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Sample records for officers general practitioners

  1. Administration of infliximab in general practitioners' offices is safe.

    PubMed

    Stuby, Ulrike; Biesenbach, Georg; Pieringer, Herwig

    2007-11-01

    Infliximab is used in the treatment of various diseases, such as rheumatoid arthritis (RA), psoriasis, psoriatic arthritis (PA), Crohn's disease (CD) and ankylosing spondylitis (AS). In most countries, infliximab is given in hospitals or infusion centers, which are experienced in the management of infusion reactions. Because of this side effect, general practitioners (GPs) might refuse to administer infliximab in their offices. The aim of this study was to investigate the safety of infliximab administration in GPs' offices. Health system in the provincial state of Upper Austria (Austria) provides reimbursement of biological treatment only in outpatient care. Infliximab is due to cost effectiveness usually administered by GPs after a specific training and initialisation of treatment by specialists in the hospital. We sent out a form to 42 cooperating GPs, containing 20 questions concerning the administration of infliximab. Thirty-four forms were returned and evaluated. Altogether, 69 patients (2 patients per doctor mean) were treated with infliximab (1-42 months; 21 months mean). The overall observation period was 697 patients-months. During this period, 487 infusions (14.5 infusions per doctor mean) were administered. From five doctors, seven adverse events (AE) in six patients were reported. In all seven cases, infusion was discontinued; two had allergic reactions and five had nausea or cardiac symptoms, not definitely of allergic origin. Severe adverse events (SAE), defined as shock, emergency treatment or hospitalisation during or after infliximab administration were reported by two doctors. In contrast, SAE during the infusion of other drugs (e.g. analgetics, vitamins) were previously seen by 16 doctors, showing the overall possibility of infusion reactions with commonly prescribed drugs. Almost all (31/34) confirmed the overall safety of infliximab administration in GP's patient care. The administration of infliximab by specially trained general practitioners

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

    PubMed

    Goldberg, David; Gask, Linda

    2002-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2014-05-21

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

  5. Cost effectiveness of treating primary care patients in accident and emergency: a comparison between general practitioners, senior house officers, and registrars.

    PubMed Central

    Dale, J.; Lang, H.; Roberts, J. A.; Green, J.; Glucksman, E.

    1996-01-01

    OBJECTIVES--To compare outcome and costs of general practitioners, senior house officers, and registrars treating patients who attended accident and emergency department with problems assessed at triage as being of primary care type. DESIGN--Prospective intervention study which was later costed. SETTING--Inner city accident and emergency department in south east London. SUBJECTS--4641 patients presenting with primary care problems: 1702 were seen by general practitioners, 2382 by senior house officers, and 557 by registrars. MAIN OUTCOME MEASURES--Satisfaction and outcome assessed in subsample of 565 patients 7-10 days after hospital attendance and aggregate costs of hospital care provided. RESULTS--Most patients expressed high levels of satisfaction with clinical assessment (430/562 (77%)), treatment (418/557 (75%)), and consulting doctor's manner (434/492 (88%)). Patients' reported outcome and use of general practice in 7-10 days after attendance were similar: 206/241 (85%), 224/263 (85%), and 52/59 (88%) of those seen by general practitioners, senior house officers, and registrars respectively were fully recovered or improving (chi2 = 0.35, P = 0.840), while 48/240 (20%), 48/268 (18%), and 12/57 (21%) respectively consulted a general practitioner or practice nurse (chi2 = 0.51, P = 0.774). Excluding costs of admissions, the average costs per case were 19.30 pounds, 17.97 pounds, and 11.70 pounds for senior house officers, registrars, and general practitioners respectively. With cost of admissions included, these costs were 58.25 pounds, 44.68 pounds, and 32.30 pounds respectively. CONCLUSION--Management of patients with primary care needs in accident and emergency department by general practitioners reduced costs with no apparent detrimental effect on outcome. These results support new role for general practitioners. PMID:8646050

  6. Intensive educational efforts combined with external quality assessment improve the preanalytical phase in general practitioner offices and nursing homes.

    PubMed

    Sølvik, Una Ørvim; Bjelkarøy, Wenche Iren; Berg, Kari van den; Saga, Anne Lise; Hager, Helle Borgstrøm; Sandberg, Sverre

    2017-05-05

    Errors in the preanalytical phase in clinical laboratories affect patient safety. The aim of this study was to evaluate the effect of intensive educational efforts together with external quality assessment (EQA) of the preanalytical phase from 2013 to 2015 to improve patient identification in primary health care in Norway. In addition, routines for venous and capillary blood sampling were investigated. A preanalytical EQA was circulated in 2013 by the Norwegian Quality Improvement of Laboratory Examinations (Noklus) to general practitioner offices and nursing homes (n=2000) to obtain information about important issues to focus on before launching an intensive educational program with courses, posters and visits in 2013-2015. Preanalytical EQA surveys were further circulated in 2014 and 2015. The response rate varied between 42% and 55%. The percentages of participants asking for the patients' name and the Norwegian identification number increased from about 8% in 2013 to about 35% in 2015. The increase was similar for those participating in only one EQA survey and for those who participated in EQA surveys both in 2013 and 2015. Guidelines for venous and capillary blood sampling were not always followed. Educational efforts more than the preanalytical EQA influenced the actions and resulted in an increase in the percentages of participants that followed the guidelines for patient identification. Some aspects of blood sampling routines need improvement.

  7. General Practitioners in Hospital

    PubMed Central

    Smith, J. Weston; O'Donovan, J. B.

    1970-01-01

    An acute general hospital of 68 beds at Tamworth, a Midland town of 50,000 people, is staffed by general practitioners for both inpatient and casualty work. During the period 1967-8 there were 889 general practitioner admissions to the hospital for intermediate surgical and medical care, the average length of stay being 6·3 days and the average cost per case £44·3. Of these patients 96 were transferred to other hospitals. The patients, doctors, and standard of medical care have benefited from this kind of service. A “satellite” hospital of this type therefore has an important role in the community for carefully selected types of cases. PMID:5429111

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

    PubMed

    Hay, I S; Batchelor, P A

    1993-07-24

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

  9. General practitioners and district nurses

    PubMed Central

    Richardson, I. M.

    1974-01-01

    Variation between Aberdeen general practitioners in referral rates for home and surgery nursing care is shown to be substantial and is related to the proportion of elderly patients in the practice, inversely to list size, to the doctor's experience, and to practice attachment of nurses. There is, however, a large unexplained variation which, it is suggested, reflects differing general practitioner perception of nursing need and nursing skill, a situation that could be improved by joint training. PMID:4413552

  10. New roles for general practitioners.

    PubMed Central

    Handysides, S.

    1994-01-01

    General practice is likely to change greatly over the next few years. Increases in care in the community and day surgery will lead to more work, and the demand for better data on practice activity will mean the development of audit and epidemiological work. To make time general practitioners will have to learn to delegate work that does not require a doctor. Fundholding has already stimulated some practices to bring services to patients rather than send patients to hospital, and this trend seems set to continue. It is important to pool resources, not only within practices but among other practices in the area--joint action will increase the ability to improve the services for patients. If general practitioners take the opportunity to gain control of the changes the morale of the profession should improve. Images p513-a p514-a PMID:8136671

  11. The general practitioner and nephrolithiasis

    PubMed Central

    Croppi, Emanuele; Cioppi, Federica; Vitale, Corrado

    2008-01-01

    Nephrolithiasis is a multifactorial disease the genesis of which is influenced by genetic, metabolic and environmental factors which determine a series of alterations in the urinary excretion of a number of substances, the cause of the disease itself. The general practitioner is often the first professional to be consulted as regards clinical and therapeutic treatment at the moment of the onset of nephrolithiasis, renal colic, inasmuch as contacted directly by the patient. His role however should not be limited to this initial phase but becomes of strategic importance throughout the subsequent diagnostic procedure; this is especially true with regard to relapses, in correctly placing the patient and, if necessary, referring him/her to the most appropriate specialist area. Running through the entire process which the lithiasic patient encounters from the onset of the disease until therapeutic treatment begins, it is clear how an appropriate initial approach can, in many cases, simplify and optimise such process. On the basis therefore of a complete medical record, and a few simple, biochemical and instrumental tests, the general practitioner is in a position to decide whether to treat the patient directly or to refer him/her to the most appropriate specialist field for investigation at a higher level. Over the last decades nephrolithiasis has progressively changed from being a disease of mainly surgical pertinence to being one of multidisciplinary medical interest in which the figure of the General Practitioner has a primary role, both during the initial diagnostic phase, by means of the correct physio-pathological identification of the problem, and in the subsequent phases as regards the choice and co-ordination of the various specialists involved. PMID:22460998

  12. In-office distance learning for practitioners.

    PubMed

    Klein, Katherine P; Miller, Kenneth T; Brown, Matthew W; Proffit, William R

    2011-07-01

    Distance learning studies involving orthodontic residents have shown that, although residents prefer being live and interactive with an instructor, they learn almost as much from watching a recorded interactive seminar followed by a live discussion. Our objective in this study was to test the acceptability and perceived effectiveness of using recorded interactive seminars and video conference follow-up discussions for in-office continuing education. Four small groups of practitioners (total, n = 23) were asked to prepare for, view, and then discuss previously recorded interactive seminars on a variety of subjects; a fifth group (5 previous participants) had live discussions of 3 topics without viewing a prerecorded seminar. All discussions were via video conference through typical broadband Internet connections, by using either WebEx (Cisco, Santa Clara, Calif) or Elluminate (Pleasanton, Calif) software. The participants evaluated their experiences by rating presented statements on a 7-point Likert scale and by providing open-ended responses. Twenty-two of the 23 participants agreed (with varying degrees of enthusiasm) that this was an enjoyable, effective way to learn, and that they would like to participate in this type of learning in the future. Everyone agreed that they would recommend this method of learning to others. The age and experience of the participants had only minor effects on their perceptions of acceptance and acceptability. The use of recorded seminars followed by live interaction through videoconferencing can be an acceptable and effective method of providing continuing education to the home or office of orthodontists in private practice, potentially saving them both time and travel expenses. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  13. A general practitioner in an ophthalmology accident and emergency department.

    PubMed

    Price, M; Phillips, C I

    1976-08-28

    After a short period of intensive training, a general practitioner successfully replaced a senior house officer (SHO) in the accident and emergency department of an eye hospital on one morning a week for a year. An unbiased observer compared the performance of the general practitioner after one year with that of a full-time SHO who had had 17 months' experience; their performances were about equal. Although a sessional general practitioner costs about 28% more than an SHO, the real cost is much less because undue length of service as an SHO or change to another specialty (because of the SHO surplus) delays achievement of a permanent grade. Continuity is a great advantage of the general practitioner. Replacement of some SHOs by general practitioners would reduce the surplus of SHOs with poor promotion prospects. The commonest diagnoses were Meibomian cysts (18%), corneal foreign bodies (20%), corneal abrasions (12%), and conjunctivitis (8%).

  14. [The general practitioner and insomnia].

    PubMed

    Cambron, L; Bruwier, G; De Bock, I; Poirrier, R

    2006-01-01

    A complaint of insomnia has to be analysed, and differentiated from hypochondria and, overall, from hypersomnia. Once confirmed and assessed as acute or chronic, it is often considered a disorder of hyperarousal, that is an imbalance between a central nervous system activating and a central nervous system inhibiting system with subcontinuous overflow from the former. An acute insomnia is less than one month of duration. As a disease, insomnia has to be categorized as a secondary or a primary disorder. Thereafter, it remains to assess the extent of social, psychological and economical interactions. These factors intervene as consequences or perpetuating factors. The capacity to assess the whole situation is really the great strength of the general practitioner who, more than anybody else, is on home ground. Laboratory findings and specialist examination come only as supporting evidence for causal links. A polysomnography realized in a sleep disorder center provides data reinforcing or correcting the diagnosis. From a sound assessment of the disease, the treatment has to be deduced by following a rigorous reasoning, devoid of guilty feelings as they are suggested to patients by mass-media talking, as well as freed from fashionable non medical practices. Today, we know that chronic insomnia is a disease with potential severe consequences and that it does not heal spontaneously.

  15. General practitioner surgery: anyone interested?

    PubMed

    Bacenas, Amber A P; Ricketts, Chelsey A; Berkowitz, Jonathan; Caron, Nadine R

    2015-01-01

    We sought to assess awareness of, exposure to and interest in general practitioner (GP) surgery and enhanced surgical skills (ESS) among family practice residents in British Columbia, Alberta and Saskatchewan. We distributed a survey to all family practice residents at 4 universities in BC, Alberta and Saskatchewan. The survey assessed demographic information, awareness of and exposure to GP surgery or ESS during training, and interest in pursuing formal ESS training. We received 174 responses (27.2% response rate). Numerous respondents were unaware of GP surgery (9.9% ± 4.5%) and ESS (17.9% ± 5.7%). Awareness was higher among respondents from rural hometowns (GP surgery and ESS awareness 100% and 94.1%, respectively), and with prior exposure to GP surgery (GP surgery and ESS awareness 96.9% and 95.4%, respectively). A minority (38.2%) had been exposed to GP surgery, with exposure higher in respondents from rural training sites and in their second postgraduate year (72.5% and 47.4%, respectively). A quarter (25.1%) of respondents were considering ESS training. Factors encouraging training included increased procedures, challenging medicine and impact on patient outcomes. The importance of ESS training opportunities and service was rated highly. Many respondents were unaware of ESS as a career option. Exposure to GP surgery during training was associated with increased awareness. Furthermore, exposure fostered interest in this important field. These results may be helpful in the development of formal ESS training programs and in curricula for family practice residency programs.

  16. [General practitioner--psychiatrist: friends or enemies?].

    PubMed

    Philippe, P

    2011-02-01

    The author's purpose is to highlight the role differences between a general practitioner and a psychiatrist. She bases her review on the literature as well as on her personal experience which consists of 25 years as a general practitioner followed by 10 years as a psychiatrist. The colleagues' respective opinion of one another was assessed by means of two questionnaires. One was administered to a hundred psychiatrists and the other to a hundred general practitioners on the occasion of two separate medical meetings. The results of these questionnaires, statements found in the medical literature as well as the author's personal experience confirm that, even if the collaboration between general practitioners and psychiatrists is considered important, it remains very difficult and conditioned by numerous preconceived ideas. By clarifying the roles and specificities of each practitioner, this article aims at improving this collaboration which is pivotal for the patient's mental health progression.

  17. Orthodontic First Aid for General Dental Practitioners.

    PubMed

    Sodipo, Ibukunoluwa; Birdsall, Joanne

    2016-06-01

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

  18. Demand for general practitioner and internist services.

    PubMed Central

    Guzick, D S

    1978-01-01

    Demand equations for general-practitioner and internist visits were estimated from 1970 CHAS-NORC survey data on health-service utilization and expenditure. Because a large proportion of respondents reported zero visits, observations were grouped according to cross-classified independent variables and regression analyses were performed using group means as data. The results showed significant differences between demand equations for general-practitioner visits and those for internist visits. Of potential importance was an apparent substitution of internists for general practitioners as ability to pay (income or insurance coverage) increased. Own-price elasticities were low for both general practitioners and internists but were even lower for the latter (0.1 to 0.02) than the former (0.2 to 0.3). The demand for services of the two specialties also differed with respect to disability days, age, sex, residence, and race. PMID:738894

  19. 7 CFR 2.4 - General officers.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Civil Rights; the General Counsel; the Inspector General; the Chief Financial Officer; the Chief Information Officer; the Judicial Officer; the Director, Office of Budget and Program Analysis; the...

  20. [Balint group--aid to general practitioner].

    PubMed

    Simunović, Rajka; Bilić, Vedran; Kumbrija, Suzana; Blazeković-Milaković, Sanja

    2004-01-01

    Professional education of general practitioner is mainly focused on biomedical aspects of treating somatic diseases, while psychological components of somatic diseases, as well as doctor-patient relationship, are generally neglected. General practitioner is in healing process daily exposed to considerable frustrations in relationships with patients. Some frustrations stem from unrecognized and neglected psychological and emotional aspects of somatic diseases which manifest in the doctor-patient relationship. The aim of this work is to show that Balint group can enhance general practitioner's professional capability, as well as his professional satisfaction, teaching him how to recognize psychological needs and problems which are integral part of somatic diseases and doctor-patient relationship as well.

  1. Training general practitioners for very remote areas.

    PubMed

    Ellis, Chris

    2008-01-01

    The days of village general practitioners doing kitchen-table surgery are long over in the industrialized world. Nonetheless, a number of remote communities all over the world are still being served by generalists working in poorly resourced conditions. While computer-guided microsurgery is being performed by the members of a surgical team in London, the only general practitioner on Tristan da Cunha, one of the remotest islands in the world, may be preparing to operate alone on a woman with a ruptured ectopic pregnancy. What are the training requirements and skill mix needed for a generalist working in such a remote area?

  2. General practitioners and their learning styles.

    PubMed

    Lewis, A P; Bolden, K J

    1989-05-01

    Continuing medical education sessions are often poorly attended by general practitioners. One reason may be that these traditionally consist of lectures by hospital consultants with a strong theoretical bias which may have little relevance to the learning needs of general practitioners. To compare the learning styles of teachers and learners in general practice, learning style questionnaires were administered to 50 hospital clinical tutors, 78 general practitioner trainers, 63 trainees and 47 non-trainer principals. The questionnaire covered four different learning preferences: activist, reflector, theorist and pragmatist. The findings showed that the learning styles of hospital tutors and general practitioner trainers were statistically significantly different to those of non-trainer principals and trainees. The tutors and trainers scored much higher on theorist styles and to a lesser extent on reflector and pragmatist styles. There were no significant differences on activist scores. Since teachers tend to teach in their preferred learning style, which may not match the style of the recipients, these findings have implications for continuing medical education in general practice. These implications are discussed.

  3. General practitioners and their learning styles.

    PubMed Central

    Lewis, A P; Bolden, K J

    1989-01-01

    Continuing medical education sessions are often poorly attended by general practitioners. One reason may be that these traditionally consist of lectures by hospital consultants with a strong theoretical bias which may have little relevance to the learning needs of general practitioners. To compare the learning styles of teachers and learners in general practice, learning style questionnaires were administered to 50 hospital clinical tutors, 78 general practitioner trainers, 63 trainees and 47 non-trainer principals. The questionnaire covered four different learning preferences: activist, reflector, theorist and pragmatist. The findings showed that the learning styles of hospital tutors and general practitioner trainers were statistically significantly different to those of non-trainer principals and trainees. The tutors and trainers scored much higher on theorist styles and to a lesser extent on reflector and pragmatist styles. There were no significant differences on activist scores. Since teachers tend to teach in their preferred learning style, which may not match the style of the recipients, these findings have implications for continuing medical education in general practice. These implications are discussed. PMID:2560001

  4. 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.

  5. 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…

  6. 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%…

  7. 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…

  8. Violence against General Practitioners in Turkey

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  9. Rheumatic diseases: a general practitioner's view.

    PubMed

    Knox, J D

    1987-12-01

    Patients with rheumatic complaints are the subject of some 10% of the general practitioner's work. Approximately half of this work is related to the hitherto relatively neglected group of varied soft-tissue conditions, most of which are self-limiting and of a minor nature. Against a background of such diagnostic 'noise', the general practitioner has to remain alert for the fainter 'signal' of serious disease--rheumatic and non-rheumatic--at an early stage. Continuity of care calls on special qualities, behaviours and abilities in the doctor to boost and maintain morale, to coordinate management and to participate in team care. In addition to more traditional therapeutic measures, including analgesics, NSAIDs, disease-modifying drugs and physiotherapy, joint replacement is seen as a significant contribution. There is room for improvement in the structure process and outcomes of delivery of care as it may relate to rheumatic diseases. A simple illustration, based on a general practice audit of gout, is suggested as a possible model by which quality of care could be enhanced at the level of individual patients. While there is not a great deal of scope afforded to the general practitioner in the exercise of primary prevention of the rheumatic diseases, early diagnosis and timely support for carers of patients suffering from chronic rheumatic diseases are areas worth attention. Promotion of self-help is seen as a worthwhile activity in humanitarian and economic terms, though it calls for an appropriate balance to be struck.

  10. [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.

  11. General practitioners and the independent contractor status

    PubMed Central

    Gray, D. J. Pereira

    1977-01-01

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

  12. Contribution of isolated general practitioner maternity units.

    PubMed Central

    Cavenagh, A J; Phillips, K M; Sheridan, B; Williams, E M

    1984-01-01

    A postal survey of isolated general practitioner maternity units in England and Wales showed that just under 4% of deliveries take place in them. Eight per cent of general practitioners are on the staffs, and in 87% of units midwives are integrated with the community midwifery service. Sixty two per cent of units have visiting consultant cover. Fifty seven per cent of patients are booked and delivered in the unit, 28% are booked and deliberately delivered elsewhere, 5% are transferred in the antenatal period, and 10% transferred as emergencies. The perinatal mortality rate for cases booked and delivered in the units is 1.1 per 1000. The number of emergency transfers was appreciably less for those units that were prepared to do their own operations. Thirty five per cent of these units are liable to be cut off in bad weather, and they will continue to fulfil an essential role in the midwifery services. PMID:6426591

  13. Minor surgery — one general practitioner's experiences

    PubMed Central

    Wall, D. W.

    1982-01-01

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

  14. Down's syndrome and the general practitioner.

    PubMed Central

    Howells, G

    1989-01-01

    People with Down's syndrome form a heterogeneous group sharing a single constant feature--an extra chromosome. This paper reviews the many clinical problems associated with Down's syndrome and emphasizes the prevention of secondary handicapping conditions. Current policies on antenatal screening for Down's syndrome are discussed. The review draws attention to the need for general practitioners to see themselves as part of a network of community services providing support to people with Down's syndrome and their families. PMID:2560050

  15. [Job satisfaction and burnout in general practitioners].

    PubMed

    Sobrequés, J; Cebrià, J; Segura, J; Rodríguez, C; García, M; Juncosa, S

    2003-03-15

    To describe job satisfaction in general practitioners (GP) in the province of Barcelona, and to analyse its relationship with their job burnout, and social and professional characteristics. Transversal observational study.Setting. Province of Barcelona, Spain. 603 General Practitioners had participated in ninety three primary care centers. Through a direct interview (individual or in group) a validated questionnaire was administered in three parts: general data (social, demographic and professional), job satisfaction (Font Roja-9 dimensions) and job burnout (Maslach Burnout Inventory-3 scales). The job satisfaction questionnaire (score ranging from 1-5) showed a global satisfaction level of 3.02 (95%CI, 2.98%-3.05%) and we obtained a 18% non response rate. There was a positive association between overall satisfaction and the following variables: less years working in primary health, working in centres providing instruction, and willingness to receive information from the survey. Low levels of satisfaction were associated to high scores in emotional exhaustion and depersonalisation scales, and low scores in personal accomplishment scale. Overall satisfaction has a medium score in the Font-Roja questionnaire. Age seems to lead to a significant tendency to decrease satisfaction as practitioners grow older. Job satisfaction and job burnout present a closely linked behaviour, inversely, as satisfaction increases when job burnout presents low scores.

  16. 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.

  17. Management of allergic rhinitis in general practitioners

    PubMed Central

    2012-01-01

    For patients suffering from allergic rhinitis (AR), general practitioners (GPs) are often their first source of medical advice. It is one of the top-ten reasons for a visit to the primary care clinics and AR was estimated to be 10-40% of the total patient visits in about 50% of the primary care clinics. The standard of management for AR among GPs is thus a key outcome assessment of AR management and implementation of international guidelines in general healthcare practice. PMID:23130327

  18. Methadone treatment by general practitioners in Amsterdam.

    PubMed Central

    van Brussel, G.

    1995-01-01

    In Amsterdam, a three-tiered program exists to deal with drug use and addiction. General practitioners form the backbone of the system, helping to deal with the majority of addicts, who are not criminals and many of whom desire to be free of addiction. Distinctions are made between drugs with "acceptable" and "unacceptable" risks, and between drug use and drug-related crime; patients who fall into the former categories are treated in a nonconfrontational, nonstigmatizing manner; such a system helps prevent the majority of patients from passing into unacceptable, criminalized categories. The overall program has demonstrated harm reduction both for patients and for the city of Amsterdam. PMID:10101375

  19. Consumer preferences for general practitioner services.

    PubMed

    Morrison, Mark; Murphy, Tom; Nalder, Craig

    2003-01-01

    This study focuses on segmenting the market for General Practitioner services in a regional setting. Using factor analysis, five main service attributes are identified. These are clear communication, ongoing doctor-patient relationship, same gender as the patient, provides advice to the patient, and empowers the patient to make his/her own decisions. These service attributes are used as a basis for market segmentation, using both socio-demographic variables and cluster analysis. Four distinct market segments are identified, with varying degrees of viability in terms of target marketing.

  20. Executive Council lists and general practitioner files

    PubMed Central

    Farmer, R. D. T.; Knox, E. G.; Cross, K. W.; Crombie, D. L.

    1974-01-01

    An investigation of the accuracy of general practitioner and Executive Council files was approached by a comparison of the two. High error rates were found, including both file errors and record errors. On analysis it emerged that file error rates could not be satisfactorily expressed except in a time-dimensioned way, and we were unable to do this within the context of our study. Record error rates and field error rates were expressible as proportions of the number of records on both the lists; 79·2% of all records exhibited non-congruencies and particular information fields had error rates ranging from 0·8% (assignation of sex) to 68·6% (assignation of civil state). Many of the errors, both field errors and record errors, were attributable to delayed updating of mutable information. It is concluded that the simple transfer of Executive Council lists to a computer filing system would not solve all the inaccuracies and would not in itself permit Executive Council registers to be used for any health care applications requiring high accuracy. For this it would be necessary to design and implement a purpose designed health care record system which would include, rather than depend upon, the general practitioner remuneration system. PMID:4816588

  1. Prescribing behavior of general practitioners: competition matters.

    PubMed

    Schaumans, Catherine

    2015-04-01

    General Practitioners (GP) have limited means to compete. As quality is hard to observe by patients, GPs have incentives to signal quality by using instruments patients perceive as quality. I investigate whether GPs prescribe more units when confronted with more competition. As there is no monetary benefit in doing so, this type of (perceived) quality competition originates from GPs satisfying patients' expectations. Market level data on per capita and per contact number of items prescribed by GPs is studied for the Belgian market of General Practitioners. I hypothesize that GP competition has a positive impact on the prescribed volume, after controlling for medical needs and GP characteristics. Properly controlling for medical needs implies the use of a two-stage linear regression model. The analysis indicates that a higher number of GPs per capita results in a higher number of units prescribed by GPs, both per capita and per contact. This is consistent with quality competition in the GP market, while inconsistent with alternatives explanations (GP scarcity, GP inducement and GP dispersing prescription in time). GPs prescribe more units when there is more competition to satisfy patients' expectations. The paper thus presents empirical evidence of (perceived) quality competition. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. General dental practitioners and hearing impairment.

    PubMed

    Messano, Giuseppe Alessio; Petti, Stefano

    2012-10-01

    Hearing impairment (HI) remains a problem among dentists Hearing loss at speech frequencies was recently reported among dentists and dental hygienists. This study aimed to investigate prevalence and factors associated with perceived HI among dentists. In 2009-2010, 100 general dental practitioners (GDPs) and 115 general (medical) practitioners (GPs) (mean ages, 43.7 and 44.4 years) from Rome (Italy), who commenced practice ≥ 10 years ago, were interviewed on a series of occupation- and recreation-related HI risk factors and on HI-associated symptoms (tinnitus, sensation of fullness, hypoacusis). Prevalence of presumptive HI (≥ 1 symptom perceived during workdays and weekends) was assessed and factors associated with presumptive HI were investigated. Prevalence was 30.0% (95% confidence interval, 21.0-39.0%) and 14.8% (95% confidence interval, 8.3-21.3%) among GDPs and GPs, respectively. Occupation (GDP vs. GP), family history of hypoacusis, hypertension, ear diseases and smoking were significantly associated with presumptive HI. Within GDPs alone, significant associations were found for frequent use of ultrasonic scalers, use of dental turbines aged≥1 year and prosthodontics as prevalent specialty. GDPs experienced HI risk than GPs. Such a risk was not generalized to all dentists, but was specific for those who frequently used noisy equipment (aged turbines, ultrasonic scalers) during their daily practice. GDPs with 10 or more years of practice who routinely use potentially noisy equipment, could be at risk of HI. In order to prevent such condition, daily maintenance and periodical replacement of dental instruments is recommended. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

    PubMed Central

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

    1989-01-01

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

  4. [Cataract surgery - essentials for the general practitioner].

    PubMed

    Amstutz, Ch; Thiel, M A; Kaufmann, Claude

    2010-08-11

    Age-related cataracts are mainly caused by life-long accumulation of oxidative stress on the lens fibres. Symptoms include reduced visual acuity, requiring more light for reading, and glare. The only treatment that provides a cure for cataracts is surgery. Phacoemulsification represents the preferred method of lens removal. It involves fragmentation of the lens using ultrasound and insertion of an artificial intraocular lens. The preoperative assessment the general practitioner provides to surgeon and anesthesia team has an important share in the low complication rate of the procedure in the event of co-existing systemic disease. Growing patient expectation for spectacle independence following cataract surgery is met to some extent using techniques for astigmatism control and presbyo-pia-correcting intraocular lenses.

  5. Dissatisfied patients: improving general practitioners' initial reactions.

    PubMed

    Bareman, F P; Nijenhuis, E M; Dokter, H J; Trijsburg, W; Out, J; Braams, F M

    1993-07-01

    General practitioners often have difficulty in dealing with dissatisfied patients. One underlying reason could be the disturbed relationship between the doctor and the dissatisfied patient. A training course has been developed taking the relationship as a starting-point. Based on Watzlawick et al.'s theory on communication GPs have been trained to react to a dissatisfied patient on a relational level ('Are you dissatisfied with my treatment?') rather than on a contents level ('How long have you been suffering from this?'). This method seeks to improve the relationship and the satisfaction of both doctor and patient. Three types of initial reaction to dissatisfied patients were offered to four groups of GPs (19 trainees in general practice and 19 trainers in general practice). Pre- and post-measurement were executed by means of registering the initial reactions on videorecorded vignettes of re-enacted dissatisfied patients. Subsequently the reactions were categorized blind by two judges. The 12 possible categories can be subdivided into categories primarily aimed at the contents or primarily aimed at the relationship. The results show that, as compared to the pre-measurements, GPs more frequently use empathic reactions and reactions in which they bring their own actions up for discussion. The number of responses in which doctors ask a further clinical question or in which GPs expect a solution whether from themselves or from others, decrease. It is concluded that the course appears to change for the better the GPs' initial reaction to dissatisfied patients.

  6. What motivates general practitioners to teach.

    PubMed

    Thomson, Jennifer; Haesler, Emily; Anderson, Katrina; Barnard, Amanda

    2014-04-01

    The Australian general practitioner (GP) teaching workforce will need to expand in order to provide for the increasing number of medical students and doctors-in-training. Understanding factors that motivate GPs to become involved in teaching in their clinical practice environments is important for developing recruitment and retention strategies. Thirty-one semi-structured interviews were conducted with a cross section of GP teachers and were subjected to thematic analysis. Themes were identified and further classified as motivations and prerequisites for teaching. The desire to update clinical knowledge was the most frequently mentioned motivation for teaching, and was described as a strategy for GP teachers to preserve clinical competence through the opportunity to learn new aspects of medicine from junior colleagues. Other motivations included personal fulfillment and enjoyment of teaching, the opportunity to pass on general practice skills and knowledge, promoting general practice as a career, and fulfilling a sense of responsibility to the profession and community. Peers, students and patients also influenced the decision to teach. Most GPs identified that time, workload, availability of space and adequate financial remuneration were prerequisites for teaching. Practice owners also often determined the GP teachers' capacity to teach. To increase the recruitment and retention of GP teachers, it is recommended that teaching organisations give more recognition to teaching as a clinical professional development activity, place more emphasis on GPs' personal enjoyment, professional responsibility and pride in teaching, and increase engagement with practice owners. © 2014 John Wiley & Sons Ltd.

  7. Impact of nurse practitioners on workload of general practitioners: randomised controlled trial

    PubMed Central

    Laurant, Miranda G H; Hermens, Rosella P M G; Braspenning, Jozé C C; Sibbald, Bonnie; Grol, Richard P T M

    2004-01-01

    Objective To examine the impact on general practitioners' workload of adding nurse practitioners to the general practice team. Design Randomised controlled trial with measurements before and after the introduction of nurse practitioners. Setting 34 general practices in a southern region of the Netherlands. Participants 48 general practitioners. Intervention Five nurses were randomly allocated to general practitioners to undertake specific elements of care according to agreed guidelines. The control group received no nurse. Main outcome measures Objective workload, derived from 28 day diaries, included the number of contacts per day for each of three conditions (chronic obstructive pulmonary disease or asthma, dementia, cancer), by type of consultation (in practice, telephone, home visit), and by time of day (surgery hours, out of hours). Subjective workload was measured by using a validated questionnaire. Outcomes were measured six months before and 18 months after the intervention. Results The number of contacts during surgery hours increased in the intervention group compared with the control group (P < 0.06), particularly for patients with chronic obstructive pulmonary disease or asthma (P < 0.01). The number of consultations out of hours declined slightly in the intervention group compared with the control group, but this difference did not reach significance. No significant changes became apparent in subjective workload. Conclusion Adding nurse practitioners to general practice teams did not reduce the workload of general practitioners, at least in the short term. This implies that nurse practitioners are used as supplements, rather than substitutes, for care given by general practitioners. PMID:15069024

  8. [Legal competence problems among general practitioners].

    PubMed

    Vassbø, Børge; Hagen, Harald Ravn; Hunskår, Steinar

    2005-08-25

    We wanted to investigate to what extent Norwegian general practitioners (GPs) working within a patient list system have patients who they are legally incompetent to treat, what services they offer these patients, and what attitudes a representative sample of the GPs has towards situations where one is asked to offer services to such patients. A questionnaire was sent to 622 randomly chosen GPs. We registered sex, age, list size, size of the local community and health region for every practice. For eight hypothetical situations, we recorded whether the doctor clearly, probably or hardly would offer services. About one quarter of the doctors had their spouses and own children below 18 on their list. Many had secretaries or colleagues on the list. From 18% to 31% of the doctors confirmed that they have prescribed reimbursable prescription drugs to one such patient. There were great variations in views on legal competence to treat in these hypothetical situations. GPs encounter problems of legal competence to treat. Many were of the view that a pragmatic approach is needed in day-to-day general practice. GPs should be aware of their own practice and aware of both legal competence problems and other challenges induced by having family, close friends and co-workers on the list.

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

    PubMed

    Bass del Campo, Germán Camilo

    2015-03-13

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

  10. [Burnout syndrome in general practitioners of Avila].

    PubMed

    Frutos-Llanes, R; Jiménez-Blanco, S; Blanco-Montagut, L E

    2014-10-01

    To determine the level of burnout in general practitioners of Avila and the influence of social, occupational and health factors. A descriptive cross-sectional epidemiological study was conducted and aimed at all Primary Care medical staff of Avila during the first half of 2011, using two questionnaires: the Maslach Burnout Inventory and other sociodemographic, health and occupational variables. A response rate of 51.8% was obtained. The mean age was 48.55±8.16, and 52% were male, 77% married, 45% with tenure, 78% worked in rural centres, and, 82% performed out of hours home visits plus clinics. The prevalence of severe burn out was low (16%) in our study was low. A high prevalence (68%) of moderate/severe level of the condition was found. Being married (P=.012), do not guards (P<.0001), working in rural areas (P=.008), and to be an area doctor (p=.03), predisposes to suffer burnout in severe or moderate/severe burnout. A moderate level of burnout was found. Contrary to what many doctors thought, the prevalence of the condition in its severe form was low, but was high when taking the severe and moderate/severe forms together. Therefore, measures should be extended to reduce occupational stress of doctors, in order to improve working practices and professional efficiency. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  11. French military general practitioner: ultrasound practice.

    PubMed

    Maurin, Olga; De Regloix, S; Lefort, H; Delort, G; Domanski, L; Tourtier, J-P; Palmier, B

    2014-09-01

    Ultrasound has been used in the field and in emergency departments for more than two decades. In a military setting, its use has grown rapidly as it has gained widespread acceptance among emergency physicians and as the range of diagnostic and triage applications has continued to expand. Technological changes have enabled ultrasound devices to become accessible to general practitioners (GP), and it could be of particular interest for military GPs in isolated environments. We have investigated both the training of French military GPs in the area of ultrasonography and the use of ultrasound devices, in daily practice and abroad, in isolated military settings. In 2011, a questionnaire was sent to all 147 in-the-field GPs of the French southeast regional military health service. The questionnaire evaluated the training of military GPs in ultrasonography, the use of ultrasound in France in daily practice, and during military operations in isolated environments abroad during 2010. The response rate was 52%. On the one hand, half the responding GPs had been specially trained in ultrasound, mainly (97%) in military institutes. On the other hand, only a quarter of doctors used ultrasound in daily practice. Among those GPs performing ultrasound examinations in France, 75% used it in 2010 during isolated operations abroad. Ultrasound examinations performed in such an austere environment were retrospectively declared useful to guide clinical reasoning (41% of examinations carried out), diagnosis (21%) and decision making as regards evacuation (11%). The challenge for the future is to make ultrasound courses mandatory for all military GPs going on overseas operations, to develop daily practice, and to investigate effective triage systems, combining both ultrasound imagery and physical examination. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Effect of general practitioners' advice against smoking

    PubMed Central

    Russell, M A H; Wilson, C; Taylor, C; Baker, C D

    1979-01-01

    During four weeks all 2138 cigarette smokers attending the surgeries of 28 general practitioners (GPs) in five group practices in London were allocated to one of four groups: group 1 comprised non-intervention controls; group 2 comprised questionnaire-only controls; group 3 were advised by their GP to stop smoking; and group 4 were advised to stop smoking, given a leaflet to help them, and warned that they would be followed-up. Adequate data for follow-up were obtained from 1884 patients (88%) at one month and 1567 (73%) at one year. Changes in motivation and intention to stop smoking were evident immediately after advice was given. Of the people who stopped smoking, most did so because of the advice. This was achieved by motivating more people to try to stop smoking rather than increasing the success rate among those who did try. The effect was strongest during the first month but still evident over the next three months and was enhanced by the leaflet and warning about follow-up. An additional effect over the longer term was a lower relapse rate among those who stopped, but this was not enhanced by the leaflet and warning about follow-up. The proportions who stopped smoking during the first month and were still not smoking one year later were 0·3%, 1·6%, 3·3%, and 5·1% in the four groups respectively (P <0·001). The results suggest that any GP who adopts this simple routine could expect about 25 long-term successes yearly. If all GPs in the UK participated the yield would exceed half a million ex-smokers a year. This target could not be matched by increasing the present 50 or so special withdrawal clinics to 10 000. PMID:476401

  13. Richard Quiller Couch — an outstanding nineteenth century general practitioner

    PubMed Central

    Bloor, D. U.

    1978-01-01

    The boom in metal mining in the mid-nineteenth century produced a fearful mortality among miners. The history of this problem is described by the life and work of Mr R. Quiller Couch, a Cornish mine surgeon and general practitioner. He was a remarkable man and an outstanding general practitioner. PMID:359798

  14. Management of mental health problems by general practitioners in Quebec.

    PubMed

    Fleury, Marie-Josée; Farand, Lambert; Aubé, Denise; Imboua, Armelle

    2012-12-01

    To document the management of mental health problems (MHPs) by general practitioners. A mixed-method study consisting of a self-administered questionnaire and qualitative interviews. An analysis was also performed of Régie de l'assurance maladie du Québec administrative data on medical procedures. Quebec. Overall, 1415 general practitioners from different practice settings were invited to complete a questionnaire; 970 general practitioners were contacted. A subgroup of 60 general practitioners were contacted to participate in interviews. The annual frequency of consultations over MHPs, either common (CMHPs) or serious (SMHPs), clinical practices, collaborative practices, factors that either support or interfere with the management of MHPs, and recommendations for improving the health care system. The response rate was 41% (n = 398 general practitioners) for the survey and 63% (n = 60) for the interviews. Approximately 25% of visits to general practitioners are related to MHPs. Nearly all general practitioners manage CMHPs and believed themselves competent to do so; however, the reverse is true for the management of SMHPs. Nearly 20% of patients with CMHPs are referred (mainly to psychosocial professionals), whereas nearly 75% of patients with SMHPs are referred (mostly to psychiatrists and emergency departments). More than 50% of general practitioners say that they do not have any contact with resources in the mental health field. Numerous factors influence the management of MHPs: patients' profiles (the complexity of the MHP, concomitant disorders); individual characteristics of the general practitioner (informal network, training); the professional culture (working in isolation, formal clinical mechanisms); the institutional setting (multidisciplinarity, staff or consultant); organization of services (resources, formal coordination); and environment (policies). The key role played by general practitioners and their support of the management of MHPs were evident

  15. Management of mental health problems by general practitioners in Quebec

    PubMed Central

    Fleury, Marie-Josée; Farand, Lambert; Aubé, Denise; Imboua, Armelle

    2012-01-01

    Abstract Objective To document the management of mental health problems (MHPs) by general practitioners. Design A mixed-method study consisting of a self-administered questionnaire and qualitative interviews. An analysis was also performed of Régie de l’assurance maladie du Québec administrative data on medical procedures. Setting Quebec. Participants Overall, 1415 general practitioners from different practice settings were invited to complete a questionnaire; 970 general practitioners were contacted. A subgroup of 60 general practitioners were contacted to participate in interviews. Main outcome measures The annual frequency of consultations over MHPs, either common (CMHPs) or serious (SMHPs), clinical practices, collaborative practices, factors that either support or interfere with the management of MHPs, and recommendations for improving the health care system. Results The response rate was 41% (n = 398 general practitioners) for the survey and 63% (n = 60) for the interviews. Approximately 25% of visits to general practitioners are related to MHPs. Nearly all general practitioners manage CMHPs and believed themselves competent to do so; however, the reverse is true for the management of SMHPs. Nearly 20% of patients with CMHPs are referred (mainly to psychosocial professionals), whereas nearly 75% of patients with SMHPs are referred (mostly to psychiatrists and emergency departments). More than 50% of general practitioners say that they do not have any contact with resources in the mental health field. Numerous factors influence the management of MHPs: patients’ profiles (the complexity of the MHP, concomitant disorders); individual characteristics of the general practitioner (informal network, training); the professional culture (working in isolation, formal clinical mechanisms); the institutional setting (multidisciplinarity, staff or consultant); organization of services (resources, formal coordination); and environment (policies). Conclusion The key

  16. Investigation of burnout in a sample of British general practitioners.

    PubMed Central

    Kirwan, M; Armstrong, D

    1995-01-01

    BACKGROUND. Recent changes in the general practitioner contract have produced increased workload and stress, poorer mental health and reduced job satisfaction. These factors might combine to increase the level of 'burnout' among general practitioners. AIM. This study set out to examine the extent of burnout among general practitioners. METHOD. A questionnaire was sent to all 295 Northamptonshire general practitioners seeking demographic details and including the Maslach burnout inventory. The results for the inventory were compared with the results from a sample of physicians and nurses in North America. RESULTS. There was a significantly higher level of burnout among the Northamptonshire doctors compared with the North American sample. There was virtually no association between age and the level of burnout, although a small negative correlation was found between age and the depersonalization of others subscale. Part-time general practitioners showed lower levels of burnout than full-time general practitioners. CONCLUSION. This study highlights the need to look both at the extent of burnout in young doctors during their training and at those characteristics of part-time general practitioners which might prevent burnout. PMID:7619573

  17. General practitioners' management of the long-term sick role.

    PubMed

    Higgins, Angela; Porter, Sam; O'Halloran, Peter

    2014-04-01

    In this paper, we use qualitative research techniques to examine the role of general practitioners in the management of the long-term sickness absence. In order to uncover the perspectives of all the main agents affected by the actions of general practitioners, a case study approach focussing on one particular employment sector, the public health service, is adopted. The role of family physicians is viewed from the perspectives of health service managers, occupational health physicians, employees/patients, and general practitioners. Our argument is theoretically framed by Talcott Parsons's model of the medical contribution to the sick role, along with subsequent conceptualisations of the social role and position of physicians. Sixty one semi-structured interviews and three focus group interviews were conducted in three Health and Social Care Trusts in Northern Ireland between 2010 and 2012. There was a consensus among respondents that general practitioners put far more weight on the preferences and needs of their patients than they did on the requirements of employing organisations. This was explained by respondents in terms of the propinquity and longevity of relationships between doctors and their patients, and by the ideology of holistic care and patient advocacy that general practitioners viewed as providing the foundations of their approach to patients. The approach of general practitioners was viewed negatively by managers and occupational health physicians, and more positively by general practitioners and patients. However, there is some evidence that general practitioners would be prepared to forfeit their role as validators of sick leave. Given the imperatives of both state and capital to reduce the financial burden of long-term sickness, this preparedness puts into doubt the continued role of general practitioners as gatekeepers to legitimate long-term sickness absence.

  18. 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

  19. [The general practitioner is not in the lead on ADHD].

    PubMed

    Damoiseaux, Roger A M J

    2015-01-01

    The diagnosis of and therapy for ADHD is complex and should be done by experts in this field. In the Netherlands, a new guideline on ADHD for general practitioners has recently been issued. Although there is some room for general practitioners to start medication for this disorder, the main message is to exercise caution in starting medication in general practice. Many children with ADHD have psychiatric comorbidity and proper diagnosis by a specialist is recommended. The main task of the general practitioner is making the right choice concerning when to refer for further diagnosis. Children sometimes show behaviour which, although it is not always what adults want, does not necessarily require psychiatric intervention and this is what a general practitioner can determine.

  20. Comparison of the work of a nurse practitioner with that of a general practitioner

    PubMed Central

    Salisbury, Christopher J.; Tettersell, Monica J.

    1988-01-01

    The work of a nurse practitioner was compared with that of a general practitioner. Both were equally available to the same patient population over the same period. The nurse practitioner saw a similar age and sex distribution of patients to the doctor but saw different types of problems. More of the patients she saw were for followup of chronic diseases, health advice and screening measures while fewer were acutely ill. The doctor dealt with four times as many patients. The nurse practitioner managed 78% of her consultations without referral to a doctor, and 89% without resorting to prescribed drugs. There was a high level of patient satisfaction with her work and 97% of the patients who saw the nurse would choose to consult her again. The role of the nurse practitioner in our practice has developed differently from a similar post in another setting, thus emphasizing the need for flexibility when defining the role. Nurse practitioners are a valuable extra resource for the development of new areas of care, rather than a cheaper substitute for a general practitioner. PMID:3255828

  1. Improving general practitioners' assessment and management of suicide risk.

    PubMed

    Paxton, R; MacDonald, F; Allott, R; Mitford, P; Proctor, S; Smith, M

    2001-01-01

    Standards for assessing and managing suicide risk were developed and incorporated into a guidance manual for general practitioners. The effects of the manual on opinions and practice were evaluated using a quasi-experimental controlled before/after design, comparing participating general practitioners with others who did not use the manual. Thirty four general practitioners participated over a six-month period. The intervention group showed changes in perceptions, with increased satisfaction with their own methods and in their recognition and assessment of suicide risk. Their practice changed, with increased recording of relevant factors in notes. The comparison group did not change in these ways. It is concluded that general practitioners' practice and opinions in assessing and managing suicide risk were significantly improved using a minimal intervention. Given the importance of the topic and the small size of this study, further research is needed, examining changes in professional practice, knowledge and attitudes.

  2. [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.

