were for treatment-naïve patients. Of the treatment-naïve patients, 19 % were initially prescribed escitalopram. Hospital physicians prescribed escitalopram to 34 % of their treatment-naïve patients, while practitioners specialized in psychiatry prescribed it to 25 %, and general practitioners prescribed it to 17 %. General practitioners, however, were responsible for initiating 87 % of all treatment-naïve patients. The most expensive SSRI, escitalopram, is prescribed as first choice to one in five patients receiving their first antidepressant of escitalopram, citalopram or sertraline. General practitioners made the bulk of all first-time SSRI prescriptions to treatment-naïve patients.

[Emergencies and urgent consultation in non-urban Swiss general practices].

PubMed

Meyer, R L; Marty, F

2007-03-07

The upcoming shortage of general practitioners in Switzerland will be a big challenge for medical out-of-hours services. Regionally ver different exists only few datas about organisational matters of and problems seen in "out-of-hours" care and "urgent consultations". Our Pilot present the prevalence of "out-of-hours care" in a general practitioner setting describes and classifies the problems seen using ICPC-2.

48 CFR 17.501 - General.

Code of Federal Regulations, 2011 CFR

2011-10-01

....501 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACTING METHODS AND CONTRACT TYPES SPECIAL CONTRACTING METHODS Interagency Acquisitions 17.501 General. (a) Interagency acquisitions are commonly conducted through indefinite-delivery contracts, such as task- and delivery-order...

48 CFR 46.401 - General.

Code of Federal Regulations, 2012 CFR

2012-10-01

....401 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Government Contract Quality Assurance 46.401 General. (a) Government contract quality assurance... conform to contract requirements. Quality assurance surveillance plans should be prepared in conjunction...

48 CFR 46.401 - General.

Code of Federal Regulations, 2014 CFR

2014-10-01

....401 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Government Contract Quality Assurance 46.401 General. (a) Government contract quality assurance... conform to contract requirements. Quality assurance surveillance plans should be prepared in conjunction...

48 CFR 46.401 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

....401 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Government Contract Quality Assurance 46.401 General. (a) Government contract quality assurance... conform to contract requirements. Quality assurance surveillance plans should be prepared in conjunction...

48 CFR 46.401 - General.

Code of Federal Regulations, 2013 CFR

2013-10-01

....401 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Government Contract Quality Assurance 46.401 General. (a) Government contract quality assurance... conform to contract requirements. Quality assurance surveillance plans should be prepared in conjunction...

48 CFR 46.401 - General.

Code of Federal Regulations, 2011 CFR

2011-10-01

....401 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Government Contract Quality Assurance 46.401 General. (a) Government contract quality assurance... conform to contract requirements. Quality assurance surveillance plans should be prepared in conjunction...

Doctors' unawareness of the drugs their patients are taking: a major cause of overprescribing?

PubMed Central

Price, D; Cooke, J; Singleton, S; Feely, M

1986-01-01

We studied the accuracy of both hospital and general practitioners' records of current drug treatment in consecutive patients who attended a general medical review clinic. Either the hospital or the general practitioner's records (obtained in a questionnaire), or both, were inaccurate for over 70% of 59 patients interviewed with their medicine. Most of the errors were due to patients taking drugs in addition to those shown in their records. Some of these were inappropriate, and many seemed unnecessary. It appears that neither hospital doctors nor general practitioners are fully aware which drugs their patients are taking, and this may contribute to overprescribing. We believe that considerable financial savings might be made if patients brought all their medicines to every consultation. PMID:3080110

Response of general practitioners to computer-generated critiques of hypertension therapy.

PubMed

van der Lei, J; van der Does, E; Man in 't Veld, A J; Musen, M A; van Bemmel, J H

1993-04-01

We recently have shown that a computer system, known as HyperCritic, can successfully audit general practitioners' treatment of hypertension by analyzing computer-based patient records. HyperCritic reviews the electronic medical records and offers unsolicited advice. To determine which unsolicited advice might be perceived as inappropriate, builders of programs such as HyperCritic need insight into providers' responses to computer-generated critique of their patient care. Twenty medical charts, describing in total 243 visits of patients with hypertension, were audited by 8 human reviewers and by the critiquing-system HyperCritic. A panel of 14 general practitioners subsequently judged the relevance of those critiques on a five-point scale ranging from relevant critique to erroneous or harmful critique. The panel judged reviewers' comments to be either relevant or somewhat relevant in 61 to 68% of cases, and either erroneous or possibly erroneous in 15 to 18%; the panel judged HyperCritic's comments to be either relevant or somewhat relevant in 65% of cases, and either erroneous or possibly erroneous in 16%. Comparison of individual members of the panel showed large differences; for example, the portion of HyperCritic's comments judged relevant ranged from 0 to 82%. We conclude that, from the perspective of general practitioners, critiques generated by the critiquing system HyperCritic are perceived equally beneficial as critiques generated by human reviewers. Different general practitioners, however, judge the critiques differently. Before auditing systems based on computer-based patient records that are acceptable to practitioners can be introduced, additional studies are needed to evaluate the reasons a physician may have for judging critiques to be irrelevant, and to evaluate the effect of critiques on physician behavior.

78 FR 10174 - Public Availability of General Services Administration FY 2012 Service Contract Inventory

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-13

... GENERAL SERVICES ADMINISTRATION [Notice-MV-2013-02; Docket No. 2013-0002; Sequence 3] Public Availability of General Services Administration FY 2012 Service Contract Inventory AGENCY: General Services Administration (GSA). ACTION: Notice of Public Availability of FY 2012 Service Contract Inventories. SUMMARY: In...

Sharing psychological skills in the general practice setting.

PubMed

Weinman, J; Medlik, L

1985-09-01

Three broad areas of work are described in this paper. The first is concerned with the nature of psychological processes within the general practice consultation and the indications these provide for skill sharing. In the second section there is an account of courses designed to develop skills in the recognition of psychological aspects of illness and in the detection of psychological problems. The third section outlines various courses for developing and improving the consulting and counselling skills of general practitioners. In addition to describing a range of skills developed by ourselves and others, two general themes emerge from this paper. The first concerns the appropriateness of the general practice setting for the sharing of psychological skills and the extent to which the psychologist may be able to complement the skills of the general practitioner. The second theme concerns the importance of helping general practitioners to identify their own learning needs as an essential first step in deciding how to structure courses to meet these needs.

Early response to psychological trauma--what GPs can do.

PubMed

Wade, Darryl; Howard, Alexandra; Fletcher, Susan; Cooper, John; Forbes, David

2013-09-01

There is a high prevalence of psychological trauma exposure among primary care patients. General practitioners are well placed to provide appropriate support for patients coping with trauma. This article outlines an evidence-based early response to psychological trauma. Psychological first aid is the preferred approach in providing early assistance to patients who have experienced a traumatic event. General practitioners can be guided by five empirically derived principles in their early response: promoting a sense of safety, calming, self efficacy, connectedness and hope. Structured psychological interventions, including psychological debriefing, are not routinely recommended in the first few weeks following trauma exposure. General practitioner self care is an important aspect of providing post-trauma patient care.

RISQy business (Relationships, Incentives, Supports, and Quality): evolution of the British Columbia Model of Primary Care (patient-centered medical home).

PubMed

MacCarthy, Dan; Hollander, Marcus J

2014-01-01

In 2002, the British Columbia Ministry of Health and the British Columbia Medical Association (now Doctors of BC) came together to form the British Columbia General Practice Services Committee to bring about transformative change in primary care in British Columbia, Canada. This committee's approach to primary care was to respond to an operational problem--the decline of family practice in British Columbia--with an operational solution--assist general practitioners to provide better care by introducing new incentive fees into the fee-for-service payment schedule, and by providing additional training to general practitioners. This may be referred to as a "soft power" approach, which can be summarized in the abbreviation RISQ: focus on Relationships; provide Incentives for general practitioners to spend more time with their patients and provide guidelines-based care; Support general practitioners by developing learning modules to improve their practices; and, through the incentive payments and learning modules, provide better Quality care to patients and improved satisfaction to physicians. There are many similarities between the British Columbian approach to primary care and the US patient-centered medical home.

48 CFR 717.700 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false General. 717.700 Section 717.700 Federal Acquisition Regulations System AGENCY FOR INTERNATIONAL DEVELOPMENT CONTRACTING METHODS AND CONTRACT TYPES SPECIAL CONTRACTING METHODS Pharmaceutical Products 717.700 General. Section...

48 CFR 717.700 - General.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false General. 717.700 Section 717.700 Federal Acquisition Regulations System AGENCY FOR INTERNATIONAL DEVELOPMENT CONTRACTING METHODS AND CONTRACT TYPES SPECIAL CONTRACTING METHODS Pharmaceutical Products 717.700 General. Section...

48 CFR 246.401 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... DEFENSE CONTRACT MANAGEMENT QUALITY ASSURANCE Government Contract Quality Assurance 246.401 General. The requirement for a quality assurance surveillance plan shall be addressed and documented in the contract file... services, the contracting officer should prepare a quality assurance surveillance plan to facilitate...

48 CFR 38.101 - General.

Code of Federal Regulations, 2011 CFR

2011-10-01

... authorize other agencies to award schedule contracts and publish schedules. For example, the Department of... CONTRACTING FEDERAL SUPPLY SCHEDULE CONTRACTING Federal Supply Schedule Program 38.101 General. (a) The... discounts. Indefinite-delivery contracts are awarded using competitive procedures to firms. The firms...

42 CFR 424.11 - General procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... under State law. (4) A nurse practitioner or clinical nurse specialist, as defined in paragraph (e)(5... section, to qualify as a nurse practitioner, an individual must— (i) Be a registered professional nurse... perform the services of a nurse practitioner in accordance with State law; and have a master's degree in...

42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Payment for a physician assistant's, nurse... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse practitioner's... services. (a) General rule. A physician assistant's, nurse practitioner's, and clinical nurse specialists...

42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Payment for a physician assistant's, nurse... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse practitioner's... services. (a) General rule. A physician assistant's, nurse practitioner's, and clinical nurse specialists...

42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Payment for a physician assistant's, nurse... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse practitioner's... services. (a) General rule. A physician assistant's, nurse practitioner's, and clinical nurse specialists...

42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Payment for a physician assistant's, nurse... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse practitioner's... services. (a) General rule. A physician assistant's, nurse practitioner's, and clinical nurse specialists...

Evidence Valued and Used by Health Promotion Practitioners

ERIC Educational Resources Information Center

Li, V.; Carter, S. M.; Rychetnik, L.

2015-01-01

The use of evidence has become a foundational part of health promotion practice. Although there is a general consensus that adopting an evidence-based approach is necessary for practice, disagreement remains about what types of evidence practitioners should use to guide their work. An empirical understanding of how practitioners conceptualize and…

Journalists' and Public Relations Practitioners' News Values: Perceptions and Cross-Perceptions.

ERIC Educational Resources Information Center

Sallot, Lynne M.; Steinfatt, Thomas M.; Salwen, Michael B.

1998-01-01

Contributes to research on the relationship between journalism and public relations by surveying journalists and public relations practitioners. Shows that the two groups share generally similar news values, but that journalists were largely unaware of this similarity. Finds that practitioners, expecting contributions of social good by public…

Recruitment and retention of general practitioners in the UK: what are the problems and solutions?

PubMed

Young, R; Leese, B

1999-10-01

Recruitment and retention of general practitioners (GPs) has become an issue of major concern in recent years. However, much of the evidence is anecdotal and some commentators continue to question the scale of workforce problems. Hence, there is a need to establish a clear picture of those instabilities (i.e. imbalances between demand and supply) that do exist in the GP labour market in the UK. Based on a review of the published literature, we identify problems that stem from: (i) the changing social composition of the workforce and the fact that a large proportion of qualified GPs are significantly underutilized within traditional career structures; and (ii) the considerable differences in the ability of local areas to match labour demand and supply. We argue that one way to address these problems would be to encourage greater flexibility in a number of areas highlighted in the literature: (i) time commitment across the working day and week; (ii) long-term career paths; (iii) training and education; and (iv) remuneration and contract conditions. Overall, although the evidence suggests that the predicted 'crisis' has not yet occurred in the GP labour market as a whole, there is no room for lack of imagination in planning terms. Workforce planners continue to emphasize national changes to the medical school intake as the means to balance labour demand and supply between the specialities; however, better retention and deployment of existing GP labour would arguably produce more effective supply-side solutions. In this context, current policy and practice developments (e.g. Primary Care Groups and Primary Care Act Pilot Sites) offer a unique learning base upon which to move forward.

Urban versus rural populations' views of health care in Scotland.

PubMed

Farmer, Jane; Hinds, Kerstin; Richards, Helen; Godden, David

2005-10-01

To compare satisfaction with, and expectations of, health care of people in rural and urban areas of Scotland. Questions were included in the 2002 Scottish Social Attitudes Survey (SSAS). The Scottish House-hold Survey urban-rural classification was used to categorize locations. A random sample of 2707 people was contacted to participate in a face-to-face interview and a self-completion questionnaire survey. SPSS (v.10) was used to analyse the data. Relationships between location category and responses were explored using logistic regression analysis. In all, 1665 (61.5%) interviews were conducted and 1507 (56.0%) respondents returned self-completion questionnaires. Satisfaction with local doctors and hospital services was higher in rural locations. While around 40% of those living in remote areas thought A&E services too distant, this did not rank as a top priority for health service improvement. This could be due to expectations that general practitioners would assist in out-of-hours emergencies. Most Scots thought services should be good in rural areas even if this was costly, and that older people should not be discouraged from moving to rural areas because of their likely health care needs. In all, 79% of respondents thought that care should be as good in rural as urban areas. Responses to many questions were independently significantly affected by rural/urban location. Most Scots want rural health care to continue to be good, but the new UK National Health Service (NHS) general practitioner contract and service redesign will impact on provision. Current high satisfaction, likely to be due to access and expectations about local help, could be affected. This study provides baseline data on attitudes and expectations before potential service redesign, which should be monitored at intervals in future.

Integrated care organizations in Switzerland.

PubMed

Berchtold, Peter; Peytremann-Bridevaux, Isabelle

2011-01-01

The Swiss health care system is characterized by its decentralized structure and high degree of local autonomy. Ambulatory care is provided by physicians working mainly independently in individual private practices. However, a growing part of primary care is provided by networks of physicians and health maintenance organizations (HMOs) acting on the principles of gatekeeping. The share of insured choosing an alternative (managed care) type of basic health insurance and therefore restrict their choice of doctors in return for lower premiums increased continuously since 1990. To date, an average of one out of eight insured person in Switzerland, and one out of three in the regions in north-eastern Switzerland, opted for the provision of care by general practitioners in one of the 86 physician networks or HMOs. About 50% of all general practitioners and more than 400 other specialists have joined a physician networks. Seventy-three of the 86 networks (84%) have contracts with the healthcare insurance companies in which they agree to assume budgetary co-responsibility, i.e., to adhere to set cost targets for particular groups of patients. Within and outside the physician networks, at regional and/or cantonal levels, several initiatives targeting chronic diseases have been developed, such as clinical pathways for heart failure and breast cancer patients or chronic disease management programs for patients with diabetes. Swiss physician networks and HMOs were all established solely by initiatives of physicians and health insurance companies on the sole basis of a healthcare legislation (Swiss Health Insurance Law, KVG) which allows for such initiatives and developments. The relevance of these developments towards more integration of healthcare as well as their implications for the future are discussed.

Integrated care organizations in Switzerland

PubMed Central

Berchtold, Peter; Peytremann-Bridevaux, Isabelle

2011-01-01

Introduction The Swiss health care system is characterized by its decentralized structure and high degree of local autonomy. Ambulatory care is provided by physicians working mainly independently in individual private practices. However, a growing part of primary care is provided by networks of physicians and health maintenance organizations (HMOs) acting on the principles of gatekeeping. Towards integrated care in Switzerland The share of insured choosing an alternative (managed care) type of basic health insurance and therefore restrict their choice of doctors in return for lower premiums increased continuously since 1990. To date, an average of one out of eight insured person in Switzerland, and one out of three in the regions in north-eastern Switzerland, opted for the provision of care by general practitioners in one of the 86 physician networks or HMOs. About 50% of all general practitioners and more than 400 other specialists have joined a physician networks. Seventy-three of the 86 networks (84%) have contracts with the healthcare insurance companies in which they agree to assume budgetary co-responsibility, i.e., to adhere to set cost targets for particular groups of patients. Within and outside the physician networks, at regional and/or cantonal levels, several initiatives targeting chronic diseases have been developed, such as clinical pathways for heart failure and breast cancer patients or chronic disease management programs for patients with diabetes. Conclusion and implications Swiss physician networks and HMOs were all established solely by initiatives of physicians and health insurance companies on the sole basis of a healthcare legislation (Swiss Health Insurance Law, KVG) which allows for such initiatives and developments. The relevance of these developments towards more integration of healthcare as well as their implications for the future are discussed. PMID:21677845

[Prevalence of chronic fatigue syndrome in 4 family practices in Leiden].

PubMed

Versluis, R G; de Waal, M W; Opmeer, C; Petri, H; Springer, M P

1997-08-02

To determine the prevalence of chronic fatigue syndrome (CFS) in general practice. Descriptive. General practice and primary health care centres in Leyden region, the Netherlands. RNUH-LEO is a computerized database which contains the anonymous patient information of one general practice (with two practitioners) and four primary health care centres. The fourteen participating general practitioners were asked what International Classification of Primary Care (ICPC) code they used to indicate a patient with chronic fatigue or with CFS. With these codes and with the code for depression patients were selected from the database. It then was determined whether these patients met the criteria of CFS by Holmes et al. The general practitioners used 10 codes. Including the code for depression a total of 601 patients were preselected from a total of 23,000 patients in the database. Based on the information from the patients' records in the database, 42 of the preselected patients were selected who might fulfill the Holmes' criteria of CFS. According to the patients' own general practitioner, 25 of the 42 patients would fulfil the Holmes' criteria. The men:women ratio was 1:5. The prevalence of CFS in the population surveyed was estimated to be at least 1.1 per 1,000 patients.

[Fax Survey to Elucidate the Information Needs of General Practitioners in Lower Saxony Regarding the Topic of Medical Implants].

PubMed

Schaper, M; Berndt, M; Schrimpf, C; Wilhelmi, M; Elff, M; Haverich, A; Wilhelmi, M

2016-12-01

Background: Medial implants help a multitude of patients to gain more health, mobility and thus, quality of life. In collaboration with a still growing expectation of life especially, i.e., within Western industrial countries, this has led to an increasing use of implants over the last years. However, although biomechanical characteristics of modern implant materials have improved considerably, one big challenge still exists - the implant-associated infection. Early diagnostic and therapeutic interventions could clearly mitigate this issue, but are general practitioners sufficiently informed regarding this topic? Material and Methods: In March 2013 and in close cooperation with the Lower Saxony association of general practitioners, we initiated a survey to elucidate the information demands of general practitioners regarding the topic of medical implants. A total of 939 members of the association were contacted via fax and 101 (10.8 %) responded. Based on the obtained data, we then evaluated which topics are most interesting for this group of medical professionals. Results: The survey clearly indicates that general practitioners request more general implant-related data, e.g., type and specification of an implant as well as its location within the individual patient and contact addresses of the implanting hospital, but also want more specific information regarding diagnostic and therapeutic strategies in the case of implant-associated complications. Conclusion: The present article reports in detail on the conducted fax survey and shows some initial strategies as to how the identified challenges might be faced. Georg Thieme Verlag KG Stuttgart · New York.

Management recommendations for knee osteoarthritis: how usable are they?

