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

PubMed

Khunti, K; Kinsella, B

2000-09-01

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

Impact of selective reporting of antibiotic susceptibility test results on the appropriateness of antibiotics chosen by French general practitioners in urinary tract infections: a randomised controlled case-vignette study.

PubMed

Bourdellon, Loic; Thilly, Nathalie; Fougnot, Sébastien; Pulcini, Céline; Henard, Sandrine

2017-08-01

Selective reporting of antibiotic susceptibility test (AST) results is a potential intervention for laboratory-based antibiotic stewardship. The aim of this study was to assess the impact of AST reporting on the appropriateness of antibiotics selected by French general practitioners for urinary tract infections (UTIs). A randomised controlled case-vignette study in a region of northeast France surveyed general practitioners between July and October 2015 on treatment of four clinical cases of community-acquired Escherichia coli UTIs (two cases of complicated cystitis, one of acute pyelonephritis and one male UTI). In Group A, selective reporting of AST results was used for the first two cases and complete reporting for the other two cases; these were reversed in Group B. The overall participation rate was 131/198 (66.2%). Provision of selective AST results significantly increased the rate of adherence to national guidelines for first-line antibiotic treatment in Cases 1, 3 and 4 by 22.4% (55.2% vs. 32.8%, P = 0.01), 67.5% (75.0% vs. 7.5%, P <0.001) and 36.3% (45.3% vs. 9.0%, P <0.001), respectively. The improvement in compliance was not significant for Case 2. Prescriptions of amoxicillin-clavulanic acid, fluoroquinolones and cephalosporins decreased by 25.0% to 45.0%, depending on the clinical vignette. Most (106/131, 81.0%) participants favoured the routine use of selective reporting of AST results. In conclusion, selective reporting of AST results seems to improve antibiotic prescribing practices in primary care, and may be considered a key element of antimicrobial stewardship programmes. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

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

PubMed

Yazdani, Shahram; Hosseinzadeh, Mohammad; Hosseini, Fakhrolsadat

2017-10-01

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

A practitioner's guide to persuasion: an overview of 15 selected persuasion theories, models and frameworks.

PubMed

Cameron, Kenzie A

2009-03-01

To provide a brief overview of 15 selected persuasion theories and models, and to present examples of their use in health communication research. The theories are categorized as message effects models, attitude-behavior approaches, cognitive processing theories and models, consistency theories, inoculation theory, and functional approaches. As it is often the intent of a practitioner to shape, reinforce, or change a patient's behavior, familiarity with theories of persuasion may lead to the development of novel communication approaches with existing patients. This article serves as an introductory primer to theories of persuasion with applications to health communication research. Understanding key constructs and general formulations of persuasive theories may allow practitioners to employ useful theoretical frameworks when interacting with patients.

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

PubMed

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

2015-11-01

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

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

PubMed Central

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

1996-01-01

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

Sources of influence on medical practice

PubMed Central

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

2000-01-01

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


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

Podiatric medical resources on the internet: a fifth update.

PubMed

Fikar, Charles R

2006-01-01

An updated selection of high-quality Internet resources of potential use to the podiatric medical practitioner, educator, resident, and student is presented. Internet search tools and general Internet reference sources are briefly covered, including methods of locating material residing on the "invisible" Web. General medical and podiatric medical resources are emphasized. These Web sites were judged on the basis of their potential to enhance the practice of podiatric medicine in addition to their contribution to education. Podiatric medical students, educators, residents, and practitioners who require a quick reference guide to the Internet may find this article useful.

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

PubMed

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

2017-05-19

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

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

PubMed

Henderson, Emily J; Rubin, Greg P

2013-05-01

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

A survey to assess the provision of conscious sedation by general dental practitioners in the Republic of Ireland.

PubMed

Fisher, Veronica; Stassen, Leo F A; Nunn, June

2011-01-01

To quantify and qualify how conscious sedation was used in general dental practice before the introduction of formal sedation teaching in the Republic of Ireland. 1. To determine the extent of use of oral, inhalational and intravenous sedation; 2. to determine the training and experience of general dental practitioners providing conscious sedation; 3. to determine the perceived barriers to the practice of conscious sedation; and, 4. to gauge the level of interest in a postgraduate course in conscious sedation. Postal questionnaire sent to one general practitioner in seven, selected randomly from the General Dental Council register, in 2007. Seventy six percent of respondents agreed that the provision of conscious sedation in general dental practice is important. However, the current provision of inhalation and intravenous sedation by respondents is low in comparison to provision in the UK. The main barrier to the use of conscious sedation in general dental practice appears to be lack of availability of training. The data from this study indicated the need for postgraduate training in conscious sedation in Ireland and a need for increased awareness of the Dental Council Code of Practice on sedation.

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

PubMed Central

YAZDANI, SHAHRAM; HOSSEINZADEH, MOHAMMAD; HOSSEINI, FAKHROLSADAT

2017-01-01

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

GDPs' self-perceived confidence and anxiety in their clinical and communication skills used when screening for oral cancer: UK variations.

PubMed

Farrand, Paul; Clover, Henry; Hutchison, Iain L

2003-07-01

To compare anxieties of general dental practitioners (GDPs) across the UK in communicating with patients about oral cancer and confidence in clinical skills required to perform soft tissue screening for oral cancer. A questionnaire was sent to 2200 randomly selected GDPs from across the UK. Responses to the questionnaires were analysed using 95% confidence intervals. Dental practitioners in general practice within England, Northern Ireland, Scotland and Wales. The response rate varied between 57% in England and 65% in Northern Ireland. A high percentage of dental practitioners across all UK regions reported performing soft tissue examinations (range 78% to 88%). The number of soft tissue examinations per month varied between 129 (95% CI 109, 148) and 162 (95% CI 154, 170) indicating criteria when selecting patients for screening. Using a nine-point rating scale (1 = not at all, 9 = extremely), confidence in the clinical skills required during oral cancer screening was generally good (ratings varying between 5.4 and 6.7). With the exception of reporting positive findings to patients (rating 4.5 to 5.2), anxiety in communication skills used during oral cancer screening was generally low (ratings varying between 1.8 and 3.9). While concerns over generalizing the results exist, the situation with respect to the clinical and communication skills required by GDPs during oral cancer screening is generally encouraging. An area of concern is discussing positive findings with patients. This may be overcome by developing specialist courses on breaking bad news within undergraduate dental curricula and programmes of continuing professional development.

What keeps Melbourne GPs satisfied in their jobs?

PubMed

Walker, Kate Anne; Pirotta, Marie

2007-10-01

Workforce shortages make it important to promote job satisfaction and career longevity in general practitioners. We aimed to investigate strategies that maintain and improve Melbourne (Victoria) GP job satisfaction. A postal survey of a random selection of The Royal Australian College of General Practitioners vocationally recognised GPs (N=860). Open ended answers were coded according to themes and compared between genders. Thirty-eight percent of surveyed GPs responded. The mean satisfaction score was 50 out of 70 (SD 9). Women GPs were more satisfied than men with life-work balance (p<0.01). Most frequently nominated themes for satisfaction were job variety, longitudinal patient relationships, belief in the value of the work and intellectual stimulation. Strategies to improve GP satisfaction were increased pay, reduced paperwork, and improved administrative systems. General practitioners were satisfied with their jobs due to the intrinsic qualities of their work and workplace. Decreasing the administrative burden, increasing remuneration and improving practice supports may improve metropolitan GP job satisfaction.

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

PubMed

Heringa, M P

2004-01-10

The major benefit of the revised version of the Dutch College of General Practitioners' practice guideline about pregnancy and puerperium is the formal starting point of professional equality of midwives and general practitioners as care providers in antenatal and postpartum care. This thorough evidence-based practice guideline is behind the most recent developments in this field. Scientific evidence on vertical HIV transmission favours screening all pregnant women and not just the selective procedure proposed in this guideline. The restrictive attitude towards routine ultrasound screening during pregnancy hardly seems in line with scientific evidence and the public demand. On the other hand the guideline is very progressive as far as the care of women with thyroid disorders is concerned even though evidence on this subject is meagre. Most importantly the transition of antenatal care from the current almost conveyor belt-like procedure to an efficient but individually-adapted care process was not addressed.

Diabetes mellitus and periodontal health: dentists' knowledge.

PubMed

Al-Khabbaz, Areej K; Al-Shammari, Khalaf F

2011-01-01

There is a strong body of evidence to support the relationship between periodontal diseases and diabetes mellitus. Unless dental practitioners are aware of this link, they cannot apply the information to their daily practice. The aim of the study was, therefore, to evaluate the knowledge of dental practitioners concerning the effect of diabetes on periodontal health. This was a cross-sectional survey of randomly selected dental practitioners in Kuwait. Participants were asked about specific periodontal complications which they believed that patients diagnosed with diabetes were more susceptible to. A total of 220 dental practitioners (133 general dental practitioners and 87 dental specialists) participated in the study. Less than 60% of all study participants reported that tooth loss due to periodontal reasons and periodontal abscess were frequent among diabetic patients. Dental specialists, especially periodontists, were significantly more aware of periodontal complications associated with diabetes. Factors significantly associated with having knowledge about the effect of diabetes on periodontal health in logistic regression analysis were dentists who were older and those who were specialists. The results of this study indicate that knowledge about the effects of diabetes on periodontal health among this sample of dental practitioners is generally low, and dentists may underestimate the outcomes of periodontal diseases in diabetic patients. Copyright © 2011 S. Karger AG, Basel.