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

    PubMed Central

    Chambers, R; Wall, D; Campbell, I

    1996-01-01

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

  4. A study of communication between general practitioners and specialists.

    PubMed Central

    Westerman, R F; Hull, F M; Bezemer, P D; Gort, G

    1990-01-01

    A random sample of referral letters from general practitioners to outpatient departments of general medicine, dermatology, neurology, and gastroenterology at an Amsterdam teaching hospital were analysed together with the specialists' replies for 144 referrals. The pairs of letters were judged by a panel of four general practitioners and four specialists. Letters were assessed according to quality and content, clarity, request for return to general practitioner care, time intervals between referral and consultation and between consultation and the specialist's reply. The judges were also asked to assess whether in their opinion the letters were of value in teaching or were discourteous. Though in general intraobserver agreement on what constitutes a good letter was low, deficiencies were revealed in the quality of letters and there were delays in transmission and missed educational opportunities. PMID:2271276

  5. General Practitioners Educational Needs in Intellectual Disability Health

    ERIC Educational Resources Information Center

    Phillips, A.; Morrison, J.; Davis, R. W.

    2004-01-01

    The community general practitioner (GP) has a central role in the provision of primary health care to people with intellectual disability (ID) as an indirect result of deinstitutionalization in Australia. This population, however, continues to experience poor health care compared to the general population. The current paper describes results from…

  6. [Skin sampling for the general practitioner].

    PubMed

    André, J; Richert, B

    2015-09-01

    Skin samplings are easily performed in general practice. They include skin biopsies, nail clippings, skin scrappings, hair pluckings as well as trichograms. The different types of skin biopsies are curetage, shaving, punch and elliptic biopsies. They are most commonly used for the diagnosis of inflammatory skin conditions and cutaneous tumors. The biopsies are performed under local anesthesia and each has specific indications. Their complications are minimal. In order to obtain as much information as possible the lesion to be biopsied should be judiciously selected, harvested without being harmed and sent to a skin-oriented pathologist. Nail clippings, skin scrapings and hair plucking allow diagnosis of superficial skin mycosis (tinea, pityriasis versicolor) and are mandatory before prescribing systemic treatment. Scrapping of an itch mite burrow may sometimes reveal the sarcopte. Trichogram may be useful in the work up of a hair loss.

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

    PubMed Central

    Usherwood, V; Usherwood, T P

    1989-01-01

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

  8. 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

  9. Minimally invasive periodontal therapy for general practitioners.

    PubMed

    Ryder, Mark I; Armitage, Gary C

    2016-06-01

    There remains a high prevalence of mild-to-moderate forms of periodontal diseases in both developed and developing countries. Although many periodontal specialty practices currently place strong emphasis on implant surgery, periodontal plastic surgery and esthetics, general dentists and hygienists have often assumed more responsibility than periodontal specialty practices for the diagnosis, treatment, assessment and maintenance, and possible referral, of their patients. To address these current trends and challenges, this volume of Periodontology 2000 presents a series of topics on the basic biological principles of periodontal disease, as well as on approaches to diagnosis, treatment planning and treatment, in what is called 'conservative' or 'noninvasive' periodontal therapy. These topics include risk assessment of the periodontal condition; reduction, elimination and/or control of etiologies and risk factors, including mechanical, antimicrobial and host-modulation approaches; considerations for evaluation of clinical outcomes based on treatment approaches; and selected topics in laser therapy, halitosis and gingival recession. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. United States General Accounting Office Publications List.

    DTIC Science & Technology

    1981-06-30

    Looseleaf, 123 pp. Managers, Your Accounting System Can Do a Lot for You. Guidelines and illustrative case studies for managers in using accounting systems...AD-AlOe 538 GENERAL ACCOUNTING OUICE WASHINGTON DC F/G 5/2 JIUN 81UNITED STATES GENERAL ACCOUNTING OFFICE PUSLICATIONS LIST.(U) UNCLASSIFIED N...Publications ............................................... 79 General ................................................... 79 Accounting and Auditing

  11. 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.

  12. 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…

  13. 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…

  14. A joint course for general practitioner and practice nurse trainers.

    PubMed Central

    Bolden, K J; Lewis, A P

    1990-01-01

    An experimental multidisciplinary course for prospective general practitioner and practice nurse trainers is described. Factual knowledge and attitudes were measured before and after the course and some of the changes measured emphasized the importance of multidisciplinary training. The ideas generated by the group of nurse trainers in terms of their future professional development were identified. PMID:2265007

  15. 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…

  16. 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…

  17. 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…

  18. 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…

  19. CT colonography: a survey of general practitioners' knowledge and interest.

    PubMed

    Flor, Nicola; Laghi, Andrea; Peri, Mauro; Cornalba, Gianpaolo; Sardanelli, Francesco

    2016-01-01

    To verify the knowledge and interest of general practitioners on computed tomography colonography (CTC). In 2014, a Web-based questionnaire was proposed to all general practitioners of [Milan, Italy]. The questionnaire consisted of ten questions concerning general practitioners' knowledge about CTC, including application of guidelines in clinical scenarios and diagnostic performance. Out of 1,053 general practitioners, 231 (22%), 155 men and 76 women (mean age 58 years), completed the survey. We found a significant difference between the age of responders and that of non-responders (p = 0.0033). Of the 231 responders, 84% were aware of the possibility of using CTC as a method for examining the colon-rectum. However, only 57% were aware about low X-ray exposure delivered by CTC and about the possibility of using a reduced cleansing protocol. Only 48% were aware that CTC accuracy in diagnosing 10-mm or larger polyps and colorectal cancers was similar to that of conventional colonoscopy, while 62% were informed about CTC advantages in comparison with double-contrast barium enema; 59% thought that CTC had a potential role as a screening test; 85-86% suggested CTC in the case of refused or incomplete conventional colonoscopy; 79% suggested immediate conventional colonoscopy in the case of at least one 10-mm polyp. About 54% usually prescribe one CTC every 4-6 months, while 36% never have, 3% one CTC per month, and 7% one every 2-3 months. Ninety-four per cent declared that they were willing to attend a course on CTC. General practitioners have limited knowledge concerning CTC. Radiological societies should fill this gap offering dedicated educational initiatives.

  20. Office of the Inspector General. Annual report

    SciTech Connect

    Wright, J.K.

    1981-03-01

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

  1. Roles of the general practitioner in different contexts.

    PubMed

    Van Dormael, M

    1995-01-01

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

  2. Variation in periodontal referral by general dental practitioners.

    PubMed

    Linden, G J

    1998-08-01

    This study investigated the extent of and reasons for variation in the periodontal referral patterns of general dental practitioners in Northern Ireland. A questionnaire was circulated to all general dental practitioners in Northern Ireland. This questionnaire investigated the management of periodontal disease in the general dental service and referral for specialist periodontal advice and treatment. A usable return was made by 355 (68%) of those surveyed. The mean number of periodontal referrals by each respondent in the past year was 6.5 (SD 7.7), range 0 to 80. Backward stepwise logistic regression analysis indicated that independent predictors of high referral rate were practice location close to the referral centre (p<0.0001); dissatisfaction with ability to treat periodontal disease under the National Health Service (p=0.001); that previous refusals of referral had not dissuaded a dentist from continuing to offer referral (p=0.002); not offering root planing as a treatment (p=0.005); and perceived inadequate postgraduate education in periodontology (p=0.03). It is concluded that considerable variation exists between general dental practitioners working in Northern Ireland in relation to the referral of patients for specialist periodontal advice and treatment. It is further concluded that in many cases non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in relation to periodontal referral.

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

    ERIC Educational Resources Information Center

    Bane, Susan; Criscione, Teri

    1983-01-01

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

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

    PubMed

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

    2016-08-01

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

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

    PubMed

    Joyce, Catherine; Veitch, Craig; Crossland, Lisa

    2003-01-01

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

  6. Ways of influencing the behaviour of general practitioners

    PubMed Central

    Horder, John; Bosanquet, Nick; Stocking, Barbara

    1986-01-01

    What evidence is there for the success or failure of the different methods used to influence the behaviour of general practitioners, whether in their work with patients, or in the organization of a practice? This preliminary exploration of the literature suggests that, although change is always occurring, its deliberate inducement is usually slow and laborious. Doubt is cast on the efficacy of existing financial incentives, and of unsolicited feedback about performance. There is little evidence for the influence of audit on behaviour but personal contact with doctors, nurses and other colleagues, and to a lesser extent with patients, is relatively effective, both in influencing the teamwork of a practice and in more formal education. However, it is combinations of different methods which most successfully influence general practitioners. PMID:3309276

  7. [The Dutch College of General Practitioners practice guideline 'Eczema'].

    PubMed

    de Vries, Corlien J H; de Witt-de Jong, Anne W F; Dirven-Meijer, Pauline C; Burgers, Jako S; Opstelten, Wim

    2014-01-01

    The Dutch College of General Practitioners practice guideline 'Eczema' provides recommendations for the diagnosis and treatment of common types of eczema: atopic dermatitis, contact dermatitis, acro-vesicular eczema, nummular eczema, hypostatic eczema, and asteatotic eczema. Age is an important factor when determining the type of eczema. According to the guideline, patient history and physical examination are sufficient in the diagnosis of eczema; additional investigations are rarely indicated. Moisturizing the skin with neutral emollients is the cornerstone of treatment for patients with eczema. If treatment with glucocorticoids is indicated, it is recommended that patients should start with short-term twice daily application, decreasing to once daily application. The guideline advises not to treat eczema patients with tar preparations. General practitioners are also advised not to prescribe calcineurin inhibitors. How work may affect eczema, or how eczema may affect work, should be considered in adult patients.

  8. [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.

  9. Communicating accuracy of tests to general practitioners: a controlled study.

    PubMed

    Steurer, Johann; Fischer, Joachim E; Bachmann, Lucas M; Koller, Michael; ter Riet, Gerben

    2002-04-06

    To assess the extent to which different forms of summarising diagnostic test information influence general practitioners' ability to estimate disease probabilities. Controlled questionnaire study. Three Swiss conferences in continuous medical education. 263 general practitioners. Questionnaire with multiple choice questions about terms of test accuracy and a clinical vignette with the results of a diagnostic test described in three different ways (test result only, test result plus test sensitivity and specificity, test result plus the positive likelihood ratio presented in plain language). Doctors' knowledge and application of terms of test accuracy and estimation of disease probability in the clinical vignette. The correct definitions for sensitivity and predictive value were chosen by 76% and 61% of the doctors respectively, but only 22% chose the correct answer for the post-test probability of a positive screening test. In the clinical vignette doctors given the test result only overestimated its diagnostic value (median attributed likelihood ratio (aLR)=9.0, against 2.54 reported in the literature). Providing the scan's sensitivity and specificity reduced the overestimation (median aLR=6.0) but to a lesser extent than simple wording of the likelihood ratio (median aLR=3.0). Most general practitioners recognised the correct definitions for sensitivity and positive predictive value but did not apply them correctly. Conveying test accuracy information in simple, non-technical language improved their ability to estimate disease probabilities accurately.

  10. General practitioners teaching new surgical trainees about clinic letter writing.

    PubMed

    Seddon, James

    2017-04-05

    Clinic letter writing is an important communication tool in the hospital out-patient setting, serving as a record of the consultation for the hospital, confirming the information gathered and the agreed outcome with the patient, and communicating progress to the general practitioner. It is a skill, and is often poorly performed. There has traditionally been a paucity of formal teaching on the subject. Classroom sessions during a regional surgical trainee year-1 'boot camp' induction, preparing new specialist trainees for the practical functions of their new roles. Forty-five minute sessions delivered to a total of 50 new first-year surgical trainees by a senior general practitioner trainee in the 2015 and 2016 boot camps. Pairs of trainees were asked to rate the quality of a letter, and then defend that rating through discussion with the group. This guided discussion was intended to allow the trainees to derive the important features of letters themselves. Feedback from the group confirmed the suspicion that this was an unknown and unmet need for these trainees. The trainees valued the teaching (100% respondents), and felt that it made them more prepared for the workplace (93% of respondents). High-quality communication between the hospital and the patient, and their general practitioner, is required for efficient, safe practice. Consideration should be given to providing brief formal training on writing clinic letters to practitioners who are new to this role. Clinic letter writing is a skill and is often poorly performed. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  11. General practitioners and work in the Third World.

    PubMed

    Holden, J D

    1991-04-01

    In recent years the number of general practitioners who have worked in the third world before entering general practice has fallen. The reasons for this are not clear but may include worries about future career prospects. Ninety four doctors who had entered general practice since 1984, after previously working in the third world, completed a questionnaire about their career experience and views about the value of such work. They were generally widely experienced and well-qualified and work abroad had not apparently harmed their careers, rather, many believed it had enhanced it. Work in the usually arduous conditions of poor countries was often considered by the respondents to lead to a wider perspective, increased maturity, confidence, self-reliance, adaptability and initiative. Doctors who are interested and suitable for work in the third world prior to entering general practice should be encouraged to pursue this possibility.

  12. Knowledge of managing avulsed tooth among general dental practitioners in Malaysia.

    PubMed

    Abdullah, Dalia; Soo, Suet Yeo; Kanagasingam, Shalini

    2016-12-01

    Dental and maxillofacial injuries are one of the areas of concern highlighted in the Malaysian National Oral Health Plan 2011-2020. General dental practitioners (GDPs) have the responsibility of diagnosing and assessing dental trauma and determining the prognosis and outcomes of trauma along with its management. The purpose of this study was to evaluate the knowledge base and preferred methods of general dental practitioners regarding the management of avulsed tooth. A random convenient sampling methodology was employed for sample selection. A pre-tested 11-item questionnaire was validated on the dental officers. The survey was distributed to 182 GDPs attending the annual Malaysian Dental Association conference in January 2010. The data obtained was statistically analyzed using descriptive analysis and logistic regression was employed to predict the probability of achieving high scores. A total of 182 general dental practitioners participated in the study, with the majority being female (n=153, 75%). The place of practice significantly affected the knowledge score. In the group that scored more than 80 points (n=84, 46%), 76% of them worked with government hospitals. Age, work duration and number of traumatised teeth previously treated had no significant effect. The odds ratio for place of practice indicates that respondents who work in government hospitals are 3.6 times more likely to score more than 80 points compared to those who worked in private clinics (OR=3.615, P=0.001). The knowledge level on the management of avulsed tooth among general dental practitioners in Malaysia needs to be improved. Strategies in improvement of the Malaysian dental educational system, continuous dental educational activities and utilisation of guidelines on trauma management should be recommended to increase the knowledge level of avulsed tooth management to ensure good treatment outcomes. Trauma prevention and further education regarding the management of avulsed tooth is an

  13. 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

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

    PubMed

    Hemphill, Elizabeth; Kulik, Carol T

    2011-05-01

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

  15. 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... TRANSPORTATION BOARD, DEPARTMENT OF TRANSPORTATION RULES OF PRACTICE PRACTITIONERS Canons of Ethics The Practitioner's Duties and Responsibilities Toward A Client § 1103.15 The practitioner's duty to clients...

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

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  17. Short-term cosmetic orthodontics for general dental practitioners.

    PubMed

    Maini, A

    2013-01-01

    The demand for cosmetic dental treatments in the UK has grown dramatically in the last decade possibly due to increased public awareness of new techniques coupled with greater media attention for celebrities following smile enhancement treatments. In view of this, the aim of this article and the associated presentation at the 2013 British Dental Conference and Exhibition is to provide an overview of short-term cosmetic orthodontics for general dental practitioners. The presentation will cover the differences between short-term cosmetic orthodontics and comprehensive orthodontic treatment, and explain how using short-term orthodontics can be an effective tool to deliver minimally invasive cosmetic dentistry.

  18. Communicating accuracy of tests to general practitioners: a controlled study

    PubMed Central

    Steurer, Johann; Fischer, Joachim E; Bachmann, Lucas M; Koller, Michael; ter Riet, Gerben

    2002-01-01

    Objective To assess the extent to which different forms of summarising diagnostic test information influence general practitioners' ability to estimate disease probabilities. Design Controlled questionnaire study. Setting Three Swiss conferences in continuous medical education. Participants 263 general practitioners. Intervention Questionnaire with multiple choice questions about terms of test accuracy and a clinical vignette with the results of a diagnostic test described in three different ways (test result only, test result plus test sensitivity and specificity, test result plus the positive likelihood ratio presented in plain language). Main outcome measures Doctors' knowledge and application of terms of test accuracy and estimation of disease probability in the clinical vignette. Results The correct definitions for sensitivity and predictive value were chosen by 76% and 61% of the doctors respectively, but only 22% chose the correct answer for the post-test probability of a positive screening test. In the clinical vignette doctors given the test result only overestimated its diagnostic value (median attributed likelihood ratio (aLR)=9.0, against 2.54 reported in the literature). Providing the scan's sensitivity and specificity reduced the overestimation (median aLR=6.0) but to a lesser extent than simple wording of the likelihood ratio (median aLR=3.0). Conclusion Most general practitioners recognised the correct definitions for sensitivity and positive predictive value but did not apply them correctly. Conveying test accuracy information in simple, non-technical language improved their ability to estimate disease probabilities accurately. What is already known on this topicMany doctors confuse the sensitivity of clinical tests and their positive predictive valueDoctors tend to overestimate information derived from such tests and underestimate information from a patient's clinical historyMost primary research on diagnostic accuracy is reported using

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

    PubMed

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

    2014-01-01

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

  20. [Should general practitioners be interested in homocysteine measurements?].

    PubMed

    Girs, N; Giet, D

    2006-01-01

    The role of hyperhomocysteinemia as a cardiovascular risk factor has been a matter of debate of several decades. The present paper briefly describes the metabolism of homocysteine, the main genetic and acquired causes of hyperhomocysteinemia and the mechanisms presumably involved in the pathogenesis of cardiovascular and thromboembolic diseases. Current evidence-based data from epidemiological and interventional studies assessing the potential role of hyperhomocysteinemia in the occurrence of vascular complications are presented. Guidelines on screening and treatment of hyperhomocysteinemia are analysed in the context of daily practice of general practitioners.

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

    PubMed

    Chappell, B; Smithson, H

    1999-05-01

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

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

    PubMed Central

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

    2016-01-01

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

  3. General practitioners' judgment of their elderly patients' cognitive status.

    PubMed

    Pentzek, Michael; Fuchs, Angela; Wiese, Birgitt; Cvetanovska-Pllashniku, Gabriela; Haller, Franziska; Maier, Wolfgang; Riedel-Heller, Steffi G; Angermeyer, Matthias C; Bickel, Horst; Mösch, Edelgard; Weyerer, Siegfried; Werle, Jochen; van den Bussche, Hendrik; Eisele, Marion; Kaduszkiewicz, Hanna

    2009-12-01

    General practitioners (GP) play an important role in detecting cognitive impairment among their patients. To explore factors associated with GPs' judgment of their elderly patients' cognitive status. Cross-sectional data from an observational cohort study (AgeCoDe study); General practice surgeries in six German metropolitan study centers; home visits by interviewers. 138 GPs, 3,181 patients (80.13 +/- 3.61 years, 65.23% female). General practitioner questionnaire for each patient: familiarity with the patient, patient morbidity, judgment of cognitive status. Home visits by trained interviewers: sociodemographic and clinical data, psychometric test performance. Multivariate regression analysis was used to identify independent associations with the GPs' judgment of "cognitively impaired" vs. "cognitively unimpaired." Less familiar patients (adjusted odds ratio [aOR] 2.42, 95% CI 1.35-4.32, for poor vs. very high familiarity), less mobile patients (aOR 1.29, 95% CI 1.13-1.46), patients with impaired hearing (aOR 5.46, 95% CI 2.35-12.67 for serious vs. no problems), and patients with greater comorbidity (aOR 1.15, 95% CI 1.08-1.22) were more likely to be rated as "cognitively impaired" by their GPs. The associations between GPs' assessments of cognitive impairment and their familiarity with their patients and patients' mobility, hearing, and morbidity provide important insights into how GPs make their judgments.

  4. [Malaria prevention: the general practitioners experience on the Reunion Island].

    PubMed

    Di Bernardo, S; Guihard, B; Wartel, G; Sissoko, D

    2012-08-01

    Malaria has been officially eradicated from the Reunion Island since 1979. However, a potentially active vector of the disease - Anopheles arabiensis - persists on the island. The risk of resurgence is quite significant. More than 90%of the patients presenting a malarial infection in Reunion Island after a stay in Madagascar or in the Comoros had followed a chemoprophylaxis that was not in accordance with the guidelines. A survey, that included 100 general practitioners, wasconducted in the Reunion Island regarding their practices concerning the malaria prevention. The upshot of all this is that these doctors themselves do not follow the optimal malaria prevention practices during journeys, and neglect their protection against mosquito bites. Travelers' consultations with the doctors before a journey represent only a modest part of their activity. However, the general practitioner is considered to be the interlocutor of choice for these patients. During these consultations, they do not refer enough to the national references which, according to a number of practitioners, are difficult to obtain. On the contrary, they refer too much to the information delivered by the pharmaceutical industry. With regard to the prescriptions of prophylactic treatments, only 40% of the doctors respect the official recommendations. This gap in the recommendations is sometimes deliberate and justified by the very high cost of a number of treatments. However, a lack of up-to-date knowledge cannot be excluded. Finally, the promotion of the protection against mosquito bites remains very poor. According to these data, it seems important to promote networking between the doctors and the reference centers, which would enhance optimal practices concerning chemoprophylaxis and protection against mosquito bites, especially targeting the "at risk" patients.

  5. General practitioners' knowledge of whiplash guidelines improved with online education.

    PubMed

    Rebbeck, T; Macedo, L; Paul, P; Trevena, L; Cameron, I D

    2013-11-01

    The primary objective of this study was to evaluate the effect of an online education program used to implement the Australian (New South Wales) whiplash guidelines with general practitioners (GP). The secondary aim was to identify factors associated with learning. An online educational and evaluation activity was developed to reflect the key messages for GP from the Australian whiplash guidelines. The educational activity was hosted on the Royal Australian College of General Practitioners' website (www.gplearning.com.au) for a period of 3 years. Participants were recruited through advertisement and media releases. Participants completed a baseline evaluation of their knowledge, participated in the interactive educational activity and completed a post-knowledge questionnaire. The primary outcome was change in professional knowledge, predictors of learning were computed using linear regression. Two hundred and fifteen GP participated. Knowledge significantly improved between baseline and post-knowledge questionnaire scores (P < 0.00001). A total of 57.2% of participants improved their knowledge by more than 20%, indicating a large effect. Low baseline knowledge predicted learning, accounting for 71% of the variance. Online education of GP significantly improved their knowledge in relation to guidelines for whiplash. Those with low baseline knowledge improved their knowledge the most, suggesting that implementation strategies should be targeted at this group.

  6. Flemish general dental practitioners' knowledge of dental radiology

    PubMed Central

    Aps, J K M

    2010-01-01

    The aim of this study was to assess general dental practitioners' knowledge of dental radiography and radiation protection in order to alert the Belgian authorities and dental professional societies. Prior to attending a postgraduate course on intraoral radiology, general dental practitioners in Flanders, Belgium, were asked to fill in a questionnaire regarding the radiological equipment and the techniques they used for intraoral radiography. The availability and type of dental panoramic equipment were also assessed. A total of 374 questionnaires were available for this study. 15% of the attendants used radiographic equipment that was more than 27 years old and 43% reported equipment that operated with a clockwork timer. 32% and 75% respectively had no idea what the kV or mA settings were on their intraoral equipment. 5% were unaware which cone geometry or geometric technique (paralleling or bisecting angle technique) they were using. 81% claimed to be using a short cone technique. 47% did not know what collimation meant, whereas 40% stated that they were using circular collimation. 38% used digital intraoral image detectors (63% were photostimulable storage phosphorplate (PSPP)), but 16% were not sure about the type of sensor they were using (PSPP or solid-state sensors). 61% also had dental panoramic equipment available, 25% of which was digital (10% charge coupled device (CCD) and 15% PSPP). These results clearly indicate the need for continued education on this subject. The latter is an important signal to Belgian authorities and dental professional societies. PMID:20100924

  7. Management of erectile dysfunction: barriers faced by general practitioners.

    PubMed

    Low, Wah-Yun; Ng, Chirk-Jenn; Tan, Ngiap-Chuan; Choo, Wan-Yuen; Tan, Hui-Meng

    2004-06-01

    To explore the barriers faced by general practitioners (GPs) in the management of patients with erectile dysfunction (ED). This was a qualitative analysis of focus group discussions and in-depth interviews involving 28 Malaysian GPs. GPs' perception of ED being not a serious condition was a major determinant of their prescribing practice. Doctor's age (younger), gender (female), short consultation time and lack of experience were cited as barriers. The GPs' prescribing habits were heavily influenced by the feedback from the first few patients under treatment, the uncertainty of etiology of ED without proper assessment and the profit margin with bulk purchase. Other barriers include Patients' coexisting medical conditions, older age, lower socio-economic status, unrealistic expectations and inappropriate use of the anti-impotence drugs. Cardiovascular side effects and cost were two most important drug barriers. The factors influencing the management of ED among the general practitioners were multiple and complex. An adequate understanding of how these factors (doctors, patients and drugs) interact can assist in the formulation and implementation of strategies that encourage GPs to identify and manage ED patients.

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

    PubMed

    Farthing, Michael J G

    2015-08-01

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

  9. Acceptance and commitment therapy - pathways for general practitioners.

    PubMed

    Smout, Matthew

    2012-09-01

    Acceptance and commitment therapy (ACT) focuses on helping patients to behave more consistently with their own values and apply mindfulness and acceptance skills to their responses to uncontrollable experiences. This article presents an overview of ACT, its evidence base and how general practitioners can apply ACT consistent practice in the primary care setting. It describes pathways for general practitioners to develop further expertise in the approach. Acceptance and commitment therapy has been associated with improved outcomes in patients with chronic pain (comparable to cognitive behaviour therapy) and several studies suggest that it may be useful in patients with mild to moderate depression. Preliminary evidence of benefit has also been shown in the setting of obsessive-compulsive disorder, psychosis, smoking, tinnitus, epilepsy and emotionally disordered eating after gastric band surgery. Acceptance and commitment therapy starts with a discussion about what the patient wants and how they have tried to achieve these aims. Strategies previously used to avoid discomfort are discussed. Psychoeducation in ACT involves metaphors, stories and experiential exercises to demonstrate the uncontrollability and acceptability of much psychological experience. In its final phase, ACT resembles traditional behaviour therapy consisting of goal setting and graduated activity scheduling toward goals directed by values.

  10. [Productivity and practice profiles of general practitioners in Tirana, Albania].

    PubMed

    Fournier, Pierre; Tourigny, Caroline; Ylli, Alban; Nuri, Besim; Haddad, Slim

    2006-01-01

    Albania, as with all Central and Eastern European countries whose health systems were highly centralized, has undertaken a number of reforms aiming to transform, among many items, the financing and delivery of primary health care services. This study assesses the practice activities of general practitioners working in the region of Tirana, over a period of 12 months. Production is measured by the number of monthly visits carried out by the practitioner, and practice profiles are determined by referral rates for specialist care and prescription rates per visit. Multi-level regression analyses, taking into account the hierarchical structure of the data, were performed to identify the factors associated with productivity and profiles of practice. Results show large urban-rural variations with respect to practice conditions, characteristics of practitioners, productivity, and profiles of practice. Productivity was weak in the city of Tirana (an average of 277 monthly visits), 18% of patients were referred to specialists, and 66% received prescriptions. In rural areas, productivity was weaker (an average of 179 monthly visits), referral rates were lower (11%), and the prescription rate was 74%. In urban and rural areas, productivity and profiles of practice were related to the characteristics of both the client and the health centre and to the type of practice. There are only a few available epidemiological studies documenting the ongoing health transition and the concomitant increase in demand for primary health care services; therefore, we are unable to (causally) link the reported low productivity of general practitioners with population needs. Physician productivity and patient care is better for certain groups and in health care settings where a wide range of services and sophisticated medical technologies are available. The capacity to efficiently plan for medical manpower is limited - this may be attributed to deficiencies of the patient registration system on

  11. GENERAL VIEW FROM EAST WITH BUILDING (OFFICE) ON RIGHT, BUILDINGS ...

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

    GENERAL VIEW FROM EAST WITH BUILDING (OFFICE) ON RIGHT, BUILDINGS #24 & #26 ON LEFT, ROADWAY BETWEEN - Tyringham Shaker Settlement, Main House & Office, Jerusalem Road, Tyringham, Berkshire County, MA

  12. Responses by general practitioners in Avon to proposals for general practice in the white paper Working for Patients.

    PubMed Central

    Whitfield, M.; Wood, N.; Wright, F.

    1989-01-01

    OBJECTIVE--To determine the views of Avon's general practitioners about the general practice proposals within the government's white paper Working for Patients. DESIGN--Postal questionnaire survey. SETTING--A county in south west England. SUBJECTS--All general practitioner principals (n = 537) under contract with Avon Family Practitioner Committee. MEASUREMENTS AND MAIN RESULTS--492 doctors (92%) responded to the survey. More than three quarters of the respondents were opposed to the government's proposals on budgets for specific surgical procedures, prescribing, and diagnostic tests; and between 63% and 93% felt negative about advantages that might accrue from the proposals. Over three quarters of general practitioners were in favour of family practitioner committees monitoring work load, prescribing, and referrals. General practitioners in large, potentially budget holding practices held similar views to doctors in smaller practices. CONCLUSIONS--Avon's general practitioners substantially reject most of the government's proposals about general practice in the white paper Working for Patients. PMID:2502223

  13. General practitioners as educators in adolescent health: a training evaluation.

    PubMed

    Van de Mortel, Thea; Bird, Jennifer; Chown, Peter; Trigger, Robert; Ahern, Christine

    2016-03-22

    General practitioners play an important role in the primary care of adolescents in both community and clinical settings. Yet studies show that GPs can lack confidence, skills and knowledge in adolescent health. This study evaluates the effectiveness of an innovative training intervention on medical participants' knowledge and confidence as adolescent health educators in a school setting. 15 general practitioners, 12 general practice registrars and 18 medical students participated in an adolescent health education workshop followed by field experience in health education sessions in secondary schools. The mixed method design included a pre and post intervention survey and focus group interviews. Mean scores on the Confidence to Teach scale increased significantly (3.34 ± 0.51 to 4.09 ± 0.33) (p < .001) as did confidence to communicate with adolescents (3.64 ± 0.48 to 4.19 ± 0.33) (p < .001). Mean knowledge scores increased significantly (7.00 ± 1.22 to 8.98 ± 1.11) (p < .001). Participants highlighted the value of learning about adolescent health issues and generic teaching skills especially lesson planning and design, practicing experiential teaching strategies and finding the 'sweet spot' when communicating with adolescents. Some participants reported that these skills would transfer to the practice setting. An applied training intervention that uses evidence-based, experiential teaching strategies and focuses on developing knowledge and practical teaching skills appropriate for the health education of adolescents can enhance knowledge and confidence to engage in community-based adolescent health education.

  14. Validation of the diagnosis of autism in general practitioner records

    PubMed Central

    Fombonne, Eric; Heavey, Lisa; Smeeth, Liam; Rodrigues, Laura C; Cook, Claire; Smith, Peter G; Meng, Linyan; Hall, Andrew J

    2004-01-01

    Background We report on the validity of the computerized diagnoses of autism in a large case-control study investigating the possible association between autism and the measles, mumps and rubella vaccine in the UK using the General Practitioner Research Database (GPRD). We examined anonymized copies of all relevant available clinical reports, including general practitioners' (GP) notes, consultant, speech therapy and educational psychologists reports, on 318 subjects born between 1973 and 1997 with a diagnosis of autism or a related disorder recorded in their electronic general practice record. Methods Data were abstracted to a case validation form allowing for the identification of developmental symptoms relevant to the diagnosis of pervasive developmental disorders (PDDs). Information on other background clinical and familial features was also abstracted. A subset of 50 notes was coded independently by 2 raters to derive reliability estimates for key clinical characteristics. Results For 294 subjects (92.5%) the diagnosis of PDD was confirmed after review of the records. Of these, 180 subjects (61.2%) fulfilled criteria for autistic disorder. The mean age at first recording of a PDD diagnosis in the GPRD database was 6.3 years (SD = 4.6). Consistent with previous estimates, the proportion of subjects experiencing regression in the course of their development was 19%. Inter-rater reliability for the presence of a PDD diagnosis was good (kappa = .73), and agreement on clinical features such as regression, age of parental recognition of first symptoms, language delay and presence of epilepsy was also good (kappas ranging from .56 to 1.0). Conclusions This study provides evidence that the positive predictive value of a diagnosis of autism recorded in the GPRD is high. PMID:15113435

  15. [Survey on the measures of asepsis taken by general practitioners].

    PubMed

    Chambonet, Jean-Yves; Cluis, Patrice

    2004-01-31

    CURRENT STATE OF THE QUESTION: Many legislative and administrative texts rule asepsis and prophylaxis in health care centres. The deontological code provides the guidelines for medical corps. To identify the measures set-up to prevent the transmission of infections in general practitioners' consulting rooms and to compare them with the data in the literature. A postal survey using a questionnaire was sent to a representative sample of 119 general practitioners in the Loire-Atlantique area in France. The response rate was of 69%. The majority of physicians declared that had a wash basin in the consulting room, 43% declared that they did not systematically wash their hands between 2 patients in their consulting rooms and 78% during home visits, 23% used an ordinary soap, 49% a hydro-alcoholic solution, and 62% wiped their hands with a cotton towel. Blood interventions were performed with gloves by more than 80% of the participants, complete decontamination procedures of the material were performed by 6%, but more than 80% used single use material. Although 45% believed they had changed their habits, 23% remained wary of any eventual recommendations and 43% made no comments. This survey method collects declarative data and remains limited with regard to information. In-depth analysis of the daily activity of the participants would be useful for an approach of performance criteria, in view of the fact that some consultations do not include any, or even partial, clinical examination. The investments required for the purchase of the material compatible with the specifications applicable to health care centres may appear excessive for their current activity. The generalisation of the use of single use material represents a great progress in the field of prevention. Comparison with similar earlier studies shows the good progress made and the improvement in quality. Nevertheless, studies using a strict methodology are necessary to establish guidelines to be applied in

  16. 7 CFR 2.4 - General officers.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Information Officer; the Judicial Officer; the Director, Office of Budget and Program Analysis; the Chief..., Education, and Economics; the Under Secretary for Marketing and Regulatory Programs; the Assistant Secretary...

  17. Ultrasound imaging in the general practitioner's office - a literature review.

    PubMed

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

    2016-03-01

    Ultrasonografia, będąca bezpieczną i nieinwazyjną metodą diagnostyczną, wykorzystującą coraz bardziej udoskonalone techniki obrazowania, stała się badaniem pierwszego wyboru w wielu schorzeniach. Coraz częściej stosowana jest w gabinecie lekarza rodzinnego jako metoda uzupełniająca badania podmiotowe i przedmiotowe.

  18. Thomas James Walker (1835-1916): Surgeon and general practitioner.

    PubMed

    Thomas, Martyn

    2016-03-11

    Thomas James Walker was a surgeon and general practitioner who worked in the city of Peterborough at a time when there were changes and innovations in the practice of medicine. After training in medicine and surgery at Edinburgh University, he qualified in London in 1857. He was a pioneer of laryngoscopy. He played an important role in introducing antiseptic surgery to the Peterborough Infirmary and was instrumental in the development of the operating theatre which opened in 1894. He was a philanthropist and collector of Roman and Saxon artefacts. In 1915, he was recognized as an outstanding member of the Peterborough community when he was offered the Freedom of the City. © The Author(s) 2016.

  19. Extended role for general practitioners in obstetrics? A medical audit.

    PubMed Central

    Shapland, D E

    1979-01-01

    A study was designed to evaluate provision of services, process of medical care, and outcome in four general-practitioner obstetric units in isolated areas (Berwick, Whitby, Guernsey, and Brecon). All units were equipped to induce labour; to perform instrumental vaginal delivery and selected breech deliveries; and to remove placentas manually. All had some fetal monitoring equipment. Caesarean sections could not be performed at Berwick and Whitby. Proportions of normal deliveries during 1976-7 varied from 75% to 93%. Perinatal mortality was acceptably low, as were transfer rates for neonates and mothers in labour. With specialist help and particular attention to training and broadening local doctors' experience of abnormal obstetrics, such units should be able to provide an excellent obstetric service. PMID:445003

  20. Idiopathic Normal Pressure Hydrocephalus: A Review for General Practitioners.

    PubMed

    Nassar, Basant R; Lippa, Carol F

    2016-01-01

    Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurodegenerative disease commonly characterized by a triad of dementia, gait, and urinary disturbance. Advancements in diagnosis and treatment have aided in properly identifying and improving symptoms in patients. However, a large proportion of iNPH patients remain either undiagnosed or misdiagnosed. Using PubMed search engine of keywords "normal pressure hydrocephalus," "diagnosis," "shunt treatment," "biomarkers," "gait disturbances," "cognitive function," "neuropsychology," "imaging," and "pathogenesis," articles were obtained for this review. The majority of the articles were retrieved from the past 10 years. The purpose of this review article is to aid general practitioners in further understanding current findings on the pathogenesis, diagnosis, and treatment of iNPH.

  1. Optimizing communication between the radiologist and the general practitioner.

    PubMed

    Jans, L B O; Bosmans, J M L; Verstraete, K L; Achten, R

    2013-01-01

    Adequate communication between radiologist and referring general practitioner (GP) is mandatory in a good practice clinical setting. Several hurdles may interfere with good communication. Inappropriate imaging requests or incomplete clinical details conveyed to the radiologist may result in inappropriate imaging and interpretation. GPs may find the radiology report confusing or may feel it takes too much time to receive the reports. Communication issues may dissatisfy GPs and make them look for alternative providers for imaging referrals. In the digital era, electronic radiology request forms, digital access for the GP to radiology images and reports and networks centralizing patient data may all help to improve communication between radiologist and GP. In this paper we outline practical ways of improving this communication.

  2. A survey of general practitioners' attitudes to benzodiazepine overprescribing.

    PubMed

    Hamilton, I J; Reay, L M; Sullivan, F M

    1990-11-01

    This survey of doctors' attitudes took place against the background of professional concern over litigation in the field of benzodiazepine prescribing and the prospect of imposed audit of General Practitioner's (GP's) work. One hundred and thirty-three GPs in the Argyll and Clyde Health Board Area responded to a postal questionnaire (44% response rate) asking about their opinions on the reasons for benzodiazepine over-prescribing. Further statements suggested possible interventions to reduce this acknowledged problem. The study group appear representative of the population from which they are drawn. Benzodiazepine over-prescribing appeared to be a meaningful term to the doctors who replied to this survey. In their replies, GPs acknowledged this to be a multifactorial problem with complex social and psychological roots. Those who responded appear to have a positive attitude to reducing the problem and appear willing to use the alternative strategies which would be required.

  3. General practitioners' opinions on the intake of painkillers among patients.

    PubMed

    Latalski, Maciej; Skórzyńska, Hanna; Pacian, Anna

    2002-01-01

    The goal of this paper is to evaluate the consumption of painkillers among patients on the basis of the opinions of general practitioners. The most frequent ailments including pain symptoms were the cases of long-continued pain (64.3%); less frequent were acute pain syndromes in the course of a disease (35.7%). The phenomenon of the excessive use of painkillers among patients with long-continued pain syndromes is observed by the GPs. Uncontrolled self-treatment is possible owing to an easy access to this type of medicaments. The excessive use of analgesic medicines in therapy frequently results from the lack of simultaneous application of other methods of pain treatment e.g., in physiotherapy, psychotherapy. Long lasting use of various types of painkillers can lead to drug addiction. This problem is observed by over a half of the GPs (67.1%).

  4. Endodontic retreatment strategies used by general dental practitioners.

    PubMed

    Kvist, Thomas; Heden, Gunnar; Reit, Claes

    2004-04-01

    Root-filled teeth with persistant periapical radiolucencies are often classified as endodontic failures. Studies have shown that general dental practitioners (GDP) do not consistantly suggest retreatment of "failures." The "Praxis Concept" (PC) theory hypothesizes that dentists conceive periapical health and disease as different states on a continuum. This study examined endodontic retreatment concepts among 157 GDPs from Värmland, Sweden. In 6 simulated cases the periapical condition, quality of root filling and presence of a root canal-retained post were systematically varied. Five options were offered: no therapy, wait and see, nonsurgical retreatment, surgical retreatment, and extraction. The investigation showed large interindividual variation in retreatment behavior among the GDPs. Only 9 dentists (6%) where found to repeatedly suggest retreatment of endodontic failures. A majority of GDPs (79%) performed in accordance with PC. The data indicate that several retreatment decision rules are used by Swedish GDPs, but PC-derived strategies attract the majority.

  5. Telephone prescribing of antibiotics. General practitioners' views and reflections.

    PubMed

    Björnsdóttir, I; Hansen, E H

    2001-09-01

    In this era of increasing problems with resistance, rational prescribing of antibiotics is extremely important. Therefore, rationales for prescribing require analyses. The objective of this study was to explore general practitioners' (GPs') reasons for prescribing antibiotics by telephone. Qualitative analysis of semistructured interviews with and observations of GPs in Iceland enquiring about the rationale for prescribing antibiotics was used. Ten GPs were interviewed for 45 min to 2 h each including three who were observed between 3 and 10 h. The GPs generally indicated a restrictive attitude to telephone prescribing, although they all gave examples of their prescribing by telephone. The prescribing was mostly but not always based on some kind of diagnosis. The factors influencing diagnosis and prescribing were largely non-clinical: knowledge of the patients as persons, including their complaint threshold, confidence in their descriptions, the GPs' communication strategies and the travelling distance between patients and GPs. The clinical factors were the patients' description of signs and symptoms and knowledge of their history. Prescriptions not based on diagnosis were 'therapeutic trial' or GP-approved self-medication. Sometimes, the GPs requested to see a patient even though the diagnosis was based on history, signs and symptoms. Multiple factors affected the decision-making process when antibiotics were prescribed by telephone, most of which were non-clinical. The diagnosis, if there was one, was generally presumptive. GPs' general attitudes correlated well with current knowledge but were contrasted by the reality of their daily work conditions.

  6. General practice registrar education beyond the practice: The public health role of general practitioners.

    PubMed

    Leeder, Stephen; Corbett, Stephen; Usherwood, Tim

    2016-05-01

    Public health is the organised efforts of society to prevent disease, promote health and prolong life in the population. While the focus of general practice is on the care of individuals and families, general practitioners (GPs) have an essential role in promoting the health of the population. The objectives of this article are to explore the links between public health and general practice, and to consider their implications for general practice registrar training. Clinical general practice contributes to promoting population health. In addition, many GPs undertake work that extends beyond clinical care. The Royal Australian College of General Practitioners' (RACGP's) curriculum includes population health and the context of practice as one of its five domains. Core skills include the incorporation of a population health perspective into clinical practice, and leadership and advocacy in addressing the health needs of the community effectively and equitably.

  7. Inequitable distribution of general practitioners in Australia: estimating need through the Robin Hood Index.

    PubMed

    Wilkinson, D; Symon, B

    2000-02-01

    From Census data, to document the distribution of general practitioners in Australia and to estimate the number of general practitioners needed to achieve an equitable distribution accounting for community health need. Data on location of general practitioners, population size and crude mortality by statistical division (SD) were obtained from the Australian Bureau of Statistics. The number of patients per general practitioner by SD was calculated and plotted. Using crude mortality to estimate community health need, a ratio of the number of general practitioners per person: mortality was calculated for all Australia and for each SD (the Robin Hood Index). From this, the number of general practitioners needed to achieve equity was calculated. In all, 26,290 general practitioners were identified in 57 SDs. The mean number of people per general practitioner is 707, ranging from 551 to 1887. Capital city SDs have most favourable ratios. The Robin Hood Index for Australia is 1, and ranges from 0.32 (relatively under-served) to 2.46 (relatively over-served). Twelve SDs (21%) including all capital cities and 65% of all Australians, have a Robin Hood Index > 1. To achieve equity per capita 2489 more general practitioners (10% of the current workforce) are needed. To achieve equity by the Robin Hood Index 3351 (13% of the current workforce) are needed. The distribution of general practitioners in Australia is skewed. Nonmetropolitan areas are relatively underserved. Census data and the Robin Hood Index could provide a simple means of identifying areas of need in Australia.

  8. National study of parental confidence in general practitioners.

    PubMed

    Freed, Gary L; Spike, Neil; O'Hara, Jonathan; Hiscock, Harriet; Rhodes, Anthea L

    2017-09-03

    To assess a national sample of Australian parental confidence in general practitioner (GP) care for illness and injury for their children. Cross-sectional, internet-based survey of a national, representative sample of parents of children birth - 17 years in Australia was used. Purposeful recruitment was used to achieve a national, representative sample of 2100 Australian parents, reflective of demographic and geographic distribution based on census data. Parents were asked to indicate their degree of confidence in a GP to handle medical problems as well as their preference for, and use of, paediatric speciality care for their children. Fewer than half of parents (44%) reported that they were completely confident in a GP to provide general care as defined as 'can handle almost all general health issues for my child'. A slightly greater proportion of parents (56%) were completely confident in a GP to provide care for minor injuries, defined as injuries not requiring an X-ray. Greater confidence in general care was seen among parents >40 years of age and those whose GP is always bulk billed. Parental confidence in GPs is an important issue. Our findings that fewer than half of parents are completely confident in their GP to provide general care to their child may be an influencing factor on current health-care utilisation trends. The potential implications of low parental confidence in GPs are greater numbers of emergency department presentations for children with lower urgency conditions and increased referrals of children for specialty care. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  9. Novel anticoagulants: general overview and practical considerations for dental practitioners.

    PubMed

    Elad, S; Marshall, J; Meyerowitz, C; Connolly, G

    2016-01-01

    Currently, 4 novel Direct Oral Anticoagulants (DOACs) were approved by the FDA. This review focuses on these agents and proposes a matrix for the general dentists to assess bleeding risk in dental management of patient on DOACs. The outline covers the pharmacology of DOACs (rivaroxaban, apixaban, edoxaban and dabigatran), bleeding complications, risk associated with discontinuation, monitoring/reversal, and implications for the dental practitioners. A total of 18 randomized controlled trials were identified with mixed results in regards to the risk for bleeding. Considering the pharmacology of DOACs and challenges in monitoring and reversing their effect, the dentist should consider carefully the management of patients on DOACs as it may differ from patients on conventional anticoagulants. Based on the type of dental procedure and the medical risk assessment, several general treatment approaches can be considered: continue DOACs, time dental treatment as late as possible after the last DOACs dose, discontinue DOACs for 24hrs, or discontinue DOACs for 48hrs. Based on the current reported dental literature, limited dental surgery may benefit from the first 2 conservative options. However, this needs to be proven in comparative clinical trials.

  10. General practitioner-hospital communications: a review of discharge summaries.

    PubMed

    Wilson, S; Ruscoe, W; Chapman, M; Miller, R

    2001-12-01

    The objective of this study was to examine the reliability, effectiveness, accuracy and timeliness of hospital to general practitioner (GP) information transfer by discharge summaries produced in a general public hospital in New South Wales, Australia. A retrospective audit of 569 patient discharge summaries and related medical records with a targeted GP interview was performed to determine receipt and clinical value of the recorded information. The main outcome measure was the number and quality of discharge summaries received by patient-nominated GPs. Summaries written for patients discharged from hospital were estimated to be received by the patient-nominated GP in 27.1% of cases. Discharge summaries audited were rated as being 63.6% accurate, with errors occurring in all facets of production. The current method of discharge summary production and distribution is unacceptable. The high number of errors (36.4%) and the low rate of receipt (27.1%), indicates that resources invested in the production of the discharge summary could be better utilized to improve information transfer.