PubMed

Poitras, Stéphane; Rossignol, Michel; Avouac, Jérôme; Avouac, Bernard; Cedraschi, Christine; Nordin, Margareta; Rousseaux, Chantal; Rozenberg, Sylvie; Savarieau, Bernard; Thoumie, Philippe; Valat, Jean-Pierre; Vignon, Eric; Hilliquin, Pascal

2010-10-01

Despite the availability of practice guidelines for the management of knee osteoarthritis, inadequacies in practices of clinicians and patients have been found, leading to suboptimal outcomes. Literature has shown that simply disseminating management recommendations does not lead to adherence. Research suggests that barriers to use should be identified and addressed to improve adherence. The objective of this study was to identify barriers to use of conservative management recommendations for knee osteoarthritis by patients, general practitioners and physiotherapists. Following systematic reviews of evidence and guidelines, 12 key management recommendations were elaborated on four themes: medication, exercise, self-management and occupation. Focus groups were separately done with patients with knee osteoarthritis, general practitioners and physiotherapists to assess barriers to the use of recommendations. Patients and general practitioners appeared generally fatalistic with regards to knee osteoarthritis, with physiotherapists being more positive regarding long-term improvement of knee osteoarthritis. For medication, discrepancies were found between recommendations and views of clinicians. Both patients and general practitioners appeared ambivalent towards exercise and activity, recognizing its usefulness but identifying it at the same time as a cause of knee osteoarthritis. Patients and general practitioners appeared to consider weight loss particularly difficult. Barriers specific to each knee osteoarthritis management recommendation and stakeholder group were identified. Recommendations to address these barriers were elaborated. Results of this study can be used to develop implementation strategies to overcome identified barriers, with the goal of facilitating the use of guideline recommendations and improving outcomes. Copyright © 2010 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Recognising meningococcal disease in primary care: qualitative study of how general practitioners process clinical and contextual information.

PubMed

Granier, S; Owen, P; Pill, R; Jacobson, L

1998-01-24

To describe the presentation of meningococcal disease in primary care; to explore how general practitioners process clinical and contextual information in children with meningococcal disease; and to describe how this information affects management. Qualitative analysis of semistructured interviews. General practices in South Glamorgan. 26 general practitioners who between January 1994 and December 1996 admitted 31 children (under 16 years of age) in whom meningococcal disease was diagnosed. Categories of clinical rules and techniques used by general practitioners in processing each case. 22 children had rashes; in 16 of them the rashes were non-blanching. When present, a haemorrhagic rash was the most important factor in the doctor's decision to admit a child. 22 children had clinical features not normally expected in children with acute self limiting illnesses--for example, lethargy, poor eye contact, altered mental states, pallor with a high temperature, and an abnormal cry. Contextual information, such as knowledge of parents' consultation patterns and their normal degree of anxiety, played an important part in the management decisions in 15 cases. Use of penicillin was associated with the certainty of diagnosis and the presence and type of haemorrhagic rash. The key clinical feature of meningococcal disease--a haemorrhagic rash--was present in only half of the study children. The general practitioners specifically hunted for the rash in some ill children, but doctors should not be deterred from diagnosing meningococcal disease and starting antibiotic treatment if the child is otherwise well, if the rash has an unusual or scanty distribution, or if the rash is non-haemorrhagic.

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

ERIC Educational Resources Information Center

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

2010-01-01

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

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

ERIC Educational Resources Information Center

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

2004-01-01

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

Adolescents' Suicidal Thinking and Reluctance to Consult General Medical Practitioners

ERIC Educational Resources Information Center

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

2010-01-01

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

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

ERIC Educational Resources Information Center

Zambrano, Sofia C.; Barton, Christopher A.

2011-01-01

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

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

ERIC Educational Resources Information Center

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

2007-01-01

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

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

ERIC Educational Resources Information Center

Aoun, Samar; Johnson, Lyn

2002-01-01

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

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

ERIC Educational Resources Information Center

Nilsen, Line Lundvoll

2011-01-01

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

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

ERIC Educational Resources Information Center

Kirby, Amanda; Davies, Rhys; Bryant, Amy

2005-01-01

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

Effect of systematic review of medication by general practitioner on drug consumption among nursing-home residents.

PubMed

Khunti, K; Kinsella, B

2000-09-01

nursing-home patients usually have many medical problems and often take many drugs. They are therefore at risk from drug side effects and interactions. to evaluate the impact of a visit by a general practitioner and a comprehensive repeat prescribing review on the consumption of inappropriate drugs in nursing homes. two general practitioners made one comprehensive visit to four randomly selected nursing homes. In each home we discussed all patients in detail with a senior member of staff. We reviewed the prescribing record of each patient and stopped items if we considered them inappropriately prescribed or unnecessary. repeat prescriptions were altered in 65% of patients: 51% had an item stopped and 26% had an item changed to a cheaper alternative or the dose reduced. There was a reduction in the mean number of repeat prescriptions prescribed. a single visit by a general practitioner to a nursing home and a comprehensive repeat prescribing review can lead to a reduction in the number of items prescribed and to substantial savings for the health service. Further rigorous, cost-effectiveness studies are needed.

A shared-care model of obesity treatment for 3-10 year old children: protocol for the HopSCOTCH randomised controlled trial.

PubMed

Wake, Melissa; Lycett, Kate; Sabin, Matthew A; Gunn, Jane; Gibbons, Kay; Hutton, Cathy; McCallum, Zoe; York, Elissa; Stringer, Michael; Wittert, Gary

2012-03-28

Despite record rates of childhood obesity, effective evidence-based treatments remain elusive. While prolonged tertiary specialist clinical input has some individual impact, these services are only available to very few children. Effective treatments that are easily accessible for all overweight and obese children in the community are urgently required. General practitioners are logical care providers for obese children but high-quality trials indicate that, even with substantial training and support, general practitioner care alone will not suffice to improve body mass index (BMI) trajectories. HopSCOTCH (the Shared Care Obesity Trial in Children) will determine whether a shared-care model, in which paediatric obesity specialists co-manage obesity with general practitioners, can improve adiposity in obese children. Randomised controlled trial nested within a cross-sectional BMI survey conducted across 22 general practices in Melbourne, Australia. Children aged 3-10 years identified as obese by Centers for Disease Control criteria at their family practice, and randomised to either a shared-care intervention or usual care. A single multidisciplinary obesity clinic appointment at Melbourne's Royal Children's Hospital, followed by regular appointments with the child's general practitioner over a 12 month period. To support both specialist and general practice consultations, web-based shared-care software was developed to record assessment, set goals and actions, provide information to caregivers, facilitate communication between the two professional groups, and jointly track progress. Primary - change in BMI z-score. Secondary - change in percentage fat and waist circumference; health status, body satisfaction and global self-worth. This will be the first efficacy trial of a general-practitioner based, shared-care model of childhood obesity management. If effective, it could greatly improve access to care for obese children. Australian New Zealand Clinical Trials Registry ACTRN12608000055303.

48 CFR 42.901 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false General. 42.901 Section 42.901 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT CONTRACT ADMINISTRATION AND AUDIT SERVICES Bankruptcy 42.901 General. The contract administration office shall take prompt...

48 CFR 2917.502 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false General. 2917.502 Section 2917.502 Federal Acquisition Regulations System DEPARTMENT OF LABOR CONTRACTING METHODS AND CONTRACT TYPES SPECIAL CONTRACTING METHODS Interagency Acquisitions Under The Economy Act 2917.502 General. (a...

48 CFR 732.402 - General.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 732.402 Federal Acquisition Regulations System AGENCY FOR INTERNATIONAL DEVELOPMENT GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Advance Payments 732.402 General. (a)-(d) [Reserved] (e)(1) U.S... organizations require the approval of the Head of the Contracting Activity, after consultation with the Mission...

48 CFR 732.402 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 732.402 Federal Acquisition Regulations System AGENCY FOR INTERNATIONAL DEVELOPMENT GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Advance Payments 732.402 General. (a)-(d) [Reserved] (e)(1) U.S... organizations require the approval of the Head of the Contracting Activity, after consultation with the Mission...

Sources of influence on medical practice

PubMed Central

Fernandez, L. A.; Martin, J. M.; del Castillo, J. d. D. L.; Gaspar, O. S.; Millan, J. I.; Lozano, M. J.; Keenoy, E. D.

2000-01-01

OBJECTIVES—To explore the opinion of general practitioners on the importance and legitimacy of sources of influence on medical practice.
METHODS—General practitioners (n=723) assigned to Primary Care Teams (PCTs) in two Spanish regions were randomly selected to participate in this study. A self administered questionnaire was sent by mail and collected by hand. The dependent variable collected the opinion on different sources that exert influence on medical practice. Importance was measured with a 9 item scale while legitimacy was evaluated with 16 items measured with a 1 to 7 point Likert scale.
RESULTS—The most important and legitimate sources of influence according to general practitioners were: training courses and scientific articles, designing self developed protocols and discussing with colleagues. The worst evaluated were: financial incentives and the role played by the pharmaceutical industry.
CONCLUSIONS—The development of medical practice is determined by many factors, grouped around three big areas: organisational setting, professional system and social setting. The medical professional system is the one considered as being the most important and legitimate by general practitioners. Other strategies of influence, considered to be very important by the predominant management culture (financial incentives), are not considered to be so by general practitioners. These results, however, are not completely reliable as regards the real network of influences existing in medical practice, which reflect instead different "value systems".


Keywords: primary health care; physicians' practice patterns; medical practice management; physicians' incentive plans PMID:10890875

Communication between primary care and physician specialist: is it improving?

PubMed

Biagetti, B; Aulinas, A; Dalama, B; Nogués, R; Zafón, C; Mesa, J

2015-01-01

Efforts have recently been made in Spain to improve the communication model between primary care and specialized care. The aim of our study was to analyze the impact of a change in the communication model between the two areas when comparing a traditional system to a consulting system in terms of satisfaction of general practitioners and the number of patient referrals. A questionnaire was used to assess the point of view on the relations with the endocrinologist team of 20 general practitioners from one primary care center at baseline and 18 months after the implementation of the new method of communication. In addition, we counted the number of referrals during the two periods. We analyzed 30 questionnaires; 13 before and 17 after the consulting system was established. Consulting system was preferred to other alternatives as a way of communication with endocrinologists. After the consulting system was implemented, general practitioners were more confident in treating hypothyroidism and diabetes. There was a decrease in the number of patient referrals to specialized care from 93.8 to 34.6 per month after implementation of the consultant system. The consultant system was more efficient in resolving problems and responding to general practitioners than the traditional system. General practitioners were more confident in self-management of hypothyroidism and diabetes. A very large decrease in the number of patient referrals was observed after implementation of the consultant system. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

Systematic review protocol of interventions to improve the psychological well-being of general practitioners.

PubMed

Murray, Marylou; Murray, Lois; Donnelly, Michael

2015-09-22

The challenges and complexities faced by general practitioners are increasing, and there are concerns about their well-being. Consequently, attention has been directed towards developing and evaluating interventions and strategies to improve general practitioner well-being and their capacity to cope with workplace challenges. This systematic review aims to evaluate research evidence regarding the effectiveness of interventions designed to improve general practitioner well-being. Eligible studies will include programmes developed to improve psychological well-being that have assessed outcomes using validated tools pertaining to well-being and related outcomes. Only programmes that have been evaluated using controlled study designs will be reviewed. An appropriately developed search strategy will be applied to six electronic databases: the Cochrane Database of Systematic Reviews, MEDLINE, Embase, CINAHL, PsycINFO and Web of Science. Studies will be screened in two stages by two independent reviewers. A third reviewer will arbitrate when required. Pre-specified inclusion and exclusion criteria will be assessed during a pilot phase early on in the review process. The Cochrane data extraction form will be adapted and applied to each eligible study by two independent reviewers, and each study will be appraised critically using standardised checklists from the Cochrane Handbook. Methodological quality will be taken into account in the analysis of the data and the synthesis of results. A narrative synthesis will be undertaken if data is unsuited to a meta-analysis. The systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidance. This will be the first systematic review on this topic, and the evidence synthesis will aid decision-making by general practitioners, policy makers and planners regarding ways in which to improve GP well-being. Findings will be disseminated at general practitioner meetings, conferences and in professional and peer-reviewed journals. PROSPERO CRD42015017899.

Opportunism in Buyer-Supplier Relations: New Insights From Quantitative Synthesis

DTIC Science & Technology

2006-03-20

the variance in the opportunism relationships. This 4 is highly functional. Academicians and practitioners would each benefit from understanding, with...1999) also support the theory. In a franchisor- franchisee relationship, opportunism is reduced by the use of written contracts and explicit procedures...commonly operationalized as solidarity (common responsibilities and interests), mutuality (mutual benefit and trust), flexibility (good faith

[Physician prescription behaviour using the example of general practitioners and their prescriptions of pharmaceuticals in Austria].

PubMed

Müller, M; Meyer, H; Stummer, H

2011-07-01

In extramural setting, general practitioners serve as gatekeepers and therefore control the demand for medical treatment and pharmaceuticals. As a result prescription habits are of major interest. The aim of the present study is to identify sample characteristics in the prescription behaviour of the general practitioners that allow one to differentiate between the individual and the basic population. The prescription behaviour of 4 231 general practitioners was operationalised by means of the two variables "quantity" and "price". Outliers in those categories, that indicate a doctor prescribing too many or too expensive drugs, were identified using Chebyshev's inequality. We found a statistically significant linear relationship between the individual characteristics of the medical doctors and their prescription behaviour (0.54≤ r ≤0.89) as well as between the variables "quantity" and "price" (r=0.86). Particularly notable seems to be the correlation between the number of the consultations and the quantity of the prescribed drugs. The average prescription amounts to approximately 1.8 pharmaceuticals per consultation. The quantity of drugs prescribed correlates with the demand for the physician's service. Only a few general practitioners deviate from this coherence. The tendency to prescribe disproportionately expensive drugs (average costs amount to € 18.4 per drug) especially applies to those general practitioners who, in addition to their occupation as a physician, are allowed to dispense the pharmaceuticals directly to the patient within their privately owned pharmacies ("Hausapotheke"). In addition to this attribute, the variables "number of patients" and "number of consultations" intensify the effect. The risk to be identified as an outlier is 7 times higher within the group of general practitioners who own a "Hausapotheke" and account for an above average number of consultations as within the group that does not incorporate those characteristics. The strong coherence between the quantity and the demand is inherent to the health-care system and explains 79% of the variance of the prescribed quantities. Only 21% of the variance is determined by outside influences such as state of health of the patients. Physicians who have a monetary benefit from also distributing the drugs, however, enhance the prescription of high priced pharmaceuticals. © Georg Thieme Verlag KG Stuttgart · New York.

'I've put diabetes completely on the shelf till the mental stuff is in place'. How patients with doctor-assessed impaired self-care perceive disease, self-care, and support from general practitioners. A qualitative study.

PubMed

Kristensen, Mads Aage Toft; Guassora, Ann Dorrit; Arreskov, Anne Beiter; Waldorff, Frans Boch; Hølge-Hazelton, Bibi

2018-06-22

This paper investigated patients' experiences of disease and self-care as well as perceptions of the general practitioner's role in supporting patients with impaired self-care ability. Qualitative interviews with 13 patients with type 2 diabetes, concurrent chronic diseases, and impaired self-care ability assessed by a general practitioner. We analyzed our data using systematic text condensation. The shifting perspectives model of chronic illness formed the theoretical background for the study. Although most patients experienced challenges in adhering to recommended self-care activities, many had developed additional, personal self-care routines that increased wellbeing. Some patients were conscious of self-care trade-offs, including patients with concurrent mental disorders who were much more attentive to their mental disorder than their somatic diseases. Patients' perspectives on diseases could shift over time and were dominated by emotional considerations such as insisting on leading a normal life or struggling with limitations caused by disease. Most patients found support in the ongoing relationship with the same general practitioner, who was valued as a companion or appreciated as a trustworthy health informant. Patient experiences of self-care may collide with what general practitioners find appropriate in a medical regimen. Health professionals should be aware of patients' prominent and shifting considerations about the emotional aspects of disease. Patients valued the general practitioner's role in self-care support, primarily through the long-term doctor-patient relationship. Therefore, relational continuity should be prioritized in chronic care, especially for patients with impaired self-care ability who often have a highly complex disease burden and situational context. Key points   Little is known about the perspectives of disease and self-care in patients with a doctor-assessed impaired ability of self-care.   • Although patients knew the prescribed regimen they often prioritized self-care routines that increased well-being at the cost of medical recommendations.   • Shifting emotional aspects were prominent in patients' considerations of disease and sustained GPs' use of a patient-centred clinical method when discussing self-care.   • Relational continuity with general practitioners was a highly valued support and should be prioritized for patients with impaired self-care.

Educational interventions for general practitioners to identify and manage depression as a suicide risk factor in young people: a systematic review and meta-analysis protocol.

PubMed

Tait, Lynda; Michail, Maria

2014-12-15

Suicide is a major public health problem and globally is the second leading cause of death in young adults. Globally, there are 164,000 suicides per year in young people under 25 years. Depression is a strong risk factor for suicide. Evidence shows that 45% of those completing suicide, including young adults, contact their general practitioner rather than a mental health professional in the month before their death. Further evidence indicates that risk factors or early warning signs of suicide in young people go undetected and untreated by general practitioners. Healthcare-based suicide prevention interventions targeted at general practitioners are designed to increase identification of at-risk young people. The rationale of this type of intervention is that early identification and improved clinical management of at-risk individuals will reduce morbidity and mortality. This systematic review will synthesise evidence on the effectiveness of education interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people. We shall conduct a systematic review and meta-analysis following the Cochrane Handbook for Systematic Reviews of Interventions guidelines and conform to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases will be systematically searched for randomised controlled trials and quasi-experimental studies investigating the effectiveness of interventions for general practitioners in identifying and managing depression as a suicide risk factor in young people in comparison to any other intervention, no intervention, usual care or waiting list. Grey literature will be searched by screening trial registers. Only studies published in English will be included. No date restrictions will be applied. Two authors will independently screen titles and abstracts of potential studies. The primary outcome is identification and management of depression. Secondary outcomes are suicidal ideation, suicide attempts, deliberate self-harm, knowledge of suicide risk factors and suicide-related behaviours, attitudes towards suicide risk and suicide-related behaviours, confidence in dealing with suicide risk factors and suicide-related behaviour. Our study will inform the development of future education interventions and provide feasibility and acceptability evidence, to help general practitioners identify and manage suicidal behaviour in young people. PROSPERO registration number: CRD42014009110.

The contribution of demographic and morbidity factors to self-reported visit frequency of patients: a cross-sectional study of general practice patients in Australia

PubMed Central

Knox, Stephanie A; Britt, Helena

2004-01-01

Background Understanding the factors that affect patients' utilisation of health services is important for health service provision and effective patient management. This study aimed to investigate the specific morbidity and demographic factors related to the frequency with which general practice patients visit a general practitioner/family physician (GP) in Australia. Methods A sub-study was undertaken as part of an ongoing national study of general practice activity in Australia. A cluster sample of 10,755 general practice patients were surveyed through a random sample of 379 general practitioners. The patient reported the number of times he/she had visited a general practitioner in the previous twelve months. The GP recorded all the patient's major health problems, including those managed at the current consultation. Results Patients reported an average of 8.8 visits to a general practitioner per year. After adjusting for other patient demographics and number of health problems, concession health care card holders made on average 2.6 more visits per year to a general practitioner than did non-card holders (p < .001). After adjustment, patients from remote/very remote locations made 2.3 fewer visits per year than patients from locations where services were highly accessible (p < .001). After adjustment for patient demographics, patients with diagnosed anxiety made on average 2.7 more visits per year (p = 0.003), those with diagnosed depression 2.2 more visits than average (p < .0001), and those with back problems 2.4 more visits (p = 0.009) than patients without the respective disorders. Conclusions Anxiety, back pain and depression are associated with greater patient demand for general practice services than other health problems. The effect of sociodemographic factors on patient utilisation of general practice services is complex. Equity of access to general practice services remains an issue for patients from remote areas, while concession health care card holders are attending general practice more frequently than other patients relative to their number of health problems. PMID:15318948

48 CFR 17.401 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... CONTRACT TYPES SPECIAL CONTRACTING METHODS Leader Company Contracting 17.401 General. Leader company... system is designated under this acquisition technique to be the leader company, and to furnish assistance and know-how under an approved contract to one or more designated follower companies, so they can...