Presentation and antimicrobial treatment of acute orofacial infections in general dental practice.

PubMed

Lewis, M A; Meechan, C; MacFarlane, T W; Lamey, P J; Kay, E

1989-01-21

Information on the presentation of orofacial infections and the use of antimicrobial agents in general dental practice in the United Kingdom was obtained using a postal questionnaire. Six hundred dentists were randomly selected and a total of 340 replies were received, giving a response rate of 57%. The dental practitioners estimated that acute infection was present in only a minority (approximately 5%) of patients. A total of seven different antibiotics were prescribed, in a variety of regimens, for the treatment of bacterial infection. However, the majority of dentists (46-62%) preferred a 5-day course of penicillin (250 mg, qid) for bacterial conditions other than acute ulcerative gingivitis, for which most practitioners (89%) prescribed 3 days of metronidazole (200 mg, tid). Nystatin was the most frequently selected anticandidal agent and topical acyclovir the most popular therapy for Herpes simplex infection.

Family systems ideas in the 10-minute consultation: using a reflecting partner or observing team in a surgery.

PubMed

Mayer, R; Graham, H; Schuberth, C; Launer, J; Tomson, D; Czauderna, J

1996-04-01

Family therapy and the ideas that underlie it have not had much impact on general practice, although there is good reason to think this could be a useful approach. As a group of general practitioners (and a practice nurse) with experience of family therapy, we were interested in demonstrating whether family therapy methods could usefully inform general practice consultations. Two surgeries were observed by the general practitioner's colleagues. Selected cases are discussed to illustrate the impact of the use of family therapy ideas and a reflecting colleague or team. Family therapy ideas can be a helpful framework within which to think about both demanding and ordinary consultations. Inviting a colleague to contribute respectfully could be useful both as a method of teaching, and in resolving difficult or faltering consultations.

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

PubMed

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

2015-08-01

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

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

Results of the peer assessment program of the College of Physicians and Surgeons of Ontario.

PubMed Central

McAuley, R G; Henderson, H W

1984-01-01

This paper describes the experience of the College of Physicians and Surgeons of Ontario in developing and conducting a program for the peer assessment of physicians' office practices that would allow the standards of medical practice to be reviewed and assessed. Following two pilot projects in 1978 and 1979 that demonstrated the need, the feasibility and the acceptance of a peer assessment program the office practices of 391 randomly selected physicians were reviewed in 1981 and 1982. Included in the sample were 255 general/family practitioners and 136 specialists in seven fields. Serious deficiencies were found in the medical records of or in the care provided by 30 of the general/family practitioners and 3 of the specialists, accounting for 8% of the practices studied. The difference between the two groups of physicians was statistically significant (p less than 0.01). No predictors of significance were demonstrated in the general/family practitioner group. When follow-up assessments were done most of the physicians were found to have made the improvements that had been recommended. PMID:6478338

PubMed Central

Baillargeon, L.; Demers, M.; Grégoire, J. P.; Pépin, M.

1996-01-01

OBJECTIVES: To describe treatment of insomnia in general practice and to identify family physicians' training needs in this area. DESIGN: Mail survey using Dillman's total design method. PARTICIPANTS: A sampling of 484 general practitioners in the Quebec City area was done to provide roughly equal representation of six practice settings. The response rate was 65%; 295 of the 315 questionnaires returned were selected for analysis. RESULTS: Most physicians reported treating insomnia with general advice and lifestyle changes; 25% reported prescribing hypnotics frequently; 56% reported they prescribed them occasionally. Although 58% often recommend relaxation techniques, only 8% taught these techniques to their patients. Other cognitive and behavioral approaches are rarely used. Most felt that training in treating insomnia should be offered. CONCLUSION: Cognitive and behavioral approaches are very effective approaches are very effective nonpharmacological treatments for insomnia. General practitioners make little use of these treatments that could be easily integrated into clinical practice. Strategies for increasing their use discussed. PMID:8616283

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

PubMed Central

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

1996-01-01

OBJECTIVE--To develop a list of indicators of the general practice care of people with chronic illnesses considered important by both patients and practitioners and to identify the indicators that are considered relevant for patient assessment of health care quality. DESIGN--Qualitative study with focus group interviews and a written consensus procedure. SETTING--General practice in the Netherlands in 1993. SUBJECTS--34 patients with chronic illness, mostly members of patient organisations, and 19 general practitioners with expertise in either chronic disease management or experience with patient surveys. MAIN MEASURES--Aspects of general practice care considered important for the delivery of good quality care that emerged from focus group interviews; the relevance of evaluations of 41 aspects of care for patients explored through the written consensus procedure. Those aspects of general practice care agreed to be both important and relevant by patients and general practitioners were considered to be suitable indicators for patient assessment of the quality of care. RESULTS--Patients and general practitioners differed to some extent in their assessment of the aspects of care that they considered important for quality. They agreed that most indicators of care that related to the ¿doctor-patient relation¿ and to ¿information and support¿ were relevant and therefore suitable as indicators for patient assessment of health care quality. There was less agreement about the relevance of indicators of ¿medical and technical care,¿ ¿availability and accessibility,¿ and ¿organisation of services.¿ CONCLUSIONS--Several indicators of the quality of general practice care of patients with chronic illness were thought to be suitable for the patient assessment of healthcare quality, but other indicators were not, mainly because of reservations by general practitioners. IMPLICATIONS-- Qualitative methods can contribute to the selection of indicators for assessment of the quality of health care in areas where scientific evidence is limited or where patients' and providers' preferences are particularly important. PMID:10158595

Coping with Workplace Violence against General Practitioners and Nurses in Heilongjiang Province, China: Social Supports and Prevention Strategies.

PubMed

Zhao, Siqi; Qu, Lijun; Liu, He; Gao, Lijun; Jiao, Mingli; Liu, Jinghua; Liang, Libo; Zhao, Yanming; Wu, Qunhong

2016-01-01

The study's objectives were to: 1) use social support theory to examine factors influencing healthcare workers' opinions about workplace violence (WPV) prevention strategies, and 2) to determine the types of support that general practitioners (GPs) and general nurses sought and expected to use after WPV exposure. A cross-sectional survey was used to assess a sample of 448 GPs and 412 general nurses from 90 township hospitals located in Heilongjiang province, China. Results revealed that workers exposed to physical, psychological or both WPV types had a strong opinion about the necessity of improving diagnosis/treatment competence, developing violence prevention guidelines and plans, using protective equipment, and reinforcing staff by providing back-up support. The last two strategies were also selected by tertiary hospital workers in our previous study. In addition, workers with high anxiety selected the following prevention strategies as most effective: improving doctor-patient communication skills; installing cameras on wards; keeping work areas bright; improvements in violence reporting, statistics, and interventions; security patrols in the key departments; reinforcing staff; and correcting inaccurate media perspectives and reports. The last four strategies were also selected by tertiary hospital workers. All respondents expected to receive organisational and social support. In conclusion, these prevention strategies should be tailored to the different requirements of specific populations. Furthermore, it is necessary for organisations, the public, and policymakers to provide powerful support in WPV prevention.

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.

Prescription data improve the medication history in primary care.

PubMed

Glintborg, Bente; Andersen, S K; Poulsen, H E

2010-06-01

Incomplete medication lists increase the risk of medication errors and adverse drug effects. In Denmark, dispensing data and pharmacy records are available directly online to treating physicians. We aimed (1) to describe if use of pharmacy records improved the medication history among patients consulting their general practitioner and (2) to characterise inconsistencies between the medication history reported by the patient and the general practitioner's recordings. Patients attending a general practitioner clinic were interviewed about their current medication use. Subsequently, the patients were contacted by phone and asked to verify the medication list previously obtained. Half of the patients were randomly selected for further questioning guided by their dispensing data: during the telephone interview, these patients were asked to clarify whether drugs registered in their pharmacy records were still in use. Pharmacy records show all drugs acquired on prescription from any national pharmacy in the preceding 2 years. The medication list was corrected accordingly. In all patients, the medication lists obtained on the in-clinic and telephone interviews were compared to the general practitioner's registrations. The 150 patients included in the study had a median age of 56 years (range 18-93 years), and 90 (60%) were women. Patients reported use of 849 drugs (median 5, range 0-16) at the in-clinic interview. Another 41 drugs (median 0, range 0-4) were added during the telephone interview. In the subgroup of 75 patients interviewed guided by pharmacy records, additionally 53 drugs (10%) were added to the 474 drugs already mentioned. The 27 patients adding more drugs guided by pharmacy records were significantly older and used more drugs (both p<0.05) than the 48 patients not adding drugs. When the medication lists were compared with the general practitioner's lists, specifically use of over-the-counter products and prescription-only medications from Anatomical Therapeutic Chemical Classification System group J, A, D, N and R were not registered by the general practitioner. Dispensing data provide further improvement to a medication history based on thorough in-clinic and telephone interviews. Use of pharmacy records as a supplement when recording a medication history seems beneficial, especially among older patients treated with polypharmacy.

A practitioner's guide to interpersonal communication theory: an overview and exploration of selected theories.

PubMed

Bylund, Carma L; Peterson, Emily B; Cameron, Kenzie A

2012-06-01

To provide a brief overview of selected interpersonal theories and models, and to present examples of their use in healthcare communication research. Nine interpersonal communication theories and their application to healthcare communication are discussed. As healthcare communication interactions often occur at an interpersonal level, familiarity with theories of interpersonal communication may reinforce existing best practices and lead to the development of novel communication approaches with patients. This article serves as an introductory primer to theories of interpersonal communication that have been or could be applied to healthcare communication research. Understanding key constructs and general formulations of these theories may provide practitioners with additional theoretical frameworks to use when interacting with patients. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

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

2018-05-13

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

Influences on the Career Development of Gay Men.