  11. 16 CFR 0.13 - Office of the Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Office of the Inspector General. 0.13 Section 0.13 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ORGANIZATION § 0.13 Office of the Inspector General. The Office of Inspector General (OIG) was established within the Federal Trade Commission in 198...

  12. 16 CFR 0.13 - Office of the Inspector General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  13. 16 CFR 0.11 - Office of the General Counsel.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  14. 16 CFR 0.11 - Office of the General Counsel.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Office of the General Counsel. 0.11 Section 0.11 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ORGANIZATION § 0.11 Office of the General Counsel. The General Counsel is the Commission's chief law officer...

  15. 16 CFR 0.11 - Office of the General Counsel.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Office of the General Counsel. 0.11 Section 0.11 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ORGANIZATION § 0.11 Office of the General Counsel. The General Counsel is the Commission's chief law officer...

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

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Office of the General Counsel. 0.11 Section 0.11 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ORGANIZATION § 0.11 Office of the General Counsel. The General Counsel is the Commission's chief law officer...

  17. 16 CFR 0.11 - Office of the General Counsel.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  18. Factors influencing early retirement intentions in Australian rural general practitioners.

    PubMed

    Pit, S W; Hansen, V

    2014-06-01

    The Australian general practice workforce is ageing. This and a trend towards higher exit intentions and earlier retirement make it increasingly important to identify those work and personal factors affecting intention to leave, which are amenable to change. To assess the various work, occupational and individual health factors associated with early retirement intentions among Australian rural general practitioners (GPs) that may be amenable to intervention. A cross-sectional study of GPs practising in rural Australia. Odds ratios of early retirement intentions across work, occupational and individual health factors were calculated. There were 92 participants (response rate 56%), and 47% of responders intended to retire before 65. GPs with medium to high burnout levels had higher odds of intending to retire. Increased job satisfaction and work ability scores were associated with decreased retirement intentions, whereas increased physical and mental work ability demands were associated with an increase in retirement intentions. Absenteeism was not related to retirement intentions but presenteeism was. GPs reporting any work-related sleep problems were found to have a 3-fold increase in the odds of early retirement intentions. The odds of early retirement intentions also increased with higher psychological distress, worsening general health and longer working hours. From a health policy reform perspective, the greatest impact on reducing early retirement intentions among ageing GPs could potentially be made by intervening in areas of working hours, burnout and work-related sleep issues, followed by job satisfaction, psychological distress, health, general workability and mental and physical work ability. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Leadership and management curriculum planning for Iranian general practitioners

    PubMed Central

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

    2015-01-01

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

  20. Higher professional education for general practitioners: postal questionnaire survey.

    PubMed

    Smith, L F; Eve, R; Crabtree, R

    2000-04-01

    There is no consensus about whether higher professional education (HPE) is necessary for general practitioners (GPs) to complete their vocational training. To investigate beliefs about the need for HPE, its funding, duration, curriculum, and whether new principals (NPs) are eligible to undertake it. A confidential postal questionnaire was sent to senior partners, GP registrars, NPs, GP trainers, and GP tutors, principally in the old South West region of England, and nationally to other 'academic' GPs. Of 1199 GPs, 750 (62.6%) replied; 561 (79.2%) responders agreed with the principle of HPE for NPs, especially members of the Royal College of General Practitioners and academic GPs; senior partners (SPs) were less likely to agree (all P < 0.001). Of 700 GPs, 331 (50.3%) believed that HPE should last one or two years, 66.4% agreed that NPs should have a major input into the HPE curriculum, and 54.6% agreed that health authorities should be major sources of funding, together with the postgraduate deans (29.9%). GP tutors and trainers should have the main responsibility for teaching HPE. The principal barriers to setting up a HPE course are the financial cost, the time cost, difficulty in changing the status quo, and various practical problems. The facilitatory influences are: the enthusiasm of the NPs and of their clinical colleagues, an appropriate educational environment, a high quality clinical base, and recognition that NPs have specific needs. Of 668 GPs, 89.7% would release NPs if an HPE course were free and locums were paid, although SPs were less likely to agree (P < 0.001); if the HPE course cost the practice money, then only 30.6% would release NPs. If adequately externally funded, then there is widespread support for HPE with most GPs willing to release NPs. NPs and existing GP teachers should decide the curriculum. Its aim should be to provide educational support for NPs during the transition from GP registrar to fully-trained GP principal.

  1. Motivation for the choice of a general practitioner--attitudes of practitioners and patients.

    PubMed

    Budak, A; Tiljak, H; Katić, M

    1994-01-01

    The aim of this study was to find out if any significant changes occurred after introducing, the free choice of a general practitioner (GP) into primary health care. The determinants of patients' choice and GP's attitudes regarding this matter were tested. A survey was conducted in 1992 by distributing questionnaires to 71 GP's and 292 patients who chose these GPs. The questionnaires were composed selectively for GPs and patients, and they all answered them anonymously. The group of GPs consisted of 37 (52.1%) GPs with vocational training and of 31 (43.7%) GPs without vocational training. The patients evaluated the GPs' characteristics as very important in choosing a particular GP. Of medium importance were the surgery characteristics (where it was situated, work organization, equipment), and recommendations were the least important. Most frequently, the patients chose a particular GP because he was already the GP of one of the family members. The GPs assessed the family to be the most important determinant for a patient to choose a particular GP. Surgery characteristics (distance and work organization) were evaluated as being of medium importance. The recommendations of a friend were of medium importance, and the recommendations of medical staff were not important, according to the opinion of the surveyed GPs. The only occurrence detected in the survey was that of a "return" phenomenon, in which patients returned to their old GPs, which was a direct consequence of the implementation of the free choice principle into health care practice. The results of this study match the results of similar studies already published, and they are argumented theoretically.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Is it economically viable to employ the nurse practitioner in general practice?

    PubMed

    Dierick-van Daele, Angelique T M; Steuten, Lotte M G; Romeijn, Arla; Derckx, Emmy W C C; Vrijhoef, Hubertus J M

    2011-02-01

    This article provides insight into the potential economic viability of nurse practitioner employment in Dutch general practices. General practitioners face the challenging task of finding the most efficient and effective mix of professionals in general practice to accommodate future care demands within scarce health care budgets. To enable informed decision-making about skill mix issues, economic information is needed. Discursive paper. A descriptive and explorative design was chosen to study the economic viability of nurse practitioner employment in general practice. The conditions under which the nurse practitioner is able to earn back his/her own cost of employment were identified. Preferences and expectations of general practitioners and health insurers about nurse practitioner reimbursement were made transparent. Although general practitioners and health insurers acknowledge the importance of the nurse practitioner in accommodating primary care demands, they have polarised views about reimbursement. The employment of nurse practitioners is seldom economically viable in current practices. It requires a reallocation of (80% of) the general practitioner's freed up time towards practice growth (12% number of patients). The economic viability of the nurse practitioner has proven difficult to achieve in every day health care practice. This study provided insight into the complex interaction of the (cost) parameters that result in economic viability and feeds a further discussion about the content of the nurse practitioner role in general practice based on optimal quality of care vs. efficiency. Effective and efficient health care can only be provided if the actual care needs of a population provide the basis for deciding which mix of professionals is best equipped to deal with the changing and increasing demand of care. A macro-level intervention is needed to help a broad-scale introduction of the nurse practitioner in general practice. © 2011 Blackwell Publishing

  3. Prescribing by Canadian General Practitioners: Review of the English Language Literature

    PubMed Central

    Lexchin, Joel

    1990-01-01

    General practitioners write the vast majority of the 190 million prescriptions issued annually in Canada. The author reviewed the English language literature to determine the general characteristics of that prescribing, the appropriateness of prescribing, and factors that influence prescribing. On average, GPs write one prescription for every two office visits. Each prescription is for 1.2 to 1.4 items. Most of any GP's prescriptions are for a group of fewer than 30 different medications. Factors that influence prescribing include generic prescribing and knowledge of drug contents, provincial drug programs, physician and patient characteristics, type of practice, source of information about drugs, and rapidity of adoption of new drugs. The author offers suggestions for improving prescribing. PMID:21234063

  4. Motivations and Training Needs of General Practitioner Preceptors

    PubMed Central

    Ren, Wen; Hasenbieke, Nulanbieke; Liu, Ying; Qiu, Yan; Zhou, Zhao-Nong; Mao, Xiao-Yan; Ren, Jing-Jing

    2017-01-01

    Background: General practitioner (GP) preceptors play an important role in the cultivation of GPs. Many problems exist in the training of GP preceptors. This study aimed to explore the willingness and training needs of GP preceptors and compare the differences between preceptors from general practice and other specialties. Methods: A total of 375 questionnaire forms were sent to 375 GP preceptors from 11 different provinces, and 344 completed forms were returned. The main outcome included general information, teaching motivations, and training needs of GP preceptors. Results: The study showed that about 89.2% of GP preceptors were willing to be teachers. The majority of respondents strongly agreed that the motivation for becoming a GP supervisor was to learn from teaching. The most important capability they should master was clinical teaching (92.2%), followed by lecture (83.1%) and doctor–patient communication (83.1%). The top three preferred methods of GP preceptors training were case discussion (78.8%), workshop (57.6%), and classroom teaching (56.4%). The domains in which most GP preceptors wanted to acquire knowledge and skill were mental health (59.3%), rehabilitation (47.1%), pediatrics (41.0%), and obstetrics (37.5%). No significant differences were found in the willingness to train GPs (χ2 = 3.34, P > 0.05) and whether they would become or continue to become a GP supervisor after the training (χ2 = 1.106, P > 0.05). Conclusions: Although most preceptors were under on-the-job training, they were glad to train GPs. To be qualified, preceptors should be trained according to the actual needs of GP preceptors. PMID:28685719

  5. Motivations and Training Needs of General Practitioner Preceptors.

    PubMed

    Ren, Wen; Hasenbieke, Nulanbieke; Liu, Ying; Qiu, Yan; Zhou, Zhao-Nong; Mao, Xiao-Yan; Ren, Jing-Jing

    2017-07-20

    General practitioner (GP) preceptors play an important role in the cultivation of GPs. Many problems exist in the training of GP preceptors. This study aimed to explore the willingness and training needs of GP preceptors and compare the differences between preceptors from general practice and other specialties. A total of 375 questionnaire forms were sent to 375 GP preceptors from 11 different provinces, and 344 completed forms were returned. The main outcome included general information, teaching motivations, and training needs of GP preceptors. The study showed that about 89.2% of GP preceptors were willing to be teachers. The majority of respondents strongly agreed that the motivation for becoming a GP supervisor was to learn from teaching. The most important capability they should master was clinical teaching (92.2%), followed by lecture (83.1%) and doctor-patient communication (83.1%). The top three preferred methods of GP preceptors training were case discussion (78.8%), workshop (57.6%), and classroom teaching (56.4%). The domains in which most GP preceptors wanted to acquire knowledge and skill were mental health (59.3%), rehabilitation (47.1%), pediatrics (41.0%), and obstetrics (37.5%). No significant differences were found in the willingness to train GPs (χ2 = 3.34, P > 0.05) and whether they would become or continue to become a GP supervisor after the training (χ2 = 1.106, P > 0.05). Although most preceptors were under on-the-job training, they were glad to train GPs. To be qualified, preceptors should be trained according to the actual needs of GP preceptors.

  6. The Office of Inspector General (OIG)

    NASA Technical Reports Server (NTRS)

    Macisco, Christopher A.

    2004-01-01

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

  7. The Office of Inspector General (OIG)

    NASA Technical Reports Server (NTRS)

    Macisco, Christopher A.

    2004-01-01

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

  8. Opinions of general practitioners in Nottinghamshire about provision of intrapartum care.

    PubMed Central

    Brown, D. J.

    1994-01-01

    OBJECTIVE--To examine the beliefs of general practitioners concerning intrapartum care. DESIGN--Postal questionnaire survey. SUBJECTS--All general practitioners with patients in Nottinghamshire Family Health Services Authority in September 1993. MAIN OUTCOME MEASURES--General practitioners' current involvement in maternity care, and beliefs on intrapartum care. RESULTS--Of 694 general practitioners sent questionnaires, 550 (79.2%) replied. 529 of these were on the obstetric list; 437 had not attended a delivery in the past 12 months; 36 had attended two or more; 358 general practitioners did not wish to provide more intrapartum care; 349 did not feel competent to do so. Reasons for not wanting to provide intrapartum care included current workload (453), disruption to personal life (407), and the fear of litigation (377). General practitioners who already booked women for home delivery were more likely to wish to do more deliveries (62/42 v 61/316, chi 2 = 85.3; P < 0.0001) and to have more positive attitudes towards increasing women's choice in maternity care (90/22 v 195/151, chi 2 = 227; P < 0.0001). CONCLUSIONS--The involvement of general practitioners in intrapartum care in Nottinghamshire is low, and most general practitioners are unwilling to increase their role. However, general practitioners who already book for home delivery are keen to do more. PMID:7950566

  9. [Knowledge, attitudes and practices of general practitioners about asthma in the city of Ouagadougou].

    PubMed

    Badoum, G; Ouédraogo, S M; Lankoande, H; Ouédraogo, G; Boncoungou, K; Bambara, M; Ouédraogo, M

    2012-01-01

    In spite of a better understanding of the physiopathology of asthma and the existence of effective molecules, morbidity and mortality of asthma across the world are constantly increasing. International guidelines are not apparently applied. This study intended to assess the knowledge, attitudes and practices of general practitioners on asthma in Ouagadougou. This was a cross-sectional anonymous self-administered questionnaire involving 93 General Practitioners practicing in Ouagadougou. The participation rate was 63.4% or 59 respondents. The majority of General Practitioners (88%).know the chronic nature of asthma and 61% of them had good knowledge of severe asthma signs. The post-exercise asthma and medication asthma were known respectively by 22% and 15% of General Practitioners. Knowledge of the technique of using pressurized metered dose inhalers was bad in 54% of General Practitioners. In intermittent asthma, 52.5% of General Practitioners prescribed steroids including 27% in oral form. Inhaled corticosteroids were associated with β2-agonists by 34% of General Practitioners in persistent asthma. After initial treatment, 44% of study physicians routinely referred their patients to pulmonologists. Drug costs, lack of in-service training and lack of national guidelines were perceived as barriers by 56%, 66% and 44% of General Practitioners. The management of asthma is not optimal. The training of General Practitioners on the management of asthma is essential.

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

    PubMed

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

    2016-04-01

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

  11. Are general practitioners satisfied with electronic discharge summaries?

    PubMed

    Alderton, Melanie; Callen, Joanne

    2007-01-01

    The aim of this study was to assess general practitioners' (GPs') satisfaction with the quality of information in electronic discharge summaries and the timeliness of their receipt of the summaries. The study was conducted in a 75-bed Australian public metropolitan hospital which uses an electronic discharge summary which is mailed to the patients' nominated GP. Eighty-five GPs were surveyed regarding their satisfaction with the content of the electronic discharge summary and the timeliness of receipt. the majority of respondents indicated that they had received the electronic discharge summary within two weeks of the patients' discharge from hospital. The majority also indicated that they were satisfied with all eight documentation data elements. Some GPs indicated that they would prefer to receive the electronic discharge summary electronically by email rather than by conventional mail, and that they would like more information in the "follow-up and recommendations" content areas of the summary. It was concluded that the majority of GPs agreed that the electronic discharge summary was an improvement over the manual discharge summary. Further developments in the safe and secure electronic transfer of discharge summary information needs to be addressed to meet the information needs of GPs.

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

    PubMed

    Nixon, Michael Simon; Vendelø, Morten Thanning

    2016-06-20

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

  13. General practitioners' relationship with preventive knowledge: a qualitative study.

    PubMed

    Bloy, Géraldine; Rigal, Laurent

    2015-09-09

    General practitioners (GPs) do not provide enough preventive care. Nonetheless, without a detailed understanding of the logical processes that underlie their practices, it remains difficult to develop effective means of improvement. Their relationship to knowledge is one of three elements that strongly structure GPs' preventive work (together with the doctor-patient relationship and the organisation of their professional space).The objective of this article was to explore the question of GPs' relationship to knowledge about prevention. In 2010-2011, semi-directive interviews with a diverse sample of 100 GPs practising in the Paris metropolitan area were conducted. These interviews were coded according a reading grid that was developed collectively and analysed in the framework of grounded theory. The cognitive universe of GPs is neither homogeneous nor stable. It is composed of biomedical knowledge (delivered via guidelines, the professional press, opinion leaders and pharmaceutical companies), clinical knowledge (fed by individual situations from their daily experience and often conflicting with epidemiologic reasoning and data) and lay knowledge (from folk culture). Plunged into this complex cognitive universe that is difficult for them to master, doctors construct their own idiosyncratic preventive style by themselves, mostly in isolation. Two types of actions emerged as likely to help GPs better appropriate preventive knowledge: clarification of scientific data (especially from epidemiology and the social sciences) but also development of a collective analysis of the cognitive work required to integrate the different types of knowledge mobilised daily in their preventive practices.

  14. Communication between general practitioners and radiologists: opinions, experience, promises, pitfalls.

    PubMed

    Bosmans, J M L; Schrans, D; Avonts, D; De Maeseneer, J M

    2014-01-01

    Studies encompassing the views and aspirations of general practitioners (GPs) concerning the radiology report are rare. We present the results of a large-scale survey among GPs in Flanders, Belgium, and examine its implications for the communication between radiologists and GPs. GPs were invited by e-mail to participate in a survey on the radiology report. Respondents could state their degree of agreement with 46 statements. Besides that, they could freely make suggestions to improve the report. Quantitative results were examined to determine majority convictions. Free text suggestions were searched for motives and convictions. Of 1323 GPs invited, 282 completed forms were prepared for analysis. 96.8% considered the report an indispensable tool. 85.5% were satisfied with it. Itemized reporting of complex examinations was favoured by a very large majority. 83 GPs (29.4%) made suggestions for improvement. Much emphasis was put upon the clinical role of the radiologist. The need to mark key images, to mention meaningful normal findings, to structure the report and to facilitate communication was also frequently mentioned. GPs expect the radiologist to think as a clinician and offer clinical answers. An automated electronic information chain may contribute to realize this objective but direct communication should always remain possible.

  15. ["...always giving comfort". General practitioners and the everyday consolation].

    PubMed

    Mattsson, Bengt; Andersson, Sven-Olof; Magda, Jagiello

    2004-12-02

    Since the time of Hippocrates" ... to always comfort" has been regarded as a part of every physician's profession. However, this daily phenomenon of medical practice has not been studied very much so far. Consolation is sometimes emphasized when care is more prominent than cure, as in palliative or intensive care or when seeing family members during these circumstances. Six general practitioners in a focus-group interview presented narratives about their experience of consolation in the consultation. They also described the last time they managed to comfort a patient. The narratives were analysed by an empirical psychological phenomenological method. Four themes emerged that gave a meaning to consolation: "presence", "be in contact", "confirmation" and "restoration". The consultations were characterized by acceptance, freedom, respect and absence of demand. However, consolation could also be associated with negative features such as instrumental and ritual behaviour and a "top-down" attitude that inhibited the healing process. Consolation as an important element of medical practice needs to be further studied.

  16. Old boys' network in general practitioners' referral behavior?

    PubMed

    Hackl, Franz; Hummer, Michael; Pruckner, Gerald J

    2015-09-01

    We analyzed the impact of social networks on general practitioners' (GPs) referral behavior based on administrative panel data from 2,684,273 referrals to specialists made between 1998 and 2007. For the definition of social networks, we used information on the doctors' place and time of study and their hospital work history. We found that GPs referred more patients to specialists within their personal networks and that patients referred within a social network had fewer follow-up consultations and less inpatient days thereafter. The effects on patient outcomes (e.g. waiting periods, days in hospital) of referrals within personal networks and affinity-based networks differed. Specifically, whereas empirical evidence showed a concentration on high-quality specialists for referrals within the personal network, suggesting that referrals within personal networks overcome information asymmetry with respect to specialists' abilities, the empirical evidence for affinity-based networks was different and less clear. Same-gender networks tended to refer patients to low-quality specialists.

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

    PubMed

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

    2013-04-01

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

  18. Survey of Irish general practitioners' preferences for continuing professional development.

    PubMed

    Maher, B; O'Neill, R; Faruqui, A; Bergin, C; Horgan, M; Bennett, D; O'Tuathaigh, C M P

    2017-06-14

    Doctors' continuing professional development (CPD) training needs are known to be strongly influenced by national and local contextual characteristics. Given the changing national demographic profile and government-mandated changes to primary care health care provision, this study aimed to investigate Irish General Practitioners' (GPs) perceptions of, and preferences for, current and future CPD programmes. A cross-sectional questionnaire, using closed- and open-ended questions, was administered to Irish GPs, focusing on training needs analysis; CPD course content; preferred format and the learning environment. The response rate was 719/1000 (71.9%). GPs identified doctor-patient communication as the most important and best-performed GP skill. Discrepancies between perceived importance (high) and current performance (low) emerged for time/workload management, practice finance and business skills. GPs identified clinically-relevant primary care topics and non-clinical topics (stress management, business skills, practice management) as preferences for future CPD. Flexible methods for CPD delivery were important. Gender and practice location (urban or rural) significantly influenced CPD participation and future course preference. The increasing diversity of services offered in the Irish primary care setting, in both clinical and non-clinical areas, should be tailored based to include GP practice location and structure.

  19. The use of neuroimaging in dementia by Irish general practitioners.

    PubMed

    Ciblis, A S; Butler, M-L; Bokde, A L W; Mullins, P G; McNulty, J P

    2016-08-01

    More than 48,000 people in Ireland are living with dementia, and the number is likely to rise to 130,000 by 2041. Dementia frequently remains undiagnosed, depriving many of early interventions and the opportunity to plan for the future. Neuroimaging is helpful in the diagnosis of dementia, yet it is often insufficiently utilised. General practitioners (GPs) often decide which patients should be referred on for specialist assessment and as such play a crucial role in dementia diagnosis. To establish the accessibility of neuroimaging in dementia by GPs, current referral patterns, confidence in referral and opinions on radiology reports. The research design was a postal survey among GPs in single and group practices in urban, rural and semi-rural areas in the east and southeast of Ireland. GPs were identified from the Irish Medical Directory and posted individual anonymous questionnaires. A third of participants reported that they had no direct access to neuroimaging. Access differed between public and private patients. GPs primarily referred to computed tomography and magnetic resonance imaging, but only 14.6 % based these referrals on published guidelines. A total of 47.8 % of participants were not very confident in their ability to choose the most appropriate modality. Access to neuroimaging investigations for suspected cases of dementia varies between locations and public and private systems. To improve diagnostic rates and ensure appropriate utilisation of imaging resources, GPs require access to clinical and referral guidelines to ensure appropriate use of neuroimaging and the best possible patient outcomes.

  20. Dutch occupational physicians and general practitioners wish to improve cooperation

    PubMed Central

    Buijs, P.; van Amstel, R.; van Dijk, F.

    1999-01-01

    OBJECTIVES: To investigate cooperation between occupational physicians (OPs) and general practitioners (GPs). METHODS: Literature review; structured interviews; questionnaires sent to randomised samples of OPs (n = 232) and GPs (n = 243). RESULTS: Actual cooperation is poor. However, more than 80% of both groups responded that they want to improve their cooperation, aiming at better quality of care. Obstacles identified by OPs include insufficient knowledge among GPs about occupational health services (OHSs) (57%) and their patients' working conditions (52%). OPs also consider that GPs suspect them of serving employers more than employees (44%) and of verifying reasons of absence, with information from GPs (34%). Responses from GPs confirm these two suspicions (48%, response 58%), adding obstacles like commercialisation of OHS, lack of financial incentives, etc. Both groups are unanimous about prerequisites for improvement, especially guaranteeing the professional autonomy of OPs (OPs 86%, GPs 76%). CONCLUSION: As a first step to overcome obstacles to cooperation, OPs must clarify their position to GP colleagues. Initiatives have been taken after presenting this study.   PMID:10658552

  1. Doctors as patients: postal survey examining consultants and general practitioners adherence to guidelines

    PubMed Central

    Forsythe, Malcolm; Calnan, Michael; Wall, Barbara

    1999-01-01

    Objectives To examine the adherence by senior NHS medical staff to the BMA guidelines on the ethical responsibilities of doctors towards themselves and their families. Design Postal semistructured questionnaire. Setting Four randomly selected NHS trusts and three local medical committees in South Thames region. Subjects Consultants and principals in general practice. Main outcome measures Personal use of health services. Results The response rate was 64% (724) for general practitioners and 72% (427) for consultants after three mailings. Most (1106, 96%) respondents were registered with a general practitioner, although little use was made of their services. 159 (26%) general practitioners were registered with a general practitioner in their own practice and 80 (11%) admitted to looking after members of their family. 73 (24%) consultants would never see their general practitioner before obtaining consultant advice. Most consultants and general practitioners admitted to prescribing for themselves and their family. Responses to vignettes for different health problems indicated a general reluctance to take time off, but there were differences between consultants and general practitioners and by sex. Views on improvements needed included the possibility of a “doctor’s doctor,” access to out of area secondary care, an occupational health service for general practitioners, and regular health check ups. Conclusion The guidelines are largely not being followed, perhaps because of the difficulties of obtaining access to general practitioners outside working hours. The occupational health service should be expanded and a general practitioner service for NHS staff piloted. Key messagesSenior doctors are not following the BMA guidelines on looking after their own and their families’ healthThey seem very reluctant to consult their general practitioner They prefer to self treat, carry on working, and consult informallyPotential barriers to access should be removed in order

  2. Pharmacists' and general practitioners' pharmacology knowledge and pharmacotherapy skills.

    PubMed

    Keijsers, Carolina J P W; Leendertse, Anne J; Faber, Adrianne; Brouwers, Jacobus R B J; de Wildt, Dick J; Jansen, Paul A F

    2015-08-01

    Understanding differences in the pharmacology knowledge and pharmacotherapy skills of pharmacists and physicians is vital to optimizing interprofessional collaboration and education. This study investigated these differences and the potential influence of work experience. The pharmacology knowledge and pharmacotherapy skills of pharmacists, general practitioners (GPs), and trainees were compared, using a written assessment; 294 participants were included. Overall scores (mean ± SD) ranged from 69.3% ± 6.5% to 76.5% ± 9.5% for basic knowledge, 70.3% ± 10.8% to 79.7% ± 8.4% for applied knowledge, and 66.3% ± 21.1% to 84.7% ± 20.7% for pharmacotherapy skills (analysis of variance all P < .05). The pharmacists had the highest scores for all domains (P < .05), with the exception of pharmacist trainees, who had comparable scores for basic knowledge and pharmacotherapy skills (both P > .05). The GPs scored the lowest for pharmacotherapy skills (P < .05). More work experience was associated with better knowledge of applied pharmacology among pharmacists (by 2% per 10 work-years), but with poorer pharmacotherapy skills among pharmacists and GPs (by 3% and 4% per 10 work-years, respectively). In conclusion, pharmacists and GPs differ in their knowledge and skills, and these differences become more pronounced with more work experience. In general, pharmacists outperform pharmacist trainees, whereas GP trainees outperform GPs. These differences could be important for interdisciplinary collaboration and education. © 2015, The American College of Clinical Pharmacology.

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

    PubMed Central

    Greß, Stefan; Schäfer, Willemijn

    2016-01-01

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

  4. General practitioners' approach to malingering in basic military training centres.

    PubMed

    Kokcu, Alper Tunga; Kurt, E

    2017-04-01

    Malingering can be defined as the abuse of the right to benefit from the health services. In this study, the frequency of the malingering cases in Basic Military Training Centres (BMTCs) and the behaviours and the attitudes of the military physicians towards the recruits who are suspected malingerers were described. A total of 17 general practitioners in nine different BMTCs in different regions of Turkey constitute the universe of this descriptive study. In the questionnaire, there were a total of 30 questions about the descriptive characteristics of the participants and their attitudes and behaviours towards malingering. Informed consent form and a questionnaire were applied through the intranet via participants' emails. In the study, 15 physicians were reached with a response rate of 88.2%. All of the physicians suspected malingering in some of the soldiers who were examined. A total of 80% of the physicians (n=12) suspected malingering in at least 10% of the patients they examined. Only 13.3% of the physicians (n=2) had officially diagnosed a case of malingering in the last training period. All of the participants stated that they did not report the official decision for every soldier suspected of malingering. Instead of reporting official decision for malingering, the military physicians apply alternative procedures for suspected malingerers. In countries where the military service is compulsory, prevalence of malingering is estimated to be higher (approximately 5-25%). The problem of malingering is often underestimated due to the fact it is usually overlooked. Malingering remains a problem for the entire military healthcare system, due to the difficulties in exact diagnosis. Therefore, it can be useful to take some practical administrative measures for the soldiers who are prone to malingering, in order to discourage the behaviour. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  5. General practitioners and doping in sport: attitudes and experience

    PubMed Central

    Laure, P; Binsinger, C; Lecerf, T; Ayotte, C

    2003-01-01

    Objectives: To examine the attitudes to, and knowledge of, doping in sport of French general practitioners (GPs), and their contact with drug taking athletes on an everyday basis. Methods: A total of 402 GPs were randomly selected from all over France and interviewed by telephone, using a prepared script. Results: The response rate was 50.5% (153 men and 49 women; mean (SD) age 45.6 (5.6) years). Of the respondents, 73% confirmed that they had the list of banned products, and only 34.5% stated that they were aware of the latest French law, brought into effect in March 1999, concerning the fight against doping. Some 11% had directly encountered a request for prescription of doping agents over the preceding 12 months (the requested substances were mainly anabolic steroids, stimulants, and corticosteroids), and 10% had been consulted by an athlete who was using doping drugs and was frightened of the health risks (the substances used were mainly anabolic steroids). Over half (52%) of the GPs favoured the prescription of drug substitutions to athletes who used doping agents. According to 87.5% of respondents, doping is a public health problem, and 80% stated that doping is a form of drug addiction. Most (89%) said that a GP has a role to play in doping prevention, but 77% considered themselves poorly prepared to participate in its prevention. Conclusion: The results suggest that (a) GPs have limited knowledge of doping and (b) are confronted with doping in their daily practice, at least occasionally. PMID:12893720

  6. Identification of smokers, drinkers and risky drinkers by general practitioners.

    PubMed

    Manthey, Jakob; Probst, Charlotte; Hanschmidt, Franz; Rehm, Jürgen

    2015-09-01

    Identification of risky substance users by general practitioners (GPs) is important for providing brief interventions or to refer cases to specialized care, but detection rates of risky users are low, with alcohol users being identified less frequently than smokers. We compared GPs' assessment and patient self-report concerning tobacco use, number of cigarettes smoked daily, alcohol use, alcohol use disorder, and different risky use definitions of 8476 primary care patients from six European countries. Further, we carried out a logistic regression predicting the GPs perception of the patients' alcohol problems. GPs identified 88.4% (95% confidence interval (CI): 87.1-89.6%; κ=0.84, 95% CI: 0.83-0.86) of all self-reported smokers but only 64.6% (95% CI: 63.2-65.9%; κ=0.35, 95% CI: 0.33-0.37) of all current drinkers, while they were unable to judge the drinking status of every ninth patient. The GPs' estimation of number of cigarettes smoked daily was slightly lower than the self-report (Δ=0.23 cigarettes/day, p<.001) but both measures were correlated with each other. Of all risky drinkers, defined as having alcohol-related problems or showing risky drinking patterns, 28.7% (95% CI: 25.9-31.4%; κ=0.34, 95% CI: 0.31-0.37) were perceived as having problems with alcohol by the GPs. Patients' self-reported health and social consequences, as well as drinking patterns predicted the GPs' perception of alcohol problems. GPs were more accurate in identifying smokers than drinkers. Concerning risky drinkers, GPs failed to diagnose a sizeable proportion but were able to detect other drinkers whom common recognition approaches had not recognized. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Musculoskeletal disorders among a group of Iranian general dental practitioners.

    PubMed

    Tirgar, Aram; Javanshir, Khodabakhsh; Talebian, Arash; Amini, Fatemeh; Parhiz, Alireza

    2015-01-01

    Dentists have to remain in a fixed position during dental practices for the accuracy required, therefore they are susceptible to musculoskeletal disorders (MSDs). Considering the infrequency of ergonomics studies in general dental practitioners (GDPs), especially in cervical region, this study aimed to reviews MSDs in the neck region among GDPs. An analytic cross-sectional study was carried out among the GDPs in 2011. A total of 60 dentists (40 males and 20 females) were examined through a combination of questionnaires (concerning their demographic information) such as the Nordic standardized musculoskeletal disorder questionnaire (NMQ) and Body Discomfort Assessment questionnaire (BDA). Each dentist's working posture was assessed using Rapid Upper Limb Assessment (RULA) and deep cervical flexor muscle endurance through a Craniocervical Flexion test (CCFT). Descriptive statistical indexes and Chi-square test were used for statistical analysis, while considering p< 0.05. The mean dental practice experience was 16.9 ± 5.6 years with average 41.2 ± 13.4 working hours per week. About 45% of dentists took regular exercises weekly. Some 83.3% of these dentists expressed to be suffering from the cervical pain, whereas, 56.7% complained about back pains and 41% shoulder problems. Female dentists were found more at risk of neckache, discomfort and pain in shoulder and hand than males. Greater pain frequency in knee was found in more experienced and older age dentists (P= 0.07). Results from the CCF test showed that the deep cervical flexor muscles endurance increased with regular exercise and decreased with aging. Many dentists experience the MSDs, especially in cervical region, as a consequence of occupational stresses. Therefore, detecting occupational risk factors, standards of work position, regular exercise and following ergonomic policy are intensely recommended.

  8. Nurse practitioners, certified nurse midwives, and physician assistants in physician offices.

    PubMed

    Park, Melissa; Cherry, Donald; Decker, Sandra L

    2011-08-01

    The expansion of health insurance coverage through health care reform, along with the aging of the population, are expected to strain the capacity for providing health care. Projections of the future physician workforce predict declines in the supply of physicians and decreasing physician work hours for primary care. An expansion of care delivered by nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) is often cited as a solution to the predicted surge in demand for health care services and calls for an examination of current reliance on these providers. Using a nationally based physician survey, we have described the employment of NPs, CNMs, and PAs among office-based physicians by selected physician and practice characteristics.

  9. General Practitioners and Dentists: A Call for Action Against Tobacco.

    PubMed

    Gallus, Silvano; Lugo, Alessandra; Garattini, Silvio; Pacifici, Roberta; Mastrobattista, Luisa; Marzo, Giuseppe; Paglia, Luigi

    2016-12-01

    To investigate the frequency of advice to quit smoking received by the Italian population from general practitioners (GP) and dentists, we analyzed a cross-sectional study. A face-to-face survey was conducted in 2014 on 3052 individuals, representative of the general Italian population aged 15 years or more. During the previous year, 89% of individuals (82% of smokers) reported that they had visited a GP while 71% (67% of smokers) had visited a dentist. Among smokers, 25% reported that they had received advice to quit smoking from their GP, and 26% from their dentist. Advice by GPs was less frequently received by smokers with higher education (multivariate odds ratios (OR) were 0.48 for intermediate and 0.38 for high as compared to low education), and more frequently by heavy smokers (≥15 cigarettes/day; OR = 1.78), those with intention to quit (OR = 2.59), with previous quit attempts (OR = 2.09), and those aware of the existence of smoking cessation services (OR = 1.59). Advice by dentists was more frequently received by smokers aged 25-44 years (OR = 3.55 compared to those aged 15-24) and those with an intention to quit (OR = 2.46). Among Italian current smokers, 32% reported that their GP and 17% that their dentist was a current smoker. The corresponding figures among young smokers were 40% and 26%, respectively. Healthcare providers have the potential to become a key reference point in the fight against smoking. However, before acting, GPs and dentists should set a good example: those who smoke should urgently quit or at least refrain from smoking during working hours. GPs and dentists, reaching the large majority of Italian smokers, can make a major contribution in the fight against tobacco. Future studies are needed to investigate possible reasons of the apparently high smoking prevalence among GPs, in order to develop tailored smoking cessation interventions for healthcare providers. © The Author 2016. Published by Oxford University Press on behalf of the

  10. General practitioners and pharmaceutical sales representatives: quality improvement research

    PubMed Central

    Spurling, Geoffrey; Mansfield, Peter

    2007-01-01

    Background and objective Interaction between pharmaceutical sales representatives (PSRs) and general practitioners (GPs) may have an adverse impact on GP prescribing and therefore may be ethically questionable. This study aimed to evaluate the interactions between PSRs and GPs in an Australian general practice, and develop and evaluate a policy to guide the interaction. Methods Doctors' prescribing, diaries, practice promotional material and samples were audited and a staff survey undertaken. After receiving feedback, the staff voted on practice policy options. The resulting policy was evaluated 3 and 9 months. Results Prior to the intervention, GPs spent on average 40 min/doctor/month with PSRs. There were 239 items of promotional material in the practice and 4660 tablets in the sample cupboard. These were reduced by 32% and 59%, respectively, at 3 months after policy adoption and the reduction was sustained at 9 months. Vioxx was the most common drug name in promotional material. Staff adopted a policy of reduced access to PSRs including: reception staff not to make appointments for PSRs or accept promotional material; PSRs cannot access sample cupboards; GPs wishing to see PSRs may do so outside consulting hours. At 3 and 9 months, most staff were satisfied with the changes. Promotional items/room were not significantly reduced at 3 months (−4.0 items/room ; 95% CI −6.61 to −1.39; p = 0.066) or 9 months (−2.63 items/room; 95% CI −5.86 to 0.60; p = 0.24). Generic prescribing significantly increased at 3 months (OR 2.28, 95% CI 1.31 to 3.86; p = 0.0027) and 9 months (OR 2.07, 95% CI 1.13 to 3.82; p = 0.016). Conclusion There was a marked reduction in interactions with PSRs with majority staff satisfaction and improved prescribing practices. The new policy will form part of the practice's orientation package. Reception staff give PSRs a letter explaining the policy. It is hoped that the extra 40 min/doctor of

  11. [General practitioners' needs for continuing medical education in the Sousse region (Tunisia)].

    PubMed

    Ben Abdelaziz, Ahmed; Haddad, Sofiène; Harrabi, Imed; Ghannem, Hassen

    2002-01-01

    A continuing medical education is an essential activity in the search for doctors' performance, provided it is adapted to the specificity of their medical practice. The objective of this work is to identify the needs of general practitioners in relation to continuing medical education. It is a structural descriptive and transversal survey of about 112 general practitioners among the 140 doctors in the Sousse region in 2000. Data have been collected through a questionnaire that develops the expectation of general practitioners concerning the themes, domains and specialties privileged in a continued training. This research shows that the diagnostic and therapeutic strategies of current affections were themes requested by 85% of general practitioners. The doctor-patient relation has been chosen by 71% of doctors. Emergency medicine was the specialty proposed by most of them. Thus, general practitioners expect a permanent training specific to their profile that could improve their clinical and relational competences.

  12. General practitioners' views on quality specifications for "outpatient referrals and care contracts".

    PubMed Central

    Bowling, A; Jacobson, B; Southgate, L; Formby, J

    1991-01-01

    OBJECTIVE--To ascertain general practitioners' views about which quality specifications should be included in contracts for hospital care. DESIGN--In depth interview study and postal survey. SETTING--General practitioners in City and Hackney Health District. SUBJECTS--Fourteen doctors were interviewed in depth; 77 of 131 doctors (59%) returned postal questionnaires. MAIN OUTCOME MEASURE--Rating of listed quality specifications. RESULTS--The most popular items which doctors thought should be included in contracts by April 1991 related to the availability of patients' notes in outpatient clinics, respect shown to general practitioners in telephone communications with hospital doctors, supply of medicines after discharge, patient management plans for general practitioners, the earlier arrival of discharge slips, the type of hospital doctor to see new outpatients, and the unnecessary duplication of investigations. CONCLUSIONS--A high premium was attached by general practitioners to effective organisation, effective communication between primary and secondary sources of care, and effective communication with patients. PMID:1888933

  13. Annual report, Office of the Inspector General

    SciTech Connect

    Mansfield, J.K.

    1980-03-01

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

  14. Patients with urinary tract infection: proposed management strategies of general practitioners, microbiologists and urologists.

    PubMed Central

    Olesen, F; Oestergaard, I

    1995-01-01

    BACKGROUND. It is difficult to implement change in general practice. It is not known how best to conduct effective continuing medical education in general practice. General practitioners' criteria for good clinical practice vary and it is unknown whether systematic education by hospital specialists could be expected to reduce variation between general practitioners. AIM. A study was undertaken to describe general practitioners', microbiologists' and urologists' strategies for diagnosis, treatment, and follow up of female patients with symptoms of urinary tract infection, a common reason for consultation in general practice. The findings of the study were to be used as a base upon which to discuss the advantages and disadvantages of using hospital specialists as a resource in general practitioners' peer group based continuing medical education. METHOD. Three vignettes together with several proposals for diagnosis, treatment and follow up were presented in a questionnaire to general practitioners, microbiologists and urologists in Denmark. The case histories concerned three female patients (aged 10, 30 and 60 years) who consulted their general practitioner for advice. The female patients were otherwise healthy and well known to the practice. General practitioners', microbiologists' and urologists' recommendations for good clinical practice were compared. RESULTS. A total of 154 general practitioners (77%), 45 microbiologists (51%) and 54 urologists (61%) who were eligible for the study responded to the questionnaire. There was considerable variation in the management strategies proposed by doctors within each specialty and between the specialties. Microbiologists and urologists were more likely to suggest treating the 30-year-old woman by giving advice and a prescription by telephone compared with their general practitioner colleagues. Conversely, the microbiologists and urologists were more likely to suggest asking the 10- and 60-year-old patients to attend the

  15. Assessment of English-Language Proficiency for General Practitioner Registrars

    ERIC Educational Resources Information Center

    Chur-Hansen, Anna; Elliott, Taryn Elizabeth; Klein, Nigel Charles; Howell, Cate Adele

    2007-01-01

    Introduction: English-language proficiency of medical practitioners is an issue attracting increasing attention in medical education. To best provide language education support, it is essential that learning needs are assessed and that useful feedback and advice are provided. We report the outcomes of a language assessment that was embedded within…

  16. General medicine and surgery for dental practitioners. Part 5--Psychiatry.

    PubMed

    Brown, S; Greenwood, M; Meechan, J G

    2010-07-10

    There are a significant number of patients in society who have some form of psychiatric disorder. It is important that dental practitioners have an awareness of the more common psychiatric disorders and their potential implications as they are likely to encounter them in clinical practice.

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

    ERIC Educational Resources Information Center

    Grembowski, David; And Others

    1989-01-01

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

  18. Video Consultation Use by Australian General Practitioners: Video Vignette Study

    PubMed Central

    2013-01-01

    Background There is unequal access to health care in Australia, particularly for the one-third of the population living in remote and rural areas. Video consultations delivered via the Internet present an opportunity to provide medical services to those who are underserviced, but this is not currently routine practice in Australia. There are advantages and shortcomings to using video consultations for diagnosis, and general practitioners (GPs) have varying opinions regarding their efficacy. Objective The aim of this Internet-based study was to explore the attitudes of Australian GPs toward video consultation by using a range of patient scenarios presenting different clinical problems. Methods Overall, 102 GPs were invited to view 6 video vignettes featuring patients presenting with acute and chronic illnesses. For each vignette, they were asked to offer a differential diagnosis and to complete a survey based on the theory of planned behavior documenting their views on the value of a video consultation. Results A total of 47 GPs participated in the study. The participants were younger than Australian GPs based on national data, and more likely to be working in a larger practice. Most participants (72%-100%) agreed on the differential diagnosis in all video scenarios. Approximately one-third of the study participants were positive about video consultations, one-third were ambivalent, and one-third were against them. In all, 91% opposed conducting a video consultation for the patient with symptoms of an acute myocardial infarction. Inability to examine the patient was most frequently cited as the reason for not conducting a video consultation. Australian GPs who were favorably inclined toward video consultations were more likely to work in larger practices, and were more established GPs, especially in rural areas. The survey results also suggest that the deployment of video technology will need to focus on follow-up consultations. Conclusions Patients with minor self

  19. Emergency medical dispatching by general practitioners in Brussels.

    PubMed

    Renier, W; Seys, B

    1995-09-01

    The objective of this study was to introduce general practitioners (GPs) to the existing emergency medical services (EMS) system, in order to improve the response to emergency residential calls. The study was based in Brussels, which has 1 million residents. A GP dispatcher (GPD) was placed in the emergency dispatch centre, with a stand-by GP, together with adequate equipment, at his or her immediate disposal. A comparative evaluation was conducted in 1994 to measure the changes brought by the availability of a stand-by GP to the emergency medical dispatching performed by the GPD in an experimental zone (EZ) in comparison with a control zone (CZ). The evolution between a first period at the beginning of the year and a second period in September was also analysed. In total, 1059 residential emergency calls were included in the study. The amount of missing data in the filing cards, collaboration between the emergency medical dispatcher (EMD) and the GPD, and evaluation of the emergency levels were improved by training the GPD and the stand-by GP. Intervention times of the stand-by GP varied according to the level of the emergency. The sending of supplementary assistance after dispatching an EMS ambulance, a stand-by GP or a GP of an on-call service was significantly different in the EZ compared with the CZ. The percentage of EMS ambulances and GPs sent increased. The evolution between the two periods was characterized in the CZ by the disappearance of the supplementary assistance performed by the stand-by GP or by the GP of the on-call service and in the EZ by a slight but not significant increased use of the mobile intensive care units (MICUs) for initial assistance. A stand-by GP was used in about 10% of the cases as supplementary assistance. A large number of non-vital urgent complaints arrive at the dispatch centre. The availability of a stand-by GP does not cause an increase (rather a decrease) in MICU use in initial care and supplementary assistance. It causes

  20. Video consultation use by Australian general practitioners: video vignette study.

    PubMed

    Jiwa, Moyez; Meng, Xingqiong

    2013-06-19

    There is unequal access to health care in Australia, particularly for the one-third of the population living in remote and rural areas. Video consultations delivered via the Internet present an opportunity to provide medical services to those who are underserviced, but this is not currently routine practice in Australia. There are advantages and shortcomings to using video consultations for diagnosis, and general practitioners (GPs) have varying opinions regarding their efficacy. The aim of this Internet-based study was to explore the attitudes of Australian GPs toward video consultation by using a range of patient scenarios presenting different clinical problems. Overall, 102 GPs were invited to view 6 video vignettes featuring patients presenting with acute and chronic illnesses. For each vignette, they were asked to offer a differential diagnosis and to complete a survey based on the theory of planned behavior documenting their views on the value of a video consultation. A total of 47 GPs participated in the study. The participants were younger than Australian GPs based on national data, and more likely to be working in a larger practice. Most participants (72%-100%) agreed on the differential diagnosis in all video scenarios. Approximately one-third of the study participants were positive about video consultations, one-third were ambivalent, and one-third were against them. In all, 91% opposed conducting a video consultation for the patient with symptoms of an acute myocardial infarction. Inability to examine the patient was most frequently cited as the reason for not conducting a video consultation. Australian GPs who were favorably inclined toward video consultations were more likely to work in larger practices, and were more established GPs, especially in rural areas. The survey results also suggest that the deployment of video technology will need to focus on follow-up consultations. Patients with minor self-limiting illnesses and those with medical

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

    PubMed

    Montalto, M; Dunt, D; Young, D

    1994-12-01

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

  2. [An advanced nurse practitioner in general medicine in the United Kingdom].

    PubMed

    Aston, Jenny

    2015-01-01

    In the United Kingdom, an advanced nurse practitioner can carry out consultations and write prescriptions in the same way as a general practitioner. Jenny Aston, a nurse for more than 30 years, works in a GP surgery in Cambridge. Here, she explains the role of nurses in the organisation of health care in the UK, and talks about her career and her missions as an advanced nurse practitioner. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  3. Should general practitioners have any role in maternity care in the future?