48 CFR 209.104-1 - General standards.

Code of Federal Regulations, 2011 CFR

2011-10-01

... International Contracting, OUSD(AT&L)DPAP(CPIC)), 3060 Defense Pentagon, Washington, DC 20301-3060. (ii....104-1 General standards. (e) For cost-reimbursement or incentive type contracts, or contracts which...; (iii) Risk of misallocations and mischarges are minimized; and (iv) Contract allocations and charges...

48 CFR 1532.102 - Description of contract financing methods.

Code of Federal Regulations, 2010 CFR

2010-10-01

... financing methods. 1532.102 Section 1532.102 Federal Acquisition Regulations System ENVIRONMENTAL PROTECTION AGENCY GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING General 1532.102 Description of contract financing methods. Progress payments based on a percentage or stage of completion are authorized for use as...

Clinical Considerations in Treating BDSM Practitioners: A Review.

PubMed

Dunkley, Cara R; Brotto, Lori A

2018-03-15

BDSM is an overlapping acronym referring to the practices of bondage and discipline, dominance and submission, and sadism and masochism. This article reviews the psychological literature on BDSM practitioners and discusses issues concerning BDSM that are relevant to clinicians and sexual health-care providers. The literature concerning the psychological health of BDSM practitioners and clinical issues in treating BDSM practitioners was exhaustively reviewed. BDSM practitioners differ minimally from the general population in terms of psychopathology. Six clinical considerations emerged: ignoring versus considering BDSM; countertransference; nondisclosure; cultural competence; closer relationship dynamics; BDSM, abuse, and pathology.

29 CFR 4.143 - Effects of changes or extensions of contracts, generally.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Application of the McNamara-O'Hara Service Contract Act Changes in Contract Coverage § 4.143 Effects of... purposes of the application of the Act's provisions. The general rule with respect to such contracts is... provisions of the Act and the regulations thereunder will apply to the changed contract in the same manner...

21 CFR 1307.11 - Distribution by dispenser to another practitioner or reverse distributor.

Code of Federal Regulations, 2010 CFR

2010-04-01

... practitioner who is registered to dispense a controlled substance may distribute (without being registered to distribute) a quantity of such substance to— (1) Another practitioner for the purpose of general dispensing... is to be distributed is registered under the Act to dispense that controlled substance; (ii) The...

8 CFR 1003.103 - Immediate suspension and summary disciplinary proceedings; duty of practitioner to notify EOIR of...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 1003.103 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE GENERAL PROVISIONS EXECUTIVE OFFICE FOR IMMIGRATION REVIEW Professional Conduct for Practitioners-Rules and... Immigration Courts any practitioner who has been found guilty of, or pleaded guilty or nolo contendere to, a...

Are biochemistry interpretative comments helpful? Results of a general practitioner and nurse practitioner survey.

PubMed

Barlow, Ian M

2008-01-01

Adding or incorporating clinical interpretative comments on biochemistry results is widespread in UK laboratories; although this consumes considerable human resource, there is still little evidence to suggest that it is either effective or appreciated by our clinical colleagues. I therefore decided to survey our local general practitioners (GPs) and nurse practitioners to analyse whether they found biochemistry comments on reports helpful. A simple questionnaire was designed and sent to 159 GPs and 81 nurse practitioners asking them whether they found this activity useful for the limited range of test groups that we routinely comment on and also whether they would like to see commenting on more groups of tests. Overall, 49.6% of questionnaires were returned. Of these, there was overwhelming support for commenting on reports and 77% would like to see comments on a greater range of tests. Although adding clinical interpretative comments is very time-consuming for senior laboratory staff, there is overwhelming support of this activity among our GPs and nurse practitioner users; therefore, our local policy of routinely adding clinical comments will remain for the foreseeable future.

A qualitative study of patient experiences of Type 2 Diabetes care delivered comparatively by General Practice Nurses and Medical Practitioners.

PubMed

Boyle, Eileen; Saunders, Rosemary; Drury, Vicki

2016-07-01

To explore patient experiences of type 2 diabetes mellitus care delivered by general practice nurses in collaboration with the general practitioner. Australian general practice nurses are expanding their role in multidisciplinary type 2 diabetes care with limited research on patient perceptions of care provision within this collaborative model. Qualitative interpretive. Purposeful sampling was used to invite the patients (n = 10). Data were collected from semi-structured face-to-face interviews. Braun and Clarke's () inductive coding thematic analysis process was used to interpret the data. All participants experienced their General Practice Nurse consultation as a clinical assessment for their General Practitioner. While they appreciated the extra time with the General Practice Nurse, they were unsure of the purpose of the consultation beyond clinical assessment. They described the ongoing challenge of living with T2DM and identified a need for additional information and advice. The results suggest that the model of general practice nurse type 2 diabetes care has an important role to play in the delivery of effective ongoing care of patients. However, this role requires further development to ensure that it is understood by the patients as a role that not only conducts clinical assessments but also provides relevant education and self-management support as part of a collaborative approach to care delivery with General Practitioners. The findings are relevant to primary health care clinicians providing diabetes care to inform more relevant supportive care by general practice nurses. © 2016 John Wiley & Sons Ltd.

78 FR 31879 - General Services Administration Acquisition Regulation (GSAR); Electronic Contracting Initiative...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-28

...); Electronic Contracting Initiative (ECI) AGENCY: Office of Acquisition Policy, General Services Administration..., Electronic Contracting Initiative, by any of the following methods: Regulations.gov : http://www.regulations... the rewrite of GSAR Part 538, Electronic Contracting Initiative (Modifications). On December 17, 2012...

41 CFR 51-5.1 - General.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 1 2011-07-01 2009-07-01 true General. 51-5.1 Section 51-5.1 Public Contracts and Property Management Other Provisions Relating to Public Contracts... or commodities on the Procurement List, the contracting activity should refer the commodities it...

National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards.

PubMed Central

Grol, R

1990-01-01

The Nederlands Huisartsen Genootschap (NHG), the college of general practitioners in the Netherlands, has begun a national programme of standard setting for the quality of care in general practice. When the standards have been drawn up and assessed they are disseminated via the journal Huisarts en Wetenschap. In a survey, carried out among a randomized sample of 10% of all general practitioners, attitudes towards national standard setting in general and to the first set of standards (diabetes care) were studied. The response was 70% (453 doctors). A majority of the respondents said they were well informed about the national standard setting initiatives instigated by the NHG (71%) and about the content of the first standards (77%). The general practitioners had a positive attitude towards the setting of national standards for quality of care, and this was particularly true for doctors who were members of the NHG. Although a large majority of doctors said they agreed with most of the guidelines in the diabetes standards fewer respondents were actually working to the guidelines and some of the standards are certain to meet with a lot of resistance. A better knowledge of the standards and a more positive attitude to the process of national standard setting correlated with a more positive attitude to the guidelines formulated in the diabetes standards. The results could serve as a starting point for an exchange of views about standard setting in general practice in other countries. PMID:2265001

Near patient testing in general practice: attitudes of general practitioners and practice nurses, and quality assurance procedures carried out.

PubMed Central

Hilton, S; Rink, E; Fletcher, J; Sibbald, B; Freeling, P; Szczepura, A; Davies, C; Stilwell, J

1994-01-01

BACKGROUND. The evaluation of near patient testing in British general practice has largely been confined to studies examining individual tests or comparing equipment. AIM. This study set out to determine the attitudes of practice staff to near patient testing, and the extent to which staff undertook quality assessment. METHOD. Four types of near patient testing machines were introduced into 12 general practices in two regions of England, south west Thames and west Midlands. General practitioner and practice nurse attitudes to near patient testing were assessed by semi-structured interview before and six months after the introduction of the machines. The extent to which routine quality assurance procedures were carried out within the surgery and as part of local and national schemes was examined. RESULTS. Although 80% of general practitioners anticipated changing patient management with near patient testing, only two fifths reported having done so after six months. Nurses generally were enthusiastic at the outset, although one third were unhappy about incorporating near patient testing into their work schedules. Time pressure was the most important factor restricting uptake of near patient testing. Nurses performed quality control regularly but complete local external quality assurance procedures were established in only half the practices. All the practices participated in a national scheme for cholesterol assays. CONCLUSION. General practitioners in this study did not find near patient testing a very useful addition to their resources. Pressure on nurses' time was the most frequently reported limitation. PMID:7748669

The utility of an online diagnostic decision support system (Isabel) in general practice: a process evaluation.

PubMed

Henderson, Emily J; Rubin, Greg P

2013-05-01

To evaluate the utility of Isabel, an online diagnostic decision support system developed by Isabel Healthcare primarily for secondary medical care, in the general practice setting. Focus groups were conducted with clinicians to understand why and how they used the system. A modified online post-use survey asked practitioners about its impact on their decision-making. Normalization process theory (NPT) was used as a theoretical framework to determine whether the system could be incorporated into routine clinical practice. The system was introduced by NHS County Durham and Darlington in the UK in selected general practices as a three-month pilot. General practitioners and nurse practitioners who had access to Isabel as part of the Primary Care Trust's pilot. General practitioners' views, experiences and usage of the system. Seven general practices agreed to pilot Isabel. Two practices did not subsequently use it. The remaining five practices conducted searches on 16 patients. Post-use surveys (n = 10) indicated that Isabel had little impact on diagnostic decision-making. Focus group participants stated that, although the diagnoses produced by Isabel in general did not have an impact on their decision-making, they would find the tool useful if it were better tailored to the primary care setting. Our analysis concluded that normalization was not likely to occur in its current form. Isabel was of limited utility in this short pilot study and may need further modification for use in general practice.

Contract law: relationship between dermatologists and third-party payers.

PubMed

Askanas, A V

1993-04-01

The relationship between third-party payers and dermatologists is generally governed by a written contract. That relationship can be more beneficial to the dermatologist, and chances of liability may be decreased, both for breach of contract and for malpractice, if the dermatologist pays close attention to the language in the contract. All contracts are generally negotiable; detrimental language in the contract often may be removed or changed. This article presents information to help prepare dermatologists to review and negotiate contracts.

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

ERIC Educational Resources Information Center

Gladman, Justin; Perkins, David

2013-01-01

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

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

ERIC Educational Resources Information Center

Usher, Wayne

2009-01-01

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

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

ERIC Educational Resources Information Center

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

2008-01-01

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

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

ERIC Educational Resources Information Center

Koritsas, Stella; Iacono, Teresa; Davis, Robert

2012-01-01

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

Professional misconduct: the case of the Medical Board of Australia v Tausif (occupational discipline).

PubMed

Colton, Caroline

2015-03-01

In 2014, the Australian Capital Territory Civil and Administrative Appeals Tribunal (ACAT) made a finding of professional misconduct against a Canberra general practitioner working in two bulk-billing medical practices established by a corporate medical practice service company, Primary Health Care Limited (Medical Board of Australia v Tausif (Occupational Discipline) [2015] ACAT 4). This column analyses that case, particularly in relation to the ACAT finding that the practitioner's professional misconduct was substantially contributed to by an unsafe system of care, specifically, the failure of Primary Health Care to provide supervision and mentoring for clinicians working at its medical centres. The case highlights the professional pressures carried by general practitioners who practise medicine within the framework of corporate bulk-billing business models. The column also examines the related issue of general practitioner co-payments in Australia and their impact on business models built around doctors purportedly characterised as independent contractors, bulk-billing large numbers of patients each day for short consultations.

[Pre travel advice - a study among Swiss general practitioners].

PubMed

Walz, Alexander; Tschudi, Peter; Badertscher, Nina; Hatz, Christoph

2013-06-01

Up to 65 % of travellers seek pre-travel advice at their general practitioner. Professionals should inform about the most common and most dangerous health threats, requiring up-to-date knowledge about epidemiology of respective disorders. The aim of the present study was to investigate the content of pre-travel advice given by general practitioners in order to provide them with better expert support from travel medicine specialists. One third of them perform pre-travel advice weekly, and some two thirds do so at least monthly. The most frequently discussed topics are malaria, immunisation, insect bite prevention and travellers' diarrhoea. Less than half of the advice sessions included talking about the risk of accidents. Apart from the need for yellow fever vaccination, referral to travel medicine experts was highest for immunocompromised and pregnant travellers, and for trips to "high risk" countries. A considerable number of practitioners do not comply with the Swiss recommendations, continuously updated in the Bulletin of the Federal Office of Public Health, possibly because only 21 % consult them at regular intervals.

48 CFR 27.403 - Data rights-General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Data rights-General. 27... CONTRACTING REQUIREMENTS PATENTS, DATA, AND COPYRIGHTS Rights in Data and Copyrights 27.403 Data rights—General. All contracts that require data to be produced, furnished, acquired, or used in meeting contract...

Do we need a critical care ultrasound certification program? Implications from an Australian medical-legal perspective.

PubMed

Huang, Stephen J; McLean, Anthony S

2010-01-01

Medical practitioners have a duty to maintain a certain standard of care in providing their services. With critical care ultrasound gaining popularity in the ICU, it is envisaged that more intensivists will use the tool in managing their patients. Ultrasound, especially echocardiography, can be an 'easy to learn, difficult to manage' skill, and the competency in performing the procedure varies greatly. In view of this, several recommendations for competency statements have been published in recent years to advocate the need for a unified approach to training and certification. In this paper, we take a slightly different perspective, from an Australian medical-legal viewpoint, to argue for the need to implement a critical care ultrasound certification program. We examine various issues that can potentially lead to a breach of the standard of care, hence exposing the practitioners and/or the healthcare institutions to lawsuits in professional negligence or breach of contract. These issues, among others, include the failure to use ultrasound in appropriate situations, the failure of hospitals to ensure practitioners are properly trained in the skills, the failure of practitioners to perform an ultrasound study that is of a reasonable standard, and the failure of practitioners to keep themselves abreast of the latest developments in treatment and management. The implications of these issues and the importance of having a certification process are discussed.

Do we need a critical care ultrasound certification program? Implications from an Australian medical-legal perspective

PubMed Central

2010-01-01

Medical practitioners have a duty to maintain a certain standard of care in providing their services. With critical care ultrasound gaining popularity in the ICU, it is envisaged that more intensivists will use the tool in managing their patients. Ultrasound, especially echocardiography, can be an 'easy to learn, difficult to manage' skill, and the competency in performing the procedure varies greatly. In view of this, several recommendations for competency statements have been published in recent years to advocate the need for a unified approach to training and certification. In this paper, we take a slightly different perspective, from an Australian medical-legal viewpoint, to argue for the need to implement a critical care ultrasound certification program. We examine various issues that can potentially lead to a breach of the standard of care, hence exposing the practitioners and/or the healthcare institutions to lawsuits in professional negligence or breach of contract. These issues, among others, include the failure to use ultrasound in appropriate situations, the failure of hospitals to ensure practitioners are properly trained in the skills, the failure of practitioners to perform an ultrasound study that is of a reasonable standard, and the failure of practitioners to keep themselves abreast of the latest developments in treatment and management. The implications of these issues and the importance of having a certification process are discussed. PMID:20550724

48 CFR 22.1003-1 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROGRAMS APPLICATION OF LABOR LAWS TO GOVERNMENT ACQUISITIONS Service Contract Act of 1965, as Amended 22.1003-1 General. This subpart 22.10 applies to all Government contracts, the principal purpose of which... does not apply to individual contract requirements for services in contracts not having as their...

Sick notes, general practitioners, emergency departments and fracture clinics

PubMed Central

Walker, C A; Gregori, A; O'Connor, P; Jaques, K; Joseph, R

2007-01-01

Background General practitioner waiting times are increasing. The two national surveys regarding general practice showed that the number of patients waiting for ⩾2 days for an appointment rose from 63% to 72% between 1998 and 2002, with 25% waiting for ⩾4 days. The Department of Health recognised that many patients discharged from hospitals and outpatient clinics required to visit their general practitioner for the sole purpose of obtaining a sick note. The report entitled Making a difference: reducing general practitioner paperwork estimated that 518 000 appointments (and 42 000 GP h) could be saved by ensuring that these patients were issued with a sick note directly from hospital rather than being referred to their general practitioner. This practice was to be adopted from July 2001 and included patients discharged from wards as well as those seen in outpatient departments. Method 50 emergency departments and fracture clinics in Scotland and England were contacted to assess whether these guidelines had been adopted. Only hospitals with both accident and emergency and fracture clinics were included; nurse‐led and paediatric departments were excluded. Results Of the 25 Scottish emergency hospitals contacted, 4 (16%) accident and emergency departments and 8 (32%) fracture clinics issued sick notes. This was compared with 5 of 25 (20%) accident and emergency departments and 12 of 25 (48%) fracture clinics in England. Four Scottish and five English accident and emergency departments stated that it was policy to give sick notes, three Scottish and four English departments said that it was policy not to give them and the rest (72% in Scotland and 64% in England) stated that they had no clear policy but “just don't give them”. Conclusion The 2001 guidance from the joint Cabinet Office/Department of Health has not been fully incorporated into standard practice in Scotland and England. If all emergency departments and fracture clinics were to issue sick notes to patients requiring >7 days absence from work, this could reduce general practitioner consultations and improve waiting times. PMID:17183039

Influences on hospital admission for asthma in south Asian and white adults: qualitative interview study.

PubMed

Griffiths, C; Kaur, G; Gantley, M; Feder, G; Hillier, S; Goddard, J; Packe, G

2001-10-27

To explore reasons for increased risk of hospital admission among south Asian patients with asthma. Qualitative interview study using modified critical incident technique and framework analysis. Newham, east London, a deprived area with a large mixed south Asian population. 58 south Asian and white adults with asthma (49 admitted to hospital with asthma, 9 not admitted); 17 general practitioners; 5 accident and emergency doctors; 2 out of hours general practitioners; 1 asthma specialist nurse. Patients' and health professionals' views on influences on admission, events leading to admission, general practices' organisation and asthma strategies, doctor-patient relationship, and cultural attitudes to asthma. South Asian and white patients admitted to hospital coped differently with asthma. South Asians described less confidence in controlling their asthma, were unfamiliar with the concept of preventive medication, and often expressed less confidence in their general practitioner. South Asians managed asthma exacerbations with family advocacy, without systematic changes in prophylaxis, and without systemic corticosteroids. Patients describing difficulty accessing primary care during asthma exacerbations were registered with practices with weak strategies for asthma care and were often south Asian. Patients with easy access described care suggesting partnerships with their general practitioner, had better confidence to control asthma, and were registered with practices with well developed asthma strategies that included policies for avoiding hospital admission. The different ways of coping with asthma exacerbations and accessing care may partly explain the increased risk of hospital admission in south Asian patients. Interventions that increase confidence to control asthma, confidence in the general practitioner, understanding of preventive treatment, and use of systemic corticosteroids in exacerbations may reduce hospital admissions. Development of more sophisticated asthma strategies by practices with better access and partnerships with patients may also achieve this.

41 CFR 51-4.1 - General.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true General. 51-4.1 Section 51-4.1 Public Contracts and Property Management Other Provisions Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 4-NONPROFIT AGENCIES § 51-4.1 General...

78 FR 42074 - Federal Acquisition Regulation; Information Collection; Examination of Records by Comptroller...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-15

...; Information Collection; Examination of Records by Comptroller General and Contract Audit AGENCY: Department of... collection requirement concerning the examination of records by comptroller general and contract audit. DATES... ``Information Collection 9000-0034, Examination of Records by Comptroller General and Contract Audit'' on your...

41 CFR 51-5.1 - General.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true General. 51-5.1 Section 51-5.1 Public Contracts and Property Management Other Provisions Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED 5-CONTRACTING REQUIREMENTS § 51-5.1...

Tips from the toolkit: 1 - know yourself.

PubMed

Steer, Neville

2010-01-01

High performance organisations review their strategy and business processes as part of usual business operations. If you are new to the field of general practice, do you have a career plan for the next 5-10 years? If you are an experienced general practitioner, are you using much the same business model and processes as when you started out? The following article sets out some ideas you might use to have a fresh approach to your professional career. It is based on The Royal Australian College of General Practitioners' 'General practice management toolkit'.