ERIC Educational Resources Information Center

Prince, Jeffrey P.

1995-01-01

Relates selected concepts from the general literature of gay and lesbian psychology to the career development of gay men. Specific concerns related to sexual identity development, the management of stigma, and psychological adjustment are reviewed, and suggestions are offered both to practitioners and researchers. (Author)

Simple case definition of clinical benign prostatic hyperplasia, based on International Prostate Symptom Score, predicts general practitioner consultation rates.

PubMed

Kok, Esther T; Bohnen, Arthur M; Jonkheijm, Rikkert; Gouweloos, Jochem; Groeneveld, Frans P M J; Thomas, Siep; Bosch, J L H Ruud

2006-10-01

To determine which case-definition of clinical benign prostatic hyperplasia (BPH) has the best predictive value for general practitioner visits for lower urinary tract symptoms (LUTS) suggestive of BPH. The incidence and prevalence rates of general practitioner visits for LUTS were also determined. A longitudinal, population-based study from 1995 to 2003 was conducted among 1688 men aged 50 to 78 years old. Data were collected on physical urologic parameters, quality of life, and symptom severity as determined from the International Prostate Symptom Score. Information on health-care-seeking behavior of all participants was collected from the general practitioner (GP) record using a computerized search engine and an additional manual check of the electronically selected files. The incidence and prevalence rate of the men at risk was 19.6% and 14.0%, respectively, and these rates increased with age. For sensitivity and the positive predictive value, the case-definition of clinical BPH as an International Prostate Symptom Score greater than 7 had the best predictive value for GP visits for LUTS within 2 years after baseline. Because only marginal improvement (greater specificity but lower sensitivity) in the prediction of GP visits for LUTS was possible by adding information on prostate volume and flow, for the prediction of future GP visits for LUTS suggestive of BPH, we suggest that the International Prostate Symptom Score questionnaire be used and that estimation of the prostate volume and flow is not required.

Economic impact of dental hygienists on solo dental practices.

PubMed

Lazar, Vickie F; Guay, Albert H; Beazoglou, Tryfon J

2012-08-01

The fact that a significant percentage of dentists employ dental hygienists raises an important question: Are dental practices that utilize a dental hygienist structurally and operationally different from practices that do not? This article explores differences among dental practices that operate with and without dental hygienists. Using data from the American Dental Association's 2003 Survey of Dental Practice, a random sample survey of U.S. dentists, descriptive statistics were used to compare selected characteristics of solo general practitioners with and without dental hygienists. Multivariate regression analysis was used to estimate the effect of dental hygienists on the gross billings and net incomes of solo general practitioners. Differences in practice characteristics--such as hours spent in the practice and hours spent treating patients, wait time for a recall visit, number of operatories, square feet of office space, net income, and gross billings--were found between solo general practitioners who had dental hygienists and those who did not. Solo general practitioners with dental hygienists had higher gross billings. Higher gross billings would be expected, as would higher expenses. However, net incomes of those with dental hygienists were also higher. In contrast, the mean waiting time for a recall visit was higher among dentists who employed dental hygienists. Depending on personal preferences, availability of qualified personnel, etc., dentists who do not employ dental hygienists but have been contemplating that path may want to further research the benefits and opportunities that may be realized.

Chronic debilitating fatigue in Irish general practice: a survey of general practitioners' experience.

PubMed

Fitzgibbon, E J; Murphy, D; O'Shea, K; Kelleher, C

1997-10-01

Doctors are called upon to treat chronic debilitating fatigue without the help of a protocol of care. To estimate the incidence of chronic debilitating fatigue in Irish general practice, to obtain information on management strategy and outcome, to explore the attitudes of practitioners (GPs) towards the concept of a chronic fatigue syndrome (CFS), and to recruit practitioners to a prospective study of chronic fatigue in primary care. A total of 200 names were selected from the database of the Irish College of General Practitioners (ICGP); 164 of these were eligible for the study. Altogether, 118 questionnaires were returned (72%). Ninety-two (78%) responders identified cases of chronic fatigue, giving an estimated 2.1 cases per practice and an incidence of 1 per 1000 population. All social classes were represented, with a male to female ratio of 1:2. Eleven disparate approaches to treatment were advocated. Many (38%) were dissatisfied with the quality of care delivered, and 45% seldom or hardly ever referred cases for specialist opinion. The majority (58%) accepted CFS as a distinct entity, 34% were undecided, and 8% rejected it. Forty-two (35%) GPs volunteered for a prospective study. Chronic fatigue is found in Irish general practice among patients of both sexes and all social classes. Doctors differ considerably in their management of patients and are dissatisfied with the quality of care they deliver. Many cases are not referred for specialist opinion. A prospective database is required to accurately assess the scale of this public health problem and to develop a protocol of care.

General practitioner fundholding: experience in Grampian.

PubMed

Wisely, I C

1993-03-13

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

Routines for interocclusal appliance therapy among general dental practitioners in a Swedish county.

PubMed

Gnauck, Maja; Helkimo, Martti; Magnusson, Tomas

2012-01-01

The aims of this study were to investigate what kind of interocclusal appliances that were chosen among Swedish dentists when treating temporomandibular disorders (TMD), the clinical rationale for the treatment, the diagnoses that warranted the appliance treatment, the use of adjunct TMD treatments and prognostic considerations, and possible differences in these respects between children/adolescents and adults with TMD, and, finally, possible differences between private practitioners and general practitioners in the public dental service. During the 12-months-period April 2009-March 2010 all general dental practitioners in the county of Jönköping, Sweden, were asked to fill in a questionnaire when performing a TMD treatment with an interocclusal appliance. A total of 394 questionnaires were filled in and returned, 216 (55%) from dentists in public dental service and 178 (45%) from private practitioners. It was found that in 40% of the cases, no pre-treatment recording of the functional status in the masticatory system had been made. The commonest reasons for the treatment were bruxism, headache, and replacement of a previous appliance. Less than half of the appliances made were hard acrylic appliances. Some kind of adjunct therapy had been made in 22% of the cases treated in public dental service. The corresponding figure for those treated by private practitioners was 25%. Therapeutic jaw exercises was the commonest adjunct therapy followed by selective occlusal adjustment. In the vast majority of cases, the dentists judged the prognosis of the treatment to be good. It is concluded that a large number of appliances made to treat TMD were soft appliances, especially in public dental service. This reflects a possible overuse of soft appliances at the expense of hard acrylic appliances. Furthermore, in a large number of cases, the treatment was performed without any pre-treatment registrations, and adjunct therapies were rarely used. In all these respects,there is an improvement potential for the treatment of TMD in general dental practice.

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

PubMed

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

2009-08-01

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

A letter on the state of general practice in England.

PubMed

Majeed, Azeem

2015-01-01

The last few years have been a time of considerable change for general practitioners in England. In 2004, general practitioners negotiated a new contract with the United Kingdom's National Health Service. In came a new pay for performance scheme, along with the option of opting out of after-hours primary care. General practitioners' pay increased and job satisfaction improved. However, rather than then entering a period of stability, general practitioners subsequently found themselves facing even more changes in their working practices. Workload has increased, new responsibilities for commissioning health services have been given to general practitioners, and their income has fallen.

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

PubMed

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

2016-08-23

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

Specialization in general practice *

PubMed Central

Hart, Julian Tudor

1980-01-01

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

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

PubMed

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

2017-05-01

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

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

PubMed

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

2016-11-01

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

Paediatric oncology information pack for general practitioners

PubMed Central

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

1988-01-01

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

Predictors of Job Satisfaction in Dental Professionals of the Bosnia and Herzegovina Federation.

PubMed

Muhic, Edin; Plancak, Darije; Lajnert, Vlatka; Muhic, Asja

2016-09-01

Working in a healthy work environment is the ultimate goal of every employee. Dentistry is a stressful career, and the reasons for dissatisfaction are numerous. The aim of this study was to determine the factors of work satisfaction in dental professionals of the Bosnia and Herzegovina Federation. A total of 134 dental professionals selected randomly from the Registry of Dental Chamber of Bosnia and Herzegovina Federation were included in the study. All of them filled out the Demographic Questionnaire and Job Satisfaction Scale (JSS). An increase in the influence of work on the quality of life as well as an increase in its frequency results in leaving the job and significantly reducing the overall job satisfaction. General dental practitioners are significantly more satisfied as compared with specialists. Significant predictors of the job satisfaction are employment status, type of the practice, and availability of dental assistants. General dental practitioners with a dental assistant employed at a private practice are more likely to be satisfied with their jobs. Employment status, practice type and availability of dental assistants are significant predictors of job satisfaction. General dental practitioners working in a private practice with a dental assistant are most likely to be satisfied.

Interoperability prototype between hospitals and general practitioners in Switzerland.

PubMed

Alves, Bruno; Müller, Henning; Schumacher, Michael; Godel, David; Abu Khaled, Omar

2010-01-01

Interoperability in data exchange has the potential to improve the care processes and decrease costs of the health care system. Many countries have related eHealth initiatives in preparation or already implemented. In this area, Switzerland has yet to catch up. Its health system is fragmented, because of the federated nature of cantons. It is thus more difficult to coordinate efforts between the existing healthcare actors. In the Medicoordination project a pragmatic approach was selected: integrating several partners in healthcare on a regional scale in French speaking Switzerland. In parallel with the Swiss eHealth strategy, currently being elaborated by the Swiss confederation, particularly medium-sized hospitals and general practitioners were targeted in Medicoordination to implement concrete scenarios of information exchange between hospitals and general practitioners with a high added value. In this paper we focus our attention on a prototype implementation of one chosen scenario: the discharge summary. Although simple in concept, exchanging release letters shows small, hidden difficulties due to the multi-partner nature of the project. The added value of such a prototype is potentially high and it is now important to show that interoperability can work in practice.