    PubMed Central

    Smith, L F

    1996-01-01

    Maternity services in England are currently being reorganized. The success of the changes will be judged against the recommendations of the Changing Childbirth report. This paper describes the nature of maternity care and of general practice. It is argued that maternity care provision by general practitioners is a central and essential part of British general practice. Specifically, it is shown how general practitioners can help to achieve the objectives of the report, and thus, have a future role. It is suggested that all general practitioners who wish maternity care to remain an essential part of general practice need to argue the case with providers and purchasers. If they do not, then it is quite likely that general practitioners will be increasingly excluded as the commissioning and contracting mechanisms become more effective with midwives providing low-risk care and consultant obstetricians high-risk care. PMID:8703528

  4. Attitudes of general dental practitioners towards endodontic standards and adoption of new technology: literature review.

    PubMed

    Peciuliene, Vytaute; Maneliene, Rasmute; Drukteinis, Saulius; Rimkuviene, Jurate

    2009-01-01

    Research data regarding attitudes of general dental practitioners towards endodontic therapy is rare. The present review summarizes existing literature and analyzes human factors that could potentially influence the outcome of endodontic treatment in general dental practice. Root canal treatment usually fails when treatment falls short of acceptable standards. The results of questionnaire surveys from several countries indicate that differences between daily general practice and academic teaching exist. The results of studies indicated that majority of general practitioners disregard the most basic principles of endodontic treatment. The most striking finding is the generally negative attitude amongst general dental practitioners towards performing endodontic treatment and adoption of new technologies in a daily endodontic practice. The results confirm that root canal treatment is technically demanding and in general practice is carried out under less than optimal conditions. This review shows the importance of continuous dental education for practitioners in order to update their knowledge.

  5. Asian mothers' use of general-practitioner and maternal/child welfare services

    PubMed Central

    Ronalds, Clare; Vaughan, J. P.; Sprackling, P.

    1977-01-01

    A matched control study was carried out to determine whether Asian immigrants in Nottingham made more or less use of the general-practitioner services than British-born white subjects. The study was limited to antenatal, postnatal, and infant care in one general practice, and information was collected from general-practitioner and health-visitor records and by an interview with the mother. The findings showed no difference between the two groups in the use of the general-practitioner or maternal and child welfare services. PMID:874935

  6. Physical therapy plus general practitioners' care versus general practitioners' care alone for sciatica: a randomised clinical trial with a 12-month follow-up.

    PubMed

    Luijsterburg, Pim A J; Verhagen, Arianne P; Ostelo, Raymond W J G; van den Hoogen, Hans J M M; Peul, Wilco C; Avezaat, Cees J J; Koes, Bart W

    2008-04-01

    A randomised clinical trial in primary care with a 12-months follow-up period. About 135 patients with acute sciatica (recruited from May 2003 to November 2004) were randomised in two groups: (1) the intervention group received physical therapy (PT) added to the general practitioners' care, and (2) the control group with general practitioners' care only. To assess the effectiveness of PT additional to general practitioners' care compared to general practitioners' care alone, in patients with acute sciatica. There is a lack of knowledge concerning the effectiveness of PT in patients with sciatica. The primary outcome was patients' global perceived effect (GPE). Secondary outcomes were severity of leg and back pain, severity of disability, general health and absence from work. The outcomes were measured at 3, 6, 12 and 52 weeks after randomisation. At 3 months follow-up, 70% of the intervention group and 62% of the control group reported improvement (RR 1.1; 95% CI 0.9-1.5). At 12 months follow-up, 79% of the intervention group and 56% of the control group reported improvement (RR 1.4; 95% CI 1.1; 1.8). No significant differences regarding leg pain, functional status, fear of movement and health status were found at short-term or long-term follow-up. At 12 months follow-up, evidence was found that PT added to general practitioners' care is only more effective regarding GPE, and not more cost-effective in the treatment of patients with acute sciatica than general practitioners' care alone. There are indications that PT is especially effective regarding GPE in patients reporting severe disability at presentation.

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

    PubMed Central

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

    1995-01-01

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

  8. [Attitudes of Japanese general practitioners towards referrals of patients with dementia].

    PubMed

    Umegaki, Hiroyuki; Suzuki, Yusuke; Kuzuya, Masafumi; Iguchi, Akihisa

    2007-01-01

    The cooperation of general practitioners and specialists is crucial to establish comprehensive medical services for demented older adults. In the current study we conducted a survey regarding the attitudes towards referrals between general practitioners and specialists by sending a questionnaire to 1,176 general practitioners. The 39.1% of the general practitioners returned the questionnaire. Of the respondents, 68.8% answered that they did not want referrals of demented patients from specialists, however, when analysis was limited to those who had an internal medicine background, only 26.3% did not want referrals. Difference of subspecialties within internists did not affect the preference for referrals. Regarding the reasons for referring the demented patients to specialists, more than 70% of the general practitioners chose "accurate diagnosis of the cause of dementia" and "decision of therapeutic plans". The majority of general practitioners in Japan may still be reluctant to follow patients with dementia mainly because they regard the practice of seeing demented patients as the subject outside of their specialty. Therefore providing general practitioners with opportunities to receive training programs regarding the practice and care of demented patients, as well as establishing support from specialists is necessary.

  9. Why and how do general practitioners teach? An exploration of the motivations and experiences of rural Australian general practitioner supervisors.

    PubMed

    Ingham, Gerard; Fry, Jennifer; O'Meara, Peter; Tourle, Vianne

    2015-10-29

    In medical education, a learner-centred approach is recommended. There is also a trend towards workplace-based learning outside of the hospital setting. In Australia, this has resulted in an increased need for General Practitioner (GP) supervisors who are receptive to using adult learning principles in their teaching. Little is known about what motivates Australian GP supervisors and how they currently teach. A qualitative study involving semi-structured interviews with 20 rural GP supervisors who work within one Regional Training Provider region in Australia explored their reasons for being a supervisor and how they performed their role. Data was analysed using a thematic analysis approach. GP supervisors identified both personal and professional benefits in being a supervisor, as well as some benefits for their practice. Supervision fulfilled a perceived broader responsibility to the profession and community, though they felt it had little impact on rural retention of doctors. While financial issues did not provide significant motivation to teach, the increasing financial inequity compared with providing direct patient care might impact negatively on the decision to be or to remain a supervisor in the future. The principal challenge for supervisors was finding time for teaching. Despite this, there was little evidence of supervisors adopting strategies to reduce teaching load. Teaching methods were reported in the majority to be case-based with styles extending from didactic to coach/facilitator. The two-way collegiate relationship with a registrar was valued, with supervisors taking an interest in the registrars beyond their development as a clinician. Supervisors report positively on their teaching and mentoring roles. Recruitment strategies that highlight the personal and professional benefits that supervision offers are needed. Practices need assistance to adopt models of supervision and teaching that will help supervisors productively manage the increasing

  10. How General Practitioners and Their Patients Adhere to Osteoporosis Management: A Follow-Up Survey among Czech General Practitioners.

    PubMed

    Vytrisalova, Magda; Touskova, Tereza; Fuksa, Leos; Karascak, Roman; Palicka, Vladimir; Byma, Svatopluk; Stepan, Jan

    2017-01-01

    Introduction: General practitioners (GPs) are key participants in osteoporosis (OP) management. The aim was to evaluate their adherence to lege artis management of the disease, potential barriers, and to discuss differences observed in comparison with the baseline survey carried out in 2007; the focus was on secondary prevention. Methods: On behalf of two professional associations, 2-round postal survey among randomly selected GPs (>1/4 of all Czech GPs) was performed in 2014. The questionnaire covered areas concerning GP's role in the fight against OP, knowledge about OP, management of OP-related fractures, barriers to the management of OP, system- and patient-related in particular, and availability and use of information sources. Results: The overall questionnaire return rate was 37% (551 respondents); mean age of the respondents was 53 year (37% men). The GP's role in the treatment of OP was rated as essential in 28 and 37% of men and women, respectively (P = 0.012). The guideline for diagnosis and treatment of OP for GPs was considered accessible by 92% of respondents. As much as 60% of the respondents were adherent to the guideline, i.e., used it repeatedly. The knowledge of several risk factors was very good, however, recommended daily intake of calcium was stated correctly by only 41% of respondents, and daily intake of vitamin D by only 40%. Three quarters reported active steps after a fracture: referral to a specialist, life-style recommendations, prescription of calcium/vitamin D supplements. Half of the respondents focus on fall prevention. System-related barriers, such as lack of possibility to prescribe selected drugs (61%) and financial limits set by health insurance company (44%) were most frequently reported. Patient-related barriers were also common, patient's non-adherence (reported by 29%) and patient's reluctance to go to a specialist (18%). Conclusion: GPs adhered to OP management more than in 2007. Knowledge of risk factors and involvement in

  11. 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.

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

    PubMed Central

    Somerset, Maggie; Weiss, Marjorie; Fahey, Tom

    2001-01-01

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

  13. 40 CFR 1.31 - Office of General Counsel.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Office of General Counsel. 1.31 Section 1.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL STATEMENT OF ORGANIZATION AND.... The office provides legal services to all organizational elements of the Agency with respect to...

  14. 40 CFR 1.31 - Office of General Counsel.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Office of General Counsel. 1.31 Section 1.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL STATEMENT OF ORGANIZATION AND.... The office provides legal services to all organizational elements of the Agency with respect to...

  15. General Unrestricted Line Officer Occupational Study

    DTIC Science & Technology

    1993-06-01

    TO PERSONNEL ACTIVITIES T131 PROMOTE FAMILY SERVICE CENTER (FSC) OR HUMAN RESOURCE MANAGEMENT (HRM) PROGRAMS T133 DEVELOP AND IMPLEMENT EQUAL...CENTER (FSC) OR HUMAN RESOURCE MANAGEMENT (HRM) PROGRAMS T133 DEVELOP AND IMPLEMENT EQUAL OPPORTUNITY (EO) POLICIES AND PROGRAMS T134 MONITOR EO...ADMINISTER DISTRIBUTION OF OFFICER OR ENLISTED PERSONNEL T131 PROMOTE FAMILY SERVICE CENTER (FSC) OR HUMAN RESOURCE MANAGEMENT (HRM) PROGRAMS T133 DEVELOP AND

  16. Views of pregnant women on the involvement of general practitioners in maternity care.

    PubMed

    Smith, L F

    1996-02-01

    The reorganization of maternity services in England following the report Changing childbirth is likely to impinge upon general practitioners' contribution to maternity care. Professionals and managers are increasingly expected to take account of patients' views when reorganizing services. This study aimed to elicit women's views about the involvement of general practitioners in maternity care and to establish the extent of continuity provided by general practitioners. A prospective cohort postal questionnaire survey was undertaken in the Bath health district to elicit the views of pregnant women about the general practitioner's role in maternity care, the continuity provided, patient satisfaction and the general practitioner-patient relationship. Responses were rated on five-point Likert scales. Women completed questionnaires at 24 and eight weeks before the birth and at two and eight weeks after the birth. Of 164 women entering the study (28 of whom were booked for home delivery and 136 for hospital delivery), 116 (71%) completed all four survey questionnaires. Of respondents 68% agreed that general practitioners play an important role in routine antenatal care and 53% that they have an important role in normal labour. These opinions appeared to be stable over time. Most women (73%) were cared for throughout their pregnancy by one general practitioner whom they knew well; such continuity was desired by nearly all the women in the study. Approximately three quarters of women were satisfied with the antenatal, postnatal and overall care provided by their general practitioner. Over half of respondents (56%) wished to get to know the doctor who would be present at the birth: the general practitioner was involved in 19 labours (16%), being present at the birth for only nine women. Women delivering at home were significantly more likely to agree with the statement that they knew the doctor present at the birth compared with those women delivering at hospital. Most women

  17. Stress, anxiety, and depression in hospital consultants, general practitioners, and senior health service managers.

    PubMed Central

    Caplan, R. P.

    1994-01-01

    OBJECTIVE--To study stress, anxiety, and depression in a group of senior health service staff. DESIGN--Postal survey. SUBJECTS--81 hospital consultants, 322 general practitioners, and 121 senior hospital managers (total 524). MAIN OUTCOME MEASURES--Scores on the general health questionnaire and the hospital anxiety and depression scale. RESULTS--Sixty five (80%) consultants, 257 (80%) general practitioners, and 67 (56%) managers replied. Of all 389 subjects, 183 (47%) scored positively on the general health questionnaire, indicating high levels of stress. From scores on the hospital anxiety and depression scale only 178 (46%) would be regarded as free from anxiety, with 100 (25%) scoring as borderline cases and 111 (29%) likely to be experiencing clinically measurable symptoms. The findings for depression were also of some concern, especially for general practitioners, with 69 (27%) scoring as borderline or likely to be depressed. General practitioners were more likely to be depressed than managers (69 (27%) v 4 (6%) scored > or = 8 on hospital anxiety and depression scale-D; P = 0.004) with no significant difference between general practitioners and consultants. General practitioners were significantly more likely to show suicidal thinking than were consultants (36 (14%) v 3 (5%); P = 0.04) but not managers (9 (13%)). No significant difference could be found between the three groups on any other measure. CONCLUSIONS--The levels of stress, anxiety, and depression in senior doctors and managers in the NHS seem to be high and perhaps higher than expected. PMID:7888846

  18. Do general practitioners adhere to the guideline on infectious conjunctivitis? Results of the Second Dutch National Survey of General Practice

    PubMed Central

    Rietveld, Remco P; ter Riet, Gerben; Bindels, Patrick JE; Schellevis, François G; van Weert, Henk CPM

    2007-01-01

    Background In 1996 the guideline 'The Red Eye' was first published by the Dutch College of General Practitioners. The extent to which general practitioners adhere to this guideline is unclear. Recently, data on the management of infectious conjunctivitis by general practitioners became available from the Second Dutch National Survey of General Practice. We measured the age-specific incidence of infectious conjunctivitis, described its management by Dutch general practitioners, and then compared these findings with the recommendations made in the guideline. Methods In 2001, over a 12-month period, data from all patient contacts with 195 general practitioners were taken from electronic medical records. Registration was episode-oriented; all consultations dealing with the same health problem were grouped into disease episodes. Data concerning all episodes of infectious conjunctivitis (ICPC-code F70 and sub codes) were analysed. Results Over one year, 5,213 new and recurrent episodes of infectious conjunctivitis were presented to general practitioners from a population of N = 375,899, resulting in an overall incidence rate of 13.9 per 1000 person-years, varying from more than 80/1000 py in children up to one-year old, to less than 12/1000 py in children over the age of 4. Topical ophthalmic ointments were prescribed in 87% of the episodes, of which 80% was antibiotic treatment. Fusidic acid gel was most frequently prescribed (69%). In most episodes general practitioners did not adhere to the guideline. Conclusion In 2001, the management of infectious conjunctivitis by Dutch general practitioners was not in accordance with the recommendations of the consensus-based guideline published five years previously, despite its wide distribution. In 2006 this guideline was revised. Its successful implementation requires more than distribution alone. Probably the most effective way to achieve this is by following a model for systemic implementation. PMID:17868475

  19. [Role of secondary care too small in Dutch College of General Practitioners' (NHG) practice guideline 'Dementia'].

    PubMed

    Olde Rikkert, Marcel G M; Lemstra, Evelien W; Verhey, Frans R J

    2012-01-01

    The third revision of the Dutch College of General Practitioners' practice guideline 'Dementia' is a major improvement and stimulates the general practitioner by providing concrete advice on stepped care in dementia diagnostics and organizing care management in order to obtain improvement in the quality and realization of dementia care in the primary care setting. However, this practice guideline does not address more effective and efficient dementia care by collaboration between primary and secondary care as it discourages the prescription of cholinesterase inhibitors and recommends limiting further diagnostic procedures to patients in whom a treatable condition is likely. Although, this new practice guideline strengthens the central role of the general practitioner in Dutch dementia care, this role would be further reinforced if general practitioners were to adopt integrated diagnostics of dementia and relevant additional diseases burden as the starting point.

  20. The working relationship between the general practitioner and the health visitor

    PubMed Central

    Draper, Juliet; Farmer, Sylvia; Field, Susan; Thomas, Hilary; Hare, M. J.

    1984-01-01

    The views of 40 health visitors from the Cambridge health district on their working relationship with general practitioners are presented. Patterns of attachment and facilities at the work base are described. The health visitors gave ratings for the frequency and facility of their contact with the general practitioners, the types of patients referred to them and their overall relationship with the doctors. The health visitors' own suggestions for improvement in the relationship are discussed. PMID:6737363

  1. Office of General Counsel Total Quality Management Plan

    DTIC Science & Technology

    1989-07-01

    Total Quality Management Plan 6. AUTHOR(S) 7...of General Counsel. - r DTIC 65 LE- E CTEn’" SEP291 989 14. SUBJECT TERMS 15. NUMBER OF PAGES TQM ( Total Quality Management ), Office of General...89) Pra-ifcr~bed ANSI Sid 139-1S ""-"’- ", ~ mmmmmu10n S S OFFICE OF GENERAL COUNSEL TOTAL QUALITY MANAGEMENT PLAN Acc’, ’ 7or. .?:" t ’_7 Codes K

  2. General practitioners using complementary and alternative medicine differ from general practitioners using conventional medicine in their view of the risks of electromagnetic fields: a postal survey from Germany.

    PubMed

    Kowall, Bernd; Breckenkamp, Jürgen; Berg-Beckhoff, Gabriele

    2015-01-01

    General practitioners (GPs) play a key role in consulting patients worried about health effects of electromagnetic fields (EMF). We compared GPs using conventional medicine (COM) with GPs using complementary and alternative medicine (CAM) concerning their perception of EMF risks. Moreover, we assessed whether the kind of alternative medicine has an influence on the results. A total of 2795 GPs drawn randomly from lists of German GPs were sent an either long or short self-administered postal questionnaire on EMF-related topics. Adjusted logistic regression models were fitted to assess the association of an education in alternative medicine with various aspects of perceiving EMF risks. Concern about EMF, misconceptions about EMF, and distrust toward scientific organizations are more prevalent in CAM-GPs. CAM-GPs more often falsely believed that mobile phone use can lead to head warming of more than 1°C (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.5-3.3), more often distrusted the Federal Office for Radiation Protection (OR = 2.2, 95% CI = 1.4-3.6), were more often concerned about mobile phone base stations (OR = 2.4, 95% CI = 1.6-3.6), more often attributed own health complaints to EMF (OR = 3.2, 95% CI = 1.8-5.6), and more often reported at least 1 EMF consultation (OR = 2.5, 95% CI = 1.6-3.9). GPs using homeopathy perceived EMF as more risky than GPs using acupuncture or naturopathic treatment. Concern about common EMF sources is highly prevalent among German GPs. CAM-GPs perceive stronger associations between EMF and health problems than COM-GPs. There is a need for evidence-based information about EMF risks for GPs and particularly for CAM-GPs. This is the precondition that GPs can inform patients about EMF and health in line with current scientific knowledge. © The Author(s) 2014.

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

    PubMed

    van den Bosch, W J

    2003-10-04

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

  4. Effectiveness of dementia follow-up care by memory clinics or general practitioners: randomised controlled trial

    PubMed Central

    Melis, René J F; Van Der Aa, Geert C H M; Golüke-Willemse, Gertie A M; De Leest, Benoit J M; Van Raak, Frank H J M; Schölzel-Dorenbos, Carla J M; Verheijen, Desiree C M; Verhey, Frans R J; Visser, Marieke C; Wolfs, Claire A; Adang, Eddy M M; Olde Rikkert, Marcel G M

    2012-01-01

    Objective To examine the effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared with general practitioners. Design Multicentre randomised controlled trial. Setting Nine memory clinics and 159 general practitioners in the Netherlands. Participants 175 patients with a new diagnosis of mild to moderate dementia living in the community and their informal caregivers. Interventions Usual care provided by memory clinic or general practitioner. Main outcome measures Caregiver rated quality of life of the patient measured with the quality of life in Alzheimer’s disease instrument and self perceived burden of the informal caregiver measured with the sense of competence questionnaire (intention to treat analysis). Results The quality of life of the patients in the memory clinic group was 0.5 (95% confidence interval −0.7 to 1.6) points higher than in the general practitioner group. Caregivers’ burden was 2.4 (−5.8 to 1.0) points lower in the memory clinic group than in the general practitioner group. Conclusion No evidence was found that memory clinics were more effective than general practitioners with regard to post-diagnosis treatment and coordination care for patients with dementia. Without further evidence on the effectiveness of these modalities, other arguments, such as cost minimisation, patients’ preferences, or regional health service planning, can determine which type of dementia care is offered. Trial registration Clinical trials NCT00554047. PMID:22589500

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

    PubMed Central

    Sokolowski, Ineta; Olesen, Frede

    2013-01-01

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

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

    PubMed

    Vedsted, Peter; Sokolowski, Ineta; Olesen, Frede

    2013-01-01

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

  7. Evaluation of a general practitioner with special interest service for dermatology: randomised controlled trial

    PubMed Central

    Salisbury, Chris; Noble, Alison; Horrocks, Sue; Crosby, Zoe; Harrison, Viv; Coast, Joanna; de Berker, David; Peters, Tim

    2005-01-01

    Objective To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a hospital dermatology clinic. Design Randomised controlled trial. Setting General practitioner with special interest dermatology service and hospital dermatology clinic. Participants Adults referred to a hospital dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest. Interventions Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual hospital outpatient care. Main outcome measures Primary outcomes were disease related quality of life (dermatology life quality index) and improvement in patients' perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment. Results 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to hospital outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference

  8. Evaluation of a general practitioner with special interest service for dermatology: randomised controlled trial.

    PubMed

    Salisbury, Chris; Noble, Alison; Horrocks, Sue; Crosby, Zoe; Harrison, Viv; Coast, Joanna; de Berker, David; Peters, Tim

    2005-12-17

    To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a hospital dermatology clinic. Randomised controlled trial. General practitioner with special interest dermatology service and hospital dermatology clinic. Adults referred to a hospital dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest. Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual hospital outpatient care. Primary outcomes were disease related quality of life (dermatology life quality index) and improvement in patients' perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment. 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to hospital outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61

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

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

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

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

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

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

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

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

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

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

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

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

  13. 33. GENERAL VIEW OF SHOPS COMPLEX LOOKING EAST, PAYMASTER'S OFFICE ...

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

    33. GENERAL VIEW OF SHOPS COMPLEX LOOKING EAST, PAYMASTER'S OFFICE IN FOREGROUND, LEFT; PUMPHOUSE, CENTER; SHOPS BUILDING TO RIGHT; SHEDS, FAR RIGHT - Soudan Iron Mine, Tower-Soudan State Park, Tower, St. Louis County, MN

  14. 29. GENERAL VIEW OF VIVIANNA ERA WORKS LOOKING NORTH. OFFICE, ...

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

    29. GENERAL VIEW OF VIVIANNA ERA WORKS LOOKING NORTH. OFFICE, STORAGE BUILDING RIGHT CENTER, ORE PLATFORM, ORE BIN LEFT CENTER, GENERATOR BUILDING BEHIND, AND ROTARY KILN AND CONDENSER PLATFORM BELOW. - Mariscal Quicksilver Mine & Reduction Works, Terlingua, Brewster County, TX

  15. GENERAL VIEW OF VIVIANNA ERA WORKS LOOKING NORTH. OFFICE, STORAGE ...

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

    GENERAL VIEW OF VIVIANNA ERA WORKS LOOKING NORTH. OFFICE, STORAGE BUILDING RIGHT CENTER, ORE PLATFORM, ORE BIN LEFT CENTER, GENERATOR BUILDING BEHIND, AND ROTARY KILN AND CONDENSER PLATFORM BELOW. - Mariscal Quicksilver Mine & Reduction Works, Terlingua, Brewster County, TX

  16. 12. GENERAL INTERIOR VIEW OF SIGNAL TOWER OFFICE FACING NORTH. ...

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

    12. GENERAL INTERIOR VIEW OF SIGNAL TOWER OFFICE FACING NORTH. - U.S. Naval Base, Pearl Harbor, Signal Tower, Corner of Seventh Street & Avenue D east of Drydock No. 1, Pearl City, Honolulu County, HI

  17. 41 CFR 105-53.131 - Office of Inspector General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... United States Attorneys on all matters relating to the detection and prevention of fraud and abuse. The..., including GSA. Each office is headed by an Inspector General appointed by the President with the advice...

  18. 12 CFR 905.14 - Office of General Counsel.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... interpretations of law, regulation and policy. (b) Responsibilities. The responsibilities of the Office of General... authority over the Federal Home Loan Banks; (4) Administering the Finance Board's Ethics, Freedom of...

  19. South side (red cross office entrance). Fitzsimons General Hospital, ...

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

    South side (red cross office entrance). - Fitzsimons General Hospital, Red Cross Building, South Eighth Street Bounded by West McAfee Avenue on South & West Harlow Avenue on North, Aurora, Adams County, CO

  20. 1. GENERAL VIEW OF RAILROAD YARD LOOKING NORTH. Office and ...

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

    1. GENERAL VIEW OF RAILROAD YARD LOOKING NORTH. Office and Car and Wheel Shops to left, Engine House No. 1 to right. Ebensburg Processing Plant and Powerhouse (Colver Mine) in far left background. - Cambria & Indiana Railroad, Colver, Cambria County, PA

  1. Economic evaluation of a general practitioner with special interests led dermatology service in primary care.

    PubMed

    Coast, Joanna; Noble, Sian; Noble, Alison; Horrocks, Sue; Asim, Oya; Peters, Tim J; Salisbury, Chris

    2005-12-17

    To carry out an economic evaluation of a general practitioner with special interest service for non-urgent skin problems compared with hospital outpatient care. Cost effectiveness analysis and cost consequences analysis alongside a randomised controlled trial. General practitioner with special interest dermatology service covering 29 general practices in Bristol. Adults referred to a hospital dermatology clinic who were potentially suitable for management by a general practitioner with special interest. Participants were randomised 2:1 to receive either care by general practitioner with special interest service or usual hospital outpatient care. Costs to NHS, patients, and companions, and costs of lost production. Cost effectiveness, using the two primary outcomes of dermatology life quality index scores and improved patient perceived access, was assessed by incremental cost effectiveness ratios and cost effectiveness acceptability curves. Cost consequences are presented in relation to all costs and both primary and secondary outcomes from the trial. Costs to the NHS for patients attending the general practitioner with special interest service were 208 pounds sterling (361 dollars; 308 euro) compared with 118 pounds sterling for hospital outpatient care. Based on analysis with imputation of missing data, costs to patients and companions were 48 pounds sterling and 51 pounds sterling, respectively; costs of lost production were 27 pounds sterling and 34 pounds sterling, respectively. The incremental cost effectiveness ratios for general practitioner with special interest care over outpatient care were 540 pounds sterling per one point gain in the dermatology life quality index and 66 pounds sterling per 10 point change in the access scale. The general practitioner with special interest service for dermatology is more costly than hospital outpatient care, but this additional cost needs to be weighed against improved access and broadly similar health outcomes.

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

    PubMed Central

    2013-01-01

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

  3. The feasibility of office-based propofol sedation for dental care in patients with intellectual disability by sedation practitioners.

    PubMed

    Vaessen, Hermanus H B; Schouten, Antonius N J; van der Hoeve, Henriette; Knape, Johannes T A

    2017-03-01

    The quality of oral health care for intellectually disabled patients is a significant challenge due to behavioral issues. Intravenous propofol sedation may be useful to relieve the anxiety and fear, and make dental procedures more acceptable. The aim of this study was to evaluate the safety and effectiveness of propofol sedation, by trained nonmedical sedation practitioners, during dental treatments in an office-based setting. Intellectually disabled patients (124) were subjected to restorative dental procedures and moderately sedated using intravenous propofol. Vital signs, cooperation of the patient, and sedation depth were continuously assessed. Propofol sedation was effective for dental treatment. All procedures resulted in a sufficient level of sedation without moderate or severe complications. Propofol sedation can be safely and effectively performed in an office-based setting by sedation practitioners, who have experience in propofol sedation and are trained in the care of patients with disabilities. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.

  4. 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.

  5. [Medical practices and expectations of general practitioners in relation to hepatitis C virus infection in the Auvergne region].

    PubMed

    Bonny, Corinne; Rayssiguier, Romain; Ughetto, Sylvie; Aublet-Cuvelier, Bruno; Baranger, Jacques; Blanchet, Gérard; Delteil, Jacques; Hautefeuille, Philippe; Lapalus, Françoise; Montanier, Patrick; Bommelaer, Gilles; Abergel, Armand

    2003-11-01

    To determine the medical practices and expectations of general practitioners concerning screening and management of hepatitis C in the Auvergne region. A survey was sent by mail to 250 general practitioners. They were then contacted by telephone interviews. 94% of general practitioners answered the survey. Each physician diagnosed an average of 0.6 new cases of hepatitis C in 1999, and had a mean of 3.2 patients with HCV in their practice. Screening was performed by 91% of general practitioners if there was a history of blood transfusion, by 87% if there was a history of intravenous drug use, by 92% in case of increased serum amino transferase levels. Screening was less frequent in case of household contact and was only performed by 68% general practitioners or of asthenia by 52% of general practitioners. Liver biopsy seems to be the main obstacle for the management of hepatitis C patients which is due to a refusal of liver biopsy by the patient according to 55% of general practitioners, a fear of complications according to 25% of general practitioners. Sixty percent of general practitioners considered that liver biopsy was performed in less than 50% of patients with hepatitis C. Fifty three percent of general practitioner thought that hepatitis C network could be useful for increasing their knowledge. Liver biopsy refusal by the patient restricts the management and therapy of patients with hepatitis C infection. Increase formation still requisite by 60 percent of general practitioner.

  6. 75 FR 82042 - Office of Inspector General; Privacy Act of 1974; Notification of the Office of Inspector General...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... also changed the name of HUD/OIG-6, Autoinvestigation of the Office of Inspector General to HUD/OIG-6... consolidation also updates routine use 9 due to legislation (IG Reform Act of 2008) enacted in 2008 changing the... changes. In accordance with section 5 U.S.C. 552a(r) and the Office of Management and Budget Circular...

  7. Qualitative study of pilot payment aimed at increasing general practitioners' antismoking advice to smokers

    PubMed Central

    Coleman, Tim; Wynn, Alison T; Stevenson, Keith; Cheater, Francine

    2001-01-01

    Objectives To elicit general practitioners' and practice nurses' accounts of changes in their clinical practice or practice organisation made to claim a pilot health promotion payment. To describe attitudes towards the piloted and previous health promotion payments. Design Qualitative, semistructured interview study. Setting 13 general practices in Leicester. Participants 18 general practitioners and 13 practice nurses. Results Health professionals did not report substantially changing their clinical practice to claim the new payments and made only minimal changes in practice organisation. The new health promotion payment did not overcome general practitioners' resistance towards raising the issue of smoking when they felt that doing so could cause confrontation with patients. General practitioners who made the largest number of claims altered the way in which they recorded patients' smoking status rather than raising the topic of smoking more frequently with patients. Participants had strong negative views on the new payment, feeling it would also be viewed negatively by patients. They were, however, more positive about health promotion payments that rewarded “extra” effort—for example, setting up practice based smoking cessation clinics. Conclusions General practitioners and practice nurses were negative about a new health promotion payment, despite agreeing to pilot it. Health promotion payments do not automatically generate effective health promotion activity, and policymakers should consider careful piloting and evaluation of future changes in health promotion payments. What is already known on this topicHealth promotion payments have been made to UK general practitioners since 1990, but their effectiveness is unknownWhat this study addsPrimary care staff held strong negative views about the pilot payments to promote smoking cessation and previous health promotion paymentsThe highest claiming practitioners altered their methods of recording smoking

  8. Dealing with uncertainty in general practice: an essential skill for the general practitioner.

    PubMed

    O'Riordan, Margaret; Dahinden, André; Aktürk, Zekeriya; Ortiz, José Miguel Bueno; Dağdeviren, Nezih; Elwyn, Glyn; Micallef, Adrian; Murtonen, Mikko; Samuelson, Marianne; Struk, Per; Tayar, Danny; Thesen, Janecke

    2011-01-01

    Many patients attending general practice do not have an obvious diagnosis at presentation. Skills to deal with uncertainty are particularly important in general practice as undifferentiated and unorganised problems are a common challenge for general practitioners (GPs). This paper describes the management of uncertainty as an essential skill which should be included in educational programmes for both trainee and established GPs. Philosophers, psychologists and sociologists use different approaches to the conceptualisation of managing uncertainty. The literature on dealing with uncertainty focuses largely on identifying relevant evidence and decision making. Existing models of the consultation should be improved in order to understand consultations involving uncertainty. An alternative approach focusing on shared decision making and understanding the consultation from the patient's perspective is suggested. A good doctor-patient relationship is vital, creating trust and mutual respect, developed over time with good communication skills. Evidence-based medicine should be used, including discussion of probabilities where available. Trainers need to be aware of their own use of heuristics as they act as role models for trainees. Expression of feelings by trainees should be encouraged and acknowledged by trainers as a useful tool in dealing with uncertainty. Skills to deal with uncertainty should be regarded as quality improvement tools and included in educational programmes involving both trainee and established GPs.

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

    PubMed

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

    2012-01-01

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

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

    PubMed Central

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

    2012-01-01

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

  11. Neil Edwin Carson. Academic general practitioner, leader and achiever.

    PubMed

    1992-06-01

    Professor Neil Carson, who is to retire as Chairman of Monash University's Department of Community Medicine at the end of this year, has completed a significant and successful term marked by many achievements. His energy, vision and ability to acquire and channel resources have helped develop a vibrant and productive department. His wise counsel and negotiating skills have led to important achievements for the cause of general practice in both the political sphere and in academic institutions. He was the founder and first president of the Australian Association for Academic General Practice. His impact on medical education, especially for general practice in Australia, has been far reaching.

  12. Forget me not - the role of the general dental practitioner in dementia awareness.

    PubMed

    McNamara, G; Millwood, J; Rooney, Y M; Bennett, K

    2014-09-01

    This paper examines the role of the general dental practitioner (GDP) in dementia awareness, using the close patient-practitioner relationship to spot the early signs and plan for future oral healthcare. Each and every member of the dental team plays an important role in the patient journey through their dental visit and helps address the barriers they face. The significance of promoting dementia friendly environments cannot be undervalued and the GDP has a key role in maintaining their patients' quality of life.

  13. General George Crook’s development as a practitioner of irregular warfare during the Indian wars.

    DTIC Science & Technology

    2017-06-09

    understanding of the context and nuance associated with the Indian problem. This study evaluates the factors that facilitated his development as a...References to this study should include the foregoing statement.) iv ABSTRACT GENERAL GEORGE CROOK’S DEVELOPMENT AS A PRACTITIONER OF IRREGULAR...Indian problem. This study evaluates the factors that facilitated his development as a practitioner of Irregular Warfare in the Rogue River Wars, the

  14. General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines.

    PubMed

    Little, P; Smith, L; Cantrell, T; Chapman, J; Langridge, J; Pickering, R

    1996-02-24

    To compare general practitioners' reported management of acute back pain with 'evidence based' guidelines for its management. Confidential postal questionnaire. One health district in the South and West region. 236 general practitioners; 166 (70%) responded. Examination routinely performed, 'danger' symptoms and signs warranting urgent referral, advice given, and satisfaction with management. A minority of general practitioners do not examine reflexes routinely (27%, 95% confidence interval 20% to 34%), and a majority do not examine routinely for muscle weakness or sensation. Although most would refer patients with danger signs, some would not seek urgent advice for saddle anaesthesia (6%, 3% to 11%), extensor plantar response (45%, 37% to 53%), or neurological signs at multiple levels (15%, 10% to 21%). A minority do not give advice about back exercises (42%, 34% to 49%), fitness (34%, 26% to 41%), or everyday activities. A minority performed manipulation (20%) or acupuncture (6%). One third rated their satisfaction with management of back pain as 4 out of 10 or less. The management of back pain by general practitioners does not match the guidelines, but there is little evidence from general practice for many of the recommendations, including routine examination, activity modification, educational advice, and back exercises. General practitioners need to be more aware of danger symptoms and of the benefits of early mobilisation and possibly of manipulation for persisting symptoms. Guidelines should reference each recommendation and discuss study methodology and the setting of evidence.

  15. [The general practitioner is amazed, the specialist is astonished - or put differently: unnecessary operations? - a fictive interview with a general practitioner].

    PubMed

    Blunier, Hans-Ulrich

    2014-12-01

    From the sight of a General Practitioner time and again certain indications for some interventions on patients in hospitals are questionable. Enough evidence-based studies are of great importance, so that the individual evidence of the patient including the view of his General Practitioner can be put in first place when making decisions for interventions. In order to generate as much data with as little time and effort possible, structures for patient-centered care have to be created over the whole therapeutic chain (GPs, specialists, hospitals), where the necessary data can be gathered. In an interview GP Dr. med. H.U. Blunier speaks his mind, about how he is persistently pursuing his goal to develop patient paths across all institutions to finally close the therapy chain in terms of an integrated health care.

  16. General practitioners' reasons for not attending a higher professional education course.

    PubMed Central

    Pitts, J; Vincent, S

    1994-01-01

    BACKGROUND. A proposal to run a higher professional education course attracted strong initial interest. However, only 12% of those 74 general practitioners expressing an interest subsequently enrolled on the course. AIM. A study was undertaken to examine the factors that demotivated the remaining 88% from attending. METHOD. A questionnaire was sent to the non-attenders, asking them to rank the impact of each of six factors on their decision not to attend. RESULTS. Major factors included time commitment, general practice workload and family pressures. Cost, attitudes of practice partners and structure of the course were much less important. CONCLUSION. It seems that the conditions imposed by the current demands of working as a general practitioner, rather than the attitudes of the general practitioners themselves, inhibit this form of continuing professional development. PMID:8037983

  17. The provision of orthodontic services by general dental practitioners. 1. Methods and descriptive results.

    PubMed

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

    1995-10-01

    Information regarding orthodontic service provision by general dental practitioners in Australia is limited. The aim of this survey was to determine the amount and variety of orthodontic services provided by general dental practitioners in the Melbourne Statistical Division, Victoria, Australia. A random sample of 307 dentists drawn from the Victorian Dentists Register was surveyed by mailed questionnaire: 218 (71%) replied. Data were collected using a fortnight log. During this time 59 per cent of the dentists saw at least one orthodontic patient; one dentist saw 66 orthodontic patients. Removable orthodontic appliances were used by 35 per cent of the dentists and fixed orthodontic appliances by 18 per cent. Twenty-six per cent provided comprehensive orthodontic treatment, 22 per cent aligned incisors, and 21 per cent corrected anterior crossbites. The general dental practitioners surveyed provided a wide range of preventive and interceptive orthodontic services to generally a small percentage of their patients.

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

    PubMed

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

    2015-04-01

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

  19. Knowledge and confidence of the Mental Health Act in Scotland: a survey of general practitioners.

    PubMed

    Conway, Lisa; Mohammed, Nabiha; Jardine, Charles; Crabb, James

    2015-01-01

    Front-line clinician general practitioners may be required to assist in the administration of mental health legislation. Limited training has been an issue previously identified. This study aims to ascertain levels of training, knowledge and confidence of general practitioners in Scotland in relation to the mental health act. An anonymous online survey of all general practitioners in one Scottish health board was completed. Eighty general practitioners in Forth Valley responded to the survey; 55% had never received any previous training in the mental health act. The majority rated knowledge of the act as fair (50%) and confidence in using the act as poor (44%). No relationship was found between previous training and current knowledge or confidence. Previous practical use of the act was associated with better current knowledge (p = 0.0074) and confidence in using the act (p = 0.0005). Of the respondents, 99% were keen to pursue further training in the act. Further practical training for general practitioners in the use of the mental health act is required to improve knowledge and confidence in this important area. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  20. General practitioners' barriers and facilitators towards new provider-initiated HIV testing strategies: a qualitative study.

    PubMed

    Joore, Ivo K; van Roosmalen, Sanne Lc; van Bergen, Jan Eam; van Dijk, Nynke

    2017-04-01

    European guidelines recommend offering an HIV test to individuals who display HIV indicator conditions (ICs). UK guidelines recommend performing a 'routine offer of HIV testing' in primary care where HIV prevalence exceeds 2 in 1000. Implementation of new provider-initiated HIV testing strategies in general practice is limited, while the numbers of undiagnosed and late for care HIV patients remain high. We have explored Dutch general practitioners' barriers to and facilitators of both strategies. We combined semi-structured in-depth interviews with focus groups. Nine general practitioners - key informants of sexually transmitted infection/HIV prevention and control - were selected for the interviews. Additionally, we organised focus groups with a broad sample of general practitioners (n = 81). Framework analysis was used to analyse the data. Various barriers were found, related to (1) the content of the guidelines (testing the right group and competing priorities in general practice), (2) their organisational implementation (lack of time, unclear when to repeat the HIV test and overlong list of ICs) and (3) the patient population (creating fear among patients, stigmatising them and fear regarding financial costs). Multiple general practitioners stated that performing a sexual risk assessment of patients is important before applying either strategy. Also, they recommended implementing the IC-guided approach only in high-prevalence areas and combining HIV tests with other laboratory blood tests. General practitioners tend to cling to old patterns of risk-based testing. Promoting awareness of HIV testing and educating general practitioners about the benefits of new provider-initiated HIV testing strategies is important for the actual uptake of HIV testing.

  1. Quality Assurance and Continuing Education Needs of Rural and Remote General Practitioners: How Are They Changing?

    ERIC Educational Resources Information Center

    Booth, Barbara; Lawrance, Richard

    2001-01-01

    A survey examined the continuing education needs of 706 rural general practitioners (GPs) across Australia. An inability to generalize findings across location indicates that regional identification by local service providers would be more effective. However, a set of topics broader than the traditional continuing medical education topics for…

  2. [Principles of rational cooperation of general practitioners and other specialists with nephrologist].

    PubMed

    Sułowicz, Władysław

    2005-01-01

    The paper presents general principles of rational cooperation of general practitioners and other specialists with nephrologist dedicate special attention concerning the slowing progression of renal failure and beneficts for patients as a result of early referral to nephrologist. The management of patients with chronic renal failure in the predialysis period and their preparation for renal replacement therapy was also described.

  3. Drug interactions in general dental practice--considerations for the dental practitioner.

    PubMed

    Dawoud, B E S; Roberts, A; Yates, J M

    2014-01-01

    The aim of this article is to explore the diverse and complex nature of pharmacological drug-drug interactions in the general dental practice setting. Using published NHS statistics, this article will highlight medications for common medical conditions that could interact with frequently prescribed drugs by the general dental practitioner.

  4. Assessment of the practicality and safety of thrombolysis with anistreplase given by general practitioners.

    PubMed

    Hannaford, P; Vincent, R; Ferry, S; Hirsch, S; Kay, C

    1995-04-01

    Recent guidelines recommend that patients with obvious acute myocardial infarction receive thrombolysis, unless contraindicated, within 60-90 minutes of summoning assistance. If this target is to be achieved, an increasing number of general practitioners are likely to be involved in the administration of thrombolytic agents. This study aimed to assess the practicality and safety of thrombolysis with anistreplase when given by general practitioners. An observational study was conducted in 805 general practices throughout the United Kingdom. Between March 1991 and September 1992, a total of 3383 patients with a clinical diagnosis of myocardial infarction were recruited--888 by 344 general practitioners who wished to include anistreplase in their management of myocardial infarction ('user' group) and 2495 by 776 general practitioners who did not wish to use anistreplase but who were willing to provide information about their cases ('comparison' group). More than half the patients were seen within two hours of onset of symptoms. A high frequency of contra-indications to thrombolysis, diagnostic uncertainty, and other, mainly practical, reasons limited the number of occasions on which anistreplase was administered. Thus, only 310 patients were given anistreplase in the community. The general practitioners in the study used anistreplase safely. Their diagnostic accuracy was high (of the 310 patients given anistreplase 69% had a definite, possible or probably myocardial infarction, 4% a definite non-cardiac diagnosis), the number of patients given anistreplase in spite of a documented contraindication was small (seven patients), and the doctors appeared to be aware of potential bleeding problems associated with thrombolysis. In all cases, the complications of acute myocardial infarction appeared to be managed appropriately. General practitioners can use anistreplase both appropriately and safely in the early management of acute myocardial infarction. Recognized

  5. The Delivery and Quality of Sexually Transmitted Infections Treatment by Private General Practitioners in Windhoek Namibia

    PubMed Central

    Iipinge, Scholastika N; Pretorius, Louise

    2012-01-01

    Introduction: The main objective for this study was to investigate the quality of Sexually Transmitted Infections (STI) treatment and control by the private sector in Namibia. Method: This was a cross-sectional study employing quantitative methodology using different methods of data collection. A self-administered questionnaire exploring General Practitioners (GPs) perceptions of factors that influence the way they manage Sexually Transmitted Infections (STI) which was then concluded with the face to face interviews and the checklist that was used while doing observations in the consulting rooms Results: A total of 50 private general practitioners in the area of Windhoek were interviewed, 48 self-administered questionnaires plus all checklists were received back from the private general practitioners. None of the private general practitioners interviewed had specific training in the syndromic management of the STIs. The 86% of all patients were seen by these private general practitioners on a medical aid, while 14 % pay cash for service provided. With regard to Urethral Discharge, an average of 56.5% of GPs could treat urethral discharge correctly as per the Namibian syndromic approach guidelines. None of the GPs could demonstrate the correct treatment of genital ulcer (whether they received medical aid or not) as recommended in the syndromic approach guidelines in Namibia (GRN, 1999; 2000). Only 28% of the GPs could demonstrate the correct treatment of Pelvic Inflammatory Disease (PID) as per the syndromic management of the STIs. For patients without medical aid the drugs prescribed and their dosages for PID are correct but the frequencies are not in line with the guidelines as for patients with medical aid. Discussion: In general, patients presenting with STIs to the GPs in private practices are not given quality of care because not all private general practitioners have time to do investigations, counseling, give condoms and to notify the partners of those with

  6. 10 CFR 1.12 - Office of the Inspector General.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Office of the Inspector General. 1.12 Section 1.12 Energy NUCLEAR REGULATORY COMMISSION STATEMENT OF ORGANIZATION AND GENERAL INFORMATION Headquarters Inspector... matters relating to the promotion of economy and efficiency and the detection of fraud and abuse in...

  7. 10 CFR 1.12 - Office of the Inspector General.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Office of the Inspector General. 1.12 Section 1.12 Energy NUCLEAR REGULATORY COMMISSION STATEMENT OF ORGANIZATION AND GENERAL INFORMATION Headquarters Inspector... matters relating to the promotion of economy and efficiency and the detection of fraud and abuse in...

  8. 10 CFR 1.12 - Office of the Inspector General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Office of the Inspector General. 1.12 Section 1.12 Energy NUCLEAR REGULATORY COMMISSION STATEMENT OF ORGANIZATION AND GENERAL INFORMATION Headquarters Inspector... matters relating to the promotion of economy and efficiency and the detection of fraud and abuse in...

  9. 10 CFR 1.12 - Office of the Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Office of the Inspector General. 1.12 Section 1.12 Energy NUCLEAR REGULATORY COMMISSION STATEMENT OF ORGANIZATION AND GENERAL INFORMATION Headquarters Inspector... matters relating to the promotion of economy and efficiency and the detection of fraud and abuse in...

  10. 40 CFR 1.29 - Office of Inspector General.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Office of Inspector General. 1.29 Section 1.29 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL STATEMENT OF ORGANIZATION... Administrator, and Congress of serious problems, abuses and deficiencies relating to EPA programs and operations...