Critical Practitioners, Developing Researchers: The Story of Practitioner Research in the Lifelong Learning Sector

ERIC Educational Resources Information Center

Hillier, Yvonne

2010-01-01

This article examines the growth of practitioner research in England through the creation of the Learning and Skills Research Network (LSRN) and identifies its effect on subsequent developments in what is generally known as the Lifelong Learning Sector (LLS). It offers an analysis of this development as a case study in developing practitioner…

Asthma management in rural New South Wales: perceptions of health care professionals and people with asthma.

PubMed

Cvetkovski, Biljana; Armour, Carol; Bosnic-Anticevich, Sinthia

2009-08-01

To investigate the perceptions and attitudes towards asthma management of general practitioners, pharmacists and people with asthma in a rural area. Qualitative semistructured interviews. Small rural centre in New South Wales. General practitioners, pharmacists and people with asthma in a rural area. General practitioners perceived that the patient provided a barrier to the implementation of optimal asthma services. They were aware that other health care professionals had a role in asthma management but were not aware of the details, particularly in relation to that of the pharmacist and would like to improve communication methods. Pharmacists also perceived the patient to be a barrier to the delivery of optimal asthma management services and would like to improve communication with the general practitioner. The impact of the rural environment for the health care professionals included workforce shortages, availability of support services and access to continuing education. People with asthma were satisfied with their asthma management and the service provided by the health care professionals and described the involvement of family members and ambulance officers in their overall asthma management. The rural environment was an issue with regards to distance to the hospital during an emergency. General practitioners and pharmacists confirmed their existing roles in asthma management while expressing a desire to improve communication between the two professions to help overcome barriers and optimise the asthma service delivered to the patient. The patient described minimal barriers to optimising asthma management, which might suggest that they might not have great expectations of asthma care.

Preparing palliative home care nurses to act as facilitators for physicians' learning: Evaluation of a training programme.

PubMed

Pype, Peter; Mertens, Fien; Wens, Johan; Stes, Ann; Van den Eynden, Bart; Deveugele, Myriam

2015-05-01

Palliative care requires a multidisciplinary care team. General practitioners often ask specialised palliative home care teams for support. Working with specialised nurses offers learning opportunities, also called workplace learning. This can be enhanced by the presence of a learning facilitator. To describe the development and evaluation of a training programme for nurses in primary care. The programme aimed to prepare palliative home care team nurses to act as facilitators for general practitioners' workplace learning. A one-group post-test only design (quantitative) and semi-structured interviews (qualitative) were used. A multifaceted train-the-trainer programme was designed. Evaluation was done through assignments with individual feedback, summative assessment through videotaped encounters with simulation-physicians and individual interviews after a period of practice implementation. A total of 35 nurses followed the programme. The overall satisfaction was high. Homework assignments interfered with the practice workload but showed to be fundamental in translating theory into practice. Median score on the summative assessment was 7 out of 14 with range 1-13. Interviews revealed some aspects of the training (e.g. incident analysis) to be too difficult for implementation or to be in conflict with personal preferences (focus on patient care instead of facilitating general practitioners' learning). Training palliative home care team nurses as facilitator of general practitioners' workplace learning is a feasible but complex intervention. Personal characteristics, interpersonal relationships and contextual variables have to be taken into account. Training expert palliative care nurses to facilitate general practitioners' workplace learning requires careful and individualised mentoring. © The Author(s) 2014.

The GP's perception of poverty: a qualitative study.

PubMed

Willems, Sara J; Swinnen, Wilfried; De Maeseneer, Jan M

2005-04-01

Health differences between people from lower and higher social classes increase. The accessibility of the health care system is one of the multiple and complex causes. The Physician's perceptions, beliefs and attitudes towards the patient are in this context important determinants. To explore the general practitioners' definition of poverty and their perception of the deprived patients' attitude towards health and health care, to get insight into the ways general practitioners deal with the problem of poverty and to present the proposals general practitioners make to improve health care for the deprived. The study involved qualitative methodology using 21 semi-structured interviews. The interviews were recorded and transcribed verbatim. The transcripts were coded using Framework Analysis techniques. Interviews were undertaken with general practitioners in primary care, working in a deprived area in the city of Ghent. In the definition of poverty, three concepts can be identified: socioeconomic aspects, psychological and individual characteristics, and socio-cultural concepts. General practitioners adopt different types of approaches to deal with deprived patients in practice: adaptation of the doctor-patient communication, lowering of the financial threshold, referral to specialists and other health care professionals. Including the issue of poverty and poverty in the curriculum of the medical students and in the in-service training for practicing doctors could have a positive impact on their attitude towards this patient group. Further research is needed into the barriers in the accessibility of the health care system for the deprived, exploring qualitatively and quantitatively the experiences and the living conditions of deprived patients and the perceptions of health care providers.

[Alternative and complementary medicine from the primary care physician's viewpoint].

PubMed

Soós, Sándor Árpád; Eőry, Ajándék; Eőry, Ajándok; Harsányi, László; Kalabay, László

2015-07-12

The patients initiate the use of complementary and alternative medicine and this often remains hidden from their primary care physician. To explore general practitioners' knowledge and attitude towards complementary and alternative medicine, and study the need and appropriate forms of education, as well as ask their opinion on integration of alternative medicine into mainstream medicine. A voluntary anonymous questionnaire was used on two conferences for general practitioners organized by the Family Medicine Department of Semmelweis University. Complementary and alternative medicine was defined by the definition of the Hungarian Academy of Sciences and certified modalities were all listed. 194 general practitioners answered the questionnaire (39.8% response rate). 14% of the responders had licence in at least one of the complementary and alternative therapies, 45% used complementary and alternative therapy in their family in case of illness. It was the opinion of the majority (91.8%) that it was necessary to be familiar with every method used by their patients, however, 82.5% claimed not to have enough knowledge in complementary medicine. Graduate and postgraduate education in the field was thought to be necessary by 86% of the responders; increased odds for commitment in personal education was found among female general practitioners, less than 20 years professional experience and personal experience of alternative medicine. These data suggest that general practitioners would like to know more about complementary and alternative medicine modalities used by their patients. They consider education of medical professionals necessary and a special group is willing to undergo further education in the field.

[General practitioner and palliative sedation].

PubMed

Schweitzer, Bart

2014-01-01

Recent publications in Dutch national newspapers on palliative sedation have raised concerns about its use in general practice. There is now evidence that there is no significant increase in the incidence of palliative sedation. Euthanasia requests were pending in 20.8% of the cases in which palliative sedation was performed, but the general practitioners could clearly justify why they made this choice. This is important because it indicates that they are aware of a sharp distinction between euthanasia and palliative sedation. Although the decision to perform palliative sedation was discussed with almost all cancer patients, patient involvement was less present in non-cancer conditions. This may be related to different disease trajectories, but it also indicates that attention should be devoted to earlier identification of patients in need of palliative care. The findings confirm that the practice of palliative sedation by general practitioners largely reflects the recommendations of the Dutch National Guideline on Palliative Sedation.

How do swine practitioners and veterinary pathologists arrive at a diagnosis of Clostridium perfringens type A enteritis in neonatal piglets?

PubMed

Chan, Gloria; Farzan, Abdolvahab; Prescott, John F; Friendship, Robert

2013-05-01

A questionnaire was administered to 22 veterinary practitioners and 17 veterinary pathologists to investigate the methods used for diagnosis of Clostridium perfringens type A enteritis in neonatal pigs. Practitioners generally diagnosed C. perfringens type A associated enteritis by age of onset of diarrhea (between 1 to 7 days of age). Most practitioners (95%) were moderately to very confident in their diagnosis. Pathologists generally diagnosed C. perfringens type A associated enteritis by combinations of isolation of the organism, genotyping or detecting the toxins of the organism, and ruling out other pathogens through histopathology. Almost half (41%) of the pathologists were not confident of their diagnosis. This study reports that the current diagnostic method for C. perfringens type A enteritis is not specific, and although many pathologists expressed reservations about making a diagnosis of C. perfringens type A enteritis, most practitioners were confident in their diagnosis, even though reported clinical signs of clostridial diarrhea are similar to those of a number of other enteric diseases.

Local and National Effects of a Quality System in Dutch General Practitioner Specialty Training: A Qualitative Study

ERIC Educational Resources Information Center

Buwalda, Nienke; Braspenning, Jozé; van Dijk, Nynke; Visser, Mechteld

2018-01-01

A quality system (named GEAR; acronym for Combined Evaluation Audit Round in English), has been introduced in eight institutes of the Dutch general practitioner specialty training. This paper focuses on the local and national effects of GEAR. Seventeen semi-structured interviews were conducted with the directors and quality co-ordinators. At a…

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

ERIC Educational Resources Information Center

Usher, Wayne

2011-01-01

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

General practitioners and learning by audit

PubMed Central

Freeling, P.; Burton, R. H.

1982-01-01

The ways in which `medical audit' can be used in the continuing education of general practitioners are examined, and certain rules for the conduct of such education in small groups of peers are put forward. However, it proved impossible to evaluate the outcome of the educational exercise because those taking part refused to audit twice any single aspect of their daily work. PMID:7086756

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

ERIC Educational Resources Information Center

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

2011-01-01

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

"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…

Orthodontic treatment by general practitioners in consultation with orthodontists--a survey of appliances recommended by Swedish orthodontists.

PubMed

Petrén, Sofia; Bjerklin, Krister; Hedrén, Pontus; Ecorcheville, Agnes

2014-01-01

The aim of the present study was to disclose the treatment procedures most frequently recommended by Swedish orthodontists for use by general practitioners and to determine whether these recommendations are reflected in the undergraduate dental program in orthodontics at Malmö University. Potential differences between the ortho- dontists' recommendations were also investigated. A questionnaire was sent to 169 consulting orthodontists, seeking their recommenda- tions for appliance therapy to be undertaken by general practitioners: 129 (63 males and 66 females) responded. The Quad Helix was the appliance most commonly recommended for correction of posterior crossbite, a plate with Z-springs for correction of anterior crossbite and the headgear activator for correction of Class II malocclusions. A significant gender difference was disclosed with respect to orthodontists' recommendations for treatment of Class II malocclusions by general practitioners, namely that female orthodontists recommended the headgear activator more frequently than males. However, this difference is most likely attributable to the gender distribution among orthodontists qualifying as specialists during the last five decades: more recently qualified orthodontists are predominantly female. The choice of appliances corresponded well with undergraduate training in orthodontics at the Faculty of Odontology in Malmö.

[The role of general practitioner in French cancer centers].

PubMed

Gangler, Anne; Delva, Rémy; Gamelin, Eric

2013-04-01

Oncology is undergoing profound change with the development of treatments and techniques, the evolution of care taking (outpatient, overall patient care, prevention and screening), attracting more and more women. This field is also concerned by the medical demography issue. Each professional team organisation and functions are meant to be reconsidered. We took interest in the general practitioner functions in cancer centers (they are present in 80% of those); a new concept which has not been studied in France yet. A questionnaire survey of general practitioners, oncologists and directors from 19 regional cancer centers and 9 private cancer clinics, was conducted during summer 2008. The overall response rate was 51% (260/512). This study aimed to underline the general practitioner main functions, who is widely qualified, with high relational ability, a role different from family physicians and oncologists, but closely working together with them, with hardly recognized specific activities: overall patient care, continuous care with the daily management of hospitalized patients allowing a reduction in oncologists working load, the continuity of care with the family physician, the involvement in the day hospital management, in the emergency department, in outpatient palliative care consultations and follow-up consultations.

Current trends in lifestyle-related disease management by general practitioners: a report from the "Heart Care Network" groups.

PubMed

2009-01-01

In Japan, it is believed that guidelines for lifestyle-related disease are used in routine clinical practice, however, there are few reports on the actual rate of healthcare conducted in accordance with these guidelines by general practitioners and on their usefulness in preventing cardiovascular events. Therefore, the Heart Care Network (HCN) groups were organized mainly by general practitioners treating lifestyle diseases in 62 areas of Japan. The HCN has collected data on lifestyle diseases in high-risk patients in routine practices and investigated management conditions, guideline target achievement rates and medication. Additionally, the incidence of cardiovascular events was assessed. We analyzed 14,064 cases. The lipid profile, blood pressure, glycemic control were significantly improved over the 3 years. The incidence of cardiovascular events were significantly reduced by the achievement of target LDL cholesterol, systolic blood pressure and hemoglobin A1c and even after adjustment for age, gender, history of myocardial infarction, the reduction of these lifestyle-related parameters remains significant. These results revealed the current trends in the healthcare activities of general practitioners, the management conditions for lifestyle diseases in CHD high-risk patients and their effects on reducing cardiovascular events.

[Gaining new knowledge in clinical practice].

PubMed

Martin, P; Rautanen, K; Thomsen, A S; Hjalt, C A; Jónsson, A; Löfroth, G

1999-01-30

A study of the diffusion of knowledge about Helicobacter pylori and gastrointestinal disease among Norwegian clinicians is reported. A questionnaire about when and how research results on Helicobacter pylori and gastrointestinal disease were taken up by doctors in their practice was sent to 200 general practitioners and 200 medical and surgical gastroenterologists. This Norwegian study is part of a comparative study of the uptake process in the five Scandinavian countries which is planned to be published in an international journal. The specialists both heard of research results and started using new treatments earlier than the general practitioners. The main sources of information for the general practitioners were the national medical journal and courses or conferences, whilst the specialists obtained their information mainly from international journals and courses or conferences. The general practitioners were more likely to treat Helicobacter pylori positive dyspepsia and to use serology as a diagnostic tool, whilst the specialists were more likely to use breath tests and had a greater belief in the role of Helicobacter pylori as a cause of gastric cancer. The great majority of both groups knew of Helicobacter pylori as a cause of peptic ulcer disease, used antibiotics in its treatment, and preferred (referral to) endoscopic biopsy as the main diagnostic tool.

Efficacy of cognitive-behavioural therapy by general practitioners for unexplained fatigue among employees: Randomised controlled trial.

PubMed

Huibers, Marcus J H; Beurskens, Anna J H M; Van Schayck, Constant P; Bazelmans, Ellen; Metsemakers, Job F M; Knottnerus, J Andre; Bleijenberg, Gijs

2004-03-01

Fatigue is a common complaint that may lead to long-term sick leave and work disability. To assess the efficacy of cognitive-behavioural therapy by general practitioners for unexplained, persistent fatigue among employees. A randomised controlled trial, using a pre-randomisation design in primary care, investigated 151 employees on sick leave with fatigue. Participants in the experimental group were offered five to seven 30 min sessions of cognitive-behavioural therapy by a general practitioner; those in the control group were offered no treatment. Main outcome measures (fatigue severity, self-reported absenteeism, registered absenteeism and clinical recovery) were assessed at 4 months, 8 months and 12 months. At baseline, 44% of the patients already met research criteria for chronic fatigue syndrome. There was no significant difference between the experimental group and the control group on primary or secondary outcomes at any point. Cognitive-behavioural therapy by general practitioners for unexplained, persistent fatigue did not prove to be an effective intervention. Since these doctors were unable to deliver this therapy effectively under ideal circumstances, it is unlikely that doctors in routine practice would be more successful in doing so.

Substitution of Hospital Care with Primary Care: Defining the Conditions of Primary Care Plus

PubMed Central

Kroese, Mariëlle Elisabeth Aafje Lydia; Spreeuwenberg, Marieke Dingena; Elissen, Arianne Mathilda Josephus; Meerlo, Ronald Johan; Hanraets, Monique Margaretha Henriëtte; Ruwaard, Dirk

2016-01-01

Objective: To analyse barriers and facilitators in substituting hospital care with primary care to define preconditions for successful implementation. Methods: A descriptive feasibility study was performed to collect information on the feasibility of substituting hospital care with primary care. General practitioners were able to refer patients, about whom they had doubts regarding diagnosis, treatment and/or the need to refer to hospital care, to medical specialists who performed low-complex consultations at general practitioner practices. Qualitative data were collected through interviews with general practitioners and medical specialists, focus groups and notes from meetings in the Netherlands between April 2013 and January 2014. Data were analysed using a conventional content analysis which resulted in categorised barriers, facilitators and policy adjustments, after which preconditions were formulated. Results: The most important preconditions were make arrangements on governmental level, arrange a collective integrated IT-system, determine the appropriate profile for medical specialists, design a referral protocol for eligible patients, arrange deliberation possibilities for general practitioners and medical specialists and formulate a diagnostic protocol. Conclusions: The barriers, facilitators and formulated preconditions provided relevant input to change the design of substituting hospital care with primary care. PMID:27616956

Nosological Inaccuracies in death certification in Northern Ireland. A comparative study between hospital doctors and general practitioners.

PubMed Central

Armour, A.; Bharucha, H.

1997-01-01

We aimed to audit nosological inaccuracies in death certification in Northern Ireland and to compare performance of hospital doctors and general practitioners. Nosology is the branch of medicine which treats of the classification of disease. 1138 deaths were registered in Northern Ireland in a 4-week period commencing 3/10/94. 195 of these were either registered by HM Coroners (HMC) or required further investigation by their staff; these cases were excluded from the study. The remaining 943 were analysed for wording and formulation inaccuracies according to the revised notes (1974), Northern Ireland Medical Certificate of Cause of Death. These are issued in book form by the Registrar of Births and Deaths. The commonest inaccuracies in death certification occur in the areas of poor terminology, sequence errors and unqualified mode. One or more inaccuracies were found in 317 (33.6%) of cases. In 13 of these (4%) cases, the inaccuracies were serious enough to warrant referral by the Registrar of Deaths to HM Coroner. The numbers of general practitioners and hospital doctors were recorded, with general practitioners being responsible for 122 (38%) and hospital doctors being responsible for 195 (62%) of inaccuracies. PMID:9185484

Right Time, Right Place: Building an Online Learning Community for Afterschool Practitioners

ERIC Educational Resources Information Center

Balow, Nancy; Benard, Bonnie; Hipps, Jerry; Lauver, Sherri; McManus, John; Montgomery, Robert; Truebridge, Sara; Vitale, Alfred; Walker, Roy

2010-01-01

In 2008, the U.S. Department of Education awarded a contract to a team of education, youth development, and web development specialists to develop an online professional learning community for grantees in the 21st Century Community Learning Centers (21st CCLC). The online community, You for Youth (Y4Y, www.Y4Y.ed.gov) will support afterschool…

Evaluation and mechanism for outcomes exploration of providing public health care in contract service in rural China: a multiple-case study with complex adaptive systems design.

PubMed

Zhou, Huixuan; Zhang, Shengfa; Zhang, Weijun; Wang, Fugang; Zhong, You; Gu, Linni; Qu, Zhiyong; Tian, Donghua

2015-02-27

The Chinese government has increased the funding for public health in 2009 and experimentally applied a contract service policy (could be seen as a counterpart to family medicine) in 15 counties to promote public health services in the rural areas in 2013. The contract service aimed to convert village doctors, who had privately practiced for decades, into general practitioners under the government management, and better control the rampant chronic diseases. This study made a rare attempt to assess the effectiveness of public health services delivered under the contract service policy, explore the influencing mechanism and draw the implications for the policy extension in the future. Three pilot counties and a non-pilot one with heterogeneity in economic and health development from east to west of China were selected by a purposive sampling method. The case study methods by document collection, non-participant observation and interviews (including key informant interview and focus group interview) with 84 health providers and 20 demanders in multiple level were applied in this study. A thematic approach was used to compare diverse outcomes and analyze mechanism in the complex adaptive systems framework. Without sufficient incentives, the public health services were not conducted effectively, regardless of the implementation of the contract policy. To appropriately increase the funding for public health by local finance and properly allocate subsidy to village doctors was one of the most effective approaches to stimulate health providers and demanders' positivity and promote the policy implementation. County health bureaus acted as the most crucial agents among the complex public health systems. Their mental models influenced by the compound and various environments around them led to the diverse outcomes. If they could provide extra incentives and make the contexts of the systems ripe enough for change, the health providers and demanders would be receptive to the transition of the policy. The innovative fund raising measures could be taken by relatively developed counties of China to conduct public health services. Policymakers could take systems thinking as a useful tool to design plans and predict the unintended outcomes during the process of public health reforms.