Education and Older People. Selected Bibliographies on Ageing 2.

ERIC Educational Resources Information Center

Norton, Dianne, Comp.

These annotated bibliographies are intended to assist researchers, students, and other practitioners interested in the topic of education and aging. How-to guides, research studies, literature reviews, essays, state-of-the-art reviews, and program descriptions are included. Works are arranged by the following subject areas: general, learning…

Prevention of Methamphetamine Abuse: Can Existing Evidence Inform Community Prevention?

ERIC Educational Resources Information Center

Birckmayer, Johanna; Fisher, Deborah A.; Holder, Harold D.; Yacoubian, George S.

2008-01-01

Little research exists on effective strategies to prevent methamphetamine production, distribution, sales, use, and harm. As a result, prevention practitioners (especially at the local level) have little guidance in selecting potentially effective strategies. This article presents a general causal model of methamphetamine use and harms that…

Coping with Workplace Violence against General Practitioners and Nurses in Heilongjiang Province, China: Social Supports and Prevention Strategies

PubMed Central

Liu, He; Gao, Lijun; Jiao, Mingli; Liu, Jinghua; Liang, Libo; Zhao, Yanming; Wu, Qunhong

2016-01-01

The study’s objectives were to: 1) use social support theory to examine factors influencing healthcare workers’ opinions about workplace violence (WPV) prevention strategies, and 2) to determine the types of support that general practitioners (GPs) and general nurses sought and expected to use after WPV exposure. A cross-sectional survey was used to assess a sample of 448 GPs and 412 general nurses from 90 township hospitals located in Heilongjiang province, China. Results revealed that workers exposed to physical, psychological or both WPV types had a strong opinion about the necessity of improving diagnosis/treatment competence, developing violence prevention guidelines and plans, using protective equipment, and reinforcing staff by providing back-up support. The last two strategies were also selected by tertiary hospital workers in our previous study. In addition, workers with high anxiety selected the following prevention strategies as most effective: improving doctor-patient communication skills; installing cameras on wards; keeping work areas bright; improvements in violence reporting, statistics, and interventions; security patrols in the key departments; reinforcing staff; and correcting inaccurate media perspectives and reports. The last four strategies were also selected by tertiary hospital workers. All respondents expected to receive organisational and social support. In conclusion, these prevention strategies should be tailored to the different requirements of specific populations. Furthermore, it is necessary for organisations, the public, and policymakers to provide powerful support in WPV prevention. PMID:27326460

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

PubMed

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

2010-01-01

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

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

PubMed Central

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

2014-01-01

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

Influence of Cone-beam Computed Tomography on Endodontic Retreatment Strategies among General Dental Practitioners and Endodontists.

PubMed

Rodríguez, Gustavo; Patel, Shanon; Durán-Sindreu, Fernando; Roig, Miguel; Abella, Francesc

2017-09-01

Treatment options for endodontic failure include nonsurgical or surgical endodontic retreatment, intentional replantation, and extraction with or without replacement of the tooth. The aim of the present study was to determine the impact of cone-beam computed tomographic (CBCT) imaging on clinical decision making among general dental practitioners and endodontists after failed root canal treatment. A second objective was to assess the self-reported level of difficulty in making a treatment choice before and after viewing a preoperative CBCT scan. Eight patients with endodontically treated teeth diagnosed as symptomatic apical periodontitis, acute apical abscess, or chronic apical abscess were selected. In the first session, the examiners were given the details of each case, including any relevant radiographs, and were asked to choose 1 of the proposed treatment alternatives and assess the difficulty of making a decision. One month later, the examiners reviewed randomly the same 8 cases with the additional information from the CBCT data. The examiners altered their treatment plan after viewing the CBCT scan in 49.8% of the cases. A significant difference in the treatment plan between the 2 imaging modalities was recorded for endodontists and general practitioners (P < .05). After CBCT evaluation, neither group altered their self-reported level of difficulty when choosing a treatment plan (P = .0524). The extraction option rose significantly to 20% after viewing the CBCT scan (P < .05). CBCT imaging directly influences endodontic retreatment strategies among general dental practitioners and endodontists. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

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

PubMed

Horner, Deborah; Asher, Kim

2005-06-01

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

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

PubMed Central

Cox, J; Mulholland, H

1993-01-01

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

Comparison of different strategies of referral to a fall clinic: how to achieve an optimal casemix?

PubMed

Schoon, Y; Hoogsteen-Ossewaarde, M E; Scheffer, A C; Van Rooij, F J M; Rikkert, M G M Olde; De Rooij, S E

2011-02-01

OBJECTIVE To study the potential differences in patient characteristics between two referral methods to a fall clinic, specifically: case-finding of patients admitted to an emergency department because of a fall, compared to direct referral to the fall clinic via the general practitioner. Cross-sectional study. Fall clinics in two university teaching hospitals in the Netherlands. Three hundred community-dwelling older people aged 65 years or over currently attending the fall clinics in Nijmegen (Group 1, n=154) and in Amsterdam (Group 2, n=146). Patients were referred by a general practitioner (Group 1) or were selected using the Carefall Triage Instrument (CTI) after visiting the emergency department (Group 2). In all patients, modifiable risk factors for recurrent falls were assessed. Group 1 had less modifiable risk factors for falling (a mean of 4 (SD 1.6) vs. a mean of 5 (SD 1.5) in Group 2, p < 0.001). Compared to Group 2, Group 1 had more prevalent " recurrent falling (≥ 2 falls)" (p=0.001) and "assisted living in homes for the aged" (p=0.037). "Fear of falling", "mobility and balance problems", "home hazards" and "osteoporosis" were significantly less prevalent in Group 1. This study suggests that patients referred to a multidisciplinary fall prevention clinic by their general practitioner have a different risk profile than those selected by case finding using the CTI. These differences have consequences for the reach of secondary care for fall-preventive interventions and will probably influence the effectiveness and efficiency of a fall prevention program.

Strategy to recognize and initiate treatment of chronic heart failure in primary care (STRETCH): a cluster randomized trial.

PubMed

van Riet, Evelien E S; Hoes, Arno W; Limburg, Alexander; van der Hoeven, Henk; Landman, Marcel A J; Rutten, Frans H

2014-01-08

Most patients with heart failure are diagnosed and managed in primary care, however, underdiagnosis and undertreatment are common. We assessed whether implementation of a diagnostic-therapeutic strategy improves functionality, health-related quality of life, and uptake of heart failure medication in primary care. A selective screening study followed by a single-blind cluster randomized trial in primary care. The study population consists of patients aged 65 years or over who presented themselves to the general practitioner in the previous 12 months with shortness of breath on exertion. Patients already known with established heart failure, confirmed by echocardiography, are excluded. Diagnostic investigations include history taking, physical examination, electrocardiography, and serum N-terminal pro B-type natriuretic peptide levels. Only participants with an abnormal electrocardiogram or an N-terminal pro B-type natriuretic peptide level exceeding the exclusionary cutpoint for non-acute onset heart failure (> 15 pmol/L (≈ 125 pg/ml)) will undergo open-access echocardiography. The diagnosis of heart failure (with reduced or preserved ejection fraction) is established by an expert panel consisting of two cardiologists and a general practitioner, according to the criteria of the European Society of Cardiology guidelines.Patients with newly established heart failure are allocated to either the 'care as usual' group or the 'intervention' group. Randomization is at the level of the general practitioner. In the intervention group general practitioners receive a single half-day training in heart failure management and the use of a structured up-titration scheme. All participants fill out quality of life questionnaires at baseline and after six months of follow-up. A six-minute walking test will be performed in patients with heart failure. Information on medication and hospitalization rates is extracted from the electronic medical files of the general practitioners. This study will provide information on the prevalence of unrecognized heart failure in elderly with shortness of breath on exertion, and the randomized comparison will reveal whether management based on a half-day training of general practitioners in the practical application of an up-titration scheme results in improvements in functionality, health-related quality of life, and uptake of heart failure medication in heart failure patients compared to care as usual. ClinicalTrials.gov NCT01202006.

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

PubMed

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

2017-02-17

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

An Analysis of Audiovisual Machines for Individual Program Presentation. Research Memorandum Number Two.

ERIC Educational Resources Information Center

Finn, James D.; Weintraub, Royd

The Medical Information Project (MIP) purpose to select the right type of audiovisual equipment for communicating new medical information to general practitioners of medicine was hampered by numerous difficulties. There is a lack of uniformity and standardization in audiovisual equipment that amounts to chaos. There is no evaluative literature on…

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

PubMed Central

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

1999-01-01

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

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

PubMed Central

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

2003-01-01

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

Process-related factors associated with disciplinary board decisions.

PubMed

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

2013-01-07

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

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

PubMed

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

2015-08-06

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

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

General practice research: attitudes and involvement of Queensland general practitioners.