  11. 12 CFR 905.11 - Office of Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Office of Inspector General. 905.11 Section 905.11 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOUSING FINANCE BOARD ORGANIZATION AND... under the Inspector General Act include: (1) Conducting and supervising audits and...

  12. An evaluation of educational outreach to general practitioners as part of a statewide cervical screening program.

    PubMed Central

    Stevens, S A; Cockburn, J; Hirst, S; Jolley, D

    1997-01-01

    OBJECTIVES: The purpose of this study was to determine the acceptability, effectiveness, and cost of a face-to-face educational outreach intervention in the context of a program aimed at increasing cervical screening in Victoria, Australia. METHODS: All identified general practitioners in a specified intervention area were offered a visit by a general practitioner educator. Practitioners completed a questionnaire evaluating the acceptability of the visit. Odds ratios for a woman being screened in the 3 months following the visits were determined. RESULTS: Fifty-nine general practitioners (69.4%) accepted the offer of a visit. Most found both the process and the content of the intervention to be acceptable. The intervention and nonintervention regions did not differ either before or after the intervention. In both regions, there was a statistically significant increase in number of Pap tests performed. There was no difference in the change in screening between the two regions. Costs were estimated at Au$34 per general practitioner visited. CONCLUSIONS: This strategy cannot be recommended for widespread use in a cervical screening program. PMID:9240109

  13. [The Dutch College of General Practitioners' practice guidelines, "Examination of the neonate": response from the perspective of general practice medicine].

    PubMed

    Springer, M P

    2002-11-09

    With the publication of the Dutch College of General Practitioners' practice guideline 'Examination of the neonate', a discussion which has lasted several decades has been brought to an end. Up to now a second neonatal examination by the general practitioner on the third, fourth or fifth day after a midwife-assisted birth was recommended. The arguments in support of this recommendation were based on the following: (a) the limited expertise of midwives in the past, (b) the experience that general practitioners had in examining children, although this experience was not specifically related to the defects for which neonates should be checked, and (c) the government bodies' wish to restrict the number of hospital deliveries by giving greater structure to the organisation of midwife care, which in practice, did not lead to large changes. Based on three studies, the practice guideline recommends that a second examination is of no added value.

  14. Experiences of a general practitioner in the daily practice about Digital Health Literacy. The real needs.

    PubMed

    Traver, M; Basagoiti, I; Martinez-Millana, A; Fernandez-Llatas, C; Traver, V

    2016-08-01

    Digital Health Literacy (DHL) is a key element to promote patient empowerment. This position paper presents the lessons learnt from the daily activities of a General Practitioner interacting with patients. General Practitioners have a main role in each stage on individual digital health literacy process. They are the first meeting point between patients and the medical knowledge; in the search phase, they are who can prescribe and validate health information; in the comprehension phase, they lead to a full understanding; and in the adoption phase, they assist in the own personal application. Major conclusions are that General Practitioners need a set of tools, organizational resources and knowledge to acquire Digital Health Literacy skills to help patients on their way from the information to the empowerment. Some of these tools and knowledge are identified to draw the future roadmap to get people with Digital Health Literacy skills.

  15. 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

  16. Measuring health inequalities in Albania: a focus on the distribution of general practitioners

    PubMed Central

    Theodorakis, Pavlos N; Mantzavinis, Georgios D; Rrumbullaku, Llukan; Lionis, Christos; Trell, Erik

    2006-01-01

    Background The health workforce has a dynamically changing nature and the regular documentation of the distribution of health professionals is a persistent policy concern. The aim of the present study was to examine available human medical resources in primary care and identify possible inequalities regarding the distribution of general practitioners in Albania between 2000 and 2004. Methods With census data, we investigated the degree of inequality by calculating relative inequality indices. We plotted the Lorenz curves and calculated the Gini, Atkinson and Robin Hood indices and decile ratios, both before and after adjusting for mortality and consultation rates. Results The Gini index for the distribution of general practitioners in 2000 was 0.154. After adjusting for mortality it was 0.126, while after adjusting for consultation rates it was 0.288. The Robin Hood index for 2000 was 11.2%, which corresponds to 173 general practitioners who should be relocated in order to achieve equality. The corresponding figure after adjusting for mortality was 9.2% (142 general practitioners), while after adjusting for consultation rates the number was 20.6% (315). These figures changed to 6.3% (100), 6.3% (115) and 19.8% (315) in 2004. Conclusion There was a declining trend in the inequality of distribution of general practitioners in Albania between 2000 and 2004. The trend in inequality was apparent irrespective of the relative inequality indicator used. The level of inequality varied depending on the adjustment method used. Reallocation strategies for general practitioners in Albania could be the key in alleviating the inequalities in primary care workforce distribution. PMID:16504028

  17. Measuring health inequalities in Albania: a focus on the distribution of general practitioners.

    PubMed

    Theodorakis, Pavlos N; Mantzavinis, Georgios D; Rrumbullaku, Llukan; Lionis, Christos; Trell, Erik

    2006-02-21

    The health workforce has a dynamically changing nature and the regular documentation of the distribution of health professionals is a persistent policy concern. The aim of the present study was to examine available human medical resources in primary care and identify possible inequalities regarding the distribution of general practitioners in Albania between 2000 and 2004. With census data, we investigated the degree of inequality by calculating relative inequality indices. We plotted the Lorenz curves and calculated the Gini, Atkinson and Robin Hood indices and decile ratios, both before and after adjusting for mortality and consultation rates. The Gini index for the distribution of general practitioners in 2000 was 0.154. After adjusting for mortality it was 0.126, while after adjusting for consultation rates it was 0.288. The Robin Hood index for 2000 was 11.2%, which corresponds to 173 general practitioners who should be relocated in order to achieve equality. The corresponding figure after adjusting for mortality was 9.2% (142 general practitioners), while after adjusting for consultation rates the number was 20.6% (315). These figures changed to 6.3% (100), 6.3% (115) and 19.8% (315) in 2004. There was a declining trend in the inequality of distribution of general practitioners in Albania between 2000 and 2004. The trend in inequality was apparent irrespective of the relative inequality indicator used. The level of inequality varied depending on the adjustment method used. Reallocation strategies for general practitioners in Albania could be the key in alleviating the inequalities in primary care workforce distribution.

  18. 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

  19. Rheumatoid arthritis - an update for general dental practitioners.

    PubMed

    de Souza, S; Bansal, R K; Galloway, J

    2016-11-18

    Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmune disorder which significantly impacts patients' lives and can lead to permanent disability. Inflammation in RA not only affects joints; but can affect organs including the heart and lungs. Early diagnosis, initiation of intensive drug therapy, and a multidisciplinary care approach have vastly improved the long-term prognosis for those living with the condition. However, RA patients often present with co-morbidities which add to the complexity of clinical management. Orofacial conditions associated with RA which dental professionals need to be aware of include periodontal disease, temporomandibular dysfunction and salivary gland dysfunction. In this article, we provide information on RA, oral health in RA and guidance on how best to manage patients with RA in general dental practice.

  20. Inequality in provider continuity for children by Australian general practitioners

    PubMed Central

    2011-01-01

    Background There is little published on provider continuity in Australian general practice and none on its effect on inequality of care for children. Method Questionnaire administered to parents of the ACT Kindergarten Health Screen asking the name of their child's usual GP and practice address between 2001 and 2008. Results Parents of 30,789 children named 433 GPs and 141 practices. In each year, an average of 77% of parents could name both the GP and the practice, an average of 11% of parents could name only the practice, and an average of 12% of parents could name neither. In each year, 25% of parents could not name a usual GP for children of Aboriginal or Torres Straight Islander descent, or children born outside of Australia, compared to 10% of all other children (p = < 0.0001). The frequency of GPs displaying continuity of care varied over time with 19% of GPs being present in the ACT in only one year and 39% of GPs being present in every year over the eight years of study. GPs displayed two different forms of transience either by working in more than one practice in each year (5% of GPs), or by not being present in the ACT region from one year to the next (15% of GPs). Fewer parents nominated transient GPs as their child's GP compared to choosing GPs who displayed continuity (p < 0.001). Conclusions Many GPs (39%) were reported to provide continuity of care for in the ACT region and some GPs (20%) displayed transient care. Indigenous children or children born outside of Australia had less equity of access to a nominated GP than all other children. Such inequity might disappear if voluntary registration of children was adopted in Australian general practice. PMID:21961728

  1. Biomedicine, holism and general medical practice: responses to the 2004 General Practitioner contract.

    PubMed

    Checkland, Kath; Harrison, Stephen; McDonald, Ruth; Grant, Suzanne; Campbell, Stephen; Guthrie, Bruce

    2008-07-01

    In 2004 a new contract was introduced for General Practitioners in the UK, which introduced a significant element of 'pay-for-performance', including both clinical and organisational targets. The introduction of this contract has caused interest across the world, particularly amongst those responsible for commissioning primary care services. It can be argued that the clinical targets in the contract (known as the Quality and Outcomes Framework, QOF) represent a move towards a more biomedical model of health and illness, which is contrary to the ideal of providing holistic (or biopsychosocial) care that has been traditionally espoused by GPs. This paper reports results from two linked studies (in England and Scotland) investigating the early stages of the new contract. We describe the way in which four practices with different organisational approaches and espoused identities have all changed their practice structures, consultations and clinical care in response to QOF in ways which will result in patients receiving a more biomedical type of care. In spite of these observed changes, respondents continued to maintain discursive claims to holism. We discuss how this disconnection between rhetoric and reality can be maintained, and consider its implications for the future development of GPs' claims to a professional identity.

  2. Informal interpreting in general practice: Comparing the perspectives of general practitioners, migrant patients and family interpreters.

    PubMed

    Zendedel, Rena; Schouten, Barbara C; van Weert, Julia C M; van den Putte, Bas

    2016-06-01

    To explore differences in perspectives of general practitioners, Turkish-Dutch migrant patients and family interpreters on interpreters' role, power dynamics and trust in interpreted GP consultations. 54 semi-structured in-depth interviews were conducted with the three parties focusing on interpreter's role, power and trust in interpreters. In line with family interpreters' perspective, patients expected the interpreters to advocate on their behalf and felt empowered when they did so. GPs, on the contrary, felt annoyed and disempowered when the family interpreters performed the advocacy role. Family interpreters were trusted by patients for their fidelity, that is, patients assumed that family interpreters would act in their best interest. GPs, on the contrary, mistrusted family interpreters when they perceived dishonesty or a lack of competence. Opposing views were found between GPs on the one hand and family interpreters and patients on the other hand on interpreter's role, power dynamics and the different dimensions of trust. These opposing perspectives might lead to miscommunication and conflicts between the three interlocutors. GPs should be educated to become aware of the difficulties of family interpreting, such as conflicting role expectations, and be trained to be able to call on professional interpreters when needed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. [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.

  4. The care of oral contraceptive users by general practitioners in Oxfordshire

    PubMed Central

    Johnson, Bridget; Thorogood, Margaret

    1977-01-01

    A questionnaire was circulated to a sample of general practitioners in Oxfordshire enquiring about the supervision of women taking oral contraceptives. A high standard of care was being offered and the doctors believed that there was a wide range of conditions that should influence the prescription of oral contraceptives. We conclude that while suitably trained paramedical staff could provide the same standard of care as the general practitioners, this could not be achieved through the use of a package insert listing possible contraindications. PMID:894634

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

    PubMed Central

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

    2016-01-01

    Aim and Objective: 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. Materials and Methods: 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: 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). Results: 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. Conclusion: 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. PMID:27829748

  6. [On general practitioners' care of patients with asthma].

    PubMed

    Von Voshaar, T; Behr, J; Brüggenjürgen, B; Deimling, A; Krüger, M; Virchow, C; Wiens, C

    2012-04-05

    This review offers readers new aspects for the guideline-compliant care of asthma patients. Here, attention is focused on illustrating the bottlenecks in the administration of good and practicable therapeutic care and listing these as "major challenges for GPs". The interdisciplinary team of authors - consisting of three hospital-based pulmonologists, one pulmonologist in private practice, one internist in general practice, one pharmacist and one health economist discussed aspects of asthma therapy relevant in clinical practice. Practicable results for the reader included an asthma pentagram, a graphic depicting the links and interactions between diagnosis, symptom management, communication, application and costs. From this emerged a consensus on four recommendations that can help GPs improve their care of their patients: (1) Whenever possible, have a specialist verifythe diagnosis. (2) Practice inhalation techniques with the patient and check up on their technique at regular intervals. (3) Monitor and fine-tune the therapeutic goals set down together with the patient. (4) Clearly define the (patient's) responsibilities and who is organizing care (communication between GP-specialist-patient-pharmacist-family members).

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

    PubMed

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

    2015-01-01

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

  8. General practitioners' hypertension knowledge and training needs: a survey in Xuhui district, Shanghai.

    PubMed

    Chen, Qian; Zhang, Xiangjie; Gu, Jie; Wang, Tianhao; Zhang, Yuan; Zhu, Shanzhu

    2013-01-28

    Hypertension prevalence is high in China, while patients' levels of hypertension awareness, treatment and control are low. General practitioners' knowledge and training relating to hypertension prevention may be an important related factor. We aimed to investigate general practitioners' knowledge of hypertension prevention and potential training needs. A questionnaire survey was conducted among all general practitioners at five community health service centers selected by convenience sampling. A total of 160 questionnaires were distributed and 147 were returned (response rate 91.9%) The questionnaire included general information; 12 subjective questions on health promotion, education and training needs; and 19 objective questions in 5 domains (epidemiology, diagnosis, treatment, referral and community management) measuring knowledge of hypertension prevention and treatment. The major difficulties in health education practice for general practitioners were poor patient compliance (77.6%) and lack of medical consultation time (49.0%). The average accuracy rate of hypertension prevention knowledge was 49.2%, ranging from 10.5% to 94.7%. The factors associated with accuracy rate were physician's education level (medical university vs. professional school, β = 13.3, P = 0.003), and type of center (training base vs. community healthcare center, β = 12.3, P < 0.0001). Most physicians (87.8%) reported being willing to attend training courses regularly and the preferred frequency was once every 2 ~ 3 months (53.5%). The preferred course was medical treatment of hypertension (82.3%) and the most favored training approach was expert lectures (80.3%). The knowledge level of hypertension prevention is low among general practitioners in urban settings. Physicians working in community clinics where they participate in a series of teaching, assessing and evaluating systems for hypertension prevention perform better than those in general healthcare centers who lack specific

  9. 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

  10. 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.

  11. 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

  12. Knowledge, Attitudes, and Preventive Practice Towards Breast Cancer among General Practitioner Health Professionals in Morocco

    PubMed

    Abda, Naima; Najdi, Adil; El Fakir, Samira; Tachfouti, Nabil; Berraho, Mohamed; Chami Khazraji, Youssef; Abousselham, Loubna; Belakhel, Latifa; Bekkali, Rachid; Nejjari, Chakib

    2017-04-01

    Background: Breast cancer is the most common cancer of women in Morocco and its diagnosis is usually made at advanced stages. The aim of this study was to describe the knowledge, practices and attitudes of general practitioners regarding early detection of breast cancer. Methods: A cross-sectional study was carried out during July 2011 on a sample of 140 general practitioners employed in basic health care facilities. Results: The majority (85.7%) of general practitioners were aware of the existence of a ministerial circular which aimed to generalize breast cancer screening. Systematic practice of clinical breast examination was reported by 18.0% of doctors for every woman between 45 and 70 years and a systematic breast self-examination check-up was reported by 59.4% of physicians. Mammography was requested by 54.1% of physicians in the presence of risk factors. Females and physicians practicing in urban areas were less likely to have a knowledge, attitudes and practices score higher than 8 as compared to male physicians and those practicing in rural areas. Discussion and conclusion: Our study showed that the knowledge, attitudes and practices of general practitioners regarding the early detection of breast cancer program were not satisfactory; hence the urgent need for improved implementation of the program in the affected regions. Creative Commons Attribution License

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  15. Outcomes associated with nurse practitioners in collaborative practice with general practitioners in rural settings in Canada: a mixed methods study.

    PubMed

    Roots, Alison; MacDonald, Marjorie

    2014-12-11

    The formalized nurse practitioner (NP) role in British Columbia is relatively new with most roles implemented in primary care. The majority of primary care is delivered by physicians using the fee-for-service model. There is a shortage of general practitioners associated with the difficulties of recruitment and retention, particularly in rural and remote locations. The uptake of the primary care NP role has been slow due to challenges in understanding the extent of its contributions. This study aims to identify the outcomes associated with the NP role in collaborative primary care practice. Three case studies where NPs were embedded into rural fee-for-service practices were undertaken to determine the outcomes at the practitioner, practice, community, and health services levels. Interviews, documents, and before and after data, were analyzed to identify changes in practise, access, and acute care service utilization. The results showed that NPs affected how care was delivered, particularly through the additional time afforded each patient visit, development of a team approach with interprofessional collaboration, and a change in style of practise from solo to group practise, which resulted in improved physician job satisfaction. Patient access to the practice improved with increased availability of appointments and practice staff experienced improved workplace relationships and satisfaction. At the community level, access to primary care improved for harder-to-serve populations and new linkages developed between the practice and their community. Acute care services experienced a statistically significant decrease in emergency use and admissions to hospital (P = 0.000). The presence of the NP improved their physician colleagues' desire to remain in their current work environment. This study identified the diversity of needs that can be addressed by the NP role. Namely, the importance of time to enhance patient care and its associated benefits, especially in the fee

  16. [EBM Service: evidence-based answers provided by general practitioners to questions asked by general practitioners--a project from South Tyrol/Italy].

    PubMed

    Piccoliori, Giuliano; Kostner, Simon; Abholz, Heinz-Harald

    2010-01-01

    General practices also require more and more evidence-based decision-making. But knowledge is increasing rapidly and guidelines produced to help doctors to find answers to their problems seem to exclude a number of problems that are important in general practices. Here we report on the introduction and activities of an EbM Service provided by general practitioners to answer questions of their colleagues. The aim is to give EBM answers, but also, in doing so, to teach the application of EBM and--in the long run--to enable the users themselves to find EBM answers. The provision of EBM answers is fairly pragmatic: after using the service the inquiring physician should be better informed, i.e., have more evidence-based information, but sometimes this need not be the "ultimate truth" that experts might deliver. EBM answers are published both on the homepage of the College of General Practitioners and in their journal. It took quite a while to implement this service, and the number of those using it has increased slowly but constantly.

  17. Early return visits by primary care patients: a retail nurse practitioner clinic versus standard medical office care.

    PubMed

    Rohrer, James E; Angstman, Kurt B; Garrison, Gregory

    2012-08-01

    The purpose of this study was to compare return visits made by patients within 2 weeks after using retail nurse practitioner clinics to return visits made by similar patients after using standard medical office clinics. Retail medicine clinics have become widely available. However, their impact on return visit rates compared to standard medical office visits for similar patients has not been extensively studied. Electronic medical records of adult primary care patients seen in a large group practice in Minnesota in 2009 were analyzed for this study. Patients who were treated for sinusitis were selected. Two groups of patients were studied: those who used one of 2 retail walk-in clinics staffed by nurse practitioners and a comparison group who used one of 4 regular office clinics. The dependent variable was a return office visit to any site within 2 weeks. Multiple logistic regression analysis was used to adjust for case-mix differences between groups. Unadjusted odds of return visits were lower for retail clinic patients than for standard office care patients. After adjustment for case mix, patients with more outpatient visits in the previous 6 months had higher odds of return visits within 2 weeks (2-6 prior visits: odds ratio [OR]=1.99, P=0.00; 6 or more prior visits: OR=6.80, P=0.00). The odds of a return visit within 2 weeks were not different by clinic type after adjusting for propensity to use services (OR=1.17, P=0.28). After adjusting for case mix differences, return visit rates did not differ by clinic type.

  18. The existential dimension in general practice: identifying understandings and experiences of general practitioners in Denmark.

    PubMed

    Assing Hvidt, Elisabeth; Søndergaard, Jens; Ammentorp, Jette; Bjerrum, Lars; Gilså Hansen, Dorte; Olesen, Frede; Pedersen, Susanne S; Timm, Helle; Timmermann, Connie; Hvidt, Niels Christian

    2016-12-01

    The objective of this study is to identify points of agreement and disagreements among general practitioners (GPs) in Denmark concerning how the existential dimension is understood, and when and how it is integrated in the GP-patient encounter. A qualitative methodology with semi-structured focus group interviews was employed. General practice setting in Denmark. Thirty-one GPs from two Danish regions between 38 and 68 years of age participated in seven focus group interviews. Although understood to involve broad life conditions such as present and future being and identity, connectedness to a society and to other people, the existential dimension was primarily reported integrated in connection with life-threatening diseases and death. Furthermore, integration of the existential dimension was characterized as unsystematic and intuitive. Communication about religious or spiritual questions was mostly avoided by GPs due to shyness and perceived lack of expertise. GPs also reported infrequent referrals of patients to chaplains. GPs integrate issues related to the existential dimension in implicit and non-standardized ways and are hindered by cultural barriers. As a way to enhance a practice culture in which GPs pay more explicit attention to the patients' multidimensional concerns, opportunities for professional development could be offered (courses or seminars) that focus on mutual sharing of existential reflections, ideas and communication competencies. Key points Although integration of the existential dimension is recommended for patient care in general practice, little is known about GPs' understanding and integration of this dimension in the GP-patient encounter. The existential dimension is understood to involve broad and universal life conditions having no explicit reference to spiritual or religious aspects. The integration of the existential dimension is delimited to patient cases where life-threatening diseases, life crises and unexplainable patient

  19. The existential dimension in general practice: identifying understandings and experiences of general practitioners in Denmark

    PubMed Central

    Assing Hvidt, Elisabeth; Søndergaard, Jens; Ammentorp, Jette; Bjerrum, Lars; Gilså Hansen, Dorte; Olesen, Frede; Pedersen, Susanne S.; Timm, Helle; Timmermann, Connie; Hvidt, Niels Christian

    2016-01-01

    Objective The objective of this study is to identify points of agreement and disagreements among general practitioners (GPs) in Denmark concerning how the existential dimension is understood, and when and how it is integrated in the GP–patient encounter. Design A qualitative methodology with semi-structured focus group interviews was employed. Setting General practice setting in Denmark. Subjects Thirty-one GPs from two Danish regions between 38 and 68 years of age participated in seven focus group interviews. Results Although understood to involve broad life conditions such as present and future being and identity, connectedness to a society and to other people, the existential dimension was primarily reported integrated in connection with life-threatening diseases and death. Furthermore, integration of the existential dimension was characterized as unsystematic and intuitive. Communication about religious or spiritual questions was mostly avoided by GPs due to shyness and perceived lack of expertise. GPs also reported infrequent referrals of patients to chaplains. Conclusion GPs integrate issues related to the existential dimension in implicit and non-standardized ways and are hindered by cultural barriers. As a way to enhance a practice culture in which GPs pay more explicit attention to the patients’ multidimensional concerns, opportunities for professional development could be offered (courses or seminars) that focus on mutual sharing of existential reflections, ideas and communication competencies. Key pointsAlthough integration of the existential dimension is recommended for patient care in general practice, little is known about GPs’ understanding and integration of this dimension in the GP–patient encounter.The existential dimension is understood to involve broad and universal life conditions having no explicit reference to spiritual or religious aspects.The integration of the existential dimension is delimited to patient cases where life

  20. Community preferences in general practice: important factors for choosing a general practitioner.

    PubMed

    Kenny, Patricia; De Abreu Lourenco, Richard; Wong, Chun Yee; Haas, Marion; Goodall, Stephen

    2016-02-01

    Understanding the important factors for choosing a general practitioner (GP) can inform the provision of consumer information and contribute to the design of primary care services. To identify the factors considered important when choosing a GP and to explore subgroup differences. An online survey asked about the respondent's experience of GP care and included 36 questions on characteristics important to the choice of GP. An Australian population sample (n = 2481) of adults aged 16 or more. Principal components analysis identified dimensions for the creation of summated scales, and regression analysis was used to identify patient characteristics associated with each scale. The 36 questions were combined into five scales (score range 1-5) labelled: care quality, types of services, availability, cost and practice characteristics. Care quality was the most important factor (mean = 4.4, SD = 0.6) which included questions about technical care, interpersonal care and continuity. Cost (including financial and time cost) was also important (mean = 4.1, SD = 0.6). The least important factor was types of services (mean = 3.3, SD = 0.9), which covered the range of different services provided by or co-located with the practice. Frequent GP users and females had higher scores across all 5 scales, while the importance of care quality increased with age. When choosing a GP, information about the quality of care would be most useful to consumers. Respondents varied in the importance given to some factors including types of services, suggesting the need for a range of alternative primary care services. © 2015 John Wiley & Sons Ltd.

  1. 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.

  2. 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…

  3. "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…

  4. 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…

  5. 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…

  6. 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…

  7. 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…

  8. 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…

  9. 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.…

  10. 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…

  11. 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…

  12. 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…

  13. 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

  14. General practitioners recognizing alcohol dependence: a large cross-sectional study in 6 European countries.

    PubMed

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

    2015-01-01

    Although alcohol dependence causes marked mortality and disease burden in Europe, the treatment rate is low. Primary care could play a key role in reducing alcohol-attributable harm by screening, brief interventions, and initiating or referral to treatment. This study investigates identification of alcohol dependence in European primary care settings. Assessments from 13,003 general practitioners, and 9,098 interviews (8,476 joint number of interviewed patients with a physician's assessment) were collected in 6 European countries. Alcohol dependence, comorbidities, and health service utilization were assessed by the general practitioner and independently using the Composite International Diagnostic Interview (CIDI) and other structured interviews. Weighted regression analyses were used to compare the impact of influencing variables on both types of diagnoses. The rate of patients being identified as alcohol dependent by the CIDI or a general practitioner was about equally high, but there was not a lot of overlap between cases identified. Alcohol-dependent patients identified by a physician were older, had higher rates of physicial comorbidity (liver disease, hypertension), and were socially more marginalized, whereas average consumption of alcohol and mental comorbidity were equally high in both groups. General practitioners were able to identify alcohol dependence, but the cases they identified differed from cases identified using the CIDI. The role of the CIDI as the reference standard should be reexamined, as older alcohol-dependent patients with severe comorbidities seemed to be missed in this assessment. © 2015 Annals of Family Medicine, Inc.

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

    PubMed Central

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

    2015-01-01

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

  16. 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…

  17. "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…

  18. 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…

  19. [Reliability study on the interpretation of electrocardiograms by general practitioners and trainees].

    PubMed

    Alonso Moreno, F J; Orueta Sánchez, R; Segura Fragoso, A; Rabadán Velasco, A I; Luna Del Pozo, L; Villarín Castro, A; Baquero Alonso, M; Rodríguez Padial, L

    2017-02-27

    To determine the reliability of the interpretation of electrocardiograms (ECG) by general practitioners and those in training by making a comparison with the interpretation made by the cardiologist. An observational study was conducted that included general practitioners working in the Toledo Health Area, physicians during their training in Family and Community Medicine, and cardiologists in their first 3 years of specialist training (R1-R3). A questionnaire was used that included 13 ECGs with no clinical details of the patient. The 13 ECGs were selected and their diagnoses made by consensus by 2 cardiologists from the Toledo Hospital Complex. The highest percentage of correct answers (82.3%) was obtained for ECG 5 (atrial fibrillation), and the lowest (26.5%) for ECG 11 (junctional rhythm). The highest diagnostic skill was achieved by the resident cardiologists, general practitioners, medical tutors, and doctors who had worked in hospital emergency departments. The highest odds ratio for a higher diagnostic skill was to work in an emergency department and be a practising general practitioner, both with almost significant results (P<.10). Family physicians and those in training have a medium level of reliability in the interpretation of an ECG compared to the cardiologist. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  20. 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…

  1. 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…

  2. 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…

  3. 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…

  4. 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…

  5. 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…

  6. 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…

  7. 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.…

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

    PubMed Central

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

    2008-01-01

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

  9. General Practitioners Can Evaluate the Material, Social and Health Dimensions of Patient Social Status

    PubMed Central

    Chatelard, Sophia; Bodenmann, Patrick; Vaucher, Paul; Herzig, Lilli; Bischoff, Thomas; Burnand, Bernard

    2014-01-01

    Objective To identify which physician and patient characteristics are associated with physicians' estimation of their patient social status. Design Cross-sectional multicentric survey. Setting Fourty-seven primary care private offices in Western Switzerland. Participants Random sample of 2030 patients ≥16, who encountered a general practitioner (GP) between September 2010 and February 2011. Main measures Primary outcome: patient social status perceived by GPs, using the MacArthur Scale of Subjective Social Status, ranging from the bottom (0) to the top (10) of the social scale.Secondary outcome: Difference between GP's evaluation and patient's own evaluation of their social status. Potential patient correlates: material and social deprivation using the DiPCare-Q, health status using the EQ-5D, sources of income, and level of education. GP characteristics: opinion regarding patients' deprivation and its influence on health and care. Results To evaluate patient social status, GPs considered the material, social, and health aspects of deprivation, along with education level, and amount and type of income. GPs declaring a frequent reflexive consideration of their own prejudice towards deprived patients, gave a higher estimation of patients' social status (+1.0, p = 0.002). Choosing a less costly treatment for deprived patients was associated with a lower estimation (−0.7, p = 0.002). GP's evaluation of patient social status was 0.5 point higher than the patient's own estimate (p<0.0001). Conclusions GPs can perceive the various dimensions of patient social status, although heterogeneously, according partly to their own characteristics. Compared to patients' own evaluation, GPs overestimate patient social status. PMID:24454752

  10. A survey of general dental practitioners in Merseyside regarding urgent appointments and suspected cancer referrals.

    PubMed

    Rogers, Simon N; Glen, Peter; Robinson, Aaron; Lowe, Derek; Grieveson, Brian; Edwards, Dympna

    2008-01-01

    The aims of this study were to investigate the current situation regarding unregistered patients in the Mersey region who seek an urgent dental appointment, and to gather information on suspected oral cancer cases seen by dentists in the previous two years and about how such cases are referred. The survey took the form of a short questionnaire sent in May 2006 to all general dental practitioners (GDPs) in the Mersey region who were registered with the regional postgraduate dental office. A total of 904 GDPs were identified and 572 (63%) returned completed survey responses. Half (276/572; 48%) reported that they could see new patients urgently under the National Health Service (NHS) and two-thirds (365/571; 64%) that they could see them either under the NHS or privately. Nineteen per cent reported that they would not see any new patients. Those in the most deprived areas were more likely to see a patient on the NHS. The waiting time for an urgent appointment, if it was offered, was over one week for nearly one-third (32%) of the dentists offering NHS care. Most dentists (84%) said that a patient suspected of having oral cancer would be referred the same day as the decision had been made to refer. Access to dental care has been a high-profile issue over the past few years. This survey indicated that in Merseyside, just under half of the dentists who responded were willing to see new patients with urgent problems under the NHS. It is suggested that this difficulty in access, together with some reported delays in obtaining appointments and the methods of onward referral, may cause additional barriers to early detection of oral cancer, especially for those in the most at-risk groups, who are also very frequently hard to reach.

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

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

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

  12. 10 CFR 1.12 - Office of the Inspector General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Office of the Inspector General. 1.12 Section 1.12 Energy... and standards that govern NRC's financial and management audit program; (b) Plans, directs, and... impact on economy and efficiency in the administration of NRC's programs and operations; (g) Keeps...

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

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

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

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

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

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

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

    ERIC Educational Resources Information Center

    Coastline Community Coll., Fountain Valley, CA.

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

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

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

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

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

    ERIC Educational Resources Information Center

    Minnesota Instructional Materials Center, White Bear Lake.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    PubMed

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

    2016-01-11

    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. © The Author(s) 2016.

  5. Attitudes of general practitioners and midwives towards ethnicity-based haemoglobinopathy-carrier screening

    PubMed Central

    Jans, Suze MPJ; de Jonge, Ank; Henneman, Lidewij; Cornel, Martina C; Lagro-Janssen, Antoinette LM

    2012-01-01

    Haemoglobinopathies (HbP) are severe autosomal recessive disorders with high prevalence among certain ethnic groups. World Health Organisation (WHO) advises implementing screening programmes for risk groups. Research in the Netherlands has shown that general practitioners and midwives do not perceive ethnicity as a risk factor for HbP. Moreover, registration of ethnicity is a controversial societal issue, which may complicate the introduction of a national preconception or antenatal carrier screening programme. This study investigates attitudes, intention and behaviour of general practitioners and midwives towards ethnicity-based HbP-carrier screening in general. A structured questionnaire based on the Theory of Planned Behaviour was sent by mail to a random selection of 2100 general practitioners and 1800 primary care midwives. Response was 35% (midwives 44.2% GPs 27.6%). Although 45% of respondents thought that offering a carrier test on the basis of ethnicity alone should become national policy, it is currently not carried out. The main factor explaining lack of intention towards ethnicity-based HbP-carrier screening was subjective norm, the perception that their peers do not think they should offer screening (52.2% variance explained). If ethnicity-based HbP-carrier screening would become national policy, most professionals report that they would carry this out. Most respondents favoured ethnicity registration for health purposes. As most practitioners look for role models among peers, debate among general practitioners and midwives should be encouraged when new policy is to be developed, articulating the voices of colleagues who already actively offer HbP-carrier screening. Moreover, primary care professionals and professional organisations need support of policy at national level. PMID:22549405

  6. 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

  7. General practitioners' reasoning when considering the diagnosis heart failure: a think-aloud study.

    PubMed

    Skånér, Ylva; Backlund, Lars; Montgomery, Henry; Bring, Johan; Strender, Lars-Erik

    2005-01-15

    Diagnosing chronic heart failure is difficult, especially in mild cases or early in the course of the disease, and guidelines are not easily implemented in everyday practice. The aim of this study was to investigate general practitioners' diagnostic reasoning about patients with suspected chronic heart failure in comparison with recommendations in European guidelines. Think-aloud technique was used. Fifteen general practitioners reasoned about six case vignettes, representing authentic patients with suspected chronic heart failure. Information about each case was added successively in five steps. The general practitioners said their thoughts aloud while reasoning about the probability of the patient having chronic heart failure, and tried to decide about the diagnosis. Arguments for and against chronic heart failure were analysed and compared to recommendations in guidelines. Information about ejection fraction was the most frequent diagnostic argument, followed by information about cardiac enlargement or pulmonary congestion on chest X-ray. However, in a third of the judgement situations, no information about echocardiography was utilized in the general practitioners' diagnostic reasoning. Only three of the 15 doctors used information about a normal electrocardiography as an argument against chronic heart failure. Information about other cardio-vascular diseases was frequently used as a diagnostic argument. The clinical information was not utilized to the extent recommended in guidelines. Some implications of our study are that 1) general practitioners need more information about how to utilize echocardiography when diagnosing chronic heart failure, 2) guidelines ought to give more importance to information about other cardio-vascular diseases in the diagnostic reasoning, and 3) guidelines ought to treat the topic of diastolic heart failure in a clearer way.

  8. Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study.

    PubMed

    van der Biezen, Mieke; Derckx, Emmy; Wensing, Michel; Laurant, Miranda

    2017-02-07

    Due to the increasing demand on primary care, it is not only debated whether there are enough general practitioners (GPs) to comply with these demands but also whether specific tasks can be performed by other care providers. Although changing the workforce skill mix care by employing Physician Assistants (PAs) and Nurse Practitioners (NPs) has proven to be both effective and safe, the implementation of those professionals differs widely between and within countries. To support policy making regarding PAs/NPs in primary care, the aim of this study is to provide insight into factors influencing the decision of GPs and managers to train and employ a PA/NP within their organisation. A qualitative study was conducted in 2014 in which 7 managers of out-of-hours primary care services and 32 GPs who owned a general practice were interviewed. Three main topic areas were covered in the interviews: the decision-making process in the organisation, considerations and arguments to train and employ a PA/NP, and the tasks and responsibilities of a PA/NP. Employment of PAs/NPs in out-of-hours services was intended to substitute care for minor ailments in order to decrease GPs' caseload or to increase service capacity. Mangers formulated long-term planning and role definitions when changing workforce skill mix. Lastly, out-of-hours services experienced difficulties with creating team support among their members regarding the employment of PAs/NPs. In general practices during office hours, GPs indented both substitution and supplementation for minor ailments and/or target populations through changing the skill mix. Supplementation was aimed at improving quality of care and extending the range of services to patients. The decision-making in general practices was accompanied with little planning and role definition. The willingness to employ PAs/NPs was highly influenced by an employees' motivation to start the master's programme and GPs' prior experience with PAs/NPs. Knowledge about

  9. 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.

  10. Information mastery and the 21st century doctor: change management for general practitioners.

    PubMed

    Tse, Justin; McAvoy, Brian R

    2006-07-17

    The Internet and computers have brought immense change in how society deals with information. Uptake of these technologies has been disjointed and has occurred in a non-uniform way among general practitioners, compared with other professionals. Information mastery is a key 21st century skill that GPs should acquire. Applying "change management" concepts may help improve uptake of information mastery skills in general practice.

  11. What is the role of the general practitioner towards the family caregiver of a community-dwelling demented relative?

    PubMed Central

    Schoenmakers, Birgitte; Buntinx, Frank; Delepeleire, Jan

    2009-01-01

    Objective To identify the attitudes and perspectives of the family physician towards the caregivers of demented relatives and to describe the caregivers’ satisfaction. Design Systematic review. Subjects The studied population consisted of dementia family and their general practitioners. Main outcome measures Outcome measures were the generic tasks and skills of the general practitioner to improve home care from the perspective of the family caregiver. Caregivers were assessed on satisfaction regarding the care provided by their general practitioner. Results The general practitioner is aware of his/her skills and limits in all aspects of dementia care and his/her role towards the family caregiver. They also acknowledged the importance of an adequate diagnostic process, but they felt uncomfortable disclosing the diagnosis to both the patient and the caregiver. They reported having more confidence in treatment matters than in diagnostic stages. Caregivers’ reports on the attitude of their general practitioner in the diagnostic process were rated from helpful to poorly empathized. General practitioners found themselves to be highly involved in dementia home care, but caregivers rated their involvement to be insufficient. The lack of appropriate communication skills of general practitioners was also not appreciated by the caregivers. A lack of time and reward was considered by the general practitioner to be a major obstacle in dementia care. Conclusion The key role of general practitioners as care providers and care planners is consolidated by the family caregivers’ confidence in their skills. Clear guidelines from early diagnosis to adequate referrals should improve the ability of the general practitioner to support these time and energy-consuming home-care situations. Intervention studies addressing the gaps in the skills of the general practitioners in dementia home care management could be helpful in supporting the family caregiver. PMID:19040191

  12. 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.

  13. Attitudes Toward Collaboration Among Practitioners in Newly Established Medical Homes: A Survey of Nurses, General Practitioners, and Specialists.

    PubMed

    Alcusky, Matthew; Ferrari, Luciano; Rossi, Giuseppina; Liu, Mengdan; Hojat, Mohammadreza; Maio, Vittorio

    2016-11-01

    The objective was to evaluate the attitudes toward collaboration of nurses, general practitioners (GPs), and specialists practicing in newly established Medical Homes (MHs) in Parma Local Health Authority (LHA), Emilia-Romagna region, Italy. The 15-item Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was administered electronically to 172 physicians (66 GPs, 106 specialists) and 113 nurses practicing in 12 MHs. In all, 191 surveys (45 GPs, 59 specialists, 87 nurses) were completed (67% response rate). The mean total score among nurses (51.5, standard deviation [SD] = 3.7) reflected a significantly (P < .01) more positive attitude toward collaboration compared with GPs (47.8, SD = 4.6) and specialists (45.3, SD = 7.7). Discrepancies in attitudes are concerning because conflicting perceptions of professional roles may impede a successful transition to integrated care within MHs in Parma LHA. Internationally, further research into understanding interprofessional relationships within MHs is needed to inform policy and build a necessary culture of team-based care. © The Author(s) 2015.

  14. The consultant's role in continuing medical education of general practitioners: the case of rheumatology.

    PubMed Central

    Badley, E M; Lee, J

    1987-01-01

    Consultant rheumatologists were surveyed by questionnaire about their contribution to the continuing education of general practitioners, and 84% (203/243) replied. Altogether 157 respondents had participated in some form of teaching, 147 in collective teaching sessions such as lectures and 99 in the teaching of small groups. Arthritis comprised 44% of the rheumatological topics taught; there was a noticeable lack of teaching on problems commonly encountered in general practice, such as soft tissue rheumatism and injury and back pain, and on clinical skills including examination and injection of joints. Eighty eight respondents made comments and suggestions. The favoured educational strategies were small group teaching, apprenticeship schemes, and interchange between general practitioners and consultants about shared cases. This contrasts with what was typically done--namely, formal lectures on rheumatoid arthritis in postgraduate medical centres. These findings raise questions about the continuing education of consultants themselves as well as about the consultants' role in teaching others. PMID:3105633

  15. Sexually transmissible diseases--knowledge and practices of general practitioners in Victoria, Australia.

    PubMed Central

    Mulvey, G; Temple-Smith, M J; Keogh, L A

    1997-01-01

    OBJECTIVE: To examine knowledge and practices in relation to sexually transmissible diseases (STDs) of general practitioners (GPs) in Victoria, Australia. METHOD: A questionnaire was distributed to 520 Victorian GPs randomly selected from the Australian Medical Publishing Company (AMPCo) database of Australian medical practitioners. RESULTS: A response rate of 85% was obtained. While sexual health consultations were common for Victorian GPs, STD caseloads were generally low. Knowledge of clinical features of symptomatic STDs and of important STD epidemiology was generally good although there was a lower awareness of the asymptomatic nature of the most prevalent STDs in Victoria. Diagnostic tests were generally selected appropriately although many GPs did not perform the gold standard combination of tests required for adequate differential diagnosis. Level of STD STD knowledge was related to frequency of advising about safe sex, diagnosing STDs, and younger practitioner age. Attendance at any of a number of postgraduate courses of relevance to the management of STDs was not related to better STD knowledge overall. CONCLUSIONS: Prevention and detection of STDs in general practice involve risk assessment and screening of asymptomatic patients as well as effective treatment of symptomatic patients and their contacts. Results presented here suggest that GPs have good knowledge and use appropriate investigations for patients presenting with symptoms of an STD. The low levels of awareness of the asymptomatic nature of many STDs and other particular aspects of STD knowledge and practice should be addressed in undergraduate and postgraduate medical education programmes. PMID:9582476

  16. Morale among general practitioners: qualitative study exploring relations between partnership arrangements, personal style, and workload

    PubMed Central

    Huby, Guro; Gerry, Marian; McKinstry, Brian; Porter, Mike; Shaw, Johnstone; Wrate, Robert

    2002-01-01

    Objectives To explore general practitioners' experiences of wellbeing and distress at work, to identify their perceptions of the causes of and solutions to distress, and to draw out implications for improving morale in general practice. Design Three stage qualitative study consisting of one to one unstructured interviews, one to one guided interviews, and focus groups. Setting Fife, Lothian, and the Borders, South East Scotland. Participants 63 general practitioner principals. Results Morale of general practitioners was explained by the complex interrelations between factors. Three key factors were identified: workload, personal style, and practice arrangements. Workload was commonly identified as a cause of low morale, but partnership arrangements were also a key mediating variable between increasing workload and external changes in general practice on the one hand and individual responses to these changes on the other. Integrated interventions at personal, partnership, and practice levels were seen to make considerable contributions to improving morale. Effective partnerships helped individuals to manage workload, but increasing workload was also seen to take away time and opportunities for practices to manage change and to build supportive and effective working environments. Conclusions Solutions to the problem of low morale need integrated initiatives at individual, partnership, practice, and policy levels. Improving partnership arrangements is a key intervention, and rigorous action research is needed to evaluate different approaches. PMID:12130611

  17. Mandatory immunization: the point of view of the French general population and practitioners.

    PubMed

    Nicolay, N; Lévy-Bruhl, D; Gautier, A; Jestin, Christine; Jauffret-Roustide, M

    2008-10-09

    This survey studies the opinion of the French general population, general practitioners and pediatricians regarding mandatory immunization. Data were collected through standardized telephone questionnaires administered to representative samples of the French population (n=4112) and of French general practitioners and pediatricians (1285 general practitioners (GPs) and 742 pediatricians). 56.5% of the general population is in favor of mandatory vaccination. Being in favor of hepatitis B vaccination, agreeing that "it would be important to continue immunizing against diphtheria in case immunization was made optional" or saying that "if immunization against diphtheria was discontinued, the disease would spread again", are some of the main determinants of a favorable opinion regarding mandatory immunization. The percentage of GPs and pediatricians in favor of mandatory immunization is 42%. Female pediatricians and those who would "insist on families in the importance of continuing immunizing all children against diphtheria in case this vaccination was only recommended" more often declare themselves in favor of mandatory immunization. The adoption of the principle of mandatory immunization seems to stem from the adoption of immunization as an individual and collective prevention tool.

  18. [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

  19. 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…

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

    PubMed

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

    2016-01-01

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

  1. Implications for cardiology nurse practitioner billing: a comparison of hospital versus office practice.

    PubMed

    Hull-Grommesh, Lori; Ellis, Elizabeth Fuselier; Mackey, Thomas A

    2010-06-01

    To discuss the implications for cardiology nurse practitioner (NP) billing and compare and contrast inpatient Medicare billing practices versus outpatient Medicare billing practices. Selected articles, text books, and government websites. In today's complex and expensive healthcare system, there has been a steady decline in the reimbursement rate for professional services to hospitals and physicians. NPs can have a significant impact on reducing this decline by billing for services provided. The cardiology NP can enhance institutional reimbursement quality and patient safety. The different billing methods such as independent billing, shared billing, and incident to billing by the cardiology NP can be complex.

  2. Ramadan and diabetes - knowledge, attitude and practices of general practitioners; a cross-sectional study.

    PubMed

    Ahmedani, Muhammad Yakoob; Hashmi, Bella Z; Ulhaque, Muhammad Saif

    2016-01-01

    Fasting during Ramadan is obligatory for all Muslims across the world. Through literature review, it has been found out that there are various articles published for the awareness of patients and general population regarding safe fasting during Ramadan. But very few studies highlight the Ramadan specific knowledge of general practitioners engaged in providing care to people with diabetes. This study aims to describe the practice, knowledge and attitude of general practitioners regarding treatment and dietary modifications for people with diabetes during Ramadan across Pakistan. A cross-sectional descriptive study was undertaken among a sample of 274 general practitioners. Data was collected by means of a questionnaire that consisted of 25 questions that were structured according to three categories i-e. Ramadan specific knowledge, diet and physical activity and treatment modification related knowledge and practices of GPs. Out of the total population of GPs surveyed, 70% responded correctly to the questions while 30% responded incorrectly. 1/4(th) of GPs incorrectly responded to questions regarding basic concepts of diabetes and Ramadan. 1/3(rd) of GPs responded incorrectly regarding questions on diet. Almost 40% of the GPs responded incorrectly to the questions regarding drug dosage adjustment in people with diabetes during Ramadan. However, more than 80% responded in agreement regarding alteration in medication timings. Almost one third of the studied populations of general practitioners across Pakistan lack the knowledge of basic principles that are important to be employed in the management of diabetes during Ramadan. Hence there is need to promote educational programmes and CMEs to improve the knowledge of our GPs that should be reflected by their sound clinical practices in the field of diabetes.