Unravelling referral paths relating to the dental care of children: a study in Liverpool.

PubMed

Harris, Rebecca V; Pender, Susan M; Merry, Alison; Leo, Anthony

2008-04-01

To describe primary care referral networks relating to children's dental care and the main influences on referral decisions taken by dentists working in a primary care setting. A postal questionnaire to all 130 general dental practitioners (GDPs) in contract with Primary Care Trusts (PCTs), and 24 Community Dental Service (CDS) dentists in Liverpool. Characteristics of patient groups and factors influencing the choice of referral pathway of children referred from primary dental care. There were good responses rates (110 [85%] GDPs and 22 [92%] CDS dentists). The two main reasons why GDPs referred children to hospitals were (a) for treatment under general anaesthetic (GA) or relative analgesia (RA) and (b) for restorative care of dentally anxious children. GDPs also referred anxious children requiring simple restorative care and/or RA to the CDS. Only eight GDPs (7%) cited a lack of experience as a reason for referral of dentally anxious children for simple restorative care, compared to 53 (48%) who cited a lack of RA facilities, and 25 (23%) who cited financial considerations. GDPs refer children to both hospital services and the CDS, and identify a lack of RA facilities and economic pressures as key reasons for referral.

41 CFR 60-741.40 - General purpose and applicability of the affirmative action program requirement.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 41 Public Contracts and Property Management 1 2014-07-01 2014-07-01 false General purpose and... Property Management Other Provisions Relating to Public Contracts OFFICE OF FEDERAL CONTRACT COMPLIANCE... requirement. (a) General purpose. An affirmative action program is a management tool designed to ensure equal...

Intrarater repeatability of shade selections with two shade guides.

PubMed

Hammad, Ihab A

2003-01-01

Color research has shown that shade guides do not always represent the color of natural teeth. Moreover, visual evaluation has been found to be unreliable and inconsistent. This investigation evaluated the effects of 2 shade guides on the intrarater repeatability (reliability) of prosthodontists and general practitioners with regard to shade selection. Ten prosthodontists and ten general practitioners (all men, 35-45 years old) with an average practice experience of 14 years participated in this study. Examiners were tested to eliminate color blindness. Each clinician used Vita Lumin Vacuum and Vitapan 3D-Master shade guides to determine the shades of the maxillary right canines of 20 patients following a standard protocol. The identification codes of the shade tabs were masked to prevent shade memory. All teeth were polished before each shade selection, and the selection process was standardized for controlled lighting and procedures. Shade selections were randomly repeated 1 month later by the same practitioners on the same group of patients in accordance with the same shade-selection protocol. Analysis of variance and t tests for individual comparisons among means were performed (P<.05). Significant interactions were found between the effects of shade guide system and specialty training on intrarater repeatability (P<.0001, analysis of variance). The intrarater repeatability of prosthodontists was significantly higher than that of general practitioners when the Vita Lumin Vacuum shade guide was used (P<.0001, t test). Use of the Vitapan 3D-Master shade guide significantly improved the intrarater repeatability of general practitioners compared with the Vita Lumin Vacuum shade guide (P<.0005). This improvement was not significant, however, among prosthodontists (P=.2861). Within the limitations of this study, the prosthodontists demonstrated superior intrarater repeatability in shade selection, especially when the Vita Lumin Vacuum shade guide was used. Use of the Vitapan 3D-Master shade guide notably improved intrarater repeatability among the general practitioners.

[Preferences of general practitioners in metropolitan France with regard to the delegation of medico-administrative tasks to secretaries assisting medico-social workers: Study in conjoint analysis].

PubMed

Chanu, A; Caron, A; Ficheur, G; Berkhout, C; Duhamel, A; Rochoy, M

2018-05-01

A general practitioner's office is an economic unit where task delegation is an essential component in improving the quality and performance of work. To classify the preferences of general practitioners regarding the delegation of medical-administrative tasks to assistant medical-social secretaries. Conjoint analysis was applied to a random sample of 175 general practitioners working in metropolitan France. Ten scenarios were constructed based on seven attributes: training for medical secretaries, logistical support during the consultation, delegation of management planning, medical records, accounting, maintenance, and taking initiative on the telephone. A factorial design was used to reduce the number of scenarios. Physicians' socio-demographic variables were collected. One hundred and three physicians responded and the analysis included 90 respondents respecting the transitivity of preferences hypothesis. Perceived difficulty was scored 2.8 out of 5. The high rates of respondents (59%; 95% CI [51.7-66.3]) and transitivity (87.5%; 95% CI [81.1-93.9]) showed physicians' interest in this topic. Delegation of tasks concerning management planning (OR=2.91; 95% CI [2.40-13.52]) and medical records (OR=1.88; 95% CI [1.56-2.27]) were the two most important attributes for physicians. The only variable for which the choice of a secretary was not taken into account was logistical support. This is a first study examining the choices of general practitioners concerning the delegation of tasks to assistants. These findings are helpful to better understand the determinants of practitioners' choices in delegating certain tasks or not. They reveal doctors' desire to limit their ancillary tasks in order to favor better use of time for "medical" tasks. They also expose interest for training medical secretaries and widening their field of competence, suggesting the emergence of a new professional occupation that could be called "medical assistant". Copyright © 2018 Elsevier Masson SAS. All rights reserved.

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 quality of health care in areas where scientific evidence is limited or where patients' and providers' preferences are particularly important. PMID:10158595

Actions by the Bonneville Power Administration to Implement the Long- Term Contracting Provisions of P.L. 96-501

DTIC Science & Technology

1981-09-04

begin necessary negotiations for initial long-term contracts. Third, the term "offer" is not defined in the Act. Under general contract law , a valid...The position that the Administrator must offer coplete and definite contracts within 9 months of December 5, 1980, is supported by general contract law definitions...conititute "offers" in contract law . This interpretation is supported by Williston, who states that an offer is always a conditional promise, which wll

Work of female rural doctors.

PubMed

Wainer, Jo

2004-04-01

To identify the impact of family life on the ways women practice rural medicine and the changes needed to attract women to rural practice. Census of women rural doctors in Victoria in 2000, using a self-completed postal survey. General and specialist practice. Two hundred and seventy-one female general practitioners and 31 female specialists practising in Rural, Remote and Metropolitan Area Classifications 3-7. General practitioners are those doctors with a primary medical degree and without additional specialist qualifications. Interaction of hours and type of work with family responsibilities. Generalist and specialist women rural doctors carry the main responsibility for family care. This is reflected in the number of hours they work in clinical and non-clinical professional practice, availability for on-call and hospital work, and preference for the responsibilities of practice partnership or the flexibility of salaried positions. Most of the doctors had established a satisfactory balance between work and family responsibilities, although a substantial number were overworked in order to provide an income for their families or meet the needs of their communities. Thirty-six percent of female rural general practitioners and 56% of female rural specialists preferred to work fewer hours. Female general practitioners with responsibility for children were more than twice as likely as female general practitioners without children to be in a salaried position and less likely to be a practice partner. The changes needed to attract and retain women in rural practice include a place for everyone in the doctor's family, flexible practice structures, mentoring by women doctors and financial and personal recognition. Women make up less than a quarter of the rural general practice workforce and an even smaller percentage of the specialist rural medical workforce. As a result their experiences are not well articulated in research on rural medical practice and their needs are not well represented in policies and programs for rural doctors. The incoming cohort of rural general practitioners has a majority of women and it is essential that the practice styles and needs of women doctors are understood in order to attract and retain women in rural medicine. This survey identifies some of the effects of family responsibilities on the work practices of female rural doctors and the changes needed to the structure of rural practice to include the way women work.

48 CFR 232.703 - Contract funding requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Contract funding... SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 232.703 Contract funding requirements. ...

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

Ranking sources of hospital quality information for orthopedic surgery patients: consequences for the system of managed competition.

PubMed

Bes, Romy Evelien; van den Berg, Bernard

2013-01-01

Healthcare quality information is crucial for the system of managed competition. Within a system of managed competition, health insurers can selectively contract care providers and are allowed to channel patients towards contracted providers. The idea is that insurers have a stronger bargaining position compared to care providers when they are able to channel patients. In the Dutch system of managed competition that was implemented in 2006, channelling patients to preferred providers has not yet been very successful. Empirical knowledge of which sources of hospital quality information they find important may help us to understand how to channel patients to preferred providers. The objective of this survey was to measure how patients rank various sources of information when they compare hospital quality in a system of managed competition. A written survey was conducted among clients of a large Dutch health insurance company. These clients underwent orthopedic surgery on the hip or knee no longer than 12 months ago. Two major players within a system of managed competition-health insurers and the government-were not seen as important sources of hospital quality information. In contrast, own experience and general practitioners (GPs) were seen as the most important sources of hospital quality information within the Dutch system of managed competition. Health insurers should take the main finding-that GPs are the most important source of hospital quality information-into account when they contract care providers and develop strategies for channeling patients towards preferred providers. A well-functioning system of managed competition will benefit patients, as it involves incentives for care providers to increase healthcare quality and to produce at the lowest cost per unit of quality.

26 CFR 1.1402(e)-5A - Applications for exemption from self-employment taxes filed after December 31, 1986, by ministers...

Code of Federal Regulations, 2010 CFR

2010-04-01

... Science practitioners. 1.1402(e)-5A Section 1.1402(e)-5A Internal Revenue INTERNAL REVENUE SERVICE... ministers, certain members of religious orders, and Christian Science practitioners. (a) In general. (1... Christian Science practitioner who files an application after December 31, 1986, for exemption from the tax...

An evaluation of a training placement in general practice for paramedic practitioner students: improving patient-centred care through greater interprofessional understanding and supporting the development of autonomous practitioners.

PubMed

Ruston, Annmarie; Tavabie, Abdol

2011-01-01

To report the extent to which the placement of paramedic practitioner students (PPSs) in accredited general practice (GP) training practices supported their development as autonomous, patient-centred practitioners and fostered interprofessional learning. A case study method was used. Sources of data included semi-structured telephone interviews (eight PPSs, eight GP trainers), an online end of placement survey and placement and assessment documentation. Interview data were transcribed and analysed using the constant comparative method. Accredited training practices in South East England. All respondents were positive that the placement provided a high-quality interprofessional learning environment which provided PPSs with learning opportunities based on assessed need, the support of experienced trainers and access to a wide range of patients and learning situations. The placement enabled PPSs to acquire the appropriate skills, knowledge and understanding to act as autonomous, patient-centred practitioners. The placement provides a sound model for expanding the skills of paramedic practitioners in order to meet the increasing demands for patient-centred, community based health care. It provided them with the skills to treat patients closer to home rather than automatically transporting them to hospital.

48 CFR 242.301 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false General. 242.301 Section 242.301 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CONTRACT MANAGEMENT CONTRACT ADMINISTRATION AND AUDIT SERVICES Contract Administration Office...

48 CFR 742.1170-1 - General.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Section 742.1170-1 Federal Acquisition Regulations System AGENCY FOR INTERNATIONAL DEVELOPMENT CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Production, Surveillance, and Reporting 742.1170-1 General. Performance monitoring is a function of contract administration used to determine contractor progress towards achieving...

Practitioners' perspectives on community-based breast cancer survivorship care in Singapore: A focus group study.

PubMed

Chan, Alexandre; Ngai, Guo Hui; Chung, Wing Lam; Yeo, Angie; Ng, Terence; Loh, Kiley Wei-Jen; Farid, Mohamad; Soong, Yoke Lim; Fok, Rose

2018-05-01

With the long-term goal of optimising the delivery of breast cancer survivorship care in Singapore, we conducted a qualitative study to gather in-depth descriptions from community practitioners (general practitioners and community pharmacists) about their perceptions of community-based cancer survivorship care in Singapore. Sixteen participants (11 general practitioners and five community pharmacists) participated in four structured focus group discussions between August and November 2016. The focus group discussions were analysed using deductive content analysis. The majority of community practitioners do not encounter breast cancer survivors in their clinical practices. Perceived barriers to community-based survivorship care include patients' lack of confidence in primary care, financial constraints and lack of empanelment. Most community practitioners concur that the success of community-based survivorship care largely depends on the co-operation and participation of survivors. Survivorship management via standardised care pathways is not fully advocated by practitioners. Survivorship care plans are identified as useful, but they should also incorporate a non-cancer-related medical history and medication list. Community practitioners in Singapore are eager to participate in the delivery of cancer survivorship care. Future studies should develop a community-based care model that involves community practitioners and evaluate the cost-effectiveness of such a care model. The current model of cancer survivorship in Singapore is not sustainable. Differences in healthcare ecosystems, cultures and resources available in an Asian context should be taken into consideration before designing a community-based cancer survivorship program in Singapore. © 2017 John Wiley & Sons Ltd.

Assessing the cost-effectiveness of a routine versus an extensive laboratory work-up in the diagnosis of anaemia in Dutch general practice.

PubMed

Kip, Michelle Ma; Schop, Annemarie; Stouten, Karlijn; Dekker, Soraya; Dinant, Geert-Jan; Koffijberg, Hendrik; Bindels, Patrick Je; IJzerman, Maarten J; Levin, Mark-David; Kusters, Ron

2018-01-01

Background Establishing the underlying cause of anaemia in general practice is a diagnostic challenge. Currently, general practitioners individually determine which laboratory tests to request (routine work-up) in order to diagnose the underlying cause. However, an extensive work-up (consisting of 14 tests) increases the proportion of patients correctly diagnosed. This study investigates the cost-effectiveness of this extensive work-up. Methods A decision-analytic model was developed, incorporating all societal costs from the moment a patient presents to a general practitioner with symptoms suggestive of anaemia (aged ≥ 50 years), until the patient was (correctly) diagnosed and treated in primary care, or referred to (and diagnosed in) secondary care. Model inputs were derived from an online survey among general practitioners, expert estimates and published data. The primary outcome measure was expressed as incremental cost per additional patient diagnosed with the correct underlying cause of anaemia in either work-up. Results The probability of general practitioners diagnosing the correct underlying cause increased from 49.6% (95% CI: 44.8% to 54.5%) in the routine work-up to 56.0% (95% CI: 51.2% to 60.8%) in the extensive work-up (i.e. +6.4% [95% CI: -0.6% to 13.1%]). Costs are expected to increase slightly from €842/patient (95% CI: €704 to €994) to €845/patient (95% CI: €711 to €994), i.e. +€3/patient (95% CI: €-35 to €40) in the extensive work-up, indicating incremental costs of €43 per additional patient correctly diagnosed. Conclusions The extensive laboratory work-up is more effective for diagnosing the underlying cause of anaemia by general practitioners, at a minimal increase in costs. As accompanying benefits in terms of quality of life and reduced productivity losses could not be captured in this analysis, the extensive work-up is likely cost-effective.

General practice in remote areas: attractions, expectations, and experiences

PubMed Central

McIntosh, Jim; Horobin, Gordon

1978-01-01

Interviews with a sample of general practitioners in remote areas of Scotland revealed a strong commitment to a wide family counsellor role as well as a wish to use clinical skills more fully. While many urban doctors express similar orientations we believe that rural practitioners feel better able to implement their preferred style of work which combines personal and professional elements. PMID:702438

[Diagnostic rationalism. Views of general practitioners on fibromyalgia].

PubMed

Daehli, B

1993-09-20

Clinical practice is characterized by having to make numerous important decisions, including the diagnosis. In this study, general practitioners were asked to agree or to disagree with statements of fibromyalgia. The main purpose was to test the usefulness of two well-known models for decision-making when studying diagnosis in cases of uncertainty and scepticism. The results show that the models are inadequate to explain the decisions.

General medicine and surgery for dental practitioners: part 2. Medical emergencies in dental practice: the drug box, equipment and basic principles of management.

PubMed

Greenwood, M; Meechan, J G

2014-06-13

Dental practitioners need knowledge of the diagnosis and management of medical emergencies. This paper deals with the general aspects of emergency treatment including basic management principles which are applicable to all emergencies. The next paper in this series, part 3, deals with more specific aspects of medical emergency management.

Prescription data improve the medication history in primary care.

PubMed

Glintborg, Bente; Andersen, S K; Poulsen, H E

2010-06-01

Incomplete medication lists increase the risk of medication errors and adverse drug effects. In Denmark, dispensing data and pharmacy records are available directly online to treating physicians. We aimed (1) to describe if use of pharmacy records improved the medication history among patients consulting their general practitioner and (2) to characterise inconsistencies between the medication history reported by the patient and the general practitioner's recordings. Patients attending a general practitioner clinic were interviewed about their current medication use. Subsequently, the patients were contacted by phone and asked to verify the medication list previously obtained. Half of the patients were randomly selected for further questioning guided by their dispensing data: during the telephone interview, these patients were asked to clarify whether drugs registered in their pharmacy records were still in use. Pharmacy records show all drugs acquired on prescription from any national pharmacy in the preceding 2 years. The medication list was corrected accordingly. In all patients, the medication lists obtained on the in-clinic and telephone interviews were compared to the general practitioner's registrations. The 150 patients included in the study had a median age of 56 years (range 18-93 years), and 90 (60%) were women. Patients reported use of 849 drugs (median 5, range 0-16) at the in-clinic interview. Another 41 drugs (median 0, range 0-4) were added during the telephone interview. In the subgroup of 75 patients interviewed guided by pharmacy records, additionally 53 drugs (10%) were added to the 474 drugs already mentioned. The 27 patients adding more drugs guided by pharmacy records were significantly older and used more drugs (both p<0.05) than the 48 patients not adding drugs. When the medication lists were compared with the general practitioner's lists, specifically use of over-the-counter products and prescription-only medications from Anatomical Therapeutic Chemical Classification System group J, A, D, N and R were not registered by the general practitioner. Dispensing data provide further improvement to a medication history based on thorough in-clinic and telephone interviews. Use of pharmacy records as a supplement when recording a medication history seems beneficial, especially among older patients treated with polypharmacy.

Perceptions of interprofessional collaboration of general practitioners and community pharmacists - a qualitative study.

PubMed

Löffler, Christin; Koudmani, Carolin; Böhmer, Femke; Paschka, Susanne D; Höck, Jennifer; Drewelow, Eva; Stremme, Martin; Stahlhacke, Bernd; Altiner, Attila

2017-03-21

Despite numerous evidences for the positive effect of community pharmacists on health care, interprofessional collaboration of pharmacists and general practitioners is very often limited. Though highly trained, pharmacists remain an underutilised resource in primary health care in most western countries. This qualitative study aims at investigating pharmacists' and general practitioners' views on barriers to interprofessional collaboration in the German health care system. A total of 13 narrative in-depth interviews, and two focus group discussions with 12 pharmacists and general practitioners in Mecklenburg-Western Pomerania, a predominantly rural region of North-Eastern Germany, were conducted. The interviews aimed at exploring general practitioners' and pharmacists' attitudes, views and experiences of interprofessional collaboration. At a second stage, two focus group discussions were performed. Fieldwork was carried out by a multi-professional team. All interviews and focus group discussions were audio taped and transcribed verbatim. The constant comparative method of analysis from grounded theory was applied to the data. There are three main findings: First, mutual trust and appreciation appear to be important factors influencing the quality of interprofessional collaboration. Second, in light of negative personal experiences, pharmacists call for a predefined, clear and straightforward way to communicate with physicians. Third, given the increasing challenge to treat a rising number of elderly patients with chronic conditions, general practitioners desire competent support of experienced pharmacists. On the ground of methodological triangulation the findings of this study go beyond previous investigations and are able to provide specific recommendations for future interprofessional collaboration. First, interventions and initiatives should focus on increasing trust, e.g. by implementing multi-professional local quality circles. Second, governments and health authorities in most countries have been and still are reluctant in advancing political initiatives that bring together physicians and pharmacists. Proactive lobbying and empowerment of pharmacists are extremely important in this context. In addition, future physician and pharmaceutical training curricula should focus on comprehensive pharmacist-physician interaction at early stages within both professional educations and careers. Developing and fostering a culture of continued professional exchange and appreciation is one major challenge of future policy and research.