PubMed

Askew, Deborah A; Clavarino, Alexandra M; Glasziou, Paul P; Del Mar, Christopher B

2002-07-15

To determine general practitioners' (GPs') attitudes towards and involvement in general practice research. Postal survey and semi-structured interviews conducted from May to September 2001. 467 of 631 GPs in four Queensland Divisions of General Practice responded to the survey (74% response rate); 18 selected GPs were interviewed. Survey - attitudes to research; access to information resources; and involvement in research. Interviews - the need for general practice research; barriers against and factors enabling greater participation in research. 389/463 (84%) GPs, especially younger and more recent graduates, had positive attitudes to research, but only 29% wanted more involvement. 223/462 (48%) were aware they had access to MEDLINE, although presumably all those with Internet access (89%) would have free access via PubMed. Barriers included the general practice environment (especially fee-for-service funding), and the culture of general practice. Enabling factors included academic mentors; opportunities to participate in reputable, established research activities relevant to general practice; and access to information resources. Although Australian general practice has a weak research culture, about a third of GPs would like to increase their involvement in research. However, the research must be perceived as relevant, and structured to minimise the inherent barriers in the environment and culture of general practice.

Collaboration between general practitioners and occupational physicians: a comparison of the results of two national surveys in France.

PubMed

Verger, Pierre; Ménard, Colette; Richard, Jean-Baptiste; Demortière, Gérard; Beck, François

2014-02-01

To study the perceptions that general practitioners (GPs) and occupational physicians (OPs) have of GPs' role in occupational health and their willingness to work together to prevent the exclusion of patients with disabilities from the workplace. Cross-sectional telephone survey of two randomly selected national samples of GPs and OPs was conducted. The majority of GPs and OPs are in favor of cooperation, especially to prevent exclusion from the workplace. However, some GPs lack trust in OPs' independence, an attitude associated negatively with the practice of GP referral to OPs to anticipate disability-related problems likely to occur when returning to work after a prolonged sick leave. There are some barriers to cooperation, on the part of both OPs and GPs. Initiatives are needed to encourage cooperation between these two types of physicians.

45 CFR 60.1 - The National Practitioner Data Bank.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

Predictors of Job Satisfaction in Dental Professionals of the Bosnia and Herzegovina Federation

PubMed Central

Muhic, Edin; Plancak, Darije; Muhic, Asja

2016-01-01

Introduction Working in a healthy work environment is the ultimate goal of every employee. Dentistry is a stressful career, and the reasons for dissatisfaction are numerous. Aim The aim of this study was to determine the factors of work satisfaction in dental professionals of the Bosnia and Herzegovina Federation. Materials and methods A total of 134 dental professionals selected randomly from the Registry of Dental Chamber of Bosnia and Herzegovina Federation were included in the study. All of them filled out the Demographic Questionnaire and Job Satisfaction Scale (JSS). Results An increase in the influence of work on the quality of life as well as an increase in its frequency results in leaving the job and significantly reducing the overall job satisfaction. General dental practitioners are significantly more satisfied as compared with specialists. Significant predictors of the job satisfaction are employment status, type of the practice, and availability of dental assistants. General dental practitioners with a dental assistant employed at a private practice are more likely to be satisfied with their jobs. Conclusions Employment status, practice type and availability of dental assistants are significant predictors of job satisfaction. General dental practitioners working in a private practice with a dental assistant are most likely to be satisfied. PMID:27847395

Autoclave performance and operator knowledge of autoclave use in primary care: a survey of UK practices.

PubMed

Coulter, W A; Chew-Graham, C A; Cheung, S W; Burke, F J

2001-07-01

Changes in the delivery of health care have increased the demand for minor surgical and screening procedures in general practice. This has increased the risk of cross-infection with blood-borne viruses and the demand for sterile instruments. The aim of this study was to investigate the knowledge and training of medical personnel in England and Wales on aspects of autoclave use, and to test the effectiveness of their practice autoclaves. An anonymous postal questionnaire and autoclave performance survey using biological indicators was made of 700 general medical practitioners selected at random from FHSA lists from 12 Health Authorities in England and Wales. The overall response rate was 53.1% (N= 372) comprising 10% general practitioners and 90% practice nurses. Eighty-two percent of respondents used autoclaves with a mean age of 2.5 years, of which 91% had been serviced in the past year. While 35% of respondents made daily observation of gauges, 19% did not routinely monitor autoclave effectiveness. Six autoclaves failed to sterilize the spore test ampoules. Fourteen percent of respondents did not autoclave instruments after every patient. Only 33.1% reported wearing gloves during minor operations. Fifty five percent had training in cross-infection prevention. It was concluded that although there has been improvement in instrument decontamination procedures in general practice compared with previous surveys, further education of medical practitioners and practice nurses in the use of autoclaves and infection prevention and control is indicated. The failure of 2% of the autoclaves to kill spores suggests the need for increased monitoring of autoclave performance. Two-thirds of practitioners exposed themselves to increased risk of infection by carrying out minor surgery without the protection of gloves. Copyright 2001 The Hospital Infection Society.

Influenza vaccination: key facts for general practitioners in Europe-a synthesis by European experts based on national guidelines and best practices in the United Kingdom and the Netherlands.

PubMed

Kassianos, George; Blank, Patricia; Falup-Pecurariu, Oana; Kuchar, Ernest; Kyncl, Jan; De Lejarazu, Raul Ortiz; Nitsch-Osuch, Aneta; van Essen, Gerrit A

2016-01-01

Currently there is no influenza vaccination guidance for European general practitioners. Furthermore, although the European Council recommends a target seasonal influenza vaccination rate of 75% in the elderly (65 years and above) and in anyone aged >6 months with a chronic medical condition, there remain wide discrepancies throughout Europe. A harmonised guideline regarding not only vaccination strategy but also for the consistent diagnosis of influenza across Europe is essential to support a common approach for the implementation of seasonal influenza vaccination across Europe. This document is based on pre-existing guidelines available in the UK and Netherlands and has been approved by a group of European experts for use throughout Europe. As well as providing a standardised influenza diagnosis, it also reviews the current recommendations for influenza vaccination, the types of vaccine available, the contraindications, vaccine use in special populations (in pregnancy, children, and in those with egg allergy), and concomitant administration with other vaccines. The effectiveness, safety, and timing of the seasonal influenza vaccine are also reviewed. A second section provides practical guidance for general practitioners for the implementation of a seasonal influenza vaccination program, including the selection and notification of those eligible for vaccination, as well as suggestions for the organisation of a vaccination programme. Finally, suggested responses to common patient misconceptions and frequently asked questions are included. The aim of this article is to harmonise the diagnosis of seasonal influenza and the approach of European general practitioners to seasonal influenza vaccination in order to better identify influenza outbreaks and to move towards reaching the target vaccination rate of 75% throughout Europe.

Influenza vaccination: key facts for general practitioners in Europe—a synthesis by European experts based on national guidelines and best practices in the United Kingdom and the Netherlands

PubMed Central

Kassianos, George; Blank, Patricia; Falup-Pecurariu, Oana; Kuchar, Ernest; Kyncl, Jan; De Lejarazu, Raul Ortiz; Nitsch-Osuch, Aneta; van Essen, Gerrit A

2016-01-01

Currently there is no influenza vaccination guidance for European general practitioners. Furthermore, although the European Council recommends a target seasonal influenza vaccination rate of 75% in the elderly (65 years and above) and in anyone aged >6 months with a chronic medical condition, there remain wide discrepancies throughout Europe. A harmonised guideline regarding not only vaccination strategy but also for the consistent diagnosis of influenza across Europe is essential to support a common approach for the implementation of seasonal influenza vaccination across Europe. This document is based on pre-existing guidelines available in the UK and Netherlands and has been approved by a group of European experts for use throughout Europe. As well as providing a standardised influenza diagnosis, it also reviews the current recommendations for influenza vaccination, the types of vaccine available, the contraindications, vaccine use in special populations (in pregnancy, children, and in those with egg allergy), and concomitant administration with other vaccines. The effectiveness, safety, and timing of the seasonal influenza vaccine are also reviewed. A second section provides practical guidance for general practitioners for the implementation of a seasonal influenza vaccination program, including the selection and notification of those eligible for vaccination, as well as suggestions for the organisation of a vaccination programme. Finally, suggested responses to common patient misconceptions and frequently asked questions are included. The aim of this article is to harmonise the diagnosis of seasonal influenza and the approach of European general practitioners to seasonal influenza vaccination in order to better identify influenza outbreaks and to move towards reaching the target vaccination rate of 75% throughout Europe. PMID:27540408

A survey on the preference for continuing professional dental education amongst general dental practitioners who attended the 26th Asia Pacific Dental Congress.

PubMed

Chan, W C; Ng, C H; Yiu, B K; Liu, C Y; Ip, C M; Siu, H H; Chiu, G K C; Hägg, U; Jin, L J

2006-11-01

To identify the subjects of interest and to examine the modes as well as means of study for continuing professional dental education amongst general dental practitioners who attended the 26th Asia Pacific Dental Congress, 28 May-1 June 2004, Hong Kong. A total of 381 general dental practitioners as the registered conference delegates from Hong Kong, Mainland China and other Asia-Pacific regions were randomly selected for the present survey. The survey was conducted through face-to-face interviews by a group of practising dentists in Hong Kong. Overall, orthodontics and prosthodontics were the most popular subjects for clinical degree programmes, whilst oral implantology and cosmetic dentistry were the highly preferred subjects for continuing education courses. Concerning the preferred mode of study for degree programmes, the part-time study mode was chosen by 68.3% of the participating dentists. A didactic teaching approach was preferred by most of the participants (81.7%) for postgraduate study. The majority of the interviewees (76.5%) were interested in a proposed clinical degree programme to be offered jointly by The University of Hong Kong and a leading university in the Mainland. Overall, there was no marked difference in the preference for continuing dental education amongst the respondents from Hong Kong, Mainland China and other Asia-Pacific regions. The present survey shows the currently preferred specialty areas and subjects for continuing professional dental education amongst the general dental practitioners who attended the 26th Asia Pacific Dental Congress, with didactic teaching as the most preferred mode of study on a part-time basis.