  3. Variables associated with general practitioners' knowledge about and diagnostic skills for schizophrenia.

    PubMed

    Turrina, Cesare; Valsecchi, Paolo; Bonomi, Silvia; Corsini, Paola; Cacciani, Paolo; Medea, Gerardo; Brignoli, Ovidio; Sacchetti, Emilio

    2006-01-01

    This study investigated the level of knowledge about schizophrenia of primary care doctors working in the city of Brescia, Italy, and variables associated with better information. The study design was devised after 2 joint meetings with leading figures of the Italian College of General Practitioners. A cross-sectional evaluation of 215 general practitioners was performed (June 2002). A random subgroup was selected to participate in a 4-month retest session in order to evaluate the reliability of the schedule (October 2002). The setting was the local health unit of Brescia, which involves 706 primary care doctors working in the city and its province. Of these, 30.5% took part in the study. A structured self-report questionnaire (SAKS) was devised for this study. General practitioners were also asked to rate videotaped cases of 5 patients with different DSM-IV diagnoses. The main outcome measures were the scores from subscales measuring knowledge of schizophrenia symptoms and signs, knowledge of antipsychotics and their adverse events, and correct diagnoses of 5 videotaped cases. Primary care doctors identified positive (79.0%), negative (72.6%) and general (72.1%) symptoms of schizophrenia (p < .001). Of the 5 cases on videotape, they correctly rated a mean of 3.1 cases. The mean percentage of anti-psychotics correctly identified was 34.1% (older) and 51.2% (novel) (p < .001). Better answers were given by doctors who knew the diagnostic criteria, had read books on psychiatry, and had attended previous courses. More teaching on the diagnosis of schizophrenia and clinical psychopharmacology should be given to general practitioners.

  4. Variables Associated With General Practitioners' Knowledge About and Diagnostic Skills for Schizophrenia

    PubMed Central

    Turrina, Cesare; Valsecchi, Paolo; Bonomi, Silvia; Corsini, Paola; Cacciani, Paolo; Medea, Gerardo; Brignoli, Ovidio; Sacchetti, Emilio

    2006-01-01

    Objective: This study investigated the level of knowledge about schizophrenia of primary care doctors working in the city of Brescia, Italy, and variables associated with better information. Method: The study design was devised after 2 joint meetings with leading figures of the Italian College of General Practitioners. A cross-sectional evaluation of 215 general practitioners was performed (June 2002). A random subgroup was selected to participate in a 4-month retest session in order to evaluate the reliability of the schedule (October 2002). The setting was the local health unit of Brescia, which involves 706 primary care doctors working in the city and its province. Of these, 30.5% took part in the study. A structured self-report questionnaire (SAKS) was devised for this study. General practitioners were also asked to rate videotaped cases of 5 patients with different DSM-IV diagnoses. The main outcome measures were the scores from subscales measuring knowledge of schizophrenia symptoms and signs, knowledge of antipsychotics and their adverse events, and correct diagnoses of 5 videotaped cases. Results: Primary care doctors identified positive (79.0%), negative (72.6%) and general (72.1%) symptoms of schizophrenia (p < .001). Of the 5 cases on videotape, they correctly rated a mean of 3.1 cases. The mean percentage of anti-psychotics correctly identified was 34.1% (older) and 51.2% (novel) (p < .001). Better answers were given by doctors who knew the diagnostic criteria, had read books on psychiatry, and had attended previous courses. Conclusion: More teaching on the diagnosis of schizophrenia and clinical psychopharmacology should be given to general practitioners. PMID:16964313

  5. Ramadan and diabetes - knowledge, attitude and practices of general practitioners; a cross-sectional study

    PubMed Central

    Ahmedani, Muhammad Yakoob; Hashmi, Bella Z.; Ulhaque, Muhammad Saif

    2016-01-01

    Background and aims: Fasting during Ramadan is obligatory for all Muslims across the world. Through literature review, it has been found out that there are various articles published for the awareness of patients and general population regarding safe fasting during Ramadan. But very few studies highlight the Ramadan specific knowledge of general practitioners engaged in providing care to people with diabetes. This study aims to describe the practice, knowledge and attitude of general practitioners regarding treatment and dietary modifications for people with diabetes during Ramadan across Pakistan. Methods: A cross-sectional descriptive study was undertaken among a sample of 274 general practitioners. Data was collected by means of a questionnaire that consisted of 25 questions that were structured according to three categories i-e. Ramadan specific knowledge, diet and physical activity and treatment modification related knowledge and practices of GPs. Results: Out of the total population of GPs surveyed, 70% responded correctly to the questions while 30% responded incorrectly. 1/4th of GPs incorrectly responded to questions regarding basic concepts of diabetes and Ramadan. 1/3rd of GPs responded incorrectly regarding questions on diet. Almost 40% of the GPs responded incorrectly to the questions regarding drug dosage adjustment in people with diabetes during Ramadan. However, more than 80% responded in agreement regarding alteration in medication timings. Conclusion: Almost one third of the studied populations of general practitioners across Pakistan lack the knowledge of basic principles that are important to be employed in the management of diabetes during Ramadan. Hence there is need to promote educational programmes and CMEs to improve the knowledge of our GPs that should be reflected by their sound clinical practices in the field of diabetes. PMID:27648026

  6. Getting a visit: how district nurses and general practitioners 'organise' each other in primary care.

    PubMed

    Speed, Shaun; Luker, Karen A

    2006-11-01

    This paper examines the ways in which district nurses and general practitioners interacted and influenced each other's work within primary care services. The data presented here examine how the developments in the organisation of primary care affected the work of district nurses during a time of turbulent change. Qualitative data from 300 hours of participant observation and 40 semi-structured interviews with 33 district nurses were analysed using grounded theory, after which a literature review was undertaken. The findings from this study were interpreted using a Foucauldian notion of power and Fox's (1995) analysis of 'organisation'. The shift in power to general practitioners (GPs) has meant that they can exercise ever-increasing authority over nurses in their employ. Strict rules governed the process of inter-professional work and nurses and doctors used creative strategies to overcome the problems that existed between them. The data show that nurses could and did resist the power of GPs but this resistance generally elicited other more punishing forms of authority. Direct and indirect threats were commonplace. The data suggest that district nurses were moving into a closer, more business-like and tightly-controlled working relationship with general practitioners, through which competing discourses interplayed and circulated between GPs and district nurses in the organisation of primary care services.

  7. Impact on quit attempts of mailed general practitioner 'brief advice' letters plus nicotine replacement therapy vouchers.

    PubMed

    Watson, Donna; Bullen, Chris; Clover, Marewa; McRobbie, Hayden; Parag, Varsha; Walker, Natalie

    2010-03-01

    To test whether a personalised letter from general practitioners advising their patients who are smokers to quit, together with an exchange card for one month of nicotine gum, prompts them to make quit attempts, is acceptable and feasible. Non-randomised before-after ecological study involving general practices in Auckland, New Zealand. Personalised letters with exchange cards for four weeks of nicotine gum were sent to 831 patients within a single Auckland health board area who were recorded as current smokers on their general practitioners files. The comparison group was the population in another Auckland health board area. We measured calls to Quitline and vouchers redeemed at pharmacies from both areas before and after the intervention. Follow-up surveys of recipients and general practitioners assessed acceptability. Quitline calls from baseline to the end of the intervention from the intervention district compared with a comparison district were not significantly higher (5%, 95% CI -2-12%, p = 0.195), but nicotine replacement therapy (NRT) voucher redemptions were significantly higher (9%, 95% CI 3-16%, p = .005). Almost 9% of the exchange cards were redeemed for NRT. Despite initial difficulties in accurately identifying smokers from their records, responding GPs found the strategy very acceptable. The strategy shows potential as a simple way to increase the number of smokers making supported quit attempts through primary care. In the light of the urgent need to increase cessation rates, a randomised trial of this promising approach is warranted.

  8. Reluctant to train, reluctant to prescribe: barriers to general practitioner prescribing of opioid substitution therapy.

    PubMed

    Longman, Christine; Temple-Smith, Meredith; Gilchrist, Gail; Lintzeris, Nicholas

    2012-01-01

    Opioid substitution therapy (OST) is a well-recognised, evidence-based treatment for opioid dependence. Since the early 1990s, Australia has used a community-based general practitioner (GP) model ofprescribing, particularly within the state of Victoria, where over 85% of OST prescribing is undertaken by GPs in community settings. Yet the majority of GPs invited to complete the required OST training decline the offer, while of those who complete training, the majority prescribe to few or no patients. This study aimed to determine the reasons for this. Twenty-two in-depth interviews were conducted with Victorian GPs exploring the reasons why the majority declined training, and for trained GPs, why they prescribed to few or no patients in the first 12 months after training. General practitioners who declined to train were predominantly influenced by negative experiences with drug-seeking patients, although other secondary reasons also affected their decision. Some GPs who completed the training were prevented from prescribing by several structural and operational barriers, many of which could be addressed. Fear of deskilling with time became a further impediment. General practitioners who became regular prescribers were highly committed with lengthy general practice experience. Concerns exist about the recruitment process for OST prescriber training, where nearly all GPs decline the offer of training, and the barriers that prevent GPs prescribing after training. Action is needed to address barriers to GP OST training and prescribing, and further research is necessary to ascertain measures required to facilitate long-term prescribing.

  9. Elevated view of general office complex, looking southeast from the ...

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

    Elevated view of general office complex, looking southeast from the roof of the lower shops. Visible is the entire machine shop, with the northern section (square towr and gabled roof) completed in 1891, and the flat-roofed rear (southern) section added in 1924. Also visible is the original skylight in the roof of the drawing room and laying out floor building, subsequently covered over with tar paper. - Johnson Steel Street Rail Company, 525 Central Avenue, Johnstown, Cambria County, PA

  10. German General Staff Officer Education and Current Challenges

    DTIC Science & Technology

    2006-05-25

    MONOGRAPH 25-05-2006 SEPT 2005-MAR 2006 5a. CONTRACT NUMBER 5b. GRANT NUMBER 4 . TITLE AND SUBTITLE German General Staff Officer Education abd Current...Competencies and Skills ...................................................................... 27 CHAPTER 4 THE GERMAN PRT IN KUNDUZ/AFGHANISTAN AND THE...of Defense, Defense Science Board 2004 Summer Study on Transition to and from Hostilities, Washington D.C., September 2, 2004 3 Ibid. 4 Note: The

  11. Preferred materials and methods employed for endodontic treatment by Iranian general practitioners.

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  13. [Dutch College of General Practitioner's practice guideline on polymyalgia rheumatica and temporal arteritis].

    PubMed

    Eizenga, Wietze H; Hakvoort, Louwe; Dubbeld, Peter; Geijer, Roeland M M; Goudswaard, A N Lex

    2010-01-01

    The practice guideline for general practitioners (GPs) on polymyalgia rheumatica and temporal arteritis was published in February 2010 by the Dutch College of General Practitioners. This guideline provides GPs with recommendations for the diagnosis and treatment of polymyalgia rheumatica. After other disorders have been excluded, the diagnosis of 'polymyalgia rheumatica' is made in patients over the age of 50 who have bilateral pain in the neck and shoulder girdle and/or hip girdle that has lasted for longer than 4 weeks, morning stiffness that lasts longer than 60 minutes and an ESR > 40 mm in the first hour. After the diagnosis is made treatment with prednisone or prednisolone 15 mg per day is started. This dosage is diminished very gradually according to a uniform treatment schedule during a period of 3 months, thereafter depending on the clinical course. The practice guideline pays attention to the diagnosis and management of temporal arteritis only when it occurs concurrently with polymyalgia rheumatica.

  14. Electronic communication experiences of home health care nurses and general practitioners: a cross-sectional study.

    PubMed

    Lyngstad, Merete; Hellesø, Ragnhild

    2014-01-01

    Future health care will require suitable means of communication between home health care nurses and general practitioners (GPs) to ensure safe care for homebound patients. The overall aim of this study was to investigate the experiences of home health care nurses and general practitioners using e-messaging in their communication. We conducted a cross-sectional study with a mailed questionnaire. A total of 584 home health care nurses and GPs who used e-messaging and 495 home health care nurses and GPs who did not use e-messaging completed the questionnaire. The results showed that there was high agreement, in all the groups, that e-messaging led to better communication quality, better access to patient information, and an improved ability to prevent and reduce errors and omissions. Nurses reported the most agreement, which led to the conclusion that it was the characteristics of the profession rather than the use of e-messaging that influenced high agreement.

  15. [The Dutch College of General Practitioners' practice guideline 'Parkinson's disease' in summary].

    PubMed

    Draijer, Willem; Eizenga, Wietze H; Sluiter, Alja; Opstelten, Wim; Goudswaard, A N Lex

    2011-01-01

    Parkinson's disease is characterised by bradykinesia in combination with one or more of the following symptoms: rigidity, resting tremor and disorders of posture and balance. Refer a patient with suspected Parkinson's disease (or parkinsonism) for diagnosis and treatment preferably to a neurologist with expertise in movement disorders. The treatment of Parkinson's disease is symptomatic; to date, there is no treatment that slows disease progression. The treatment of patients with Parkinson's disease and its related disorders involves collaboration of the neurologist, Parkinson's disease nurse and general practitioner. In addition to recognizing the hypokinetic-rigid syndrome, the general practitioner has a role in diagnosing and treating associated symptoms and disorders, and in supporting and counseling the patient and their partner or caregiver.

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

    PubMed

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

    2010-07-01

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

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

    PubMed

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

    2013-01-01

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

  18. Why do General Practitioners Decline Training to Improve Management of Medically Unexplained Symptoms?

    PubMed Central

    Peters, Sarah; Clifford, Rebecca; Iredale, Wendy; Gask, Linda; Rogers, Anne; Dowrick, Christopher; Hughes, John; Morriss, Richard

    2007-01-01

    Background General practitioners’ (GPs) communication with patients presenting medically unexplained symptoms (MUS) has the potential to somatize patients’ problems and intensify dependence on medical care. Several reports indicate that GPs have negative attitudes about patients with MUS. If these attitudes deter participation in training or other methods to improve communication, practitioners who most need help will not receive it. Objective To identify how GPs’ attitudes to patients with MUS might inhibit their participation with training to improve management. Design Qualitative study. Participants GPs (N = 33) who had declined or accepted training in reattribution techniques in the context of a research trial. Approach GPs were interviewed and their accounts analysed qualitatively. Results Although attitudes that devalued patients with MUS were common in practitioners who had declined training, these coexisted, in the same practitioners, with evidence of intuitive and elaborate psychological work with these patients. However, these practitioners devalued their psychological skills. GPs who had accepted training also described working psychologically with MUS but devalued neither patients with MUS nor their own psychological skills. Conclusions GPs’ attitudes that suggested disengagement from patients with MUS belied their pursuit of psychological objectives. We therefore suggest that, whereas negative attitudes to patients have previously been regarded as the main barrier to involvement in measures to improve patient management, GPs devaluing of their own psychological skills with these patients may be more important. PMID:17443362

  19. Factors influencing root canal retreatment strategies by general practitioners and specialists in Australia.

    PubMed

    Wenteler, G L; Sathorn, C; Parashos, P

    2015-05-01

    To evaluate the effect of tooth radiographic features on root canal retreatment strategies used by general dental practitioners and dental specialists in Australia. A descriptive survey study comprising a web-based questionnaire was sent to general dental practitioners and specialists. The questionnaire diagrammatically represented six different clinical scenarios with variables including type of coronal restoration, quality of root filling and the size and presence of a periapical radiolucency. Treatment options included no treatment, orthograde retreatment, periapical surgery and replacement with an implant. For each of the six scenarios, the participant was asked to select a minimum size cut-off point where treatment would be initiated and also indicate the preferred treatment option. A total of 639 questionnaires were submitted online. In teeth without a cast core restoration, the quality of root filling influenced the selection of no treatment as an option (P < 0.001). The presence of a cast post/core restoration influenced both the treatment cut-off point and treatment option, with more practitioners selecting larger lesions as cut-off points (P < 0.001) and more treatment options involving both implant placement (P < 0.001) and periapical surgery (P < 0.001). With more complex treatment planning (i.e. cast post/core restorations and inadequate root filling), general practitioners proposed implant placement more readily compared with specialists (P < 0.001). General practitioners and specialists vary their root canal retreatment strategies according to quality of root filling and type of coronal restoration. Whilst all clinical scenarios could be managed by contemporary endodontic techniques, teeth were still treatment planned for extraction and replacement with an implant. This may be due to the fact that implants are heavily marketed by the dental industry and with more stringent outcome criteria applied to the assessment of root canal treatment compared

  20. General practitioners' knowledge of hand surgery in Singapore: a survey study.

    PubMed

    Chee, Kin Ghee; Puhaindran, Mark Edward; Chong, Alphonsus Khin Sze

    2012-08-01

    Hand surgery is a subspecialty with a dedicated training programme in Singapore. Currently, Singapore is one of two countries in the world that still provides dedicated advanced hand specialty training. As hand surgeons depend on referrals from institutions and general practitioners, appropriate hand surgical referral requires the referring physician to have knowledge and understanding of common hand conditions as well as less common but more urgent surgical conditions, and their available surgical treatments. This study aimed to determine the knowledge of hand surgery and hand surgical conditions among general practitioners. A questionnaire survey was conducted during a continuing medical education symposium on hand surgery in Singapore. Participants responded to 12 questions on hand trauma by keying the answers into a computer database system. The results were then analysed. A total of 35 general practitioners responded to our survey, and they were able to answer 53% of the questions correctly. We found knowledge gaps among the participants regarding hand surgical conditions, and identified areas where increased education during medical school, postgraduate training and continuing medical education may be beneficial. Areas that were found to be weak included recognising injuries that pose a high risk for developing wound infection, complications of topical steroid injection in trigger finger treatment and hand tumours. Improving hand surgery knowledge among general practitioners not only leads to improved primary care, but it can also facilitate prompt recognition of surgical problems and subsequent referral to appropriate hand surgeons for treatment. This may possibly reduce the load of tertiary institutions in treating non-urgent hand conditions.

  1. The 'surprise' question in advanced cancer patients: A prospective study among general practitioners.

    PubMed

    Moroni, Matteo; Zocchi, Donato; Bolognesi, Deborah; Abernethy, Amy; Rondelli, Roberto; Savorani, Giandomenico; Salera, Marcello; Dall'Olio, Filippo G; Galli, Giulia; Biasco, Guido

    2014-07-01

    Using the 'surprise' question 'Would you be surprised if this patient died in the next year?' may improve physicians' prognostic accuracy and identify people appropriate for palliative care. Determine the prognostic accuracy of general practitioners asking the 'surprise' question about their patients with advanced (stage IV) cancer. Prospective cohort study. Between December 2011 and February 2012, 42 of 50 randomly selected general practitioners (Bologna area, Italy) prospectively classified 231 patients diagnosed with advanced cancer according to the 'surprise' question and supplied the status of each patient 1 year later. Of the 231 patients, general practitioners responded 'No' to the 'surprise' question for 126 (54.5%) and 'Yes' for 105 (45.5%). After 12 months, 104 (45.0%) patients had died; 87 (83.7%) were in the 'No' group. The sensitivity of the 'surprise' question was 69.3%; the specificity was 83.6%. Positive predictive value was 83.8%; negative predictive value was 69.0%. The answer to the 'surprise' question was significantly correlated with survival at 1 year. Patients in the 'No' group had an odds ratio of 11.55 (95% confidence interval: 5.83-23.28) and a hazard ratio of 6.99 (95% confidence interval: 3.75-13.03) of being dead in the next year compared to patients in the 'Yes' group (p = 0.000 for both odds ratio and hazard ratio). When general practitioners used the 'surprise' question for their patients with advanced cancer, the accuracy of survival prognosis was very high. This has clinical potential as a method to identify patients who might benefit from palliative care. © The Author(s) 2014.

  2. Open access radiology services: availability to general practitioners in the UK.

    PubMed Central

    Morgan, G F

    1985-01-01

    A postal survey was carried out among secretaries of local medical committees to ascertain the availability of open access to radiology services in the United Kingdom. The results from different areas showed a wide variation of access, ranging from virtually none to complete access. General practitioner representatives on management teams might encourage open access to radiology services, and health authorities might be encouraged to introduce complete open access. PMID:3931842

  3. [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.

  4. 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

  5. Knowledge, attitudes and practices of general practitioners in Karachi District Central about tetanus immunization in adults.

    PubMed

    Ahmed, S I; Baig, L; Thaver, I H; Siddiqui, M I; Jafery, S I; Javed, A

    2001-10-01

    To assess the knowledge, attitude and practices of general practitioners regarding tetanus immunization in adults. The study was conducted in District Central, Karachi. This was a Knowledge, Attitude and practices (KAP) survey. From a list of 1050 general practitioners (GPs), 100 were selected through simple random sampling and interviewed through a written questionnaire. Only 25% general practitioners had adequate knowledge about pre-exposure and 13% both pre- and post-exposure tetanus immunization. All were ready to participate in any program to update their knowledge. Ninety seven percent were practicing only post-exposure immunization. In unimmunized patients with history of road side/street injury, 55% started tetanus immunization with tetanus toxoid (TT) only, 43% with Anti Tetanus Serum/Tetanus Immunoglobin (ATS/TIG) and only 2% with both TT and ATS/TIG. Only 13% GPs advised their patients to complete three doses of tetanus toxoid after initial contact. As majority of GPs had poor knowledge and incorrect practices so interventions like seminars and display of immunization protocols in the clinics are recommended.

  6. [Pain experience and pain therapy of tumor patients in the view of general practitioners].

    PubMed

    Janig, H; Pipam, W; Lastin, S; Sittl, R; Bernatzky, G; Likar, R

    2005-04-01

    The aim of the study presented in this paper is to find out how general practitioners evaluate their cancer patients' health, quality of life and type and extent of pain. In addition the study aims to get information about the training in pain therapy and palliative medicine. A representative sample of 440 of all Austrian general practitioners was interviewed via a standardized questionnaire. The consent for the questioning had been obtained by telephone. The state of health and quality of life of the treated cancer patients are described as little satisfying and most unfavourably affected by the disease. The physicians suppose that the patients experience pain more intense than could be expected of them as endurable. Nevertheless the cancer patients appreciate pain therapy. As a result the medical training in pain therapy and palliative medicine should be improved. At the same time the future general practitioners should gain psychological competences, which would consequently provide them with a broad spectrum of treatment needed when dealing with pain patients (suffering from cancer).

  7. Association of occupational burnout and type of personality in Iranian general practitioners.

    PubMed

    Ahmadpanah, Mohammad; Torabian, Saadat; Dastore, Kamel; Jahangard, Leila; Haghighi, Mohammad

    2015-06-05

    Physicians experience high level of occupational burnout that exposes them to physical and mental exhaustion as well as job dissatisfaction. The association between different types of personality traits and occupational burnout among a group of Iranian general practitioners is assessed. One hundred general practitioners working in emergency wards of eight hospitals in Iran were studied. Occupational burnout was measured using the Maslach Burnout Inventory and type of personality was assessed using the Holland personality test. An average of 15.4% of personnel displayed high frequency in subscale of emotional exhaustion, 14.5% displayed high frequency in subscale of depersonalization, and 10.2% displayed high frequency in subscale of lack of personal accomplishment. Realistic personality was revealed in 2%, social types in 41%, investigative type in 35%, enterprising types in 6.0%, artistic type in 13% and conventional type of personality in 3.0% of them. The subjects with social personality experienced the lowest burnout. There were negative correlation between physician experiences and different subdivisions of burnout. A notable number of Iranian general practitioners suffered occupational burnout, especially emotional exhaustion. The majority of physicians had social or investigative personalities.

  8. Participation of general practitioners in the management of their “hospital at home” patients

    PubMed

    Leung, Inès; Casalino, Enrique; Pateron, Dominique; Grateau, Gilles; Garandeau, Elzbieta; de Stampa, Matthieu

    2016-10-19

    Objectives: Hospital at home (HAH) care is becoming increasingly popular in France and requires the involvement of general practitioners (GPs) in the care of their patients. The objective of this study was to identify the incentives and barriers to the involvement of general practitioners in HAH. Materials and methods: A qualitative study was carried out using semi-structured interviews during a focus group with 12 GPs. All interviews were recorded and then transcribed verbatim and data analysis used the grounded theory method. Results: General practitioners appeared to be familiar with the indications and places of care for HAH, but they highlighted the difficulties associated with the HAH request circuit. GPs identified difficulties determining their exact role in HAH, which were improved by their clinical expertise in home visits. Doctors stressed the complexity of home care, but they were assisted by the coordinating physician and they requested specific training. Conclusion: We identified incentives and barriers to the participation of GPs in HAH. The request circuit needs to be simplified, home visits need to be strengthened and support must be provided to GPs in their management of complex care.

  9. National survey of job satisfaction and retirement intentions among general practitioners in England.

    PubMed

    Sibbald, Bonnie; Bojke, Chris; Gravelle, Hugh

    2003-01-04

    To measure general practitioners' intentions to quit direct patient care, to assess changes between 1998 and 2000, and to investigate associated factors, notably job satisfaction. Analysis of national postal surveys conducted in 1998 and 2001. England. 1949 general practitioner principals, of whom 790 were surveyed in 1998 and 1159 in 2001. Overall job satisfaction and likelihood of leaving direct patient care in the next five years. The proportion of doctors intending to quit direct patient care in the next five years rose from 14% in 1998 to 22% in 2001. In both years, the main factors associated with an increased likelihood of quitting were older age and ethnic minority status. Higher job satisfaction and having children younger than 18 years were associated with a reduced likelihood of quitting. There were no significant differences in regression coefficients between 1998 and 2001, suggesting that the effect of factors influencing intentions to quit remained stable over time. The rise in intentions to quit was due mainly to a reduction in job satisfaction (1998 mean 4.64, 2001 mean 3.96) together with a slight increase in the proportion of doctors from ethnic minorities and in the mean age of doctors. Doctors' personal and practice characteristics explained little of the variation in job satisfaction within or between years. Job satisfaction is an important factor underlying intention to quit, and attention to this aspect of doctors' working lives may help to increase the supply of general practitioners.

  10. Assessment of the performance of general practitioners by the use of standardized (simulated) patients.

    PubMed Central

    Rethans, J J; Sturmans, F; Drop, R; van der Vleuten, C

    1991-01-01

    A study was undertaken whereby a set of standardized (simulated) patients visited general practitioners without being detected, in a health care system where doctors had fixed patient lists. Thirty nine general practitioners were each visited during normal surgery hours by four standardized patients who were designed to be indistinguishable from real patients. The objective of the study was to see whether the actual performance of general practitioners, as assessed by standardized patients, met predetermined consensus standards of care for actual practice. The patients presented standardized accounts of headache, diarrhoea, shoulder pain and diabetes. The mean group scores of the doctors on the predefined standards of care for the different complaints ranged from 33 to 68%. The results show that standardized patients may be the method of choice in the assessment of the quality of actual care of doctors. It is hypothesized that the substandard scores of the doctors do not reflect inadequate competence, but are a result of the difference between competence and performance. PMID:2031767

  11. An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice.

    PubMed

    McInnes, Susan; Peters, Kath; Bonney, Andrew; Halcomb, Elizabeth

    2015-09-01

    To identify facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general (family) practice. Internationally, a shortage of doctors entering and remaining in general practice and an increasing burden of chronic disease has diversified the nurse's role in this setting. Despite a well-established general practice nursing workforce, little attention has been paid to the ways doctors and nurses collaborate in this setting. Integrative literature review. CINAHL, Scopus, Web of Life, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews and Trove (dissertation and theses) were searched for papers published between 2000 and May 2014. This review was informed by the approach of Whittemore and Knafl (2005). All included papers were assessed for methodological quality. Findings were extracted, critically examined and grouped into themes. Eleven papers met the inclusion criteria. Thematic analysis revealed three themes common to the facilitators of and barriers to collaboration and teamwork between GPs in general practice: (1) roles and responsibilities; (2) respect, trust and communication; and (3) hierarchy, education and liability. This integrative review has provided insight into issues around role definition, communication and organizational constraints which influence the way nurses and general practitioners collaborate in a team environment. Future research should investigate in more detail the ways doctors and nurses work together in general practice and the impact of collaboration on nursing leadership and staff retention. © 2015 John Wiley & Sons Ltd.

  12. Office proctology and sigmoidoscopy.

    PubMed

    Fraser, A

    1990-05-01

    Proctoscopy and sigmoidoscopy are readily acquired skills and should be routine office procedures for general practitioners. Correct positioning of the patient is of utmost importance to a successful examination.

  13. 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

  14. 4 CFR 28.11 - Filing a charge with the Office of General Counsel.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 4 Accounts 1 2010-01-01 2010-01-01 false Filing a charge with the Office of General Counsel. 28.11 Section 28.11 Accounts GOVERNMENT ACCOUNTABILITY OFFICE GENERAL PROCEDURES GOVERNMENT ACCOUNTABILITY... GOVERNMENT ACCOUNTABILITY OFFICE Procedures § 28.11 Filing a charge with the Office of General Counsel....

  15. [Factors influencing general practitioners and specialists of general practice to declare in favor of accepting the role of family doctors].

    PubMed

    Lapcević, Mirjana; Dimitrijević, Ivan; Ristić, Jelena; Vuković, Mira; Nikolić, Radivoje; Stanojević, Petar

    2006-10-01

    Protection and promotion of health of an individual, family and society as the whole depends on the organization and efficiency of the public health service. Modern health service is focused on the health prevention and improvement of the family which is the basic unit of society. The life cycle of the family indicates crisis related to development and underdevelopment as well as some expected and unexpected life situations and this is very important when discussing about many somatic and mental diseases. The objective of our project which included 473 specialists of general practice and 355 general practitioners was to determine the factors which influence the positive attitude of the general practitioners about becoming a family doctor. A total of 828 doctors in Serbia were required to answer the set of eight questions. Statistical analysis included Pearson chi square test with contingency tables and logistic regression, while dependent variable was doctor's attitude about becoming a family doctor in a certain situation. The answer 'no' or 'I don't know' was scored 1 point and the 'yes' answer was graded 2 points. Eight questions mentioned above were independent variables. Logistic model accounting for 79.3% of dependent variable was obtained. Positive attitude of doctors was very much affected by family problems and great majority of these doctors were specialists of general practice. Other questions were not so important for our results. Specialists of general practice, regardless of their working experience and years of practice, gave significantly more positive answers, and the situation was quite opposite with general practitioners. Family medicine supported by modern information systems provides ideal model of comprehensive and complete health prevention with high level of rationalism, quality, efficiency and cost-effectiveness.

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

    PubMed Central

    Bashir, K; King, M; Ashworth, M

    1994-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  18. The role of the general practitioner and the orthodontist in the provision of orthodontic care.

    PubMed

    Linge, L

    1987-06-01

    Orthodontics is a small branch of dentistry but one of the oldest and most widespread of dental specialties. It is characterized by long-term treatment objectives which are related to dentofacial morphology and function, growth, facial balance and maturation. Owing to the lack of baseline data it has not been included in the recommendations of the FDI for a stepwise procedure towards 'Health for All by the Year 2000'. Serious efforts should be made to allow inclusion of orthodontics by overcoming this data problem. It is strongly recommended that an internationally acceptable index for orthodontic purposes at the community level be developed. Problems of integration of orthodontic services within oral health care programmes are most significant at medium resource levels when priorities have to be established among many highly desirable dental services. In upper resource levels with less caries and periodontal disease than before the general practitioner should be aware of the rapidly increasing needs for service among elderly people due to improved oral health in adults. For the sake of efficiency, control and quality orthodontic treatment should preferably be carried out by appropriately educated orthodontists, even if the case appears simple in the beginning. Simple cases treated by specialists consume fewer resources than are needed for a system of effective communication and delegation to the general practitioner. Continuing education of all practitioners and other members of the dental team should be carried out in personnel categories and across the boundaries between them.

  19. Employment law: A guidance note for general practitioners on providing patient information to employers.

    PubMed

    Garnett, Adele; Tobin, Andrew

    2017-01-01

    Medical practitioners are often caught between a patient who is reluctant to provide their employer with personal health information and an employer who is requesting more detailed health information. This article outlines the rights and responsibilities of employees and employers with regards to the provision of personal health information within employment, and how medical practitioners can assist in advocating for their patient. Topics covered include legal requirements for medical certificates; when certificates can be questioned by an employer; and whether employers can request additional health information from a general practitioner (GP) or independent specialist. In many cases, employers have the right to seek further health information from their employees (eg for health and safety obligations), and employees can face disciplinary action and even dismissal if they are uncooperative. As GPs are necessarily involved in the pro-vision of this information, it is important that they have a general understanding of employment law as it relates to the provision of a patient's personal health information to employers.

  20. Use of histopathology services by general practitioners: recent changes in referral practice.

    PubMed Central

    Shorrock, K

    1993-01-01

    AIMS--To determine the nature and magnitude of the histopathological workload generated by specimens received from general practitioners and to assess the trends in referral practice. METHODS--All material submitted by general practitioners to the Leicester district histopathology service from 1989 to January 1993 was identified from departmental records. All GP referrals from October to December 1992 were also analysed. Total numbers of referrals from all sources were used for comparison. Specimens were also analysed according to diagnostic categories. RESULTS--There has been a progressive rise, both in the absolute number and the proportion of specimens relative to other surgical specimens submitted by GPs. Most are skin biopsy specimens. There were clear changes over the study period in the relative proportion of different types of lesions received, with a substantial increase in samples of benign naevi and papillomas. There was some evidence of a corresponding decrease in the number of these lesions submitted by hospital practitioners. The number of malignant skin tumours from GPs was small and the proportion had not increased over the study period. CONCLUSIONS--Histopathological workload generated by GPs is increasing but it still represents a small proportion of the total. The major increase is in benign skin lesions. PMID:8254104

  1. Diagnostic accuracy of a general practitioner with video-otoscopy collected by a health care facilitator compared to traditional otoscopy.

    PubMed

    Lundberg, Thorbjörn; Biagio de Jager, Leigh; Swanepoel, De Wet; Laurent, Claude

    2017-08-01

    Video-otoscopy is rapidly developing as a new method to diagnose common ear disease and can be performed by trained health care facilitators as well as by clinicians. This study aimed to compare remote asynchronous assessments of video-otoscopy with otoscopy performed by a general practitioner. Children, aged 2-16 years, attending a health center in Johannesburg, South Africa, were examined. An otologist performed otomicroscopy and a general practitioner performed otoscopy. Video-otoscopy was performed by a health care facilitator and video sequences were stored on a server for assessment by the same general practitioner 4 and 8 weeks later. At all examinations, a diagnosis was set and the tympanic membrane appearance was graded using the OMgrade-scale. The otologist's otomicroscopic diagnosis was set as reference standard to compare the accuracy of the two otoscopic methods. Diagnostic agreement between otologist's otomicroscopic examination and the general practitioner's otoscopic examination was substantial (kappa 0.66). Agreement between onsite otomicroscopy and the general practitioners asynchronous video assessments were also substantial (kappa 0.70 and 0.80). Video-otoscopy performed by a health care facilitator and assessed asynchronously by a general practitioner had similar or better accuracy compared to face-to-face otoscopy performed by a general practitioner. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. CBCT technology for diagnosis and treatment planning: what general practitioners should consider.

    PubMed

    Jansen, Curtis E

    2014-01-01

    The use of cone-beam computed tomography (CBCT) for diagnosis and treatment planning for a range of applications, including tooth removal, implant, endodontic, orthodontic, temporomandibular joint disorder, and obstructive airway cases, is well known. However, general practitioners should understand that beyond diagnosing fractures and tooth/root anomalies and assessing hard tissue before and after implant placement, this extraoral 3-dimensional (3-D) technology can be beneficial for performing more common diagnostic tasks, such as panoramic x-rays and bitewings. When used in place of intraoral sensors, it spares patients the discomfort of the rigid sensor. CBCT, which uses a fraction of the radiation dose of medical CT, can also be used to help clinicians create digital versions of their conventional impressions and poured models for digital transmission to other dental team members. For the growing number of practitioners who place implants, CBCT provides the ability to execute "top-down" treatment planning to offer patients restorative-based implant placement.

  3. Prescribing at the hospital-general practice interface. II: Impact of hospital outpatient dispensing policies in England on general practitioners and hospital consultants.

    PubMed Central

    Sibbald, B.; Wilkie, P.; Raftery, J.; Anderson, S.; Freeling, P.

    1992-01-01

    OBJECTIVE--To assess the impact on general practitioners and hospital consultants of hospital outpatient dispensing policies in England. DESIGN--Postal questionnaire and telephone interview survey of general practitioners and hospital consultants in January 1991. SETTING--94 selected major acute hospitals in England. PARTICIPANTS--20 general practitioners in the vicinity of each of 94 selected hospitals and eight consultants from each, selected by chief pharmacists. MAIN OUTCOME MEASURES--Proportions of general practitioners unable to assume responsibility for specialist drugs and of consultants wishing to retain responsibility; association between dispensing restrictions and the frequency of general practitioners being asked to prescribe hospital initiated treatments. RESULTS--Completed questionnaires were obtained from 1207 (64%) of 1887 general practitioners and 457 (63%) of 729 consultants. 570 (46%) general practitioners felt unable to take responsibility for certain treatments, principally because of difficulty in detecting side effects (367, 30%), uncertainty about explaining treatment to patients (332, 28%), and difficulty monitoring dosage (294, 24%). Among consultants 328 (72%) wished to retain responsibility, principally because of specialist need for monitoring (93, 20%), urgent need to commence treatment (64, 14%), and specialist need to initiate or stabilise treatment (63, 14%). The more restricted the drug supply to outpatients, the more frequently consultants asked general practitioners to prescribe (p less than 0.01) and complete a short course of treatment initiated by the hospital (p less than 0.001). CONCLUSIONS--Restrictive hospital outpatient dispensing shifts clinical responsibility on to general practitioners. Hospital doctors should be able to retain responsibility for prescribing when the general practitioner is unfamiliar with the drug or there is a specialist need to initiate, stabilise, or monitor treatment. PMID:1734993

  4. Prescribing at the hospital-general practice interface. II: Impact of hospital outpatient dispensing policies in England on general practitioners and hospital consultants.

    PubMed

    Sibbald, B; Wilkie, P; Raftery, J; Anderson, S; Freeling, P

    1992-01-04

    To assess the impact on general practitioners and hospital consultants of hospital outpatient dispensing policies in England. Postal questionnaire and telephone interview survey of general practitioners and hospital consultants in January 1991. 94 selected major acute hospitals in England. 20 general practitioners in the vicinity of each of 94 selected hospitals and eight consultants from each, selected by chief pharmacists. Proportions of general practitioners unable to assume responsibility for specialist drugs and of consultants wishing to retain responsibility; association between dispensing restrictions and the frequency of general practitioners being asked to prescribe hospital initiated treatments. Completed questionnaires were obtained from 1207 (64%) of 1887 general practitioners and 457 (63%) of 729 consultants. 570 (46%) general practitioners felt unable to take responsibility for certain treatments, principally because of difficulty in detecting side effects (367, 30%), uncertainty about explaining treatment to patients (332, 28%), and difficulty monitoring dosage (294, 24%). Among consultants 328 (72%) wished to retain responsibility, principally because of specialist need for monitoring (93, 20%), urgent need to commence treatment (64, 14%), and specialist need to initiate or stabilise treatment (63, 14%). The more restricted the drug supply to outpatients, the more frequently consultants asked general practitioners to prescribe (p less than 0.01) and complete a short course of treatment initiated by the hospital (p less than 0.001). Restrictive hospital outpatient dispensing shifts clinical responsibility on to general practitioners. Hospital doctors should be able to retain responsibility for prescribing when the general practitioner is unfamiliar with the drug or there is a specialist need to initiate, stabilise, or monitor treatment.

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

    PubMed Central

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

    2015-01-01

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

  6. General practitioners' attitudes towards research in primary care: qualitative results of a cross sectional study

    PubMed Central

    Rosemann, Thomas; Szecsenyi, Joachim

    2004-01-01

    Background Research in General Practice requires the participation of General practitioners (GPs). In Germany there is little tradition of research in this field, and GPs are not used to be participants in research. Little is known about German GPs attitudes towards research. Therefore the aim of our study was to assess the willingness of German General Practitioners to participate in primary care research and their attitude towards research in general practice. The results should enable a more successful approach to GPs in further studies. Methods Cross sectional study using semi-structured interviews with a random sample of 76 General Practitioners who participate in the teaching of medical students at the University of Heidelberg. Results Despite little experience, over 85 % of GPs appreciated research in their field. Important reasons for scepticism about research were the gap between theoretical research and practical work of GPs and the domination of research by specialists. Main barriers for participation are clinical workload, administrative overload and the newly introduced Disease Management Programs. The highest motivation for GPs to participate in research emanates from the will to substantiate their quality of care with solid research data. Conclusions Financial incentives and personal support e.g. with study nurses are certainly necessary to establish a research culture and to overcome main barriers against participation. The most successful approach to motivate GPs to participate is to convince them that research documents their quality of care. This data may reflect the facts on which the financial resources are provided in the future health care system. PMID:15613246

  7. Pre-operative diagnostic radiograph interpretation by general dental practitioners for root canal treatment

    PubMed Central

    Sherwood, I Anand

    2012-01-01

    Objectives The aim of this study was to evaluate which radicular radiographic features general dentists want to interpret, determine which of the radicular radiographic features general dentists interpret and which ones they miss in a diagnostic radiograph and correlate how accurately general dentists are able to interpret radiographic features. Methods 20 general dental practitioners were selected and given 2 sets of questionnaires. The first set asked them to fill out the findings they would elucidate in a diagnostic radiograph while the second set consisted of 30 randomly selected intraoral radiographs to interpret. Results In the first set of questionnaires, more than 50% of dentists said they would interpret periapical changes, calcification, root curvature and the number of root canals. Less than 50% said they would interpret canal morphology, open apex, resorption, fracture, number of roots and lamina dura. In the second set of questionnaires, more than 90% missed grade 1 or 2 periapical changes (according to periapical index scoring), resorption and canal calcification. More than 80% of dentists missed extra roots and root curvature buccally while no dentists were able to interpret the periodontal ligament width changes, lamina dura and canal variation (C-shape). Using a paired t-test, there was significant variation in answers between the first set and second set of questionnaires. Conclusion It is concluded from this study that general dental practitioners are able to detect radiographic changes when they are extensive but they miss periodontal ligament width and lamina dura changes. PMID:22074878

  8. [What factors aid in the recruitment of general practice as a career? An enquiry by interview of general practitioners].

    PubMed

    Natanzon, Iris; Ose, D; Szecsenyi, J; Joos, S

    2010-05-01

    In some parts of Germany there is already a lack of general practitioners (GPs). The reasons for this lack are complex. On the one hand there is an increasing demand for GPs as a result to demographic changes and an increase in the number of chronic diseases. On the other hand fewer medical students decide to become a general practitioner. The aim of this study was to explore, from the perspective of GPs, factors influencing the choice of general practice as a career. Also analysed is the extent to which those factors influence medical students in their carrier choice. 16 GPs were interviewed. Qualitative content analysis according to Mayring has been assisted by the Atlas.ti software program. GPs thought that the occupational orientation of medical students would be strongly dependent on the attractiveness of their future profession. Factors affecting the day-to-day work of general practice and may deterring the carrier choice of students were: poor working and general conditions leading to an increasing dissatisfaction among GPs; decreasing prestige of GPs caused by changed personal and occupational values and attitudes within the society; as well as poor representation and image of general practice as a discipline within the medical curriculum. Various approaches aimed at different target groups can be derived from these identified factors: the government providing general and occupational conditions that would relieve GPs of excessive bureaucracy; universities and medical associations meeting the challenge by improving undergraduate and postgraduate education in general practice; and GPs themselves giving a more self-confident presentation of general practice. Georg Thieme Verlag KG Stuttgart * New York.

  9. Knowledge structure and theme trends analysis on general practitioner research: A Co-word perspective.

    PubMed

    Hong, Yang; Yao, Qiang; Yang, Ying; Feng, Jun-Jian; Wu, Shu-de; Ji, Wen-Xue; Yao, Lan; Liu, Zhi-Yong

    2016-01-29

    General practitioners (GPs) are the most important providers of primary health care, as proven by related research published several decades ago. However, the knowledge structure and theme trends of such research remain unclear. Accordingly, this study aimed to provide an overview of the development of research on GPs over the period of 1999 to 2014. Studies on GPs conducted from 1999 to 2014 were retrieved from PubMed. In this work, co-word, social network analysis, and theme trends analyses were conducted to reveal the knowledge structures and thematic evolution of research on GPs. The number of conducted studies on GPs increased. However, growth speed slowed down during the past 16 years. A total of 27 high-frequency keywords were identified in 1999 to 2003, and more new and specific high-frequency keywords emerged in the subsequent periods. The dynamic of this field was first divergent and then considered convergent. Specifically, network centralization is 19.77%, 19.09%, and 13.04% in 1999 to 2003, 2004 to 2008 and 2009 to 2014, respectively. The major topics of research on GPs completed from 1999 to 2014 were "physician/family,"attitude of health personnel," and "primary health care," and "general practitioner" communities, and so on. The research themes on GPs are relatively stable at the beginning of the 21(st) century. However, the thematic evolution and research topics of research on GPs are changing dynamically in recent years. Themes related to the roles and competencies of GPs, and the relations between general practitioner and patients/others have become research foci on GPs. In addition, more substantial research especially on comprehensive approaches and holistic modeling, which have been defined in the European Definition of General Practice/Family Medicine, are expected to be accomplished.

  10. Office of Inspector General audit report on small disadvantaged business program at the Chicago Operations Office

    SciTech Connect

    1999-01-01

    The Office of Inspector General performed audits of the Small Disadvantaged Business Program at five management and operating contractors in FY 1994. The audits disclosed that none of the contractors fully met the intent of the Act and implementing regulations. The contractors awarded some subcontracts to firms of questionable program eligibility. Also, two of the contractors concentrated awards among a limited number of small disadvantaged businesses, and used procurement practices that precluded opportunities for many small disadvantaged businesses to participate. The objective of this audit was to determine whether Chicago was providing the maximum practicable opportunity for small disadvantaged businesses to participate in contract awards.

  11. A randomised controlled trial to improve the role of the general practitioner in cancer rehabilitation: effect on patients’ satisfaction with their general practitioners

    PubMed Central

    Bergholdt, Stinne Holm; Hansen, Dorte Gilså; Larsen, Pia Veldt; Kragstrup, Jakob; Søndergaard, Jens

    2013-01-01

    Objective To test whether a complex intervention facilitating early cancer rehabilitation by involvement of the general practitioner (GP) soon after diagnosis improves patients’ satisfaction with their GPs. Design A cluster randomised controlled trial. All general practices in Denmark were randomised to an intervention or a control group before the start of the study. Patients included those with cancer who were subsequently allocated to either group based on the randomisation status of their GP. Participants Adult patients with cancer treated for incident cancer at the public regional hospital (Vejle Hospital, Denmark) were included between May 2008 and February 2009. A total of 955 patients registered with 323 practices were included, of which 486 patients were allocated to the intervention group and 469 to the control group. Intervention The intervention included a patient interview assessing the need for rehabilitation, improved information from the hospital to GPs including information on the patients’ current needs along with information about needs of patients with cancer in general. Further, GPs were encouraged to proactively contact the patients and facilitate the patients’ rehabilitation course. Outcome measures 6 months after inclusion of the patient, patient satisfaction with their GP during the last 12 months in five different dimensions of GP care was assessed using the Danish version of the EuroPEP (European Patients Evaluate General Practice Care) questionnaire (DanPEP). 14 months after inclusion, patient satisfaction with the GP regarding the cancer course and GP's satisfaction with own contribution to the patients’ rehabilitation course were assessed using ad hoc questions specifically designed for this study. Results No overall effect of the intervention was observed. Subgroup analysis of the patients with breast cancer showed statistically significant improvement of satisfaction with the GP in two of the five DanPEP dimensions

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

    PubMed Central

    Carter, Geoff; Abbey, Robyn

    2016-01-01

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

  13. Observance of proper mercury hygiene practices by Jordanian general dental practitioners.

    PubMed

    Sawair, Faleh A; Hassoneh, Yazan; Jamleh, Ahmed O; Al-Rabab'ah, Mohammad

    2010-01-01

    To assess the knowledge and observance of proper mercury hygiene and amalgam waste management (AWM) among Jordanian general dental practitioners (GDPs). Interviews were conducted with randomly selected 250 Jordanian GDPs, using a specially designed questionnaire. Out of the total of 250 GDPs, 228 (91.2%) agreed to participate. The questionnaire covered aspects related to professional information and total amalgam contact (TAC) of these practitioners. The second part focused on the degree of awareness of the protocols related to mercury hygiene and safe AWM. Mean TAC was 3.2+/-3.6 hours per week. Of the Jordanian practitioners, 22.6% reported no undergraduate training in amalgam safety measures. Almost a quarter of GDPs did not have proper ventilation in their clinics, around 20-25% did not use protective clothing or eye protection, 5.3% were mixing amalgam manually, and 13.9% used their bare fingers for inserting the freshly mixed amalgam. Most of unused amalgam ends up through the drain or in trash; there are no recycling facilities to be used. Most Jordanian GDPs do not strictly follow the mercury hygiene and AWM guidelines. Promoting the American Dental Association (ADA) guidelines through undergraduate and postgraduate training will help GDPs acquire proper attitude towards the proper hygiene practices described in these recommendations.