Medicines information provided by pharmaceutical representatives: a comparative study in Australia and Malaysia

PubMed Central

2010-01-01

Background Pharmaceutical representatives provide medicines information on their promoted products to doctors. However, studies have shown that the quality of this information is often low. No study has assessed the medicines information provided by pharmaceutical representatives to doctors in Malaysia and no recent evidence in Australia is present. We aimed to compare the provision of medicines information by pharmaceutical representatives to doctors in Australia and Malaysia. Methods Following a pharmaceutical representative's visit, general practitioners in Australia and Malaysia who had agreed to participate, were asked to fill out a questionnaire on the main product and claims discussed during the encounter. The questionnaire focused on provision of product information including indications, adverse effects, precautions, contraindications and the provision of information on the Pharmaceutical Benefit Scheme (PBS) listings and restrictions (in Australia only). Descriptive statistics were produced. Chi-square analysis and clustered linear regression were used to assess differences in Australia and Malaysia. Results Significantly more approved product information sheets were provided in Malaysia (78%) than in Australia (53%) (P < 0.001). In both countries, general practitioners reported that indications (Australia, 90%, Malaysia, 93%) and dosages (Australia, 76%, Malaysia, 82%) were frequently provided by pharmaceutical representatives. Contraindications, precautions, drug interactions and adverse effects were often omitted in the presentations (range 25% - 41%). General practitioners in Australia and Malaysia indicated that in more than 90% of presentations, pharmaceutical representatives partly or fully answered their questions on contraindications, precautions, drug interactions and adverse effects. More general practitioners in Malaysia (85%) than in Australia (60%) reported that pharmaceutical representatives should have mentioned contraindications, precautions for use, drug interaction or adverse effects spontaneously (P < 0.001). In 48% of the Australian presentations, general practitioners reported the pharmaceutical representatives failed to mention information on PBS listings to general practitioners. Conclusions Information on indications and dosages were usually provided by pharmaceutical representatives in Australia and Malaysia. However, risk and harmful effects of medicines were often missing in their presentations. Effective control of medicines information provided by pharmaceutical representatives is needed. PMID:21118551

41 CFR 101-25.110-2 - Tires obtained through Federal Supply Schedules or regional term contracts.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Federal Supply Schedules or regional term contracts. 101-25.110-2 Section 101-25.110-2 Public Contracts... REGULATIONS SUPPLY AND PROCUREMENT 25-GENERAL 25.1-General Policies § 101-25.110-2 Tires obtained through Federal Supply Schedules or regional term contracts. When tire manufacturers ship tires direct against...

41 CFR 101-25.110-2 - Tires obtained through Federal Supply Schedules or regional term contracts.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Federal Supply Schedules or regional term contracts. 101-25.110-2 Section 101-25.110-2 Public Contracts... REGULATIONS SUPPLY AND PROCUREMENT 25-GENERAL 25.1-General Policies § 101-25.110-2 Tires obtained through Federal Supply Schedules or regional term contracts. When tire manufacturers ship tires direct against...

[Assessment of patient care needs in general practice].

PubMed

Laubach, W; Schmidt, R; Fischbeck, S; Röhrig, B; Jansky, M

2012-02-01

In the German health system general practice has changed drastically in the past few years and patients' opportunities to get medical informations have increased significantly. In light of this, patients' needs in general practice should be re-assessed. 279 patients from 16 practices mainly in Hessen and Rhineland-Palatinate were interviewed. Using principal factor analysis, 51 questions about doctors were analyzed regarding possible dimensions of patient care needs. The dimensions of patient care needs could be described with four scales: (1) social situation and emotional support, (2) the practitioner's expertise, explanations and information, (3) empathy and esteem for patients and (4) availability of the practitioner and care to chronic patients. In older age groups the importance of psychosocial care was emphasized as well as the practitioner's availability and care for patients with chronic diseases. Patient care needs are concentrated in four scales, which include psychosocial and continuous care and availability for patients with chronic diseases. These tasks should be further emphasized in medical education and also represented in the remuneration of practitioners. © Georg Thieme Verlag KG Stuttgart · New York.

Specialization and competition in dental health services.

PubMed

Grytten, Jostein; Skau, Irene

2009-04-01

The number of specialists within dental health services has increased over the last few years. This raises the issue of how the services should be organized and funded. We describe the effect of one way of organizing the services, which is by relying on competition. In Norway, some oral specialists face real competition with general dental practitioners for the same patients (prosthetists, periodontists and endodontists), while other specialists do not (orthodontists and oral surgeons). The latter specialists have skills that give them exclusive possibilities to practice their profession. We find that competition can be effective for the specialists who experience real competition with general dental practitioners for patients. In situations where real competition does not exist, specialists can obtain market power and raise their fees. Our results are based on an analysis of a representative set of data from general dental practitioners and specialists in Norway. The specialities in which practitioners can exercise market power raise challenges related to the type of public policy that can reduce this market power in an appropriate way, and without involving too large costs for the authorities. (c) 2008 John Wiley & Sons, Ltd.

48 CFR 49.301 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false General. 49.301 Section 49.301 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TERMINATION OF CONTRACTS Additional Principles for Cost-Reimbursement Contracts Terminated for Convenience 49...

48 CFR 2819.7001 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... BUSINESS PROGRAMS Forecasts of Expected Contract Opportunities 2819.7001 General. Section 501 of Public Law 100-656, the Business Opportunity Development Reform Act of 1988, requires executive agencies having... expected contract opportunities, or classes of contract opportunities that small business concerns...

48 CFR 2032.402 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Chief Financial Officer, Division of Accounting and Finance, to ensure completeness of contractor... REQUIREMENTS CONTRACT FINANCING Advance Payments for Non-Commercial Items 2032.402 General. (a) The contracting... contract terms concerning advance payments. (b) Before authorizing any advance payment agreements, except...

[Websites of dental practices evaluated].

PubMed

Poorterman, J H G; Tjiook, S P; Moeijes, S F S; Brand, H S

2014-05-01

In 2013, a dental practice without a website is almost unthinkable. Using a sample of309 dentists drawn from the list of members of the Dutch Dental Association in 2012, a study was carried out to find out whether the dental practice of the general dental practitioner had a website. The content of each website was subsequently inventoried using a questionnaire. Eighty-nine percent of the dental practices had a website. The content of the websites, however, varied enormously. An element such as the professional registration number with a reference to the professional register were absent in 73% of the websites and the date of the most recent update of the website was mentioned only once. The name of the dentist, his or her professional qualification and an email address were missing on respectively 9%, 20% and 9% of the websites. Contracts of the practice with insurance companies were rarely clearly indicated. The websites of many practices would benefit considerably from a significant improvement.

Social Case-work in General Practice: An Alternative Approach

PubMed Central

Ratoff, L.; Pearson, Barbara

1970-01-01

During a two-year period a senior case-worker was seconded by a voluntary family case-work agency, the Liverpool Personal Service Society, to work with three general practitioners. The commonest reasons for referral of the 157 new patients to the social worker over this study period were extreme poverty; housing, matrimonial, and psychiatric problems; and problems of fatherless families. The successful and valuable co-operation between the general practitioners, case-worker, and various specialist professional and financial services of the Society have proved that a professional social worker has an important role in the general-practice team. PMID:5420213

Randomised clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow up.

PubMed Central

Koes, B. W.; Bouter, L. M.; van Mameren, H.; Essers, A. H.; Verstegen, G. M.; Hofhuizen, D. M.; Houben, J. P.; Knipschild, P. G.

1992-01-01

OBJECTIVE--To compare the effectiveness of manipulative therapy, physiotherapy, treatment by the general practitioner, and placebo therapy in patients with persistent non-specific back and neck complaints. DESIGN--Randomised clinical trial. SETTING--Primary health care in the Netherlands. PATIENTS--256 patients with non-specific back and neck complaints of at least six weeks' duration who had not received physiotherapy or manipulative therapy in the past two years. INTERVENTIONS--At the discretion of the manipulative therapists, physiotherapists, and general practitioners. Physiotherapy consisted of exercises, massage, and physical therapy (heat, electrotherapy, ultrasound, shortwave diathermy). Manipulative therapy consisted of manipulation and mobilisation of the spine. Treatment by general practitioners consisted of drugs (for example, analgesics), advice about posture, home exercises, and (bed)rest. Placebo treatment consisted of detuned shortwave diathermy (10 minutes) and detuned ultrasound (10 minutes). MAIN OUTCOME MEASURES--Changes in severity of the main complaint and limitation of physical functioning measured on 10 point scales by a blinded research assistant and global perceived effect measured on a 6 point scale by the patients. RESULTS--Many patients in the general practitioner and placebo groups received other treatment during follow up. Improvement in the main complaint was larger with manipulative therapy (4.5) than with physiotherapy (3.8) after 12 months' follow up (difference 0.9; 95% confidence interval 0.1 to 1.7). Manipulative therapy also gave larger improvements in physical functioning (difference 0.6; -0.1 to 1.3). The global perceived effect after six and 12 months' follow up was similar for both treatments. CONCLUSIONS--Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months. PMID:1532760

Physician-reported practices on continuous deep sedation until death: A descriptive and comparative study.

PubMed

Papavasiliou, Evangelia Evie; Chambaere, Kenneth; Deliens, Luc; Brearley, Sarah; Payne, Sheila; Rietjens, Judith; Vander Stichele, Robert; Van den Block, Lieve

2014-06-01

Research on continuous deep sedation until death has focused on estimating prevalence and describing clinical practice across care settings. However, evidence on sedation practices by physician specialty is scarce. To compare and contrast physician-reported practices on continuous deep sedation until death between general practitioners and medical specialists. A secondary analysis drawing upon data from a large-scale, population-based, retrospective survey among physicians in Flanders, Belgium in 2007. Symptom prevalence and characteristics of sedation (drugs used, artificial nutrition and hydration administered, intentions, and decision-making) were measured. Response rate was 58.4%. The frequency of continuous deep sedation until death among all deaths was 11.3% for general practitioners and 18.4% for medical specialists. General practitioners reported significantly higher rates of severity and mean intensity of pain, delirium, dyspnea, and nausea in the last 24 h of life for sedated patients and a higher number of severe symptoms than medical specialists. No differences were found between groups in the drugs used, except in propofol, reported only by medical specialists (in 15.8% of all cases). Artificial nutrition and hydration was withheld or withdrawn in 97.2% of general practitioner and 36.2% of medical specialist cases. Explicit life-shortening intentions were reported by both groups (for 3%-4% of all cases). Continuous deep sedation until death was initiated without consent or request of either the patient or the family in 27.9% (medical specialists) and 4.7% (general practitioners) of the cases reported. Considerable variation, often largely deviating from professional guidelines, was observed in physician-reported performance and decision-making, highlighting the importance of providing clearer guidance on the specific needs of the context in which continuous deep sedation until death is to be performed. © The Author(s) 2014.

[Hospitalisation Rates and Duration of Hospital Stays of Patients from an Ambulatory Health Centre Compared to Traditional General Practices - A Practical Example].

PubMed

Woebkenberg, J; Schneider, N

2015-06-01

The reduction of treatment costs in the health-care system is a great challenge for all participating persons and institutions in Germany. In particular, we notice an evident increase in the costs of hospitalisation treatment in the last 20 years. The reduction of a further increase in stationary treatment costs by reducing the hospitalisation rate and the duration of stationary treatment as managed by cooperation of general practitioners and medical specialists could be an important possibility. Is it possible to reduce the hospitalisation rate and the duration of the hospital treatment by cooperation of general practitioners and internal specialists in an ambulatory health centre? The hospitalisation rate and the average duration of the stationary treatment of the "Praxisgemeinschaft" (PG) of the "Gesundheitscentrum Damme" (GCD) at the local hospital were retrospectively analysed for the years 2002 up to 2011 and compared with the data of the remaining general practitioner offices and the data of the "Deutsche Krankenhausstatistik" (German Hospital statistics). We did indeed find a slight increase for the hospitalisation rate from 0.012 to 0.019% of all the ambulant treated patient cases of the PG; but this increase was statistically significantly lower compared with the results of the remaining practitioner offices of the local area as well the data of the "Deutsche Krankenhausstatistik". Similarly, the duration of hospital treatment for the patients of the PG could be significantly more reduced from 10.80 to 6.49 days compared to the results of the 2 other above-mentioned groups. Both the hospitalisation rate as well as the duration of hospital treatment can significantly reduced by cooperation of general practitioner and internal specialist in an ambulatory health centre. © Georg Thieme Verlag KG Stuttgart · New York.

[The relationships between the general practitioner and the oncological radiotherapist. A preliminary study by telephone interviews].

PubMed

Baio, A; Cavallini Francolini, D; Corbella, F; De Vecchi, P; Ragone, L; Tinelli, C; Franchini, P

1999-11-01

We addressed the issue of the relationship between the general practitioner (GP) and the radiotherapist to improve the quality of care of cancer patients. The study consisted in evaluating medical requests and phone interviews, with a questionnaire with yes/no and multiple choice answers to the following 5 questions: 1) Do you think a cancer diagnosis is always a hopeless death sentence? 2) Is it professionally rewarding to cure a cancer patient? 3) Are you satisfied with your relationship, as a general practitioner, with oncologic reference centers? 4) Is it more wearing for a general practitioner to manage a cancer than a noncancer patient? 5) Would you answer a questionnaire about the relationship between the general practitioner, the cancer patient and the oncologist? We evaluated 1590 medical requests and made 401 phone interviews; 255 colleagues (70%) answered the questionnaire. Medical requests were correctly and completely formulated by GPs in 45% of cases. A cancer diagnosis was not considered a hopeless death sentence in 90.9% of cases and 76% of GPs considered it professionally rewarding to cure a cancer patient. 75.6% of GPs considered it more wearing to manage a cancer than a noncancer patient, and female GPs felt this more strongly than their male counterparts. Irrespective of gender, GPs over 50 years of age tend to consider cancer a hopeless and fatal disease. The relationship with oncologic centers was considered satisfactory in 86.2% of cases. However, since cancer patients need greater medical care, GPs would like a closer cooperation with oncologists. The great interest GPs took in this study encourages further investigation through a more in depth questionnaire designed with the help of GPs themselves and interested statisticians.

Challenges for IT-supported shared care: a qualitative analyses of two shared care initiatives for diabetes treatment in Denmark “I'll never use it” (GP5).

PubMed Central

Granlien, Maren Fich; Simonsen, Jesper

2007-01-01

Purpose To investigate the circumstances as to why it is so difficult in the primary care sector to implement IT based infrastructures supporting shared care. Case study The qualitative analysis includes two separate case studies of IT-supported shared care implemented in two different regions of Denmark throughout 2005. The study comprises 21 interviews and 35 hours of observations. The data were analysed through a coding process that led to the emergence of three main challenges impeding the organisational implementation of IT-supported shared care. Discussion and conclusion The two cases faced the same challenges that led to the same problem: The secondary care sector quickly adopted the system while the primary sector was far more sceptical towards using it. In both cases, we observe a discrepancy of needs satisfied, especially with regard to the primary care sector and its general practitioners which hinder bridging the primary sector (general practitioners) and the secondary sector (hospitals and outpatient clinics). Especially the needs associated with the primary sector were not being satisfied. We discovered three main challenges related to bridging the gap between the two sectors: (1) Poor integration with the general practitioners' existing IT systems; (2) low compatibility with general practitioners' work ethic; (3) and discrepancy between the number of diabetes patients and the related need for shared care. We conclude that development of IT-supported shared care must recognise the underlying and significant differences between the primary and secondary care sectors: If IT-supported shared care does not meet the needs of the general practitioners as well as the needs of the secondary care sector the initiative will fail. PMID:17627300

Are general practitioners well informed about fibromyalgia?

PubMed

Kianmehr, Nahid; Haghighi, Anousheh; Bidari, Ali; Sharafian Ardekani, Yaser; Karimi, Mohammad Ali

2017-12-01

Fibromyalgia syndrome (FMS) is a common rheumatologic disorder characterized by easy fatigability, widespread musculoskeletal pain and sleep disorder. In spite of its high prevalence, general practitioners, as primary care providers, seem to have inadequate knowledge about FMS. This study aimed to assess Iranian general practitioners' knowledge about FMS and its treatment. A detailed questionnaire (including items on signs and symptoms, diagnostic criteria and treatment) was completed by 190 general practitioners (54.7% male; mean age: 41 years). Data analysis was performed with SPSS for Windows 15.0 and awareness about all aspects of FMS was reported as percentages. About one-third (30%) of the participants had seen at least one case of FMS during their practice. Most subjects (62.7%) claimed to know 1-6 tender points. Only 3.2% knew 16-18 points. The common proposed symptoms of FMS were widespread pain (72.6%), excessive fatigue (72.6%), weakness (60.5%), sleep disorder (36.3%), anxiety (34.7%) and depression (34.2%). Wrong symptoms including elevated erythrocyte sedimentation rate and C-reactive protein, arthritis, joint swelling, weight loss and abnormal radiologic findings were selected by 27.9%, 18.9%, 14.7%, 12.6% and 2.1% of the physicians, respectively. Moreover, selective serotonin reuptake inhibitors, tricyclic antidepressant and pregabalin were identified as treatment options for FMS by, respectively, 45.8%, 22.1% and 15.3% of the participants. Finally, 52.1% and 23.7% of the subjects incorrectly considered nonsteroidal anti-inflammatory drugs and corticosteroids as treatment modalities for FMS. Iranian general practitioners are not well informed about FMS. Therefore, FMS should be specifically integrated in continuing medical education programs and undergraduate medical training curriculum. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

The working hours of general practitioners 2000-2008.

PubMed

Aasland, Olaf G; Rosta, Judith

2011-06-03

There is little reliable information available on the working hours of general practitioners (GPs). The purpose of our study is to describe the development of weekly working hours of Norwegian general practitioners in the period from 2000 to 2008, as well as the length of their patient lists and their perceived workload. General practitioners in the reference panel of the Research Institute of the Norwegian Medical Association have reported their weekly working hours for 2000, 2002, 2004, 2006 and 2008, and the length of their patient lists for 2002 and 2008. We used non-overlapping 95 per cent confidence intervals for testing inter-group differences in interval variables and proportions. From 227 to 316 general practitioners responded to each survey round. Average weekly working hours constituted 45.1 hours (95 per cent CI: 43.6-46.5 hours) in 2000 and 46.4 hours (95 per cent CI: 45.2-47.6 hours) in 2008. The number of hours increased for women GPs, while the number of hours remained basically unchanged for men from 2000 to 2008. Average length of the patient lists in 2002 and 2008 constituted 1,325 and 1,278 for men, and 1,155 and 1,144 for women GPs respectively. The proportion of GPs who responded that they perceived their workload as unacceptable decreased significantly, from 38.1 per cent in 2000 to 25.5 per cent in 2008. Average weekly working hours for GPs increased by approximately one hour from 2000 to 2008, and this increase is found mainly among women GPs. We believe that the reduction in the proportion reporting to have an unacceptable workload can be explained by the introduction of the list-patient system, which has given the doctors better control of their own workload.

Acupuncture in Australian general practice: trends in reimbursed acupuncture services from 1995 to 2011.

PubMed

Wardle, Jonathan Lee; Adams, Jon; Sibbritt, David William

2013-03-01

To ascertain the extent of and trends in the use of acupuncture in Australian general practice and the characteristics of patients receiving publicly subsidised acupuncture services from general practitioners (GPs). Secondary analysis of national patient Medicare data for claims by all non-specialist medical practitioners for Medicare Benefits Schedule items for an attendance where acupuncture was performed by a medical practitioner from 1995 to 2011. Use of acupuncture by GPs, patients' sex and age and the socioeconomic disadvantage index of GP's practice. There has been a 47.7% decline in the number of acupuncture claims by GPs per 100 000 population in the period from 1995 to 2011. Acupuncture claims were made by 3.4% of GPs in 2011. Women were almost twice as likely to receive acupuncture from a GP as men, and patients in urban areas were more than twice as likely to receive acupuncture from a GP as patients in rural areas. Acupuncture claims were highest in areas that were socioeconomically advantaged. Claims for reimbursement for acupuncture by GPs have declined significantly in Australian general practice even though the use of acupuncture by the Australian public has increased. This may be due to increased use of referrals or use of non-medical practitioners, barriers to acupuncture practice in general practice or non-specific factors affecting reimbursement for non-vocationally registered GPs.