The feasibility of using manual segmentation in a multifeature computer-aided diagnosis system for classification of skin lesions: a retrospective comparative study.

PubMed

Chang, Wen-Yu; Huang, Adam; Chen, Yin-Chun; Lin, Chi-Wei; Tsai, John; Yang, Chung-Kai; Huang, Yin-Tseng; Wu, Yi-Fan; Chen, Gwo-Shing

2015-05-03

To investigate the feasibility of manual segmentation by users of different backgrounds in a previously developed multifeature computer-aided diagnosis (CADx) system to classify melanocytic and non-melanocytic skin lesions based on conventional digital photographic images. In total, 347 conventional photographs of melanocytic and non-melanocytic skin lesions were retrospectively reviewed, and manually segmented by two groups of physicians, dermatologists and general practitioners, as well as by an automated segmentation software program, JSEG. The performance of CADx based on inputs from these two groups of physicians and that of the JSEG program was compared using feature agreement analysis. The estimated area under the receiver operating characteristic curve for classification of benign or malignant skin lesions based were comparable on individual segmentation by the gold standard (0.893, 95% CI 0.856 to 0.930), dermatologists (0.886, 95% CI 0.863 to 0.908), general practitioners (0.883, 95% CI 0.864 to 0.903) and JSEG (0.856, 95% CI 0.812 to 0.899). The agreement in the malignancy probability scores among the physicians was excellent (intraclass correlation coefficient: 0.91). By selecting an optimal cut-off value of malignancy probability score, the sensitivity and specificity were 80.07% and 81.47% for dermatologists and 79.90% and 80.20% for general practitioners. This study suggests that manual segmentation by general practitioners is feasible in the described CADx system for classifying benign and malignant skin lesions. 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.

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

PubMed

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

2012-12-01

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

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

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

PubMed Central

Smith, L. F.

1992-01-01

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

[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.

How Do Urban Indian Private Practitioners Diagnose and Treat Tuberculosis? A Cross-Sectional Study in Chennai

PubMed Central

Bronner Murrison, Liza; Ananthakrishnan, Ramya; Sukumar, Sumanya; Augustine, Sheela; Krishnan, Nalini; Pai, Madhukar; Dowdy, David W.

2016-01-01

Setting Private practitioners are frequently the first point of healthcare contact for patients with tuberculosis (TB) in India. Inappropriate TB management practices among private practitioners may contribute to delayed TB diagnosis and generate drug resistance. However, these practices are not well understood. We evaluated diagnostic and treatment practices for active TB and benchmarked practices against International Standards for TB Care (ISTC) among private medical practitioners in Chennai. Design A cross-sectional survey of 228 practitioners practicing in the private sector from January 2014 to February 2015 in Chennai city who saw at least one TB patient in the previous year. Practitioners were randomly selected from both the general community and a list of practitioners who referred patients to a public-private mix program for TB treatment in Chennai. Practitioners were interviewed using standardized questionnaires. Results Among 228 private practitioners, a median of 12 (IQR 4–28) patients with TB were seen per year. Of 10 ISTC standards evaluated, the median of standards adhered to was 4.0 (IQR 3.0–6.0). Chest physicians reported greater median ISTC adherence than other MD and MS practitioners (score 7.0 vs. 4.0, P<0.001), or MBBS practitioners (score 7.0 vs. 4.0, P<0.001). Only 52% of all practitioners sent >5% of patients with cough for TB testing, 83% used smear microscopy for diagnosis, 33% monitored treatment response, and 22% notified TB cases to authorities. Of 228 practitioners, 68 reported referring all patients with new pulmonary TB for treatment, while 160 listed 27 different regimens; 78% (125/160) prescribed a regimen classified as consistent with ISTC. Appropriate treatment practices differed significantly between chest physicians and other MD and MS practitioners (54% vs. 87%, P<0.001). Conclusion TB management practices in India’s urban private sector are heterogeneous and often suboptimal. Private providers must be better engaged to improve diagnostic capacity and decrease TB transmission in the community. PMID:26901165

How Do Urban Indian Private Practitioners Diagnose and Treat Tuberculosis? A Cross-Sectional Study in Chennai.

PubMed

Bronner Murrison, Liza; Ananthakrishnan, Ramya; Sukumar, Sumanya; Augustine, Sheela; Krishnan, Nalini; Pai, Madhukar; Dowdy, David W

2016-01-01

Private practitioners are frequently the first point of healthcare contact for patients with tuberculosis (TB) in India. Inappropriate TB management practices among private practitioners may contribute to delayed TB diagnosis and generate drug resistance. However, these practices are not well understood. We evaluated diagnostic and treatment practices for active TB and benchmarked practices against International Standards for TB Care (ISTC) among private medical practitioners in Chennai. A cross-sectional survey of 228 practitioners practicing in the private sector from January 2014 to February 2015 in Chennai city who saw at least one TB patient in the previous year. Practitioners were randomly selected from both the general community and a list of practitioners who referred patients to a public-private mix program for TB treatment in Chennai. Practitioners were interviewed using standardized questionnaires. Among 228 private practitioners, a median of 12 (IQR 4-28) patients with TB were seen per year. Of 10 ISTC standards evaluated, the median of standards adhered to was 4.0 (IQR 3.0-6.0). Chest physicians reported greater median ISTC adherence than other MD and MS practitioners (score 7.0 vs. 4.0, P<0.001), or MBBS practitioners (score 7.0 vs. 4.0, P<0.001). Only 52% of all practitioners sent >5% of patients with cough for TB testing, 83% used smear microscopy for diagnosis, 33% monitored treatment response, and 22% notified TB cases to authorities. Of 228 practitioners, 68 reported referring all patients with new pulmonary TB for treatment, while 160 listed 27 different regimens; 78% (125/160) prescribed a regimen classified as consistent with ISTC. Appropriate treatment practices differed significantly between chest physicians and other MD and MS practitioners (54% vs. 87%, P<0.001). TB management practices in India's urban private sector are heterogeneous and often suboptimal. Private providers must be better engaged to improve diagnostic capacity and decrease TB transmission in the community.

The Commander’s Emergency Response Program: A Model for Future Implementation

DTIC Science & Technology

2010-04-07

unintended Effects. The INVEST-E methodology serves as a tool for commanders and their designated practitioners to properly select projects, increasing...for commanders and their designated practitioners to properly select projects, increasing the effectiveness of CERP funds. 4 TABLE OF...and unintended Effects. The INVEST-E methodology serves as a tool for commanders and their designated practitioners to properly select projects

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

PubMed

Dahlhaus, Anne; Siebenhofer, Andrea; Guethlin, Corina

2015-01-01

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

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

PubMed

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

2017-05-01

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

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

PubMed Central

2012-01-01

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

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

PubMed

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

2012-08-07

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

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

PubMed

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

2016-01-01

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

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

PubMed

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

1988-11-05

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

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

PubMed Central

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

1988-01-01

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

Prescribing of psychotropic medication for nursing home residents with dementia: a general practitioner survey.

PubMed

Cousins, Justin M; Bereznicki, Luke Re; Cooling, Nick B; Peterson, Gregory M

2017-01-01

The aim of this study was to identify factors influencing the prescribing of psychotropic medication by general practitioners (GPs) to nursing home residents with dementia. GPs with experience in nursing homes were recruited through professional body newsletter advertising, while 1,000 randomly selected GPs from southeastern Australia were invited to participate, along with a targeted group of GPs in Tasmania. An anonymous survey was used to collect GPs' opinions. A lack of nursing staff and resources was cited as the major barrier to GPs recommending non-pharmacological techniques for behavioral and psychological symptoms of dementia (BPSD; cited by 55%; 78/141), and increasing staff levels at the nursing home ranked as the most important factor to reduce the usage of psychotropic agents (cited by 60%; 76/126). According to GPs, strategies to reduce the reliance on psychotropic medication by nursing home residents should be directed toward improved staffing and resources at the facilities.

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

PubMed

Uslu, S; Natanzon, I; Joos, S

2014-06-01

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

[French general practitioners and electromagnetic fields].

PubMed

Lambrozo, Jacques; Souques, Martine; Bourg, Fabrice; Guillaume, Xavier; Perrin, Anne

2013-05-01

To assess the perception of risk of general practitioners (GPs) about electromagnetic fields (EMF), their sources of information, as well as their patients' level of concern. Six hundred French GPs were selected according to the quotas method. They were asked to answer 24 items via an electronic questionnaire using the Computer-Assisted Web Interviewing (CAWI) method. The GPs know the main EMF sources: cell phone towers, cell phones, power-lines, microwave ovens and WiFi networks. Patients mostly complain or worry about the first three sources and ask their GP for information about these. GPs themselves search for information in the mainstream media rather than in the usual scientific and medical press. As a consequence, their knowledge about potential risks of EMF is deemed rather crude. The GPs are sensitive to environmental concerns, particularly regarding EMF exposure. However, according to the results analysis, they do not have the same approach because of an obvious lack of mastery in a complex and poorly informed situation. A serious educational effort is essential and would be welcomed by practitioners, who are aware of their responsibilities in terms of counseling, diagnosis and care. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Process-related factors associated with disciplinary board decisions

PubMed Central

2013-01-01

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

A modified Delphi method toward multidisciplinary consensus on functional convalescence recommendations after abdominal surgery.