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

    PubMed

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

    2016-01-01

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

  15. Knowledge, attitude and practice of General Practitioners towards adverse drug reaction reporting in South of Iran, Shiraz (Pharmacoepidemiology report).

    PubMed

    Peymani, Payam; Tabrizi, Reza; Afifi, Saba; Namazi, Soha; Heydari, Seyed Taghi; Shirazi, Mohammad Khabaz; Nouraei, Hasti; Sadeghi, Elham; Lankarani, Kamran B; Maharlouei, Najmeh

    2016-03-16

    An adverse drug reaction (ADRs) is linked with the use of medications and unpredictable negative consequences. The Iranian Pharmacovigilance center (IPC) has reported that the rate of ADR is very low. Thus, this study was performed to find the reasons for this under-reporting, and investigate the level of knowledge, attitude and practice (KAP) of General Practitioners (GPs) about spontaneous reporting system in Shiraz. The present cross-sectional study was conducted on 350 general practitioners (GPs) working in Shiraz, Iran from Oct 2014 to March 2015. A semi-structured questionnaire was used which included demographic features, and evaluated KAPs of GPs regarding ADRs, Pharmacovigilance, and yellow card reporting. Statistical analysis was done by descriptive and analytical statistics (frequency, Mean±SD, Student t-test, Chi-square) using SPSS version 16. Of 350 (95.1%) GPs, 333 completed the questionnaire. The respondents aged from 26 to76 years, of whom 176 (52.9%) were males with mean age 39.6±8.8 SD years. In regard to work place, 85 (25.5%) had their own office, and 112 (33.7%), 101 (30.9%), and 35 (10.5%) worked in private hospitals, in governmental hospitals, and in more than one place, respectively. Work experience mean was 13.3±8.2SD years and median was 12 years (range 1-50 years). Although, less than half of the participants (n = 151; 45.3%) described ADR correctly, 215 (64.6%) respondents claimed that they were not familiar with physician's responsibility regarding ADR reporting. Overall, few of the participants were aware of the steps in either ADR reporting or using Yellow Card System. On the whole, 100 (30%) respondents achieved acceptable knowledge score, while the median score was 9 out of 14 and minimum and maximum being 5 and 14, respectively. The physicians in Shiraz have poor knowledge of the pharmacovigilance system; however self-education leads to a better knowledge and positive attitude regarding ADRs reporting system. National

  16. Factors influencing general practitioners in the referral of elderly cancer patients.

    PubMed

    Delva, Fleur; Marien, Emilie; Fonck, Marianne; Rainfray, Muriel; Demeaux, Jean-Louis; Moreaud, Philippe; Soubeyran, Pierre; Sasco, Annie J; Mathoulin-Pélissier, Simone

    2011-01-06

    A number of studies have identified advanced age as a barrier to accessing specialised oncological care. Many factors can influence the care provided for elderly patients after a diagnosis of cancer has been established or is suspected. Only one European study has analysed the decision processes leading general practitioners (GPs) to refer elderly patients with cancer to oncologists. The objectives of the current study are to describe the factors that influence these decisions and to identify the particular factors and GP characteristics that are associated with systematic referral of these patients in South-West France. This is a cross-sectional study on a representative sample of GPs in Aquitaine, South-West France. Questionnaire items were selected using a Delphi consensus approach and sent by post. Two logistic regression models were constructed to investigate GPs' decisions to refer these patients. The response rate obtained was 30%. Half of the general practitioners reported "always" referring their elderly cancer patients to oncologists. More than 75% reported being influenced by patient-related elements (patient and/or family wishes, comorbid factors, unsuitability of invasive investigations, physical and mental autonomy), by cancer-related elements (severity of symptoms, expected side-effects) and an organisational element (whether the general practitioner was used to collaborating with oncologists). Logistic regression analysis showed that cancer site and organisational difficulties in patient management were significantly associated with the decision to refer elderly patients with early-stage cancer. For advanced stages, oncology training, patient age, organisational difficulties in patient management and stage of cancer were significantly associated with the decision to refer elderly patients. Cancer-linked factors and organisational difficulties have been highlighted as influencing the decisions of GPs in the referral of elderly patients to a cancer

  17. Antibiotic prescription patterns of South African general medical practitioners for treatment of acute bronchitis.

    PubMed

    Ncube, N B Q; Solanki, G C; Kredo, T; Lalloo, R

    2017-01-30

    Antibiotic resistance is a significant public health problem. Prudent use of antibiotics is crucial in reducing this resistance. Acute bronchitis is a common reason for consultations with general medical practitioners, and antibiotics are often prescribed even though guidelines recommend not prescribing them for uncomplicated acute bronchitis. To analyse the antibiotic prescription patterns of South African (SA) general medical practitioners in the treatment of acute bronchitis. The 2013 claims for members of 11 health insurance schemes were analysed to assess antibiotic prescription patterns for patients diagnosed with acute bronchitis. The patterns were assessed by type of bronchitis, chronic health status of the patients, sex and age group. The types of antibiotic prescribed were also analysed. Of 166 821 events analysed, an antibiotic was prescribed in more than half (52.9%). There were significant differences by type of bronchitis and chronic health status. Patients with viral bronchitis were more likely to be prescribed an antibiotic than those with bacterial bronchitis (odds ratio (OR) 1.17, 95% confidence interval (CI) 1.08 - 1.26). Patients with a chronic illness were less likely to be prescribed an antibiotic than those without (OR 0.58, 95% CI 0.57 - 0.60). More than 70% of the antibiotics prescribed were cephalosporins, penicillins and other beta-lactams. Prescription rates of antibiotics for acute bronchitis by SA general medical practitioners are high. There is an urgent need to follow the guidelines for antibiotic use for acute bronchitis to reduce the likelihood of increasing resistance to available antibiotics.

  18. A randomised controlled trial to improve general practitioners' services in cancer rehabilitation: effects on general practitioners' proactivity and on patients' participation in rehabilitation activities.

    PubMed

    Bergholdt, Stinne Holm; Søndergaard, Jens; Larsen, Pia Veldt; Holm, Lise Vilstrup; Kragstrup, Jakob; Hansen, Dorte Gilså

    2013-02-01

    Few studies have evaluated initiatives targeting implementation of cancer rehabilitation. In this study we aim to test the effects of a complex intervention designed to improve general practitioners' (GPs) involvement in cancer rehabilitation. Outcomes were proactive contacts to patients by their GP reported by the patients and GPs, respectively, and patients' participation in rehabilitation activities. Cluster randomised controlled trial. All general practices in Denmark were randomised to an intervention group or to a control group (usual procedures). Patients were subsequently allocated to the intervention or the control group based on randomisation status of their GP. Between May 2008 and February 2009, adult patients treated for incident cancer at Vejle Hospital, Denmark, were assessed for eligibility. A total of 323 general practices were included, allocating 486 patients to an intervention and 469 to a control group. The intervention included a patient interview about rehabilitation with a rehabilitation coordinator at the hospital, comprehensive information to the GP about individual needs for rehabilitation, and an encouragement to the GP to contact the patient proactively. Questionnaires were administered to patients and GPs at 14 months after inclusion. At baseline average age of patients was 63 years and 72% were female. The most frequent cancer localisations were breast (43%), lung (15%), and malignant melanoma (8%). The intervention had no effect on either patient- or GP-reported extent of GP proactivity. Further, no effect was observed on patient participation in rehabilitation activities during the 14-month follow-up period. The intervention had no effect on GP proactivity or on patient participation in rehabilitation activities. However, analyses showed a significant association between proactivity and participation and we, therefore, conclude that increased GP proactivity may facilitate patient participation in rehabilitation activities.

  19. Imported malaria in the UK: advice given by general practitioners to British residents travelling to malaria endemic areas

    PubMed Central

    Campbell, Harry

    1987-01-01

    General practitioners are in a key position to provide advice to those travelling to malaria endemic areas. A study of at-risk travellers revealed that 54% visited their general practitioner before their intended trip overseas and of these 79% were given advice about antimalarial precautions. Of those advised 98% carried antimalarial tablets with them on their trip but only 46% had any knowledge of other methods of personal protection against malaria. Fewer non-white than white British residents received information from their general practitioners. It is suggested that general practitioners should be better informed about current malaria transmission and currently recommended chemoprophylactic drugs and dosages. It is also suggested that the major public health priority should be to stimulate a greater involvement of non-health service agencies in order to make the public aware of the risk of malaria and seek medical advice before travel. PMID:3668936

  20. Are "part-time" general practitioners workforce idlers or committed professionals?

    PubMed

    Dwan, Kathryn M; Douglas, Kirsty A; Forrest, Laura E

    2014-09-19

    The traditional view of general practice holds that only general practitioners (GPs) in full-time clinical practice can provide quality patient care. Nevertheless, increasing numbers of GPs are choosing to work sessionally, that is, ostensibly "part-time". There are concerns about the health workforce's ability to meet demand and also fears that patient care may be compromised. We sought answers to a) what activities do GPs undertake when not consulting patients, b) why do they choose to work sessionally, and c) does sessional general practice reflect a lack of commitment to patients and the profession? Semi-structured interviews were conducted with GPs who worked sessionally, (i.e. six or fewer sessions a week in clinical general practice, where a session comprises four consecutive hours of patient care). These data were analysed qualitatively and saturation was reached. The majority of participants were in full-time paid employment, while part-time in clinical general practice. They reported that consultations increasingly required the management of patients with complex, chronic conditions who also required psychological management. Coupled with unrealistic patient expectations, these factors led GPs to be concerned about maintaining the quality patient care they considered professionally desirable. Many diversified their work activities to ensure that they retained their professional standards. "Part-time" general practice is a misnomer that masks the contribution these GPs make as part of the health workforce. Sessional practice more accurately describes the nature of our participants' clinical work. Their choice of sessional work is a professional response to the increasing demands within the consultation. It enables GPs to maintain their commitment to quality patient care and their profession, while attenuating the challenges of demanding consultations. Sessional general practitioners demonstrate strong commitment to their patients and the profession.

  1. Narratives about patients with psychological problems illustrate different professional roles among general practitioners.

    PubMed

    Davidsen, Annette Sofie; Reventlow, Susanne

    2011-09-01

    General practitioners are not trained in psychotherapy. They are, however, experienced in hearing people's stories. This qualitative interview study aimed to explore the stories GPs recounted about psychological interventions with patients. It showed that the GPs had recounted very different types of narrative, and that the same GP recounted the same type of narrative throughout the interview. Some told detailed narratives including the patient's life situation, whereas others kept to biomedical matters. Co-creation of patients' narratives had a therapeutic function, and patients obtained agency and power in these stories. The narrative style reflected the professional identity of the GP.

  2. [Communication general practitioner/patient in the light of the patient' rights law].

    PubMed

    Schetgen, M

    2006-09-01

    The law relating to patients' rights, published in 2002 in Belgium, could change communication and even relations between general practitioners and their patients. This law stipulates, among other things, the information to be communicated to the patient, the rules for file sharing and litigation procedure. In the field, this law should be applied more by the spirit rather than the letter so as to preserve trust, the source of a real partnership. Moreover, one could be surprised by the fact that a law on patients' rights is not followed by rules also defining their duties.

  3. PSYCHIATRIC MORBIDITY AND REFERRAL IN GENERAL PRACTICE—A SURVEY OF GENERAL PRACTITIONERS IN BANGALORE CITY4

    PubMed Central

    Gautam, Shiv; Kapur, R. L.; Shamasundar, C.

    1980-01-01

    SUMMARY 60 General practitioners having M.B., B.S. qualification from all age group practicing in Bangalore city's centrally located locality were personally visited and a specially designed proforma was administered to find out whether they come across Psychiatric patients in their general practice, if yes what percentage of their practice ? Whether they referred any cases for Psychiatric consultation, what factors determined their decision to refer a case to the psychiatrist. 9% General practitioners reportedly were seeing Psychiatric cases, on an average 10% of total patients seen by GP's were suffering from Psychiatric illness. 85% GP's had referred cases for Psychiatric consultation and factors which determined GP's decision to refer a case were : Request from patient to see a Specialist, patient was excited and unmanageable, pressure from relatives of patients serious impirsonment of patients' working capacity, patient finds it more acceptable to be told by a Specialist that he has nervous trouble, lack of emotional support from family of patient. Less commonly given reasons inlcuded inability to diagnose a case, for confirmation of diagnosis and treatment, for detailed examination and investigation, for better managment, resistant casses and lack of time to deal with Psychiatric problems. These findings have been discussed and their implications in planning further services have been highlighted. PMID:22058484

  4. Informed consent: a survey of general dental practitioners in Belgaum city.

    PubMed

    Kotrashetti, Vijayalakshmi S; Kale, Alka D; Hebbal, Mamata; Hallikeremath, Seema R

    2010-01-01

    The informed consent process allows the patient or legal guardian to participate in and retain autonomy over the medical service received. Obtaining informed consent may also decrease the practitioner's liability from claims associated with miscommunication. The aim of this study was to assess knowledge and practices of general dental practitioners (GDPs) regarding informed consent. 118 GDPs in Belgaum city, Karnataka, India, were given questionnaires asking for information on their knowledge and practices related to informed consent. The questions covered general information, treatment-specific issues and the consent process. 80 responses were received out of which 44 were complete. 63.6% of GDPs reported that they obtained written consent. All of them reported that they obtained only general consent. 4 of them obtained written consent in the local language. 37 said they gave a detailed explanation of the procedure. 3 said they did not inform their patients on radiation exposure. Dentists should upgrade their knowledge regarding legal jurisprudence and legal medicine to avoid any litigation.

  5. Continuing professional development and revalidation: an analysis of general practitioners' recorded learning.

    PubMed

    Howard, John; Sparrow, Nigel; Turnbull, Caroline Jane; Hydes, A Lemuel

    2009-07-01

    Revalidation will be introduced in 2010; it will require general practitioners (GPs) to demonstrate they are fit to practise according to standards set by the Royal College of General Practitioners (RCGP). This will include the requirement to achieve 50 continuing professional development (CPD) credits per year. There has been no published analysis of GPs' current CPD. This paper describes a retrospective analysis of the learning logs kept by 71 practising GPs undertaking the interim Membership by Assessment of Performance (iMAP) programme, considering quantity of recorded learning, evidence of reflection on outcome and spread of content across the domains of the General Medical Council's Good Medical Practice (GMP). The average GP iMAP candidate undertook 87 hours of CPD over the year (range 21.5 hours to 293.5 hours); 16 (22.5%) undertook less than 50 hours while 22 recorded more than 100 hours. The GPs averaged five different types of CPD and 31 recorded outcomes across the year. Most GPs recorded outcomes in each domain of GMP. Those who logged more activities were also those more likely to record a wider spread of learning across the RCGP's curriculum. These results suggest that the RCGP's proposed managed CPD scheme is feasible based on the current CPD activity of this self-selected group.

  6. Effect of the remuneration system on the general practitioner's choice between surgery consultations and home visits.

    PubMed Central

    Kristiansen, I S; Holtedahl, K

    1993-01-01

    OBJECTIVE--To assess the influence of the remuneration system, municipality, doctor, and patient characteristics on general practitioners' choices between surgery and home visits. DESIGN--Prospective registration of patient contacts during one week for 116 general practitioners (GPs). SETTING--General practice in rural areas of northern Norway. MAIN OUTCOME MEASURE--Type of GP visit (surgery v home visit). RESULTS--The estimated home visit rate was 0.14 per person per year. About 7% (range 0-39%) of consultations were home visits. Using multilevel analysis it was found that doctors paid on a "fee for service" basis tended to choose home visits more often than salaried doctors (adjusted odds ratio 1.90, 99% confidence interval 0.98, 3.69), but this was statistically significant for "scheduled" visits only (adjusted OR 4.50, 99% CI 1.67, 12.08). Patients who were older, male, and who were living in areas well served by doctors were more likely to receive home visits. CONCLUSION--In the choice between home visits and surgery consultations, doctors seem to be influenced by the nature of the remuneration when the patient's problem is not acute. Although home visiting is a function of tradition, culture, and organisational characteristics, the study indicates that financial incentives may be used to change behaviour and encourage home visiting. PMID:8120504

  7. Office and 24-h ambulatory blood pressure control by treatment in general practice: the 'Monitoraggio della pressione ARteriosa nella medicina TErritoriale' study.

    PubMed

    Zaninelli, Augusto; Parati, Gianfranco; Cricelli, Claudio; Bignamini, Angelo A; Modesti, Pietro A; Pamparana, Franco; Bilo, Grzegorz; Mancia, Giuseppe; Gensini, Gian F

    2010-05-01

    Guidelines recommend that blood pressure (BP) should be lowered in hypertensive patients to prevent cardiovascular accidents. Management of antihypertensive treatment by general practitioners is usually based on office measurements, which may not allow an assessment of BP control over 24 h, which requires ambulatory BP monitoring (ABPM) to be implemented. This is rarely done in general practice, and limited information is available on the consistency between the evaluations of the response to treatment provided by office measurement and by ABPM in this setting. To assess concordance between office BP measurements and ABPM-based estimates of hypertension control in a general practice setting. Prospective, comparative between techniques. General practice. Seventy-eight general practices, representative of all Italian regions, participated in this study by recruiting sequential hypertensive adults on stabilized treatment, who were subdivided into even groups with office BP, respectively, controlled or noncontrolled by treatment. In each individual, ABPM was applied by the general practitioner after appropriate training, and 24-h ABP values were defined as controlled or not according to current guidelines. Concordance between office and ABPM evaluation of BP control was assessed with kappa statistics. Positive and negative predictive values of office measurement versus ABPM were estimated. Between July 2005 and November 2006, 190 general practitioners recruited 2059 hypertensive patients based on office BP measurements; in 1728 patients, a 24-h ABPM was performed, yielding 1524 recordings considered as valid for further analysis. The agreement between the assessment of BP control by office measurement and by ABPM was poor (kappa = 0.120), with office measurements showing a satisfactory positive predictive value (0.842) and a poor negative predictive value (0.278); the situation was worse in patients with three or more among the following features: male sex, age of at

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

    PubMed

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

    2014-03-01

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

  9. [Halitosis management by the general dental practitioner- results of an International Consensus Workshop*].

    PubMed

    Seemann, Rainer; Duarte da Conceicao, Mauricio; Filippi, Andreas; Greenman, John; Lenton, Patricia; Nachnani, Sushma; Quirynen, Marc; Roldán, Silvia; Schulze, Hendrik; Sterer, Nir; Tangerman, Albert; Winkel, Edwin G; Yaegaki, Ken; Rosenberg, Mel

    2014-01-01

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

  10. Responses to language barriers in consultations with refugees and asylum seekers: a telephone survey of Irish general practitioners

    PubMed Central

    MacFarlane, Anne; Glynn, Liam G; Mosinkie, Phillip I; Murphy, Andrew W

    2008-01-01

    Background Refugees and asylum seekers experience language barriers in general practice. Qualitative studies have found that responses to language barriers in general practice are ad hoc with use of both professional interpreters and informal interpreters (patients' relatives or friends). However, the scale of the issues involved is unknown. This study quantifies the need for language assistance in general practice consultations and examines the experience of, and satisfaction with, methods of language assistance utilized. Methods Data were collected by telephone survey with general practitioners in a regional health authority in Ireland between July-August 2004. Each respondent was asked a series of questions about consulting with refugees and asylum seekers, the need for language assistance and the kind of language assistance used. Results There was a 70% (n = 56/80) response rate to the telephone survey. The majority of respondents (77%) said that they had experienced consultations with refugees and asylum seekers in which language assistance was required. Despite this, general practitioners in the majority of cases managed without an interpreter or used informal methods of interpretation. In fact, when given a choice general practitioners would more often choose informal over professional methods of interpretation despite the fact that confidentiality was a significant concern. Conclusion The need for language assistance in consultations with refugees and asylum seekers in Irish general practice is high. General practitioners rely on informal responses. It is necessary to improve knowledge about the organisational contexts that shape general practitioners responses. We also recommend dialogue between general practitioners, patients and interpreters about the relative merits of informal and professional methods of interpretation so that general practitioners' choices are responsive to the needs of patients with limited English. PMID:19102735

  11. Recognition of dementia in general practice: comparison of general practitioners' opinions with assessments using the mini-mental state examination and the Blessed dementia rating scale.

    PubMed

    Mant, A; Eyland, E A; Pond, D C; Saunders, N A; Chancellor, A H

    1988-09-01

    In a study of 226 elderly residents in a retirement village in Sydney, Australia, general practitioners' opinions about dementia status had high positive and negative predictive values and high specificity, but low sensitivity when evaluated against the mini-mental state examination and the Blessed dementia rating scale. General practitioners were found to disagree with these two measures more often when patients were in advanced old age, and when they considered the patients to be depressed. We conclude that the general practitioner can increase his or her sensitivity to dementia in the elderly by use of either measure.

  12. [Knowledge, attitudes and practise of the general practitioners with the epileptic patients: qualitative research with 11 semi-structured interviews].

    PubMed

    Gélineau, A Chartier; Grimaud, J; de Toffol, B

    2008-02-01

    Studies on how general practitioners follow epileptic patients are few and far between. This is surprising, since for these patients, the general practitioner is the first person to be consulted in the context of the current standardised treatment pathway. Our goal was to describe and analyze general practitioners' knowledge, attitudes and habits concerning medical, psychological and social care of epileptic patients. We applied a qualitative method using semi-structured interviews with 11 general practitioners in the Eure-et-Loir, an administrative district in France. The interviews were recorded, with full transcripts being written and analyzed by themes. The results revealed great variability in care practices and in the perception general practitioners have of epilepsy. They report not knowing enough about the illness. They perceive clearly the anxiety of patients and their families, but exert little medical, psychiatric or social impact on patients. Treatment of the disease is at the core of the general practitioner's relationship with the patient. If attitudes towards epilepsy are to be changed, relevant knowledge and correct practices remain to be implemented. Demand for training is currently centred on treatment but it would be helpful to introduce inter-disciplinary training on standardisation of practices and more detailed correspondence with neurologists.

  13. General practitioners' preferences with regard to colorectal cancer screening organisation Colon cancer screening medico-legal aspects.

    PubMed

    Papin-Lefebvre, Frédérique; Guillaume, Elodie; Moutel, Grégoire; Launoy, Guy; Berchi, Célia

    2017-09-06

    French health authorities put general practitioners at the heart of the colorectal cancer screening. This position raises organisational issues and poses medico-legal problems for the professionals and institutions involved in these campaigns, related to the key concepts of medical decisions and suitability of standards. The objective of our study is to reveal the preferences of general practitioners related to colorectal cancer screening organisation with regard to the medico-legal risk METHODS: A discrete choice questionnaire presenting hypothetical screening scenarios was mailed to 2114 physicians from 20 French different areas. The preferences of 358 general practitioners were analysed using logistic regression models. The factors that have significant impact on the preferences of general practitioners are the capacity of the primary care professional in the procedure, the manner in which pre-screening information is given to patients, the manner in which screening results are given to patients, the number of reminders sent to patients who test positive and who do not undergo a colonoscopy and the remuneration of the attending physician. Our results reveals that current colorectal cancer screening organisation is not adapted to general practitioners preferences. This work offers the public authorities avenues for reflection on possible developments in order to optimize the involvement of general practitioners in the promotion of cancer screening programme. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. The prevention of type 2 diabetes: general practitioner and practice nurse opinions

    PubMed Central

    Williams, Rhys; Rapport, Frances; Elwyn, Glyn; Lloyd, Brendan; Rance, Jaynie; Belcher, Sally

    2004-01-01

    Background: Primary prevention of type 2 diabetes is now possible with lifestyle or pharmacological interventions in people who are at risk. Primary care would seem to be the legitimate setting for this to take place. Aim: To explore the views of general practitioners and practice nurses about the detection and management of people at risk of developing type 2 diabetes. Design of study: Qualitative study. Setting: One local health board area in Wales. Method: General practitioners and practice nurses participated in multi-professional focus groups, and opinions of participants were analysed into themes and sub-themes according to focus group content analysis methodology to search for ‘markers of text’. Results: Participants from 21 practices were involved. Participants' opinions on the detection and management of individuals at risk of developing type 2 diabetes were polarised into those who considered these activities inappropriate for primary care and those who were already engaged in the detection, management and follow-up of these individuals. For the former, existing workload, the questionable role of primary care as a ‘screening service’, lack of resources, and conflict and concern about increasing specialisation were given as justification. Those already engaged in these activities emphasised their importance but were also concerned with the lack of available resources. Other concerns were the perceived low motivation of patients to modify their lifestyle and the unnecessary medicalisation of the precursor conditions of impaired glucose tolerance and impaired fasting glycaemia. The prevention of type 2 diabetes was seen as largely the responsibility of other agencies such as health promotion and education. Conclusion: The often strongly held views about this topic are at least partly influenced by current pressures on primary care. To make the primary prevention of type 2 diabetes a reality, either practitioners need to be motivated and resourced to

  15. Malaysian private general practitioners' views and experiences on continuous professional development: A qualitative study.

    PubMed

    Abdul Samad, N; Md Zain, A; Osman, R; Lee, P Y; Ng, C J

    2014-01-01

    Continuous professional development (CPD) is an important aspect of a medical practitioner's career. AIMing to be at par with other developed countries for high quality of professional practice, Malaysia is planning to implement compulsory CPD for the doctors. The aim of the study was to explore the private general practitioners' (GPs) views, experiences and needs regarding CPD programme in the primary care service. This study used a qualitative methodology. Seven semi-structured interviews and three focus group discussions were conducted with private general practitioners from an urban area of Malaysia between January and December 2012. An interview topic guide was developed based on literature review and researchers' discussions and it was used to guide the interviews. All the interviews were audio-recorded, transcribed verbatim and the transcripts formed the data for analysis using the thematic approach. GPs undertook a wide range of CPD programmes to keep up with medical advances, meet patients' expectations and improve financial rewards. Conferences, lectures and online recourses were the most mentioned methods of keeping updated. Some of the GPs felt that peer motivation and networking seem to motivate and facilitate participation in CPD programmes. However, they were wary of the validity and relevance of some CPD programmes, particularly those related to pharmaceutical industry. Although the participants agreed to the new mandatory CPD regulation, they voiced concerns on how it would be implemented and wished for a more effective method of monitoring. Organised peer support and relevant CPD content may improve GP participation in CPD but adequate regulatory measure should be in place to monitor the CPD activities.

  16. General practitioners' continuing education: a review of policies, strategies and effectiveness, and their implications for the future.

    PubMed Central

    Smith, F; Singleton, A; Hilton, S

    1998-01-01

    BACKGROUND: The accreditation and provision of continuing education for general practitioners (GPs) is set to change with new proposals from the General Medical Council, the Government, and the Chief Medical Officer. AIM: To review the theories, policies, strategies, and effectiveness in GP continuing education in the past 10 years. METHOD: A systematic review of the literature by computerized and manual searches of relevant journals and books. RESULTS: Educational theory suggests that continuing education (CE) should be work-based and use the learner's experiences. Audit can play an important role in determining performance and needs assessment, but at present is largely a separate activity. Educational and professional support, such as through mentors or co-tutors, has been successfully piloted but awaits larger scale evaluation. Most accredited educational events are still the postgraduate centre lecture, and GP Tutors have a variable role in CE management and provision. Controlled trials of CE strategies suggest effectiveness is enhanced by personal feedback and work prompts. Qualitative studies have demonstrated that education plays only a small part in influencing doctors' behavior. CONCLUSION: Maintaining good clinical practice is on many stakeholders' agendas. A variety of methods may be effective in CE, and larger scale trials or evaluations are needed. PMID:10071406

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

    PubMed

    Leitgeb, Norbert; Schröttner, Jörg; Böhm, Michael

    2005-05-01

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

  18. A survey of pain complaints and treatment by general practitioners in the Spanish public health organization.

    PubMed

    Bosch, F; Toranzo, I; Baños, J E

    1990-09-01

    The therapeutic habits of general practitioners are an important clue when drug therapy is considered, because they are treating the most frequent complaints. When pain problems are considered, it would be valuable to determine the characteristics of the pain consultations and their therapeutic attempts to solve these complaints. The present study was designed to elucidate the characteristics of pain diagnoses and treatment approaches at primary-care level in Spain. A total of 299 patients were evaluated, considering pain location, diagnostic syndrome, previous therapies, and treatments selected by the 13 participating physicians. Limb and back pain were the most frequent pain complaints. A third of the patients had received previous treatment and 36% were self-medicating, mainly with aspirin or paracetamol. Physicians prescribed diclofenac at full doses, but aspirin and paracetamol were used at subtherapeutic dosages. The study showed that (a) rheumatic pain was the most frequent at primary-care level, (b) a high level of self-medication was determined, therefore recommending a careful drug history, and (c) misconceptions about analgesic drugs may partially explain the therapeutic failure in some patients. Educational programs in rheumatic pain and analgesic therapy for general practitioners are strongly recommended.

  19. Barriers to screening and diagnosis of peripheral artery disease by general practitioners.

    PubMed

    Haigh, Kate Jamilla; Bingley, John; Golledge, Jonathan; Walker, Philip J

    2013-12-01

    Peripheral artery disease (PAD) is a strong predictor of cardiovascular morbidity and mortality yet it is under-recognised and undertreated. General practitioners (GPs) are best positioned to detect patients with PAD. This article investigates awareness of PAD by GPs; the prevalence of screening for PAD and tools used for screening and diagnosis, in particular the ankle-brachial index (ABI); and the barriers to PAD screening and measurement of the ABI in the general practice setting. A cross-sectional survey of primary care practitioners was conducted between September 2011 and March 2012. A mail-out survey was distributed to 1120 GPs practising in Queensland, Australia: 287 (26%) responded; 61% of GPs reported screening for PAD; 58% of GPs reported 'never' measuring the ABI; and 70% reported using arterial duplex ultrasound as their first-line diagnostic tool. Equipment availability, time constraints and lack of training and skills were identified as the most significant barriers to screening and ABI testing. In conclusion, there are deficits in the utilisation of guideline recommendations relating to PAD screening and diagnosis by Australian GPs. Our data suggest that earlier detection of PAD may be achieved through GP education combined with increased access to ABI equipment or the availability of a more time-efficient test.

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

    PubMed Central

    Hanley, Anne

    2015-01-01

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

  1. General medical practitioners need to be aware of the theories on which our work depend.

    PubMed

    Thomas, Paul

    2006-01-01

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

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

    PubMed Central

    Thomas, Paul

    2006-01-01

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

  3. Challenges in managing patients in Australia with chronic hepatitis B: the General Practitioners' perspective.

    PubMed

    Wallace, Jack; Hajarizadeh, Behzad; Richmond, Jacqui; McNally, Stephen

    2013-10-01

    General Practitioners (GPs) are essential to reducing the impact of chronic hepatitis B (CHB) given their clinical management role where only 56% of people with the infection in Australia have been diagnosed. This qualitative study aimed to identify the challenges GPs face in effectively responding to CHB. Semi-structured interviews were conducted with 26 GPs self-identifying as having a 'high caseload' of patients and/or a particular interest in CHB. Participants were recruited from five jurisdictions and came from diverse ethnicities, clinical experience and practice profile. Interview data were analysed according to the principles of grounded theory. Patient and GP knowledge, a lack of community awareness, and language and cultural diversity impeded the GP response to CHB. Communication with specialists was reported as challenging with unclear referral pathways, limited feedback from specialists after referral, and poor liaison and support for managing people living with CHB. Regulations restricting GPs capacity to respond included the lack of prescribing opportunities, fear of Medicare auditing for screening the populations most at risk, and inadequate financial support given the complexity of CHB and the communities most affected by the infection. General Practitioners require additional skills and resources to support the effective management of people with CHB. These include improved awareness and knowledge about the infection, adequate financial resources to support patient management, and effective referral pathways and support. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

  4. Attitudes and behaviours in smoking cessation among general practitioners in Finland 2001.

    PubMed

    Barengo, Noël C; Sandström, H Patrick; Jormanainen, Vesa J; Myllykangas, Markku T

    2005-01-01

    To investigate whether smoking by general practitioners (GPs) and gender influence smoking cessation advice. A self-administered questionnaire, originally developed by the WHO and modified according to the Finnish health care system was sent by mail to physicians who were members of the Finnish Medical Association (FMA). Participants were restricted to those who were living in Finland and were younger than 65 years. Numbers of participants was 3,057 and the response rate 69%. Smoking male GPs gave less smoking cessation advice only to patients with a stomach ulcer or patients using oral contraceptive pills compared with their non-smoking colleagues. Male GPs gave less smoking cessation advice to pregnant patients or patients using contraceptive pills than female GPs. Female smoking GPs less likely advised patients who were pregnant or who were using oral contraceptive pills to stop smoking than non-smoking female GPs (p <0.001). The percentage of GPs who have never distributed smoking cessation information was lower in men (41%) than in women (45%; p-value: 0.052). Minor differences in anti-smoking advice to patients between smoking and non-smoking general practitioners were found. The little involvement of GPs in health promotion activities regarding tobacco control is of concern.

  5. Analysis of a general practitioner's work in a private nursing home for the elderly

    PubMed Central

    Andrew, R.A.

    1988-01-01

    A quantitative analysis was made over a fouryear period (1984-87) of the work and time involved for one rural general practitioner in caring for 42 elderly patients living in a private nursing home. The results were compared with those for the rest of the practice. The study showed that the consultation rate for nursing home patients was 50% higher than the rate for the remaining practice patients aged 65 years or over, and more than twice that for the whole practice. The prescribing rate in the nursing home was twice that of the 65+ years group and six times the rate for the whole practice. The hospital referral rate for nursing home patients was twice that of the 65-74 years group, and four times that for the whole practice. The time involved per year in looking after each nursing home patient was nearly twice that for the remaining practice patients aged 65-74 years, and three times that for practice patients aged under 65 years. From this study it would appear that concentrations of elderly patients in nursing homes in areas served by only a few general practitioners can cause considerable increases in workload. This could present problems in the organization of suitable care. PMID:3267743

  6. Helping general practitioners to keep up with the literature: evaluation of an RCGP initiative.

    PubMed

    Gordon, M D

    1984-05-01

    The recent Report of The Medical Information Review Panel suggested that locally-produced abstracting bulletins are likely to be of great value in promoting continuing education; most notably by helping GPs to 'keep up with the literature'. The Report identified Current Medical Abstracts for Practitioners ( CMAP ), a publication produced by the S.E. Scotland Faculty of the Royal College of General Practitioners ( RCGP ), as an example of the kind of bulletin it had in mind. It further suggested that the role and effectiveness of this publication should be investigated. A survey of the readership of CMAP was therefore carried out. It was found that CMAP is regularly read by only 28% of those to whom it is sent (free of charge). More particularly, CMAP is read predominantly by those GPs who are already conscientious users of medical literature: they use the bulletin as a complement and supplement to their other professional reading. Those GPs who devote little time to journal reading, in general, tend to ignore CMAP . They do not seek to use it as a substitute for more extensive reading of medical journals. It therefore appears that CMAP does little to overcome the problem of GPs who do not keep up with the literature, and it is unlikely that similar publications will be initiated in other areas. Indeed, publication of CMAP may be ceased, at least in its present form.

  7. Is international travel useful for general practitioners? A survey of international travel scholarships.

    PubMed Central

    Holden, J; Evans, P

    1998-01-01

    BACKGROUND: The Royal College of General Practitioners has offered international travel scholarships for the past decade. Each year a number of general practitioners travel from the UK to work or study assisted by the scheme, while others come to this country for similar purposes. AIM: To investigate the value of international scholarships for recipients and others. METHOD: All those receiving awards in 1988-94 were surveyed by postal questionnaire. RESULTS: Fifty-one out of 58 award winners (88%) replied. Almost all cited some of a wide variety of personal benefits from international travel, and some established continuing links with colleagues overseas. Many gave examples of useful results for others, both patients and colleagues. Scholarships appear to have made a significant contribution to careers, especially for those based outside Britain. CONCLUSION: Relatively modest travel scholarships were viewed both favourably in hindsight and produced a wide range of benefits to recipients, colleagues, and patients. International travel should probably be considered more widely in career planning. PMID:9624751

  8. [Social representations of vaccination among patients and general practitioners: a study based on hierarchized evocation].

    PubMed

    Sardy, Romain; Ecochard, René; Lasserre, Evelyne; Dubois, Jean-Pierre; Floret, Daniel; Letrilliart, Laurent

    2012-01-01

    In France, there is a discrepancy between perceptions and practices related to vaccination, the causes of which are poorly understood. The purpose of this study was to examine and compare patients' and physicians' social representations of vaccination. A qualitative study based on hierarchized evocation was conducted on a sample of 30 patients and 30 general practitioners. The participants were asked to write down seven words or word groups (word associations) induced by the concept of "vaccination" and to rank them in order of importance. The associations were grouped by theme and sub-theme. Their frequency, connotations and importance were compared between the two groups. The results show that, overall, the physicians had a positive view of vaccination, while the patients had a more neutral view (polarity index: + 0.38 vs + 0.07, p < 0.01). Among both patients and general practitioners, vaccination tends to be perceived as a form of medical care mainly targeting children and aimed at prevention, and its effectiveness is considered to be implicit. However, the patients appeared to be more concerned about the potential side effects of certain vaccinations, while the GPs emphasized the harmlessness of vaccination. The participating GPs also tended to take a collective view of vaccination, while some patients criticized the lack of targeted vaccinations. Better communication on these key aspects of representations may help to increase confidence in vaccination and to close the gap between perception and practice.

  9. Diagnoses, demographics, and utilization of care as encountered by three U.S. Navy general medical officers.

    PubMed

    Poggi, M M; Smith, G J; Campbell, R S

    2000-09-01

    U.S. Navy general medical officers (GMOs) are physicians serving as general practitioners. Although exceptions exist, most GMOs are not board-certified in a specialty. They are post-graduate year 1 (PGY-1)-trained, state-licensed physicians analogous to civilian general practitioners. We conducted a retrospective study using data generated from patient visits with active duty males and females from June 1 to 30, 1998, to describe diagnoses, demographics, and utilization of care patterns encountered by three PGY-1-trained GMOs at an ambulatory clinic. A total of 781 patient encounters with 123 diagnoses from a patient population of 3,178 were recorded. This is an average of 260 patient encounters per GMO, at a rate of 2.52 patients seen per patient-care hour. Fifty-seven consultations/referrals were requested (7.3% of encounters, 1.8% of the patient population). Personnel assigned to the clinic accounted for 4.2% of visits (2% of the patient population). Patient satisfaction was rated as "excellent" to "satisfactory," and no significant morbidity was observed at 1.5-year follow-up. With PGY-1 training, GMOs provide primary care to a substantial volume of prescreened patients and treat patients with a majority of diagnoses without referral or unacceptable complications. The role of GMOs, and perhaps other physicians without specialty training (i.e., general practitioners), in selected settings seems valid and may have advantageous medicoeconomic implications for military and civilian managed care systems.

  10. Changes in pathology test ordering by early career general practitioners: a longitudinal study.

    PubMed

    Magin, Parker J; Tapley, Amanda; Morgan, Simon; Henderson, Kim; Holliday, Elizabeth G; Davey, Andrew R; Ball, Jean; Catzikiris, Nigel F; Mulquiney, Katie J; van Driel, Mieke L

    2017-07-17

    To assess the number of pathology tests ordered by general practice registrars during their first 18-24 months of clinical general practice. Longitudinal analysis of ten rounds of data collection (2010-2014) for the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing, multicentre, cohort study of general practice registrars in Australia. The principal analysis employed negative binomial regression in a generalised estimating equations framework (to account for repeated measures on registrars).Setting, participants: General practice registrars in training posts with five of 17 general practice regional training providers in five Australian states. The registrar participation rate was 96.4%. Number of pathology tests requested per consultation. The time unit for analysis was the registrar training term (the 6-month full-time equivalent component of clinical training); registrars contributed data for up to four training terms. 876 registrars contributed data for 114 584 consultations. The number of pathology tests requested increased by 11% (95% CI, 8-15%; P < 0.001) per training term. Contrary to expectations, pathology test ordering by general practice registrars increased significantly during their first 2 years of clinical practice. This causes concerns about overtesting. As established general practitioners order fewer tests than registrars, test ordering may peak during late vocational training and early career practice. Registrars need support during this difficult period in the development of their clinical practice patterns.

  11. 39 CFR 230.3 - Cooperation with the Office of Inspector General.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Cooperation with the Office of Inspector General. 230.3 Section 230.3 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION OFFICE OF INSPECTOR GENERAL General Policy and Authority § 230.3 Cooperation with the Office of...

  12. 22 CFR 23.5 - Claims for settlement by Department of State or General Accounting Office.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... General Accounting Office. 23.5 Section 23.5 Foreign Relations DEPARTMENT OF STATE FEES AND FUNDS FINANCE AND ACCOUNTING § 23.5 Claims for settlement by Department of State or General Accounting Office. Claims for settlement by the Department of State or by the General Accounting Office shall be...

  13. 14 CFR 385.16 - Heads of Offices and Assistant General Counsels.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Heads of Offices and Assistant General... Functions to Staff Members § 385.16 Heads of Offices and Assistant General Counsels. The heads of Offices and Assistant General Counsels have the authority to: (a) Grant requests for permission to withdraw...

  14. 39 CFR 230.3 - Cooperation with the Office of Inspector General.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 39 Postal Service 1 2012-07-01 2012-07-01 false Cooperation with the Office of Inspector General. 230.3 Section 230.3 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION OFFICE OF INSPECTOR GENERAL General Policy and Authority § 230.3 Cooperation with the Office of...

  15. 39 CFR 230.3 - Cooperation with the Office of Inspector General.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 39 Postal Service 1 2011-07-01 2011-07-01 false Cooperation with the Office of Inspector General. 230.3 Section 230.3 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION OFFICE OF INSPECTOR GENERAL General Policy and Authority § 230.3 Cooperation with the Office of...

  16. 39 CFR 230.3 - Cooperation with the Office of Inspector General.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 39 Postal Service 1 2014-07-01 2014-07-01 false Cooperation with the Office of Inspector General. 230.3 Section 230.3 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION OFFICE OF INSPECTOR GENERAL General Policy and Authority § 230.3 Cooperation with the Office of...

  17. 39 CFR 230.3 - Cooperation with the Office of Inspector General.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 39 Postal Service 1 2013-07-01 2013-07-01 false Cooperation with the Office of Inspector General. 230.3 Section 230.3 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION OFFICE OF INSPECTOR GENERAL General Policy and Authority § 230.3 Cooperation with the Office of...

  18. The role of general practitioners in medical school admission interview panels in the UK (2012-2014): a national survey.

    PubMed

    Rashid, Mohammed Ahmed; Benson, John

    2016-07-01

    Recent primary care workforce pressures in the UK have prompted national reviews. Recommendations to increase the proportion of medical students entering general practice have led to interest in the role of medical schools in career choices. This study sought to identify the career backgrounds of admissions leads at UK medical schools and the proportion of general practitioners on admission interview panels. A national survey using a proforma circulated to all UK medical school admission leads via the Medical Schools Council. UK medical schools. UK medical schools. Prevalence of assessment lead and panel members' professional groups. Responses were received from 18 (54.5%) of the 33 UK medical schools. General practitioners led the admissions process in 2 (11%) of these. Fifteen schools were able to furnish detailed data about interview panel composition, having held a combined total of 876 distinct interview panels during the 2012-2013 and 2013-2014 admission years; 683 panels (78%) included a secondary care physician, but only 261 panels (29.8%) included general practitioners. General practitioner representation ranged from 3.8% to 100% of individual schools' panels; however, eight schools (about half the respondents able to offer numbers of participants) omitted general practitioner representation in more than half of their interview panels. Despite the UK policy focus to increase the proportion of medical students becoming general practitioners, doctors from this clinical background are not proportionately represented as admissions leads or on admissions interview panels. Increasing general practitioner involvement in admissions processes may be one way in which medical schools can support general practice as a career aspiration.

  19. 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

  20. Constitution and monitoring of an epidemiological surveillance network with sentinel general practitioners.

    PubMed

    Chauvin, P

    1994-08-01

    The Réseau National Télé-informatique de surveillance et d'information sur les Maladies Transmissibles (RNTMT) (French communicable diseases computerised surveillance network) comprises a network of sentinel general practitioners (SGP). These benevolent volunteers are responsible for the weekly epidemiological surveillance. Since its creation, 1,700 SGPs have participated in the RNTMT, representing a total of more than 120,000 connections to the RNTMT telematic service center. The principal motivation of these benevolent SGPs was to 'actively participate in public health', although only a minority of them (17.6%) had any training in this field. Such a system, based on the benevolent and voluntary activity of SGPs, requires a good understanding of SGPs' attitudes towards epidemiological surveillance in general and the tool used, in order to quantitatively and qualitatively follow their participation and to provide regular and useful feedback to the surveillance actors.

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

    PubMed Central

    Paynton, D; Dunleavey, J; Smith, H

    1998-01-01

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

  2. [Reasons for General Practitioner Shortage – a Comparison Between France and Switzerland].

    PubMed

    Cerny, Thomas; Rosemann, Thomas; Tandjung, Ryan; Chmiel, Corinne

    2016-05-25

    Both France and Switzerland face a general practitioner (GP) shortage. What differences or parallels exist between the two countries with regard to the causes for this shortage? What conclusions might be drawn from a systematic comparison? Literature review with qualitative and semi-quantitative content analysis. Parallels exist in the comparing categories work contents, working structure, income and social status, medical school formation, private life, psychological motives. Differences are found in the categories biography and social selection, medical socialisation, residency. In Switzerland, residency is not uniformly structured, rarely institutionally organised and contains only few elements specific to general medicine. In France, medical socialisation not only exalts the specialists, but also strongly devaluates the GPs. By systematic analysis and comparison of both countries' pertinent literature, France and Switzerland can deepen their understanding of GP shortage. This paper identifies possible fields of action from medical school through residency up to workplace conditions that are pivotal in addressing the shortage of GPs.

  3. Simplified basic periodontal examination (BPE) in children and adolescents: a guide for general dental practitioners.

    PubMed

    Cole, Emma; Ray-Chaudhuri, Arijit; Vaidyanathan, Mina; Johnson, Joanna; Sood, Sanjeev

    2014-05-01

    Dental plaque-induced periodontal diseases are common in children and adults. Guidelines were previously not available for the periodontal screening of under 18s. However, new guidelines have been introduced by the British Society of Periodontology and the British Society of Paediatric Dentistry which set out recommendations for the periodontal screening and management of under 18s in primary dental care. This article provides a practical guide for general dental practitioners on how to use the BPE in children and adolescents, and highlights the importance of early detection and management of periodontal diseases in this age group. A failure to use the modified BPE in a young patient who is later diagnosed with periodontitis may leave a dentist vulnerable to a medico-legal complaint or claim. New BPE guidelines for children and adolescents have been introduced by the BSPD and BSP; it is important that all dentists are aware of these guidelines and how to implement them in general practice.