The PTSD Practitioner Registry: An Innovative Tracking, Dissemination, and Support Tool for Providers in Military and Nonmilitary Settings

DTIC Science & Technology

2016-10-01

Watertown, MA 02472 REPORT DATE: October 2016 TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical Research and Materiel Command Fort Detrick...Rebekah Zincavage Project Role: Qualitative Researcher Nearest person month worked: 1 Contribution to Project: Ms. Zincavage developed the...Military and Nonmilitary Settings PRINCIPAL INVESTIGATOR: Raymond C. Rosen, PhD CONTRACTING ORGANIZATION: New Englad Research Instituites, Inc

Use of programme budgeting and marginal analysis to set priorities for local NHS dental services: learning from the north east of England.

PubMed

Holmes, R D; Steele, J G; Exley, C; Vernazza, C R; Donaldson, C

2018-05-03

Priority setting is necessary where competing demands exceed the finite resources available. The aim of the study was to develop and test a prioritization framework based upon programme budgeting and marginal analysis (PBMA) as a tool to assist National Health Service (NHS) commissioners in their management of resources for local NHS dental services. Twenty-seven stakeholders (5 dentists, 8 commissioners and 14 patients) participated in a case-study based in a former NHS commissioning organization in the north of England. Stakeholders modified local decision-making criteria and applied them to a number of different scenarios. The majority of financial resources for NHS dental services in the commissioning organization studied were allocated to primary care dental practitioners' contracts in perpetuity, potentially constraining commissioners' abilities to shift resources. Compiling the programme budget was successful, but organizational flux and difficulties engaging local NHS commissioners significantly impacted upon the marginal analysis phase. NHS dental practitioners' contracts resemble budget-silos which do not facilitate local resource reallocation. 'Context-specific' factors significantly challenged the successful implementation and impact of PBMA. A local PBMA champion embedded within commissioning organizations should be considered. Participants found visual depiction of the cost-value ratio helpful during their initial priority setting deliberations.

The medical profession and changing attitudes towards advertising and competition.

PubMed

Bell, J D; Fay, M T

1991-02-27

This paper examines the attitudes of general medical practitioners towards competition and advertising and the changes that have occurred between 1985 and 1988. The data was derived from a self completion questionnaire, 1500 of which were evenly distributed among the members of five professions; doctors, dentists, lawyers, accountants and veterinarians. General practitioners are now favourably disposed towards advertising by the profession as a whole in an effort to increase awareness of medical services (70% in favour in 1988 compared to only 53% in 1985), but the perceived need for increased business efficiency has lessened (70% in 1988 compared to 78% in 1985). Collegiality continues to be the dominant ideology but this position has weakened slightly. In 1988 only 65% of general practitioners regarded other members of the profession as colleagues rather than competitors, compared to 73% in 1985.

[Hyperkalemia - what the general practitioner must know].

PubMed

Schnyder, Aurelia; Hüsler, Carina; Binet, Isabelle

2015-03-25

Hyperkalemia can be a challenge for the general practitioner as it can prove to be benign as well as life-threatening. From a diagnostic point of view, four possibilities have to be differenciated: a pre-analytical cause, potassium release through cell lysis, a potassium shift, a reduced renal excretion of potassium. The first differential diagnosis can often be carried out by a thorough medical history, in particular the medication intake. Also, the first clinical and laboratory investigations can take place at the general practitioner's clinic. If the hyperkalemia proves to be a true hyperkalemia or cannot be explained by poly-medication and known diseases of the patient, not yet identified renal, endocrine or cardiac diseases should be searched for. If a serious condition is identified as the cause of hyperkalemia the patient should be referred to a specialized clinic.

A survey to assess the provision of conscious sedation by general dental practitioners in the Republic of Ireland.

PubMed

Fisher, Veronica; Stassen, Leo F A; Nunn, June

2011-01-01

To quantify and qualify how conscious sedation was used in general dental practice before the introduction of formal sedation teaching in the Republic of Ireland. 1. To determine the extent of use of oral, inhalational and intravenous sedation; 2. to determine the training and experience of general dental practitioners providing conscious sedation; 3. to determine the perceived barriers to the practice of conscious sedation; and, 4. to gauge the level of interest in a postgraduate course in conscious sedation. Postal questionnaire sent to one general practitioner in seven, selected randomly from the General Dental Council register, in 2007. Seventy six percent of respondents agreed that the provision of conscious sedation in general dental practice is important. However, the current provision of inhalation and intravenous sedation by respondents is low in comparison to provision in the UK. The main barrier to the use of conscious sedation in general dental practice appears to be lack of availability of training. The data from this study indicated the need for postgraduate training in conscious sedation in Ireland and a need for increased awareness of the Dental Council Code of Practice on sedation.

48 CFR 49.304-1 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false General. 49.304-1 Section 49.304-1 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TERMINATION OF CONTRACTS Additional Principles for Cost-Reimbursement Contracts Terminated for Convenience 49...

48 CFR 49.305-1 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false General. 49.305-1 Section 49.305-1 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TERMINATION OF CONTRACTS Additional Principles for Cost-Reimbursement Contracts Terminated for Convenience 49...

48 CFR 1.601 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... In some agencies, a relatively small number of high level officials are designated contracting officers solely by virtue of their positions. Contracting officers below the level of a head of a... REGULATIONS SYSTEM Career Development, Contracting Authority, and Responsibilities 1.601 General. (a) Unless...

Are We in Sync? How Industry Practitioners and Academics Profile Managerial Competencies: A Study of an Association to Advance Collegiate Schools of Business-Accredited Business School in Hong Kong

ERIC Educational Resources Information Center

Ko, Stephen; Chan, Simon C. H.

2017-01-01

The authors draw on the taxonomy of managerial competencies to assess the alignment of perceptions between industry practitioners and business academics when profiling managerial competencies required for effective performance in workplaces. Findings show that the set of managerial competency profiles, as viewed by practitioners, generally fit…

Coalition of attitude and practice behaviors among dental practitioners regarding pregnant patient's oral health and pregnant patient's perception toward oral health in and around Pondicherry.

PubMed

Jeelani, S; Khader, K Abdul; Rangdhol, R Vishwanath; Dany, A; Paulose, Swetha

2015-08-01

This study aims to evaluate the knowledge, attitude, practice behaviors among general dental practitioners and assess the perception toward oral health by pregnant patients in and around Puducherry. A self-designed and structured questionnaire was used to obtain information from the dental practitioner and the pregnant patients. The majority of the dental practitioners had a lack of knowledge, attitude, practice behaviors regarding pregnant patient's oral health and similarly majority of pregnant patient's perception toward oral health was poor. Drowning and dilemmatic attitude and practice behavior of dentists to be streamlined to render right care to the pregnant women at the right time. Perplexing perception toward oral health care by pregnant women to be overcome to orient them to understand the impact of oral health on their general systemic health.

48 CFR 632.705 - Contract clauses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Contract clauses. 632.705 Section 632.705 Federal Acquisition Regulations System DEPARTMENT OF STATE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 632.705 Contract clauses. ...

48 CFR 32.705 - Contract clauses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Contract clauses. 32.705 Section 32.705 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 32.705 Contract clauses. ...

48 CFR 32.005 - Consideration for contract financing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Consideration for contract... GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING 32.005 Consideration for contract financing. (a... separate consideration for the contract financing clause. The value of the contract financing to the...

48 CFR 43.103 - Types of contract modifications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... only by the contracting officer. Unilateral modifications are used, for example, to— (1) Make... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Types of contract... CONTRACT MANAGEMENT CONTRACT MODIFICATIONS General 43.103 Types of contract modifications. Contract...

48 CFR 43.103 - Types of contract modifications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... only by the contracting officer. Unilateral modifications are used, for example, to— (1) Make... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Types of contract... CONTRACT MANAGEMENT CONTRACT MODIFICATIONS General 43.103 Types of contract modifications. Contract...

48 CFR 304.602 - General.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false General. 304.602 Section 304.602 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE MATTERS Contract Reporting 304.602 General. HHS' Departmental Contracts Information System (DCIS) captures...

48 CFR 801.602-70 - General review requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false General review... AFFAIRS GENERAL DEPARTMENT OF VETERANS AFFAIRS ACQUISITION REGULATION SYSTEM Career Development, Contracting Authority, and Responsibilities 801.602-70 General review requirements. (a) Contracting officers...

The pattern of clinical advice sought by general practitioners from a medical consultant in clinical biochemistry.

PubMed Central

Bhatnagar, D

1997-01-01

Clinical biochemistry departments can be a valuable source of clinical advice for further investigations and the need for referral to specialist clinics. This paper outlines the pattern of clinical advice sought by general practitioners in a district hospital setting, and addresses some of the issues regarding seeking such advice and the implications for continuing medical education and training. PMID:9196966

The specialty of family dentistry: a future for general dental practitioners?

PubMed

Li, R W; Chow, T W

2004-01-01

A new Specialty in dentistry, Family Dentistry, has been established to provide a structured, co-ordinated training for general dental practitioners who are the major oral health service providers. The training emphasizes the importance of continuing and comprehensive care, the interface between primary and secondary care, the relationship between the patient and his/her family and the community, and a holistic approach in treatment planning and delivery.

Roles of General Practitioners in the Provision of Health Care Services for People with Intellectual Disabilities: A National Census in Taiwan

ERIC Educational Resources Information Center

Lin, Jin-Ding; Hsu, Shang-Wei; Yen, Chia-Feng; Chou, Ying-Ting; Wu, Chia-Ling; Chu, Cordia M.; Loh, Ching-Hui

2009-01-01

Aims: The aims of the present study were to explore the perceptions of general practitioners (GPs) in the provision of health care services for people with intellectual disabilities and to analyse GPs' priorities in the delivery of health care services to this group of people in Taiwan. Methods: The study employed a cross-sectional design and was…

Does Media Use Result in More Active Communicators? Differences Between Native Dutch and Turkish-Dutch Patients in Information-Seeking Behavior and Participation During Consultations With General Practitioners.

PubMed

Schinkel, Sanne; Van Weert, Julia C M; Kester, Jorrit A M; Smit, Edith G; Schouten, Barbara C

2015-08-01

This study investigates differences between native Dutch and Turkish-Dutch patients with respect to media usage before and patient participation during medical consultations with general practitioners. In addition, the authors assessed the relation between patient participation and communication outcomes. The patients were recruited in the waiting rooms of general practitioners, and 191 patients (117 native Dutch, 74 Turkish-Dutch) completed pre- and postconsultation questionnaires. Of this sample, 120 patients (62.8%; 82 native Dutch, 38 Turkish-Dutch) agreed to have their consultations recorded to measure patient participation. Compared with Turkish-Dutch patients of similar educational levels, results showed that native Dutch patients used different media to search for information, participated to a greater extent during their consultations and were more responsive to their general practitioner. With respect to the Turkish-Dutch patients, media usage was related to increased patient participation, which was correlated with having fewer unfulfilled information needs; however, these relations were not found in the native Dutch patient sample. In conclusion, interventions that enhance participation among ethnic minority patients will better fulfill informational needs when such interventions stimulate information-seeking behavior in that group before a medical consultation.

Coding of procedures documented by general practitioners in Swedish primary care-an explorative study using two procedure coding systems

PubMed Central

2012-01-01

Background Procedures documented by general practitioners in primary care have not been studied in relation to procedure coding systems. We aimed to describe procedures documented by Swedish general practitioners in electronic patient records and to compare them to the Swedish Classification of Health Interventions (KVÅ) and SNOMED CT. Methods Procedures in 200 record entries were identified, coded, assessed in relation to two procedure coding systems and analysed. Results 417 procedures found in the 200 electronic patient record entries were coded with 36 different Classification of Health Interventions categories and 148 different SNOMED CT concepts. 22.8% of the procedures could not be coded with any Classification of Health Interventions category and 4.3% could not be coded with any SNOMED CT concept. 206 procedure-concept/category pairs were assessed as a complete match in SNOMED CT compared to 10 in the Classification of Health Interventions. Conclusions Procedures documented by general practitioners were present in nearly all electronic patient record entries. Almost all procedures could be coded using SNOMED CT. Classification of Health Interventions covered the procedures to a lesser extent and with a much lower degree of concordance. SNOMED CT is a more flexible terminology system that can be used for different purposes for procedure coding in primary care. PMID:22230095

Collaboration of occupational physicians with national health system and general practitioners in Italy

PubMed Central

PERSECHINO, Benedetta; FONTANA, Luca; BURESTI, Giuliana; RONDINONE, Bruna Maria; LAURANO, Patrizia; FORTUNA, Grazia; VALENTI, Antonio; IAVICOLI, Sergio

2016-01-01

A good cooperation between occupational physicians and other healthcare professionals is essential in order to achieve an overall improvement of workers/patients’ well-being. Unfortunately, collaboration between occupational physicians and other physicians is often lacking or very poor. In this context, using a self-administered questionnaire, we investigated the cooperation of Italian occupational physicians with the National Health System (NHS) facilities and with the general practitioners in order to identify any potential critical issues that may hinder an effective and collaborative relationships between these professionals. The survey was conducted from October 2013 to January 2014. Nearly all of the interviewed occupational physicians have had contacts with colleagues of the Departments for Prevention and Occupational Health and Safety of the NHS. Regarding the relationship between occupational physicians and general practitioners findings showed that their cooperation is quite difficult and it would not seem a two-way collaboration. Cooperation between occupational physicians and NHS would benefit from the development of communication strategies and tools enhancing the support and assistance functions of the NHS facilities. The elaboration and subsequent application of operational guidelines and standardized procedures of communication would also improve collaboration between occupational physicians and general practitioners that is currently considered rather insufficient and incomplete. PMID:27733729

How do swine practitioners and veterinary pathologists arrive at a diagnosis of Clostridium perfringens type A enteritis in neonatal piglets?

PubMed Central

Chan, Gloria; Farzan, Abdolvahab; Prescott, John F.; Friendship, Robert

2013-01-01

A questionnaire was administered to 22 veterinary practitioners and 17 veterinary pathologists to investigate the methods used for diagnosis of Clostridium perfringens type A enteritis in neonatal pigs. Practitioners generally diagnosed C. perfringens type A associated enteritis by age of onset of diarrhea (between 1 to 7 days of age). Most practitioners (95%) were moderately to very confident in their diagnosis. Pathologists generally diagnosed C. perfringens type A associated enteritis by combinations of isolation of the organism, genotyping or detecting the toxins of the organism, and ruling out other pathogens through histopathology. Almost half (41%) of the pathologists were not confident of their diagnosis. This study reports that the current diagnostic method for C. perfringens type A enteritis is not specific, and although many pathologists expressed reservations about making a diagnosis of C. perfringens type A enteritis, most practitioners were confident in their diagnosis, even though reported clinical signs of clostridial diarrhea are similar to those of a number of other enteric diseases. PMID:24155437

18 CFR 1308.1 - Purpose and organization.

Code of Federal Regulations, 2012 CFR

2012-04-01

... deals with matters applicable throughout the part, incuding definitions. Subpart B deals with Contracting Officers' decisions. Subpart C deals with general matters concerning the TVA Board of Contract... CONTRACT DISPUTES General Matters § 1308.1 Purpose and organization. The regulations in this part implement...

18 CFR 1308.1 - Purpose and organization.

Code of Federal Regulations, 2011 CFR

2011-04-01

... deals with matters applicable throughout the part, incuding definitions. Subpart B deals with Contracting Officers' decisions. Subpart C deals with general matters concerning the TVA Board of Contract... CONTRACT DISPUTES General Matters § 1308.1 Purpose and organization. The regulations in this part implement...

18 CFR 1308.1 - Purpose and organization.

Code of Federal Regulations, 2014 CFR

2014-04-01

... deals with matters applicable throughout the part, incuding definitions. Subpart B deals with Contracting Officers' decisions. Subpart C deals with general matters concerning the TVA Board of Contract... CONTRACT DISPUTES General Matters § 1308.1 Purpose and organization. The regulations in this part implement...

Principal-agent relationships in general practice: the first wave of English Personal Medical Services pilot contracts.

PubMed

Sheaff, R; Lloyd-Kendall, A

2000-07-01

To investigate how far English National Health Service (NHS) Personal Medical Services (PMS) contracts embody a principal-agent relationship between health authorities (HAs) and primary health care providers, especially, but not exclusively, general practices involved in the first wave (1998) of PMS pilot projects; and to consider the implications for relational and classical theories of contract. Content analysis of 71 first-wave PMS contracts. Most PMS contracts reflect current English NHS policy priorities, but few institute mechanisms to ensure that providers realise these objectives. Although PMS contracts have some classical characteristics, relational characteristics are more evident. Some characteristics match neither the classical nor the relational model. First-wave PMS contracts do not appear to embody a strong principal-agent relationship between HAs and primary health care providers. This finding offers little support for the relevance of classical theories of contract, but also implies that relational theories of contract need to be revised for quasi-market settings. Future PMS contracts will need to focus more on evidence-based processes of primary care, health outputs and patient satisfaction and less upon service inputs. PMS contracts will also need to be longer-term contracts in order to promote the 'institutional embedding' of independent general practice in the wider management systems of the NHS.

48 CFR 632.705-70 - DOSAR contract clause.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false DOSAR contract clause. 632.705-70 Section 632.705-70 Federal Acquisition Regulations System DEPARTMENT OF STATE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 632.705-70 DOSAR contract clause. The contracting...

Exploring the potential role of the advanced nurse practitioner within a care path for patients with chronic fatigue syndrome.

PubMed

Ryckeghem, Hannah; Delesie, Liesbeth; Tobback, Els; Lievens, Stefaan; Vogelaers, Dirk; Mariman, An

2017-07-01

To explore the experiences and expectations of patients with chronic fatigue syndrome and general practitioners to develop the potential role of an advanced nurse practitioner at the diagnostic care path of abnormal fatigue developed for regional transmural implementation in the Belgian provinces of East and West Flanders. Patients with chronic fatigue syndrome experience an incapacitating chronic fatigue that is present for at least 6 months. Since many uncertainties exist about the causes and progression of the disease, patients have to cope with disbelief and scepticism. Access to health care may be hampered, which could lead to inappropriate treatments and guidance. Qualitative design. Individual semi-structured interviews were conducted with patients with chronic fatigue syndrome and general practitioners in Belgium. Data were collected over 9 months in 2014-2015. All interviews were audio recorded and transcribed for qualitative analysis using open explorative thematic coding. Fifteen patients and 15 general practitioners were interviewed. Three themes were identified: mixed feelings with the diagnosis, lack of one central intermediator and insufficient coordination. Participants stressed the need for education, knowledge and an intermediator to provide relevant information at the right time and to build up a trust relationship. This qualitative exploration underscores some clear deficiencies in the guidance of patients suffering from chronic fatigue syndrome and abnormal fatigue. An advanced nurse practitioner as a central intermediator in the transmural care of these patients could promote interdisciplinary/multidisciplinary collaboration and effective communication, provide education and ensure a structured and coordinated approach. © 2016 John Wiley & Sons Ltd.

48 CFR 432.703 - Contract funding requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Contract funding requirements. 432.703 Section 432.703 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 432.703 Contract funding requirements. ...

48 CFR 1832.705 - Contract clauses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Contract clauses. 1832.705 Section 1832.705 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 1832.705 Contract clauses. ...

48 CFR 32.703 - Contract funding requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Contract funding requirements. 32.703 Section 32.703 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 32.703 Contract funding requirements. ...

48 CFR 632.703 - Contract funding requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Contract funding requirements. 632.703 Section 632.703 Federal Acquisition Regulations System DEPARTMENT OF STATE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 632.703 Contract funding requirements. ...

48 CFR 632.703 - Contract funding requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Contract funding requirements. 632.703 Section 632.703 Federal Acquisition Regulations System DEPARTMENT OF STATE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 632.703 Contract funding requirements. ...