PubMed

van Vliet, Daphne C R; van der Meij, Eva; Bouwsma, Esther V A; Vonk Noordegraaf, Antonie; van den Heuvel, Baukje; Meijerink, Wilhelmus J H J; van Baal, W Marchien; Huirne, Judith A F; Anema, Johannes R

2016-12-01

Evidence-based information on the resumption of daily activities following uncomplicated abdominal surgery is scarce and not yet standardized in medical guidelines. As a consequence, convalescence recommendations are generally not provided after surgery, leading to patients' insecurity, needlessly delayed recovery and prolonged sick leave. The aim of this study was to generate consensus-based multidisciplinary convalescence recommendations, including advice on return to work, applicable for both patients and physicians. Using a modified Delphi method among a multidisciplinary panel of 13 experts consisting of surgeons, occupational physicians and general practitioners, detailed recommendations were developed for graded resumption of 34 activities after uncomplicated laparoscopic cholecystectomy, laparoscopic and open appendectomy, laparoscopic and open colectomy and laparoscopic and open inguinal hernia repair. A sample of occupational physicians, general practitioners and surgeons assessed the recommendations on feasibility in daily practice. The response of this group of care providers was discussed with the experts in the final Delphi questionnaire round. Out of initially 56 activities, the expert panel selected 34 relevant activities for which convalescence recommendations were developed. After four Delphi rounds, consensus was reached for all of the 34 activities for all the surgical procedures. A sample of occupational physicians, general practitioners and surgeons regarded the recommendations as feasible in daily practice. Multidisciplinary convalescence recommendations regarding uncomplicated laparoscopic cholecystectomy, appendectomy (laparoscopic, open), colectomy (laparoscopic, open) and inguinal hernia repair (laparoscopic, open) were developed by a modified Delphi procedure. Further research is required to evaluate whether these recommendations are realistic and effective in daily practice.

Early Childhood Assessment: Suggested Best Practices and Selected Instruments. Wisconsin Department of Public Instruction Bulletin No. 5091.

ERIC Educational Resources Information Center

Wisconsin State Dept. of Public Instruction, Madison.

The purpose of this manual is to provide supplemental information and to serve as a general resource for practitioners involved in the developmental and educational assessment of young children. The first section focuses on the process of assessing young handicapped children and includes specific information on indicators of potential problems in…

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

PubMed

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

2016-09-01

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

Characteristics of complaints resulting in disciplinary actions against Danish GPs.

PubMed

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

2013-09-01

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

Impact of faxed health alerts on the preparedness of general practitioners during communicable disease outbreaks.

PubMed

Rosewell, Alexander; Patel, Mahomed; Viney, Kerri; Marich, Andrew; Lawrence, Glenda L

2010-03-01

The NSW Department of Health (NSW Health) faxed health alerts to general medical practitioners during measles outbreaks in March and May 2006. We conducted a retrospective cohort study of randomly selected general practitioners (GPs) (1 per medical practice) in New South Wales to investigate the effectiveness of faxing health alerts to GPs during a communicable disease outbreak. Fax transmission data allowed comparison of GPs sent and not sent the measles alert for self-reported awareness and practice actions aimed at the prevention and control of measles. A total of 328 GPs participated in the study. GPs who were sent the alert were more likely to be aware of the measles outbreak (RR 1.18, 95% CI 1.02, 1.38). When analysed by whether a fax had been received from either NSW Health or the Australian General Practice Network, GPs who reported receiving a faxed measles alert were more likely to be aware of the outbreak (RR 2.56, 95% CI 1.84, 3.56), to offer vaccination to susceptible staff (RR 6.46, 95% CI 2.49, 16.78), and be aware of other infection control recommendations. Respondents reported that the faxed alerts were useful with 65% reporting that the alerts had reminded them to consider measles in the differential diagnosis. This study shows that faxed health alerts were useful for preparing GPs to respond effectively to a communicable disease outbreak. The fax alert system could be improved by ensuring that all general practices in New South Wales are included in the faxstream database and that their contact details are updated regularly.

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.

[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 corollary a questioning of the viability of the health care system as we know it. At the time of writing this article, the Belgian Health Care Knowledge Centre (KCE) is completing, at the request of the Belgian Ministry (SPF) of Health a study entitled "Burn Out of General Practitioners: which prevention, which solutions" whose goal is to make recommendations for the prevention and support of this issue. To measure the real impact of the solutions eventually implemented, we need to create a tool for a regular assessment of the prevalence of this problem in our country.

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

PubMed

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

2018-04-01

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

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

PubMed Central

Poulton, B C

1996-01-01

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

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

ERIC Educational Resources Information Center

Pilat, Dirk

2016-01-01

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

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

PubMed Central

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

2011-01-01

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

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

PubMed Central

2010-01-01

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

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

PubMed

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

2012-01-01

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

Referring patients to specialists: A structured vignette survey of Australian and British GPs

PubMed Central

Jiwa, Moyez; Gordon, Michael; Arnet, Hayley; Ee, Hooi; Bulsara, Max; Colwell, Brigitte

2008-01-01

Background In Australia and in the United Kingdom (UK) access to specialists is sanctioned by General Practitioners (GPs). It is important to understand how practitioners determine which patients warrant referral. Methods A self-administered structured vignette postal survey of General Practitioners in Western Australia and the United Kingdom. Sixty-four vignettes describing patients with colorectal symptoms were constructed encompassing six clinical details. Nine vignettes, chosen at random, were presented to each individual. Respondents were asked if they would refer the patient to a specialist and how urgently. Logistic regression and parametric tests were used to analyse the data Results We received 260 completed questionnaires. 58% of 'cancer vignettes' were selected for 'urgent' referral. 1632/2367 or 69% of all vignettes were selected for referral. After adjusting for clustering the model suggests that 38.4% of the variability is explained by all the clinical variables as well as the age and experience of the respondents. 1012 or 42.8 % of vignettes were referred 'urgently'. After adjusting for clustering the data suggests that 31.3 % of the variability is explained by the model. The age of the respondents, the location of the practice and all the clinical variables were significant in the decision to refer urgently. Conclusion GPs' referral decisions for patients with lower bowel symptoms are similar in the two countries. We question the wisdom of streaming referrals from primary care without a strong evidence base and an effective intervention for implementing guidelines. We conclude that implementation must take into account the profile of patients but also the characteristics of GPs and referral policies. PMID:18194578

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

PubMed

Førde, R; Aasland, O G; Akre, V

1996-09-30

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

Professional attitudes to patient participation groups: an exploratory study

PubMed Central

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

1980-01-01

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

Referrals from general practitioners to a social services department

PubMed Central

Sheppard, M. G.

1983-01-01

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

A survey of general practitioners' views on autopsy reports.

PubMed Central

Karunaratne, S; Benbow, E W

1997-01-01

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

Characteristics of complaints resulting in disciplinary actions against Danish GPs

PubMed Central

2013-01-01

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

Assessing the knowledge of bronchial asthma among primary health care physicians in Crete: A pre- and post-test following an educational course

PubMed Central

Rovithis, Emmanouil; Lionis, Christos; Schiza, Sofia E; Bouros, Dimosthenis; Karokis, Antonis; Vlachonikolis, loannis; Siafakas, Nikolaos M

2001-01-01

Aim To assess the level of knowledge for bronchial asthma of the primary healthcare physicians serving a rural population on the island of Crete, both before and immediately after a one-day educational course. Methods Twenty-one primary health care physicians, randomly selected from a list of 14 Health Care Centres on the island of Crete were invited to participate in the study and attended an educational course. Nine of the 21 physicians were fully qualified general practitioners, while the remainder were non-specialized (NSs) physicians who had recently graduated from the University of Crete, Medical School. A questionnaire of 20 items based on current bronchial asthma clinical guidelines was used. Three scores, the mean total, knowledge subscore and attitudes subscore, were calculated for each group of physicians, both before and after the course. Results At baseline mean total score and knowledge and attitudes subscores were higher for non-specialized physicians than for the general practitioners, but the differences were not statistically significant (p > 0.05). The knowledge subscore was improved in both groups, however the difference was statistically significant only for the non-specialized physicians (t = 2.628, d.f. = 11, p < 0.05). The mean total score after the course was significantly higher for the non-specialized physicians in comparison to that of the general practitioners (t=-2.688, d.f. = 19, p < 0.05). Conclusions This study adds to the information about the success of continuing medical education, and also demonstrates that the recent graduates in the studied population, could be educated with more positive results than the fully qualified practitioners PMID:11511327

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

PubMed

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

2017-01-17

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

Accessing remote data bases using microcomputers

PubMed Central

Saul, Peter D.

1985-01-01

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

How do general dentists and orthodontists determine where to refer patients requiring oral and maxillofacial surgical procedures?