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

    PubMed

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

    2013-03-13

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

  5. [Summary of the Dutch College of General Practitioners' practice guideline on food hypersensitivity].

    PubMed

    Luning-Koster, Marleen N; Lucassen, Peter L B J; Boukes, Froukje S; Goudswaard, A N Lex

    2011-01-01

    October 2010 the Dutch College of General Practitioners issued a revised version of their previous practice guideline of 1995 on food hypersensitivity in infants. If patients suspect either themselves or their child of having a food allergy, this is usually not demonstrated in subsequent investigation. Wrongly prescribed elimination diets may have adverse effects. Examination of serum specific IgE levels has no place in the diagnosis of food allergy in general practice. An open elimination challenge is especially suitable in order to exclude a food allergy. A sure diagnosis of food allergy can only be made by a double-blind placebo-controlled food challenge. There are no proven effective measures that can prevent food allergy.

  6. Resource effects of training general practitioners in risk communication skills and shared decision making competences.

    PubMed

    Cohen, David; Longo, M F; Hood, Kerenza; Edwards, Adrian; Elwyn, Glyn

    2004-08-01

    Involving patients more in decisions about their own care requires doctors to be trained in effective ways of communicating information and in developing competences to negotiate levels of patient involvement which are most appropriate for each case. The aim of this study was to determine the cost of such training and identify which service resource variables are subsequently affected. An explanatory cluster randomized crossover trial was carried out which involved training general practitioners (GPs) in the use of risk communication (RC) tools, shared decision making (SDM) competences or both. Continuing care by GPs of patients with one of four chronic conditions (menopausal symptoms, menorrhagia, atrial fibrillation, prostatism) was reviewed before and after training. Cost of training was assessed by prospective monitoring of resources used. Data on prescribing, referrals and investigations were collected via questionnaires to participating practitioners. Data on follow-up GP consultations were extracted from medical records. Three two-level logistic models were performed to investigate the probability of training having an effect on prescribing, referrals and investigations ordered at the review consultation. Training cost pound 1218 per practitioner which increased the cost of a consultation by pound 2.89. Training in SDM or combined with RC significantly affected the probability of a prescription being issued to women with menopausal symptoms and menorrhagia (although RC on its own had no effect) but did not significantly affect prescribing for patients with prostatism or atrial fibrillation. It did not significantly affect the probability of investigations, referrals or follow-up GP visits for any of the conditions. Unless training has a major influence on consultation length, it is unlikely to have any major impacts on cost.

  7. Health Education and General Practitioner Training in Hypertension Management: Long-Term Effects on Kidney Function.

    PubMed

    Jafar, Tazeen H; Allen, John C; Jehan, Imtiaz; Hameed, Aamir; Saffari, Seyed Ehsan; Ebrahim, Shah; Poulter, Neil; Chaturvedi, Nish

    2016-06-06

    In the Control of Blood Pressure and Risk Attenuation trial, a 2×2 factorial design study (2004-2007), the combined home health education and trained general practitioner intervention delivered over 2 years was more effective than no intervention (usual care) in lowering systolic BP among adults with hypertension in urban Pakistan. We aimed to assess the effectiveness of the interventions on kidney function. In 2012-2013, we conducted extended follow-up of a total of 1271 individuals aged ≥40 years with hypertension (systolic BP ≥140 mmHg, diastolic BP ≥90 mmHg, or receipt of antihypertensive treatment) and serum creatinine measurements with 2 years in-trial and 5 years of post-trial period in 12 randomly selected low-income communities in Karachi, Pakistan. The change in eGFR from baseline to 7 years was assessed among randomized groups using a generalized estimating equation method with multiple imputation of missing values. At 7 years of follow-up, adjusted mean eGFR remained unchanged, with a change of -0.3 (95% confidence interval [95% CI], -3.5 to 2.9) ml/min per 1.73 m(2) among adults randomly assigned to the combined home health education plus trained general practitioner intervention compared with a significant decline of -3.6 (95% CI, -5.7 to -2.0) ml/min per 1.73 m(2) in those assigned to usual care (P=0.01, modified intention-to-treat analysis). The risk for the combined intervention of death from kidney failure or >20% decline in eGFR relative to usual care was significantly reduced (risk ratio, 0.47; 95% CI, 0.25 to 0.89). The combined home health education plus trained general practitioner intervention is beneficial in preserving kidney function among adults with hypertension in communities in Karachi. These findings highlight the importance of scaling up simple strategies for renal risk reduction in low- and middle-income countries. Copyright © 2016 by the American Society of Nephrology.

  8. 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.

  9. An Assessment of Private General Practitioners Contracting for Public Health Services Delivery in O.R. Tambo District, South Africa

    PubMed Central

    Hongoro, Charles; Funani, I Itumeleng N.; Chitha, Wezile; Godlimpi, Lizo

    2015-01-01

    Low- and middle-income countries are striving towards universal health coverage in a variety of ways. Achieving this goal requires the participation of both public and the private sector providers. The study sought to assess existing capacity for independent general practitioner contracting in primary care, the reasons for the low uptake of government national contract and the expectations of general practitioners of such contractual arrangements. This was a case study conducted in a rural district of South Africa. The study employed both quantitative and qualitative data collection methods. Data were collected using a general practitioner and practice profiling tool, and a structured questionnaire. A total of 42 general practitioners were interviewed and their practices profiled. Contrary to observed low uptake of the national general practitioner contract, 90% of private doctors who had not yet subscribed to it were actually interested in it. Substantial evidence indicated that private doctors had the capacity to deliver quality care to public patients. However, low uptake of national contarct related mostly to lack of effective communication and consultation between them and national government which created mistrust and apprehension amongst local private doctors. Paradoxically, these general practitioners expressed satisfaction with other existing state contracts. An analysis of the national contract showed that there were likely to benefit more from it given the relatively higher payment rates and the guaranteed nature of this income. Proposed key requisites to enhanced uptake of the national contract related to the type of the contract, payment arrangements and flexibility of the work regime, and prospects for continuous training and clinical improvements. Low uptake of the national General Practitioner contract was due to variety of factors related to lack of understanding of contract details. Such misunderstandings between potential contracting parties

  10. Decisions of practitioners regarding placement of amalgam and composite restorations in general practice settings.

    PubMed

    Pink, F E; Minden, N J; Simmonds, S

    1994-01-01

    This study was undertaken to analyze the current reasons practitioners in general practice settings choose to place amalgam and composite restorations. Data were gathered on individual restorations in the clinical setting to provide information on reasons practitioners state that restorations are placed, the type of material most often placed in different restoration classifications, and the age of restorations at the time of replacement. The results of this study indicate that approximately one-half of all restorations, both amalgam and composite, were placed to treat primary caries. One-half of the remaining restorations placed, i.e., not including those with primary caries, were placed to treat recurrent caries. With respect to restorative materials, amalgam was most often placed in class 1 and class 2 situations (88.9% of the amalgam restorations reported), while composite was most often placed in class 3, 4, or 5 situations (77.4% of the composite restorations reported). From the total data set returned for replaced restorations, only 20% of the data forms reported on verified longevity of the restoration being replaced. Analysis of these data gave a calculated median longevity for amalgam and composite restorations of 10 years and 5 years respectively.

  11. General dental practitioners' beliefs on the perceived effects of and their preferences for remuneration mechanisms.

    PubMed

    Wright, D; Batchelor, P A

    2002-01-12

    To identify GDPs preferences for differing remuneration mechanisms and their beliefs on the effect of the mechanisms in care provision. Postal questionnaire survey of 300 GDPs holding an NHS contract with a London Health Authority. GDPs perceive that remuneration mechanisms are important in determining the provision of care but not overall disease levels. There were differences in the preferred remuneration mechanisms when working under the NHS compared with the non-NHS sector. When providing care under the NHS, either the current remuneration system or a salaried plus bonus would be the preferred choice, while for non-NHS care a fee-per-item mechanism is preferred. Fee-per-item arrangement was the preferred choice of younger general practitioners compared with older practitioners. Females showed a greater preference for a salaried with bonus arrangement compared with males. If policy makers are to use remuneration mechanisms to influence the provision of care effectively, the beliefs that care providers hold about various mechanisms are important to understand how they would respond to changes in the system.

  12. Enhancing youth health in primary care: lessons learned from general practitioners.

    PubMed

    Dadich, Ann; Jarrett, Carmen; Robards, Fiona; Bennett, David

    2014-01-01

    Primary care represents a fundamental component of the health system, particularly for young people. However, youth access to primary care is less than ideal. To optimize clinician capacity to promote youth health, an interactive training module was developed and tailored to the needs of general practitioners. As part of an exploratory study, 11 participants were interviewed to determine the perceived capacity of the module to promote youth-friendly primary care. Findings suggest the module can enhance clinician skills, knowledge, and confidence to promote youth health; however, it has a limited ability to inform how organizational capacity might be bolstered-this includes the development of interagency networks. In this epoch of primary care reform, these findings are important for two key reasons. First, they reveal the need to bolster clinicians' perceived ability to use youth healthcare skills; second, they highlight the complementary importance of organizational support to ensure and sustain youth-friendly practices. The article concludes with a discussion of key implications for policymakers, practitioners, and researchers.

  13. General practitioners' knowledge, practices, and obstacles in the diagnosis and management of dementia.

    PubMed

    Pathak, Krishna P; Montgomery, Anthony

    2015-01-01

    To identify general practitioners' (GPs) knowledge, practices, and obstacles with regard to the diagnosis and management of dementia. Standardized questionnaires covering knowledge, practices, and obstacles were distributed among a purposive sample of GPs in Kathmandu, Nepal. Three hundred and eighty GPs responded (response rate = 89%). Knowledge of practitioners' with regard to the diagnosis and management of dementia was unsatisfactory (<50%). Diagnosis and management barriers are presented with regard to GP, patient, and carer factors. Specifically, the results address the following issues: communicating the diagnosis, negative views of dementia, difficulty diagnosing early-stage dementia, acceptability of specialists, responsibility for extra issues, knowledge of dementia and aging, less awareness of declining abilities, diminished resources to handle care, lack of specific guidelines, and poor awareness of epidemiology. Demographic changes mean that dementia will represent a significant problem in the future. The following paper outlines the problems and solutions that the Nepalese medical community needs to adopt to deal effectively with diagnosis, care, and management of dementia.

  14. Professional training and roles of community pharmacists in malaysia: views from general medical practitioners.

    PubMed

    Hassali, Ma; Awaisu, A; Shafie, Aa; Saeed, Ms

    2009-01-01

    This pilot study aimed to explore the perceptions of general medical practitioners (GPs) towards the professional training and roles of community pharmacists. A self-administered questionnaire was distributed to all private clinics (n=160) run by GPs in a northern state of Malaysia. The instrument contained questions to evaluate the practitioners' level of agreement using a 5-point Likert-type scale. Of 160 GPs, 80 returned the questionnaire (response rate 50%). The respondents agreed that: GPs should consider the community pharmacists' recommendations whenever there is/are any problem(s) with the prescriptions given by them (46.3%); community pharmacists are the best healthcare professionals to educate patients about safe and appropriate use of medications (52.5%); the pharmacy profession had undergone a major metamorphosis from a product-oriented profession to a more patient-centred and outcome-oriented one (61.3%); if dispensing separation is implemented, they will work closely with the community pharmacists in monitoring patients' pharmacotherapeutic outcomes (77.5%). The current findings suggest that GPs would support an extension of the role of the community pharmacists in number of activities of patient care activities such as medication counselling. Thus, suggesting potential collaborative care between GPs and community pharmacists towards patient care and the needs to develop and incorporate topics on inter-professional relationship in the current medical and pharmaceutical education curriculums.

  15. Skin conditions are the commonest new reason people present to general practitioners in England and Wales.

    PubMed

    Schofield, J K; Fleming, D; Grindlay, D; Williams, H

    2011-11-01

    Knowledge of the prevalence and incidence of skin conditions is a prerequisite for designing clinical services and providing appropriate training for primary health care professionals. In the U.K. the general practitioner and practice nurse are the first point of medical contact for persons with skin conditions. We aimed to obtain contemporary data in age-, gender- and diagnosis-specific detail on persons presenting to primary care with skin problems. Comparisons were made with similar data for other major disease groups and with similar data from other recent years. We used surveillance data collected in the Weekly Returns Service (WRS) of the Royal College of General Practitioners during 2006 and trend data for subsequent years. The WRS sentinel practices monitor all consultations by clinical diagnosis in a representative population of 950,000 in England and Wales. For conditions included in chapter XII of the International Classification of Diseases Ninth Revision (ICD9), 15% of the population consulted; a further 9% presented with skin problems classified elsewhere in the ICD9, making a total of 24%. There was no evidence of increasing or decreasing trend since 2006. Skin infections were the commonest diagnostic group, while 20% of children < 12 months were diagnosed with atopic eczema. Considered collectively, the incidence of new episodes of skin disorders (including diagnoses outside chapter XII) exceeded incidences for all other major disease groupings. Compared with other major disease groups, skin conditions are the most frequent reason for consultation in general practice. This result emphasizes the need for appropriate education and training for all medical students and particularly for continuing education in dermatology for all primary health care professionals. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.

  16. Re-licensing of general practitioners using the current UK revalidation proposals: a cross sectional study.

    PubMed

    Charlton, Rodger; Coomber, J; Thistlethwaite, J E

    2011-12-01

    Objective To explore the views of general practitioners (GPs) on the feasibility of collecting supporting information for the Royal College of General Practitioners (RCGP) revalidation portfolio and mapping of this evidence to the General Medical Practice framework for proposed UK medical re-licensing. Design Cross sectional study with a questionnaire. Setting One inner city and one mixed urban/rural primary care organisation in the West Midlands, England and one rural primary care organisation in Wales. Participants 51/69 GPs who submitted a revalidation portfolio from November 2009 to February 2010. Results The majority of GPs considered the majority of work based supporting information was feasible to collect within a 5 year revalidation cycle; most concerns were expressed about providing evidence for extended practice, learning credits, and patient satisfaction and colleague feedback surveys (59%, 63%, 72%, and 77%, respectively, of GPs considered it feasible to collect this evidence) due to workload time constraints and lack of automatic access to evidence from others, which differed by GP work role. Two-thirds of participants (65%) stated that the submission of a portfolio of evidence was a feasible component of GP revalidation, reporting reservations on the appropriateness of patient and colleague feedback surveys and extended practice (55%, 57%, and 59% respectively) to provide objective evidence. GPs requested further clarity on the evidence mapping process. Conclusion Overall, GPs reported a positive response to the RCGP revalidation proposals. Concerns were focused on collecting the newer types of supporting information and the ability of GPs non-principals to collect this evidence. GP revalidation training and preparation is required.

  17. Adoption and use of digital technologies among general dental practitioners in the Netherlands.

    PubMed

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

    2015-01-01

    To investigate (1) the degree of digital technology adoption among general dental practitioners, and to assess (2) which personal and practice factors are associated with technology use. A questionnaire was distributed among a stratified sample of 1000 general dental practitioners in the Netherlands, to measure the use of fifteen administrative, communicative, clinical and diagnostic technologies, as well as personal factors and dental practice characteristics. The response rate was 31.3%; 65.1% replied to the questionnaire on paper and 34.9% online. Each specific digital technology was used by between 93.2% and 6.8% of the dentists. Administrative technologies were generally used by more dentists than clinical technologies. Dentists had adopted an average number of 6.3 ± 2.3 technologies. 22.5% were low technology users (0 to 4 technologies), 46.2% were intermediate technology users (5 to 7 technologies) and 31.3% were high technology users (8 to 12 technologies). High technology users more frequently had a specialization (p<0.001), were younger on average (p=0.024), and worked more hours per week (p=0.003) than low technology users, and invested more hours per year in professional activities (p=0.026) than intermediate technology users. High technology use was also more common for dentists working in practices with a higher average number of patients per year (p<0.001), with more dentists working in the practice (p<0.001) and with more staff (p<0.001). With few exceptions, all dentists use some or a substantial number of digital technologies. Technology use is associated with various patterns of person-specific factors, and is higher when working in larger dental practices. The findings provide insight into the current state of digital technology adoption in dental practices. Further exploration why some dentists are more reluctant to adopt technologies than others is valuable for the dental profession's agility in adjusting to technological developments.

  18. Varicella and Herpes Zoster in Madrid, based on the Sentinel General Practitioner Network: 1997–2004

    PubMed Central

    Pérez-Farinós, Napoleón; Ordobás, María; García-Fernández, Cristina; García-Comas, Luis; Cañellas, Soledad; Rodero, Inmaculada; Gutiérrez-Rodríguez, Ángeles; García-Gutiérrez, Juan; Ramírez, Rosa

    2007-01-01

    Background Varicella (chickenpox) is the primary disease caused by varicella-zoster virus. It is extremely contagious and is frequent in children. Indeed, in the absence of vaccination, a high proportion of the population is liable to contract it. Herpes zoster -more frequent among adults- is caused by reactivation of the latent virus. The objective of this study is to describe the status of and time trend for varicella and herpes zoster in the Madrid Autonomous Region prior to the introduction of the vaccine to the general population. Methods Data source: individualised varicella and herpes zoster case records kept by the Madrid Autonomous Region Sentinel General Practitioner Network for the period 1997–2004. Cumulative incidences, crude and standardised incidence rates, and age-specific rates of varicella and herpes zoster were calculated for each year. Kendall's Tau-b correlation coefficient was calculated to evaluate whether incidence displayed a time trend. Spectral density in the time series of weekly incidences was estimated using a periodogram. Results Standardised annual varicella incidence rates ranged from 742.5 (95% CI: 687.2 – 797.7) to 1239.6 (95% CI: 1164.5 – 1313.4) cases per 100 000 person-years. Most cases affected children, though complications were more frequent in adults. Varicella incidence displayed an annual periodicity but no trend over time. Most herpes zoster cases occurred at advanced ages, with incidence registering a rising annual trend but no seasonality factor. Conclusion In the absence of vaccination, no significant changes in varicella incidence were in evidence recent years, though these were observed in the incidence of herpes zoster. Sentinel general practitioner networks are a valid instrument for surveillance of diseases such as varicella. Further varicella vaccination-coverage and vaccine-efficacy studies are called for. PMID:17570859

  19. Consultations in primary care for symptoms attributed to electromagnetic fields – a survey among general practitioners

    PubMed Central

    Huss, Anke; Röösli, Martin

    2006-01-01

    Background Five percent of the Swiss population attribute symptoms to electromagnetic fields (EMF). General practitioners (GPs) might play a key role in recognising an emerging health risk, since they are the first to observe and follow up persons who attribute symptoms to EMF. It is unclear to what extent EMFs have become an issue in general practice and which experiences GPs report from the consultations. Methods We conducted telephone interviews in a random sample of GPs in Switzerland in order to assess the frequency of consultations in primary care due to EMF and the GPs' experience with these patients. Results 342 general practitioners were interviewed, corresponding to a response rate of 28.2%. 69% of the GPs reported at least one consultation due to EMF, but GPs with a certificate in complementary medicine were much more likely to report EMF consultations. The median of EMF consultation numbers within one year was three. An overview of the most recent EMF-related consultation per GP yielded sleep disorders, headaches and fatigue as the most often reported symptoms and mobile phone base stations, power lines and the own use of mobile phones as the main EMF sources suspected to be associated to symptoms. GPs judged the association between EMF and the symptoms to be plausible in 54% of the cases. There was no combination of symptoms and EMF sources that was remarkably and consistently judged to be a plausible cause of the symptoms. Conclusion In our survey, GPs often judged the association between the health problems and the suspected exposure to be plausible. This plausibility assessment seems to be based on grounds of preventive positions in a situation of scientific uncertainty. More research effort is needed to obtain more insight on a potential association between long term EMF exposure and unspecific symptoms. PMID:17074080

  20. Survey of general practitioner, family physician, and chiropractor's beliefs regarding the management of acute whiplash patients.

    PubMed

    Ferrari, Robert; Russell, Anthony Science

    2004-10-01

    Questionnaire Survey. The purpose of this study was to survey the whiplash management beliefs for practicing general practitioners, family physicians, and chiropractors. Many treatments are prescribed by general practitioners, family physicians, and chiropractors for acute whiplash, but to date no survey of management beliefs for acute whiplash has been reported. A total of 483 physicians and 123 chiropractors in the urban setting of Edmonton, Alberta, Canada were asked to participate by completing a questionnaire with 24 items designed to assess management beliefs regarding acute whiplash. A total of 362 physicians (75%) and 88 chiropractors (72%) completed the survey. Only 1% of physicians and none of the chiropractors believed that whiplash patients should be prescribed bed rest until almost all their pain goes away. As well, only 1% of physicians and none of the chiropractors believed that patients with acute whiplash should not return to work until almost all their pain goes away. More than 89% of physicians and 76% of chiropractors believed that encouragement of maintaining normal activities, even if they hurt, is important in the recovery from whiplash. Also, 91% of physicians and 84% of chiropractors agreed that exercise therapy was effective in acute whiplash patients. Physicians are more likely to have negative feelings about treating patients who have whiplash, were more likely to believe there was nothing physically wrong with many patients with chronic whiplash, and agree that nonsteroidal anti-inflammatory drugs and muscle relaxants are effective in acute whiplash. Chiropractors are more likely to agree that traction, transcutaneous electrical nerve stimulation, manipulation, massage, and acupuncture are effective in acute whiplash. Physicians and chiropractors generally hold beliefs that are consistent with the current evidence regarding the most helpful approaches to acute whiplash, although chiropractors were more likely to be supportive of passive

  1. General Practitioners' preferences and use of educational media: a German perspective

    PubMed Central

    Vollmar, Horst Christian; Rieger, Monika A; Butzlaff, Martin E; Ostermann, Thomas

    2009-01-01

    Background Several studies suggest that General Practitioners (GPs) prefer "traditional" media such as journals or quality circles when they are seeking out different options to meet their continuing medical education (CME) requirements. A survey was designed in order to gain a better understanding of German General Practitioners' preferences for different forms of educational media that will meet their CME needs. Methods Four hundred and forty nine (N = 449) German physicians were contacted to take part in this study on the occasion of one of their quality circle meetings. The participating physicians received a standardized 26-item-questionnaire that surveyed their preferences for different forms of educational media. A factor analysis was performed in order to determine whether the observed variables can be explained largely or entirely in terms of the underlying patterns. Results Two hundred and sixty-four physicians with an average age of 51.1 years participated (28.5% female, 71.5% male). We found that GPs favor learning environments such as: journals, colleagues, and quality circles. New media like the internet was used less often for their learning activities, even though the usage of the internet in general was quite high. The most important requirements for media in medical education as perceived by the participants were its relevancy for daily practice and dependability. Conclusion Despite a growing use of the Internet it seems that German GPs favor "classical/traditional" settings for their learning activities. These results should be taken into consideration when planning CME or CPD programs or other learning activities. Trial registration Current Controlled Trials ISRCTN36550981. PMID:19220905

  2. General Practitioners' preferences and use of educational media: a German perspective.

    PubMed

    Vollmar, Horst Christian; Rieger, Monika A; Butzlaff, Martin E; Ostermann, Thomas

    2009-02-16

    Several studies suggest that General Practitioners (GPs) prefer "traditional" media such as journals or quality circles when they are seeking out different options to meet their continuing medical education (CME) requirements. A survey was designed in order to gain a better understanding of German General Practitioners' preferences for different forms of educational media that will meet their CME needs. Four hundred and forty nine (N = 449) German physicians were contacted to take part in this study on the occasion of one of their quality circle meetings. The participating physicians received a standardized 26-item-questionnaire that surveyed their preferences for different forms of educational media. A factor analysis was performed in order to determine whether the observed variables can be explained largely or entirely in terms of the underlying patterns. Two hundred and sixty-four physicians with an average age of 51.1 years participated (28.5% female, 71.5% male). We found that GPs favor learning environments such as: journals, colleagues, and quality circles. New media like the internet was used less often for their learning activities, even though the usage of the internet in general was quite high. The most important requirements for media in medical education as perceived by the participants were its relevancy for daily practice and dependability. Despite a growing use of the Internet it seems that German GPs favor "classical/traditional" settings for their learning activities. These results should be taken into consideration when planning CME or CPD programs or other learning activities. Current Controlled Trials ISRCTN36550981.

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

    PubMed

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

    2011-09-01

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

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

    PubMed Central

    2011-01-01

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

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

    PubMed

    Dwairy, Mai; Dowell, Anthony C; Stahl, Jean-Claude

    2011-08-23

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

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

    PubMed Central

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

    2012-01-01

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

  7. On the primary care frontlines: the role of the general practitioner in smoking-cessation activities and diabetes management.

    PubMed

    Kunzel, Carol; Lalla, Evanthia; Albert, David A; Yin, Hong; Lamster, Ira B

    2005-08-01

    Advances in understanding the relationship between oral disease and systemic conditions need to be translated into clinical practice. Relevant here is assessing dentists' active involvement in in-office smoking-cessation activities and management of the patient with type 1 or type 2 diabetes. The authors mailed a survey to a net sample of 132 active general practitioners (GPs) in the northeastern United States during fall 2002. They drew a random sample of GPs listed in the designated states from the 2001 American Dental Association directory. They received 105 responses, for a response rate of 80 percent. With regard to smoking-cessation activities and management of diabetic patients, a majority of GPs reported having a lack of knowledge, viewed such activities as peripheral to their role and disagreed that colleagues and/or patients expected them to perform such activities. More GPs performed both activities on an assessing/advising basis than on an active management basis. Results suggest that approaches to changing dentists' behavior should aim not only at increasing knowledge but at overcoming attitudes and orientations associated with actively managing patients who smoke and patients who have diabetes. The profession's growing evidence base supports an increased primary and preventive care role for dentists. This role affords them opportunities to expand the bounds of dental practice, improve therapeutic outcomes and promote patients' overall health.

  8. Are general practitioners getting the information they need from hospitals to manage their lung cancer patients? A qualitative exploration.

    PubMed

    Rowlands, Stella; Callen, Joanne; Westbrook, Johanna

    2012-01-01

    The delivery of cancer services is primarily hospital-based; however, General Practitioners (GPs) have a key role to play within the context of a multidisciplinary model of care. In order to fulfill their role in cancer care GPs must receive complete and timely information from appropriate members of the hospital team. The aim of this study was to investigate perceptions of the quality, format and timeliness of the patient information GPs receive from a multidisciplinary hospital-based lung cancer team, and elicit how communication between the team and the GP could be improved. Data were collected using semi-structured interviews with a representative sample (n=22) of members of the hospital team and a sample of GPs (n=8). A grounded theory approach was used to categorise the data. Most communications with GPs were from medical officers; however, GPs desired information from all health professional groups in the hospital-based lung cancer team. Most GPs were dissatisfied with the timing of communication. A multidisciplinary discharge summary was suggested as a means of providing both clinical and social information from the team to the GP. Further developments in electronic health records could improve access to patient information by GPs. Results from this study illustrate the need for GPs to receive information from all members of the multidisciplinary hospital team so that they may fulfill their diverse role in supporting patients through all phases of the cancer journey.

  9. Assessing the outcome of making it easier for patients to change general practitioner: practice characteristics associated with patient movements.

    PubMed Central

    Thomas, K; Nicholl, J; Coleman, P

    1995-01-01

    BACKGROUND. The government white paper, Promoting better health, suggested that primary health care services should be made more responsive to patient needs and that competition, brought about by the freer movement of patients between practices, could act as a mechanism for improving the quality of the services provided. Policy changes reflecting these aims were introduced with the 1990 contract for general practitioners. AIM. A study was carried out to estimate the volume of patient movement between practices not attributable to a patient's change of address or to a major change in the practice they had left, and to investigate which practice characteristics patients moved towards and which they moved away from when changing general practitioner. METHOD. Data on 2617 patient movements during June 1991 were collected from five family health services authorities. These patient movements were analysed in relation to data on practice characteristics obtained from family health services authority records. RESULTS. The estimated volume of movement of patients between practices was small (1.6% of the registered population per year). The majority of movements were between group practices; a quarter of the movements recorded were to single-handed general practitioners. However, the ratio of the number of movements from group practices to single-handed general practitioners compared with those from single-handed general practitioners to group practices was 1.37 (95% confidence interval 1.19 to 1.57). In choosing single-handed general practitioners these patients were willing to forgo access to a woman general practitioner, extended services and greater hours of general practitioner availability. Among the subset of movements between group practices, patients were more likely to gain access to a practice nurse, longer surgery hours and a woman general practitioner as a consequence of their move. CONCLUSION. The scale of patient movement observed did not indicate any

  10. General practitioners learning qualitative research: A case study of postgraduate education.

    PubMed

    Hepworth, Julie; Kay, Margaret

    2015-10-01

    Qualitative research is increasingly being recognised as a vital aspect of primary healthcare research. Teaching and learning how to conduct qualitative research is especially important for general practitioners and other clinicians in the professional educational setting. This article examines a case study of postgraduate professional education in qualitative research for clinicians, for the purpose of enabling a robust discussion around teaching and learning in medicine and the health sciences. A series of three workshops was delivered for primary healthcare academics. The workshops were evaluated using a quantitative survey and qualitative free-text responses to enable descriptive analyses. Participants found qualitative philosophy and theory the most difficult areas to engage with, and learning qualitative coding and analysis was considered the easiest to learn. Key elements for successful teaching were identified, including the use of adult learning principles, the value of an experienced facilitator and an awareness of the impact of clinical subcultures on learning.

  11. A survey of general practitioners' attitudes to the involvement of clergy in patient care.

    PubMed Central

    Jones, A W

    1990-01-01

    A questionnaire was sent to a sample of general practitioners in the Avon health district asking whether they perceived a role for the clergy in patient care. Doctors were questioned about both their theoretical attitudes to and practical involvement of clergy in relation to some 20 specific concerns of patients (for example, bereavement, divorce, depression, chronic illness) and to explain from a series of options their reasons for referring or failing to refer patients to clergy. The responses of the 228 respondents showed that they perceived a significant role for the clergy in theory which was not matched in practice. The reasons for the gap between theory and practice are analysed and discussed and suggestions are made as to how the positive responses may be more effectively developed towards improving patient care. PMID:2081063

  12. Truth or consequences: the potential implications of short-term cosmetic orthodontics for general dental practitioners.

    PubMed

    Chate, R A C

    2013-12-01

    Until recently, cosmetic dentistry has focused on the use of traditional restorative techniques, bleaching and the so-called facial rejuvenators such as injectable dermal fillers and Botox. More latterly, the short-term use of aesthetic removable aligners and ceramic fixed appliance brackets have been promoted for use by general dental practitioners as a means of minimising the invasive amount of restorative dental treatment that would otherwise be required to achieve the desired degree of aesthetic improvement. Nevertheless, there are inherent risks and complications associated with short-term orthodontic treatments that are deliberately limited in their outcomes and these, together with the potential ramifications for the long-term dental health of patients, are discussed.

  13. The acceptability of chronic disease management programmes to patients, general practitioners and practice nurses.

    PubMed

    Tracey, Jocelyn; Bramley, Dale

    2003-02-21

    To evaluate the perceived effectiveness and acceptability of a disease management programme for patients with congestive heart failure (CHF) in South Auckland. Focus groups were held with patients, and practice nurses (PNs) and general practitioners (GPs) interviewed to develop the questionnaires. Questionnaires were posted to the 150 patients, 14 GPs and 6 PNs involved in the programme. The programme was reported as changing patient lifestyle behaviours and patient understanding of medications and CHF. GP management was also seen as having improved. All aspects of the programme were seen as important: clinical review with a GP, educational sessions with a PN, patient-held care plan and educational material. The main issues were lack of time for practice staff to be involved, and payment for their time. Disease management programmes such as this are of value and are acceptable to both patients and providers.

  14. Network organizations of general practitioners: antecedents of formation and consequences of participation.

    PubMed

    Fattore, Giovanni; Salvatore, Domenico

    2010-05-11

    Network forms of organization are increasingly popular in primary care. At the end of the 1990s General Practitioners (GPs) in Italy were given the opportunity to adopt network forms of organization with the aim of improving the quality of their services. However factors affecting GPs' choices to join a network and the consequences of network membership have not been evaluated. Administrative data of a Local Health Authority in Central Italy were analyzed using statistical methods at individual and dyadic levels of analysis. Homophily factors seem to influence a GP's choice of network. The consequences of network membership on GP performances seem very limited. When considering to foster the diffusion of network organizational forms in health care creating a network structure, like that of Italian GPs, is not sufficient. Other features of the implementation phase, work organization and human resource management should also be considered.

  15. [Contact from general practitioners to unvaccinated girls can increase HPV vaccination consent].

    PubMed

    Hohwü, Lena; Bro, Flemming

    2012-04-02

    The aim of the study was to evaluate the impact of general practitioners (GPs) follow-up of unvaccinated girls in the Danish Human Papillomavirus catch-up vaccination programme. Telephone interviews were conducted with the GPs to explore their follow-up procedure. The girls were divided into two groups: 1) girls contacted by their GP and 2) girls not contacted by their GP. Ten months later 61% of the girls, who had been contacted, had started vaccination in the follow-up group compared to 53% of girls, who had not been contacted (p < 0.02). Follow-up by GPs increased the likelihood of subsequent vaccination in a group of unvaccinated girls.

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

    PubMed

    Bazex, Jacques; Cabanis, Emmanuel Alain

    2010-06-01

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

  17. Interaction between participants in focus groups with older patients and general practitioners.

    PubMed

    Moen, Janne; Antonov, Karolina; Nilsson, J Lars G; Ring, Lena

    2010-05-01

    Group interaction is put forward as the principal advantage for focus group research, although rarely reported on. The aim of the article is to contribute to the methodological knowledge regarding focus group research by providing an empirical example of the application of the Lehoux, Poland, and Daudelin template suggested for analysis of the interaction in focus groups. The data source was 18 focus groups' performance in Sweden: 12 with older patients and 6 with general practitioners (GPs). GPs found common ground in belonging to the same profession, whereas the older patients, instead of constituting a group in the word's real sense, started just sharing a common focus. We found the template easy to understand and use, except for identifying participants' explicit and implicit purposes for participating. Furthermore, adding an interaction analysis to the content analysis helped us appreciate and clarify the contexts from which these data were created.

  18. General practitioners with a special clinical interest: a model for improving respiratory disease management.

    PubMed Central

    Williams, Siân; Ryan, Dermot; Price, David; Langley, Carol; Fletcher, Monica; Everden, Paul

    2002-01-01

    Health care technology is continuously moving forward with great advances in all fields of medicine. The way in which health care is delivered has been stuck in a primary care/secondary care model, which is failing to meet patients' needs. Existing structures are inefficient because they do not maximise use of skills. A new way of delivering services is proposed using an intermediate level specialist--a general practitioner with a special clinical interest (GPSCI), to increase access at a location close to the patient while giving support to the wider primary health community. We explore how the role of GPSCI might work using the field of respiratory medicine as an exemplar. The concept is transferable to other therapeutic areas. PMID:12392127

  19. General practitioners' knowledge of ageing and attitudes towards older people in China.

    PubMed

    Yang, Yanni; Xiao, Lily Dongxia; Ullah, Shahid; Deng, Lanlan

    2015-06-01

    To explore general practitioners (GPs)knowledge of ageing, attitudes towards older people and factors affecting their knowledge and attitudes in a Chinese context. Four hundred GPs were surveyed using the Chinese version of the Aging Semantic Differential (CASD) and the Chinese version of the Facts on Aging Quiz (CFAQ1) scale. The CASD scores indicated that GPs had a neutral attitude towards older people. The CFAQ1 scores indicated a low level of knowledge about ageing. GPs' awareness of the mental and social facts of ageing was poorer compared to that of physical facts. Male GPs had a significantly higher negative bias score than female GPs. No other variables had a statistically significant influence on knowledge and attitudes. The findings suggest the need for education interventions for GPs regarding knowledge of ageing and also provide evidence to guide future development of continuing medical programs for this group of medical doctors. © 2013 ACOTA.

  20. A survey of root canal treatment of molar teeth by general dental practitioners in private practice in Saudi Arabia

    PubMed Central

    Al-Fouzan, Khalid S.

    2010-01-01

    The purpose of this study was to evaluate the practice and depth of knowledge of root canal treatment by general dental practitioners working in private dental centers in different cities within the Kingdom of Saudi Arabia. A questionnaire was distributed to 400 general dental practitioners. Completed questionnaires were analyzed in term of simple summary statistics. A total of 252 (63%) practitioners responded. The majority of the respondents were Syrians (59%) and Egyptians (32%). Ninety-one per cent of the respondents indicated that they performed root canal treatment. Amongst those who carried out root canal treatment, only seven practitioners (3%) used rubber dam for isolation. More than half of the respondents (55%) used saline to irrigate canals during treatment. Forty-six per cent of practitioners used formocresol as an inter appointment medicament. The standardized and step-back preparation techniques were the method of choice for the majority of the respondents (91%). Ninety-seven per cent of the practitioners used stainless steel hand instruments to prepare root canals and the majority (92%) used gutta-percha for obturation. Seventy-four per cent of the respondent used cold lateral condensation. The average number of radiographs routinely taken for root canal treatment was four. Ninety-three per cent indicated that they usually completed a root canal treatment of molar teeth in three or more visits. Eighty-eight per cent of the practitioners preferred waiting for 1 or 2 weeks to restore the teeth permanently. Results of this study confirm that many general dental practitioners are not following quality guidelines for endodontic treatment. PMID:23960485

  1. A survey of root canal treatment of molar teeth by general dental practitioners in private practice in Saudi Arabia.

    PubMed

    Al-Fouzan, Khalid S

    2010-07-01

    The purpose of this study was to evaluate the practice and depth of knowledge of root canal treatment by general dental practitioners working in private dental centers in different cities within the Kingdom of Saudi Arabia. A questionnaire was distributed to 400 general dental practitioners. Completed questionnaires were analyzed in term of simple summary statistics. A total of 252 (63%) practitioners responded. The majority of the respondents were Syrians (59%) and Egyptians (32%). Ninety-one per cent of the respondents indicated that they performed root canal treatment. Amongst those who carried out root canal treatment, only seven practitioners (3%) used rubber dam for isolation. More than half of the respondents (55%) used saline to irrigate canals during treatment. Forty-six per cent of practitioners used formocresol as an inter appointment medicament. The standardized and step-back preparation techniques were the method of choice for the majority of the respondents (91%). Ninety-seven per cent of the practitioners used stainless steel hand instruments to prepare root canals and the majority (92%) used gutta-percha for obturation. Seventy-four per cent of the respondent used cold lateral condensation. The average number of radiographs routinely taken for root canal treatment was four. Ninety-three per cent indicated that they usually completed a root canal treatment of molar teeth in three or more visits. Eighty-eight per cent of the practitioners preferred waiting for 1 or 2 weeks to restore the teeth permanently. Results of this study confirm that many general dental practitioners are not following quality guidelines for endodontic treatment.

  2. 48 CFR 1552.203-71 - Display of EPA Office of Inspector General Hotline poster.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Display of EPA Office of... Provisions and Clauses 1552.203-71 Display of EPA Office of Inspector General Hotline poster. As prescribed... all contract options. Display of EPA Office of Inspector General Hotline Poster (AUG 2000) (a) For...

  3. 48 CFR 1552.203-71 - Display of EPA Office of Inspector General Hotline poster.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Display of EPA Office of... Provisions and Clauses 1552.203-71 Display of EPA Office of Inspector General Hotline poster. As prescribed... all contract options. Display of EPA Office of Inspector General Hotline Poster (AUG 2000) (a) For...

  4. 48 CFR 1552.203-71 - Display of EPA Office of Inspector General Hotline poster.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Display of EPA Office of... Provisions and Clauses 1552.203-71 Display of EPA Office of Inspector General Hotline poster. As prescribed... all contract options. Display of EPA Office of Inspector General Hotline Poster (AUG 2000) (a) For...

  5. 48 CFR 1552.203-71 - Display of EPA Office of Inspector General Hotline poster.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Display of EPA Office of... Provisions and Clauses 1552.203-71 Display of EPA Office of Inspector General Hotline poster. As prescribed... all contract options. Display of EPA Office of Inspector General Hotline Poster (AUG 2000) (a) For...

  6. 14 CFR 385.16 - Heads of Offices and Assistant General Counsels.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Heads of Offices and Assistant General Counsels. 385.16 Section 385.16 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION... Functions to Staff Members § 385.16 Heads of Offices and Assistant General Counsels. The heads of...

  7. 38 CFR 1.205 - Notification to the Attorney General or United States Attorney's Office.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Violations § 1.205 Notification to the Attorney General or United States Attorney's Office. VA police and/or... Attorney General or United States Attorney's Office. 1.205 Section 1.205 Pensions, Bonuses, and Veterans..., will be responsible for notifying the appropriate United States Attorney's Office, pursuant to 28 U.S.C...

  8. 38 CFR 1.205 - Notification to the Attorney General or United States Attorney's Office.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Violations § 1.205 Notification to the Attorney General or United States Attorney's Office. VA police and/or... Attorney General or United States Attorney's Office. 1.205 Section 1.205 Pensions, Bonuses, and Veterans..., will be responsible for notifying the appropriate United States Attorney's Office, pursuant to 28 U.S.C...

  9. 38 CFR 1.205 - Notification to the Attorney General or United States Attorney's Office.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Violations § 1.205 Notification to the Attorney General or United States Attorney's Office. VA police and/or... Attorney General or United States Attorney's Office. 1.205 Section 1.205 Pensions, Bonuses, and Veterans..., will be responsible for notifying the appropriate United States Attorney's Office, pursuant to 28 U.S.C...

  10. 38 CFR 1.205 - Notification to the Attorney General or United States Attorney's Office.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Violations § 1.205 Notification to the Attorney General or United States Attorney's Office. VA police and/or... Attorney General or United States Attorney's Office. 1.205 Section 1.205 Pensions, Bonuses, and Veterans..., will be responsible for notifying the appropriate United States Attorney's Office, pursuant to 28 U.S.C...

  11. 29 CFR 2550.408b-2 - General statutory exemption for services or office space.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false General statutory exemption for services or office space... exemption for services or office space. (a) In general. Section 408(b)(2) of the Employee Retirement Income... to a party in interest, including a fiduciary, for office space or any service (or a combination of...

  12. [What Are the Main Factors Assisting General Practitioners in the Development of Educational Strategies?

    PubMed

    Chapron, Anthony; Fiquet, Laure; Allory, Emmanuel; Brinchault, Graziella; Hugé, Sandrine; Pommier, Jeanine

    2017-03-06

    General practitioners (GP) are in a special position to conduct educational strategies for their patients with chronic disease. Despite the GP’s desire to be involved in patient education, this approach remains underdeveloped.Objective: To determine the factors required support the development of educational strategies in general practice from the GPs’ perspective.Methods: Qualitative study based on a “modified nominal group technique” carried out among 21 GPs (not specifically trained in patient education) participating as investigators in an interventional study testing a structured educational strategy. The interventional study based on processes and tools specifically developed to suit general practice was held during their usual consultations. Thirty one patients with COPD were followed for 9 months.Results: GPs identified 23 specific factors restructured after the clarification-reformulation step in 6 main factors required for the development of educational strategies in general practice. The consensus revealed that reinforcement of initial and continuing medical training was the most frequently cited factor and was considered to be a priority. The development of inter- and intra-professional cooperation was the second leading factor to be taken into account.Conclusion: The improvement of GP training and the promotion of areas of cooperation could help GPs to develop educational strategies during their consultations. These results may provide insight to regional health agencies concerning the deployment of patient education in primary care.

  13. [What are the main factors assisting general practitioners in the development of educational strategies?

    PubMed

    Chapron, Anthony; Fiquet, Laure; Allory, Emmanuel; Brinchault, Graziella; Hugé, Sandrine; Pommier, Jeanine

    2017-03-06

    General practitioners (GP) are in a special position to conduct educational strategies for their patients with chronic disease. Despite the GP’s desire to be involved in patient education, this approach remains underdeveloped.Objective: To determine the factors required support the development of educational strategies in general practice from the GPs’ perspective.Methods: Qualitative study based on a “modified nominal group technique” carried out among 21 GPs (not specifically trained in patient education) participating as investigators in an interventional study testing a structured educational strategy. The interventional study based on processes and tools specifically developed to suit general practice was held during their usual consultations. Thirty one patients with COPD were followed for 9 months.Results: GPs identified 23 specific factors restructured after the clarification-reformulation step in 6 main factors required for the development of educational strategies in general practice. The consensus revealed that reinforcement of initial and continuing medical training was the most frequently cited factor and was considered to be a priority. The development of inter- and intra-professional cooperation was the second leading factor to be taken into account.Conclusion: The improvement of GP training and the promotion of areas of cooperation could help GPs to develop educational strategies during their consultations. These results may provide insight to regional health agencies concerning the deployment of patient education in primary care.

  14. Suicide prevention in primary care: General practitioners' views on service availability

    PubMed Central

    2010-01-01

    Background Primary care may be a key setting for suicide prevention. However, comparatively little is known about the services available in primary care for suicide prevention. The aims of the current study were to describe services available in general practices for the management of suicidal patients and to examine GPs views on these services. We carried out a questionnaire and interview study in the North West of England. We collected data on GPs views of suicide prevention generally as well as local mental health service provision. Findings During the study period (2003-2005) we used the National Confidential Inquiry Suicide database to identify 286 general practitioners (GPs) who had registered patients who had died by suicide. Data were collected from GPs and practice managers in 167 practices. Responses suggested that there was greater availability of services and training for general mental health issues than for suicide prevention specifically. The three key themes which emerged from GP interviews were: barriers accessing primary or secondary mental health services; obstacles faced when referring a patient to mental health services; managing change within mental health care services Conclusions Health professionals have an important role to play in preventing suicide. However, GPs expressed concerns about the quality of primary care mental health service provision and difficulties with access to secondary mental health services. Addressing these issues could facilitate future suicide prevention in primary care. PMID:20920302

  15. Accuracy of anthropometric measurements by general practitioners in overweight and obese patients.

    PubMed

    Sebo, Paul; Herrmann, François R; Haller, Dagmar M

    2017-01-01

    We recently showed that abdominal obesity measurements (waist and hip circumference, waist-to-hip ratio) were inaccurate when performed by general practitioners (GPs). We hypothesise that measurement error could be even higher in overweight and obese patients due to difficulty in locating anatomical landmarks. We aimed to estimate GPs' measurement error of general (weight, height and body mass index (BMI)) and abdominal obesity measurements across BMI subgroups. This cross-sectional study involved 26 GPs in Geneva, Switzerland. They were asked to take measurements on 20 volunteers within their practice. Two trained research assistants repeated the measures after the GPs ("gold standard"). The proportion of measurement error was computed by comparing the GPs' values (N = 509) to the average value of two measurements taken in turn by the research assistants and stratified by BMI subgroup (normal/underweight: <25 kg/m(2), overweight: 25 ≤ BMI < 30 kg/m(2), obese: ≥30 kg/m(2)). General obesity measurements were less prone to measurement error than abdominal obesity measurements, regardless of the BMI subgroup. The proportions of error increased across BMI subgroups (except for height), and were particularly high for abdominal obesity measurements in obese patients. Abdominal obesity measurements are particularly inaccurate when GPs use these measurements to assess overweight and obese patients. These findings add further strength to recommendations for GPs to favour use of general obesity measurements in daily practice, particularly when assessing overweight or obese patients.

  16. Perception and attitude of general