48 CFR 432.703 - Contract funding requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Contract funding requirements. 432.703 Section 432.703 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 432.703 Contract funding requirements. ...

48 CFR 32.703 - Contract funding requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Contract funding requirements. 32.703 Section 32.703 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 32.703 Contract funding requirements. ...

48 CFR 32.703 - Contract funding requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Contract funding requirements. 32.703 Section 32.703 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 32.703 Contract funding requirements. ...

48 CFR 432.113 - Customary contract financing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... financing. 432.113 Section 432.113 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Non-Commercial Item Purchase Financing 432.113 Customary contract financing. The contracting officer may determine the necessity for customary contract financing. The...

[Midazolam sedation in the general dental practice].

PubMed

Bertens, J; Abraham-Inpijn, L; Meuwissen, P J

1994-03-01

The general dental practitioner is occasionally confronted with patients who, on the basis of psychological--and often somatic--criteria, are difficult to treat. Medicinal sedation in combination with anxiety reduction may be deemed appropriate for such patients. In the Netherlands inhalation sedation by means of a combination of oxygen and nitrous oxide is generally used. The limitations and disadvantages of this method have directed attention towards sedation by means of midazolam, a quick-acting benzodiazepine. In view of the complications which may accompany the administration of midazolam, the general practitioner working alone or in a group practice is advised against using midazolam sedation. Such use should be reserved for a dentist working in a hospital setting, who is able to consult with a physician regarding the advisability of administering midazolam. Even then, the safety of the patient requires that the practitioners have a proper insight into the physical state of the patient, work according to a protocol and in accordance with clearly defined responsibilities, and provide adequate accommodation during and after treatment.

The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

PubMed Central

Varley, Anna; Warren, Fiona C.; Richards, Suzanne H.; Calitri, Raff; Chaplin, Katherine; Fletcher, Emily; Holt, Tim A.; Lattimer, Valerie; Murdoch, Jamie; Richards, David A.; Campbell, John

2016-01-01

Background Nurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings. Objective To investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition. Design Questionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage. Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a general practitioner or nurse. Settings 15 general practices and 7012 patients receiving the nurse triage intervention in four regions of the UK. Participants 45 nurse practitioners and practice nurse trained in the use of clinical decision support software. Methods We investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling. Results Valid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio 0.19, 95% confidence interval 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more likely to recommend patients for follow-up (OR 3.17, 95% CI 1.18–5.55). Conclusion Nurse characteristics were associated with disposition of triage calls to within practice follow-up. Nurse practitioners or those who reported feeling ‘more prepared’ for the role were more likely to manage the call definitively. Practices considering nurse triage should ensure that nurses transitioning into new roles feel adequately prepared. While standardised training is necessary, it may not be sufficient to ensure successful implementation. PMID:27087294

Chronic psychiatric patients without psychiatric care: a pilot study.

PubMed

Längle, G; Welte, W; Rösger, U; Günthner, A; U'Ren, R

2000-10-01

The study is based on the hypothesis that in any catchment area there are patients with chronic mental illness who are unknown to a comprehensive psychiatric/psychosocial care system. A standardized questionnaire was sent to all general practitioners in a circumscribed catchment area in southwestern Germany in an attempt to identify such a group, to ascertain what the practitioners considered to be the needs of these patients, and to find out why the patients were not receiving specialized psychiatric care. Of 97 general practitioners contacted, 62 returned the questionnaire. Within a study period of 3 months, 89 patients were identified as having a significant psychiatric disorder, of whom 53% were older than 60 years and 15% were schizophrenic. General practitioners most frequently said that provision of specialized psychiatric care was the most pressing need of these patients, followed by a need for psychosocial services. They also said that the major reason patients did not participate in the mental health system was patient refusal of such services. Having identified the existence of a group of chronic psychiatric patients who are not receiving specialized psychiatric care, further in-depth field studies to pursue some of the issues raised in this pilot study will be necessary to determine whether further efforts to reach psychiatric patients without defined psychiatric care would be worthwhile. These issues include estimates of the prevalence of such patients in a defined population, patients' more specific reasons for refusal of psychiatric care, and the quality of psychiatric care they receive from general practitioners in comparison with patients who receive more conventional psychiatric care.

48 CFR 4.801 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false General. 4.801 Section 4.801 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Government Contract Files 4.801 General. (a) The head of each office performing contracting...

48 CFR 4.801 - General.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false General. 4.801 Section 4.801 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Government Contract Files 4.801 General. (a) The head of each office performing contracting...

48 CFR 4.801 - General.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false General. 4.801 Section 4.801 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Government Contract Files 4.801 General. (a) The head of each office performing contracting...

48 CFR 4.801 - General.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false General. 4.801 Section 4.801 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Government Contract Files 4.801 General. (a) The head of each office performing contracting...

48 CFR 4.801 - General.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false General. 4.801 Section 4.801 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Government Contract Files 4.801 General. (a) The head of each office performing contracting...

48 CFR 3432.402 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false General. 3432.402 Section 3432.402 Federal Acquisition Regulations System DEPARTMENT OF EDUCATION ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Advance Payments 3432.402 General. (a)-(d) [Reserved] (e) The HCA...

Planning for transit-supportive development : a practitioner's guide. Section 2 : general transit-supportive development planning topics.

DOT National Transportation Integrated Search

2014-06-01

Planning for Transit-Supportive Development: A Practitioners Guide is a toolkit of practical and innovative measures to help : Metropolitan Planning Organizations (MPOs), regional planners, transit agencies, and local government elected o...

Patterns and predictors of help-seeking contacts with health services and general practitioner detection of suicidality prior to suicide: a cohort analysis of suicides occurring over a two-year period.

PubMed

Leavey, Gerard; Rosato, Michael; Galway, Karen; Hughes, Lynette; Mallon, Sharon; Rondon, Janeet

2016-04-30

Contact with primary care and psychiatric services prior to suicide may be considerable, presenting opportunities for intervention. However, there is scant knowledge on the frequency, nature and determinants of contact. Retrospective cohort study-an analysis of deaths recorded as suicide by the Northern Ireland Coroner's Office linked with data from General Practice patient records over a 2 year period Eighty-seven per cent of suicides were in contact with General Practice services in the 12 months before suicide. The frequency of contact with services was considerable, particularly among patients with a common mental disorder or substance misuse problems. A diagnosis of psychiatric problems was absent in 40% of suicides. Excluding suicide attempts, the main predictors of a noted general practitioner concern for patient suicidality are male gender, frequency of consultations, diagnosis of mental illness and substance misuse. Despite widespread and frequent contact, a substantial proportion of suicidal people were undiagnosed and untreated for mental health problems. General Practitioner alertness to suicidality may be too narrowly focused.

[Medical opinion leaders conflict of interests: effects of disclosures on the trust of the public and general practitioners].

PubMed

Chakroun, R; Milhabet, I

2011-08-01

Key medical opinion leaders influence the behaviors of physicians and patients. By law, they have to disclose their interests with pharmaceutical companies when they communicate in the media. Up to now, it appears that no study has explored the effect of opinion leaders' disclosures despite their potential impact on public health and economy. The study objective was to assess the effects of opinion leaders' disclosures of interest on the public and general practitioners' trust in opinion leader by comparison with the overall medical community. In an experimental setting, three opinion leader profiles were built that differed only by the disclosure of their interests (hidden vs. weak vs. strong interests). One of the three profiles was randomly assigned to the subjects of two groups: 67 students and 60 general practitioners. According to an Anova analysis, the main effects and interactions of the disclosure of interests, of the message recipients, and of the assessed targets on the level of trust were measured. The results show that the average level of trust expressed by general practitioners was lower than that expressed by the general public. The level of trust in the opinion leader was lower than that of the overall medical community. The level of trust of exposed subjects fell much lower with stronger disclosed interests. While the general public did not distinguish trust between opinion leaders and the overall medical community, practitioners showed a significantly lower level of trust in opinion leaders with increasingly strong levels of disclosed interests. These study results refute the assertion that public trust would be reduced by the disclosure of interests. They reinforce the importance of the "who judges who" and "which kind of disclosure impacts who ?" effects and draw attention to further research on the role of social interactions in both mass and group communications. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Developing Common Competencies for Southeast Asian General Dental Practitioners.

PubMed

Chuenjitwongsa, Supachai; Poolthong, Suchit; Bullock, Alison; Oliver, Richard G

2017-09-01

Current policy in Southeast Asian dental education focuses on high-quality dental services from new dental graduates and the free movement of dental practitioners across the region. The Southeast Asian Nations (ASEAN) Dental Councils have proposed the "Common Major Competencies for ASEAN General Dental Practitioners" to harmonize undergraduate dental education. This article discusses how the ASEAN competencies were developed and established to assist the development of general dental practitioners with comparable knowledge, skills, and attitudes across ASEAN. The competencies were developed through four processes: a questionnaire about current national oral health problems, a two-round Delphi process that sought agreement on competencies, a panel discussion by representatives from ASEAN Dental Councils, and data verification by the representatives after the meeting. Key themes of the ASEAN competencies were compared with the competencies from the U.S., Canada, Europe, Australia, and Japan. A total of 33 competency statements, consistent with other regions, were agreed upon and approved. Factors influencing the ASEAN competencies and their implementation include oral health problems in ASEAN, new knowledge and technology in dentistry, limited institutional resources, underregulated dental schools, and uneven distribution of dental practitioners. The ASEAN competencies will serve as the foundation for further developments in ASEAN dental education including policy development, curriculum revision, quality assurance, and staff development. Collaboration amongst stakeholders is essential for successful harmonization of ASEAN dental education.

The description of physical signs of illness in photographs by physicians with abnormal colour vision.

PubMed

Campbell, John L; Spalding, J Anthony B; Mir, Fraz A

2004-07-01

Physicians with congenital colour vision deficiency (CCVD) have reported difficulties recognising certain physical signs of illness, for example, jaundice, red rashes and pallor, and interpreting coloured charts, diagrams and slide projections. However, there has been little study of the effects of CCVD on the performance of medical practitioners. The aim of this study was to look for evidence of the effect of CCVD on the ability of physicians to recognise and describe physical signs of illness that have colour as either the main or an important feature. Twenty-three general practitioners with CCVD were shown 11 colour photographs depicting colour signs of illness and were asked to describe the signs they saw and rate their confidence in making their descriptions. Their responses were compared to those of 23 age-matched general practitioners with normal colour vision. General practitioners with CCVD compared to those with normal colour vision had less ability and confidence in detecting physical signs in the photographs and naming the colours. The results of this study support other evidence that physicians with CCVD have difficulties detecting some colour signs of illness and naming the colours. Because of the use of photographs the extent of the problem in clinical practice is unknown but medical practitioners with CCVD should be aware of the possibility of failing to detect or correctly assess physical signs that are characterised by colour.

The Effect of a Surgical Skills Course on Confidence Levels of Rural General Practitioners: An Observational Study.

PubMed

Byrd, Pippa; Ward, Olga; Hamdorf, Jeffrey

2016-10-01

Objective  To investigate the effect of a short surgical skills course on general practitioners' confidence levels to perform procedural skills. Design  Prospective observational study. Setting  The Clinical Evaluation and Training Centre, a practical skills-based educational facility, at The University of Western Australia. Participants  Medical practitioners who participated in these courses. Nurses, physiotherapists, and medical students were excluded. The response rate was 61% with 61 participants providing 788 responses for pre- and postcourse confidence levels regarding various surgical skills. Intervention  One- to two-day surgical skills courses consisting of presentations, demonstrations, and practical stations, facilitated by specialists. Main Outcome Measures  A two-page precourse and postcourse questionnaire was administered to medical practitioners on the day. Participants rated their confidence levels to perform skills addressed during the course on a 4-point Likert scale. Results  Of the 788 responses regarding confidence levels, 621 were rated as improved postcourse, 163 were rated as no change, and 4 were rated as lower postcourse. Seven of the courses showed a 25% median increase in confidence levels, and one course demonstrated a 50% median increase. All courses showed statistically significant results ( p  < 0.001). Conclusion  A short surgical skills course resulted in a statistically significant improvement in the confidence levels of rural general practitioners to perform these skills.

41 CFR 105-53.112 - General statement of functions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... contracting; real and personal property management; transportation, public transportation, public utilities... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false General statement of functions. 105-53.112 Section 105-53.112 Public Contracts and Property Management Federal Property...

48 CFR 214.407-3 - Other mistakes disclosed before award.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Missile Defense Agency: General Counsel, MDA. (ix) Defense Contract Management Agency: General Counsel... before award. 214.407-3 Section 214.407-3 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CONTRACTING METHODS AND CONTRACT TYPES SEALED BIDDING Opening of...

41 CFR 128-48.503 - General procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false General procedures. 128-48.503 Section 128-48.503 Public Contracts and Property Management Federal Property Management... bills of sale, contracts, mortgages, or other satisfactory documentary evidence. (3) The facts and...

7 CFR 1726.250 - General.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ELECTRIC SYSTEM CONSTRUCTION POLICIES AND PROCEDURES Modifications to RUS Standard Contract Forms § 1726.250 General. RUS provides standard forms of contract for the procurement of materials, equipment, and construction and for contract amendments and various related forms for use by RUS borrowers. See § 1726.304 for...

48 CFR 214.407-3 - Other mistakes disclosed before award.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Missile Defense Agency: General Counsel, MDA. (ix) Defense Contract Management Agency: General Counsel... before award. 214.407-3 Section 214.407-3 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CONTRACTING METHODS AND CONTRACT TYPES SEALED BIDDING Opening of...

48 CFR 214.407-3 - Other mistakes disclosed before award.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) Missile Defense Agency: General Counsel, MDA. (ix) Defense Contract Management Agency: General Counsel... before award. 214.407-3 Section 214.407-3 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CONTRACTING METHODS AND CONTRACT TYPES SEALED BIDDING Opening of...

48 CFR 214.407-3 - Other mistakes disclosed before award.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Missile Defense Agency: General Counsel, MDA. (ix) Defense Contract Management Agency: General Counsel... before award. 214.407-3 Section 214.407-3 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CONTRACTING METHODS AND CONTRACT TYPES SEALED BIDDING Opening of...

48 CFR 214.407-3 - Other mistakes disclosed before award.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) Missile Defense Agency: General Counsel, MDA. (ix) Defense Contract Management Agency: General Counsel... before award. 214.407-3 Section 214.407-3 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CONTRACTING METHODS AND CONTRACT TYPES SEALED BIDDING Opening of...

48 CFR 731.370 - Predetermined fixed rates for indirect costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... INTERNATIONAL DEVELOPMENT GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts... determining the indirect costs applicable under contracts with educational institutions. ...

48 CFR 731.370 - Predetermined fixed rates for indirect costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... INTERNATIONAL DEVELOPMENT GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts... determining the indirect costs applicable under contracts with educational institutions. ...

48 CFR 543.205 - Contract clauses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 543.205 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION CONTRACT MANAGEMENT CONTRACT MODIFICATIONS Change Orders 543.205 Contract clauses. The contracting officer shall insert 552.243-71, Equitable Adjustments, in solicitations and contracts containing FAR 52.243-4, Changes. [74 FR...

48 CFR 2932.703 - Contract funding requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Contract funding requirements. 2932.703 Section 2932.703 Federal Acquisition Regulations System DEPARTMENT OF LABOR GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 2932.703 Contract funding requirements. (a...

48 CFR 2932.703 - Contract funding requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Contract funding requirements. 2932.703 Section 2932.703 Federal Acquisition Regulations System DEPARTMENT OF LABOR GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 2932.703 Contract funding requirements. (a...

48 CFR 543.205 - Contract clauses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Section 543.205 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION CONTRACT MANAGEMENT CONTRACT MODIFICATIONS Change Orders 543.205 Contract clauses. The contracting officer shall insert 552.243-71, Equitable Adjustments, in solicitations and contracts containing FAR 52.243-4, Changes. [74 FR...

Divisions of general practice in Australia: how do they measure up in the international context?

PubMed Central

Smith, Judith; Sibthorpe, Beverly

2007-01-01

Background Since the late 1980s, there has been evidence of an international trend towards more organised primary care. This has taken a number of forms including the emergence of primary care organisations. Underpinning such developments is an inherent belief in evidence that suggests that well-developed primary care is associated with improved health outcomes and greater cost-effectiveness within health systems. In Australia, primary care organisations have emerged as divisions of general practice. These are professionally-led, regionally-based, and largely government-funded voluntary associations of general practitioners that seek to co-ordinate local primary care services, and improve the quality of care and health outcomes for local communities. Discussion In this paper, we examine and debate the development of divisions in the international context, using six roles of primary care organisations outlined in published research. The six roles that are used as the basis for the critique are the ability of primary care organisations to: improve health outcomes; manage demand and control costs; engage primary care physicians; enable greater integration of health services; develop more accessible services in community and primary care settings; and enable greater scrutiny and assurance of quality of primary care services. Summary We conclude that there has been an evolutionary approach to divisions' development and they now appear embedded as geographically-based planning and development organisations within the Australian primary health care system. The Australian Government has to date been cautious in its approach to intervention in divisions' direction and performance. However, options for the next phase include: making greater use of contracts between government and divisions; introducing and extending proposed national quality targets for divisions, linked with financial or other incentives for performance; government sub-contracting with state-based organisations to act as purchasers of care; pursuing a fund-holding approach within divisions; and developing divisions as a form of health maintenance organisation. The challenge for the Australian Government, should it wish to see divisions' role expand, is to find mechanisms to enable this without compromising the relatively strong GP engagement that increasingly distinguishes divisions of general practice within the international experience of primary care organisations. PMID:17626642

Adult Dental Trauma: What Should the Dental Practitioner Know?

PubMed

Chauhan, Ravi; Rasaratnam, Lakshmi; Alani, Aws; Djemal, Serpil

2016-05-01

The management of adult dental trauma can be a daunting challenge for practitioners at any level. Like medical emergencies, initial management can have a large influence on prognosis. It is important that practitioners understand the basic principles of managing the acute presentations of dental trauma. This article aims to illustrate a step-by-step approach in order to improve the management within general dental practice for better outcomes for patients.

Diabetes mellitus and periodontal health: dentists' knowledge.

PubMed

Al-Khabbaz, Areej K; Al-Shammari, Khalaf F

2011-01-01

There is a strong body of evidence to support the relationship between periodontal diseases and diabetes mellitus. Unless dental practitioners are aware of this link, they cannot apply the information to their daily practice. The aim of the study was, therefore, to evaluate the knowledge of dental practitioners concerning the effect of diabetes on periodontal health. This was a cross-sectional survey of randomly selected dental practitioners in Kuwait. Participants were asked about specific periodontal complications which they believed that patients diagnosed with diabetes were more susceptible to. A total of 220 dental practitioners (133 general dental practitioners and 87 dental specialists) participated in the study. Less than 60% of all study participants reported that tooth loss due to periodontal reasons and periodontal abscess were frequent among diabetic patients. Dental specialists, especially periodontists, were significantly more aware of periodontal complications associated with diabetes. Factors significantly associated with having knowledge about the effect of diabetes on periodontal health in logistic regression analysis were dentists who were older and those who were specialists. The results of this study indicate that knowledge about the effects of diabetes on periodontal health among this sample of dental practitioners is generally low, and dentists may underestimate the outcomes of periodontal diseases in diabetic patients. Copyright © 2011 S. Karger AG, Basel.

17 CFR 38.401 - General requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... designated contract market, in making available on its Web site information pertaining to new product... MARKETS Availability of General Information § 38.401 General requirements. (a) General. (1) A designated contract market must have procedures, arrangements and resources for disclosing to the Commission, market...

17 CFR 38.401 - General requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... designated contract market, in making available on its Web site information pertaining to new product... MARKETS Availability of General Information § 38.401 General requirements. (a) General. (1) A designated contract market must have procedures, arrangements and resources for disclosing to the Commission, market...

48 CFR 49.109-1 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false General. 49.109-1 Section 49.109-1 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TERMINATION OF CONTRACTS General Principles 49.109-1 General. When a termination settlement has been...