PubMed

Schlieve, Thomas; Funderburk, Joseph; Flick, William; Miloro, Michael; Kolokythas, Antonia

2015-03-01

This study investigated the influence of specific criteria on referral selection among general dentists and orthodontists in deciding referrals to oral and maxillofacial surgeons. A cross-sectional study was designed to examine the importance of criteria used by 2 groups of practitioners, general dentists and orthodontists, for deciding on referrals to oral and maxillofacial surgeons. Data were collected by 2 multiple-choice surveys. The surveys were e-mailed to general dentists and orthodontists practicing in the state of Illinois and to graduates from the University of Illinois at Chicago (UIC) College of Dentistry and the UIC Department of Orthodontics. Participants were asked to rate referral criteria from most important to least important. Analysis of variance was used to examine the data for any differences in the importance of the criteria for each question and linear regression analysis was used to determine whether any 1 criterion was statistically meaningful within each group of practitioners. In total, 235 general dental practitioners and 357 orthodontists completed the survey, with a 100% completion rate. The most important criterion for referral to oral and maxillofacial surgeons in the general dentist group was the personal and professional relationship of the referring doctor to the specialist. In the orthodontist group, no single criterion was statistically meaningful. General dentists tend to develop long-term relationships with their patients, and when deciding the appropriate referrals it appears that personal and professional relationships that promote trust and open communication are key elements. General dentists favor these relationships when making referral decisions across a wide spectrum of procedures. Orthodontists do not place a substantial value on a specific criterion for referral and therefore may not develop the same relationships between patient and doctor and between doctors as general dentists. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Continuing Professional Education of Insurance and Risk Management Practitioners: A Comparative Case Study of Customer Service Representatives, Insurance Agents and Risk Managers

ERIC Educational Resources Information Center

Krauss, George E.

2009-01-01

The purpose of this study is to understand how selected insurance practitioners learn and developed in their practices setting. The selected insurance practitioners (collectively customer service representatives, insurance agents, and risk managers) are responsible for the counseling and placement of insurance products and the implementation of…

General practice recruitment for people at risk of schizophrenia: the Buckingham experience.

PubMed

Falloon, I R

2000-11-01

The process of detecting people at high risk of schizophrenia from a community sample is a major challenge for prevention of psychotic disorders. The aim of this paper is to describe early detection procedures that can be implemented in primary care settings. A selected literature review is supplemented by experiences and data obtained during the Buckingham Integrated Mental Health Care Project. General medical practitioners have been favoured as the agents most likely to prove helpful in detecting the key risk factors that predict the onset of schizophrenic disorders, as well as in recognising the earliest signs and symptoms of these conditions. However, the practical problems of screening for multiple and subtle risk factors in general practice are substantial, and general practitioners (GPs) often have difficulty recognising the earliest signs of a psychotic episode. A range of strategies to assist GPs detect early signs of psychosis in their patients are considered. It is feasible to implement primary care setting early detection procedures for people at risk of schizophrenia. Implementation is aided by the use of a brief screening questionnaire, training sessions and case supervision; and increased collaboration with mental health services and other community agencies.

Shifting attention from objective risk factors to patients' self-assessed health resources: a clinical model for general practice.

PubMed

Hollnagel, H; Malterud, K

1995-12-01

The study was designed to present and apply theoretical and empirical knowledge for the construction of a clinical model intended to shift the attention of the general practitioner from objective risk factors to self-assessed health resources in male and female patients. Review, discussion and analysis of selected theoretical models about personal health resources involving assessing existing theories according to their emphasis concerning self-assessed vs. doctor-assessed health resources, specific health resources vs. life and coping in general, abstract vs. clinically applicable theory, gender perspective explicitly included or not. Relevant theoretical models on health and coping (salutogenesis, coping and social support, control/demand, locus of control, health belief model, quality of life), and the perspective of the underprivileged Other (critical theory, feminist standpoint theory, the patient-centred clinical method) were presented and assessed. Components from Antonovsky's salutogenetic perspective and McWhinney's patient-centred clinical method, supported by gender perspectives, were integrated to a clinical model which is presented. General practitioners are recommended to shift their attention from objective risk factors to self-assessed health resources by means of the clinical model. The relevance and feasibility of the model should be explored in empirical research.

General practitioners in partnership with management: an organisational model for debate.

PubMed Central

Starey, N; Bosanquet, N; Griffiths, J

1993-01-01

The role of general practitioners is changing and expanding. Doctors have more control over the treatment received by their patients but remain largely unaccountable to the public and management. This article proposes an organisational model for integrating primary and secondary care which retains the advantages of fund-holding while giving management control over overall strategy. It proposes that general practitioners control funds for all primary and secondary care. Secondary care will be contracted through a joint team of managers and an elected general practice executive committee. A new health care purchasing authority will contract for primary services with individual practices or primary care provider units. General practitioners will have local contracts reflecting their desire to provide an expanded range of services and the needs of the community. PMID:8461651

42 CFR 440.166 - Nurse practitioner services.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

42 CFR 440.166 - Nurse practitioner services.

Code of Federal Regulations, 2011 CFR

2011-10-01

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

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

PubMed

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

2007-06-01

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

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.

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

PubMed

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

2018-03-01

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

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 created mistrust and apprehension, which are fundamental antitheses of any effective contractual arrangement. The idea of a one-size-fits-all contract was probably inappropriate. PMID:28299145

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2017-08-03

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

Identifying critical success factors for designing selection processes into postgraduate specialty training: the case of UK general practice.

PubMed

Plint, Simon; Patterson, Fiona

2010-06-01

The UK national recruitment process into general practice training has been developed over several years, with incremental introduction of stages which have been piloted and validated. Previously independent processes, which encouraged multiple applications and produced inconsistent outcomes, have been replaced by a robust national process which has high reliability and predictive validity, and is perceived to be fair by candidates and allocates applicants equitably across the country. Best selection practice involves a job analysis which identifies required competencies, then designs reliable assessment methods to measure them, and over the long term ensures that the process has predictive validity against future performance. The general practitioner recruitment process introduced machine markable short listing assessments for the first time in the UK postgraduate recruitment context, and also adopted selection centre workplace simulations. The key success factors have been identified as corporate commitment to the goal of a national process, with gradual convergence maintaining locus of control rather than the imposition of change without perceived legitimate authority.

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

PubMed Central

Taylor, Donald H; Esmail, Aneez

1999-01-01

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

Non-steroidal anti-inflammatory drug prescribing patterns in general practice: comparison of a general practitioner-based survey and a pharmacy-based survey in France.

PubMed

Clinard, F; Sgro, C; Bardou, M; Dumas, M; Hillon, P; Bonithon-Kopp, C

2001-01-01

In order to assess biases occurring in primary care prescription studies, we compared non-steroidal anti-inflammatory drug (NSAID) prescribing patterns reported by general practitioners directly (GP-based survey) and from a pharmacy-based survey of general practitioner prescribing (pharmacy-based survey). Volunteer GPs of the administrative area of Côte d'Or (France) returned a mailed questionnaire on NSAID prescribing patterns for consecutive patients seen during a 2-month period. In order to obtain a reference basis, pharmacies of the same administrative area provided all prescriptions that included NSAIDs during a 1-week period originating in general practice. The rate of participation was 25% for the GPs and 40% for the pharmacies. Participant GPs were representative of GPs of the area with regard to sex, year of graduation and practice area but pharmacies from rural areas were over-represented. The GP-based survey and the pharmacy-based survey provided respectively 770 and 1050 prescriptions. There were no differences between either survey in the type of NSAIDs prescribed and in the most frequently associated drugs. GPs who volunteered in the GP survey prescribed NSAIDs more frequently orally and at higher doses than GPs involved in the pharmacy-based survey. They also prescribed more gastroprotective drugs, especially in the elderly. None of these results could be explained by differences in patient characteristics and GP practice areas. GPs who actively participate in prescription surveys exhibit prescribing patterns that fit better with official recommendations than the average. Although selection biases cannot be ruled out, it is suggested that some changes in GP prescription habits may have been induced by the survey itself.

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

PubMed Central

Baker, D; Klein, R

1991-01-01

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

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

PubMed

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

2007-01-01

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

Dental radiography in New Zealand: digital versus film.

PubMed

Ting, N A; Broadbent, J M; Duncan, W J

2013-09-01

Digital x-ray systems offer advantages over conventional film systems, yet many dentists have not adopted digital technology. To assess New Zealand dental practitioners' use of--and preferences for--dental radiography systems. Cross-sectional survey. General and specialist dental practice. Postal questionnaire survey of a sample of 770 dentists (520 randomly selected general dental practitioners and all 250 specialists) listed in the 2012 NZ Dental Council Register. Type of radiography systems used by dentists. Dentists' experiences and opinions of conventional film and digital radiography. The participation rate was 55.2%. Digital radiography systems were used by 58.0% of participating dentists, most commonly among those aged 31-40 years. Users of digital radiography tended to report greater satisfaction with their radiography systems than users conventional films. Two-thirds of film users were interested in switching to digital radiography in the near future. Reasons given by conventional film users for not using digital radiography included cost, difficulty in integrating with other software systems, concern about potential technical errors, and the size and nature of the intra-oral sensors. Many dental practitioners have still not adopted digital radiography, yet its users are more satisfied with their radiography systems than are conventional film users. The latter may find changing to a digital system to be satisfying and rewarding.

42 CFR 441.22 - Nurse practitioner services.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

42 CFR 441.22 - Nurse practitioner services.

Code of Federal Regulations, 2011 CFR

2011-10-01

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

GPs, violence and work performance - 'just part of the job?'.

PubMed

Coles, Jan; Koritsas, Stella; Boyle, Malcolm; Stanley, Janet

2007-03-01

This study explored the impact of work related violence on general practitioners' work performance. A postal survey of 1000 randomly selected GPs about work related violence. Those GPs reporting incidents of work related violence in the past 12 months were asked to write about its effect on them in response to an open question. Eighty-five GPs responded. Seventy-three percent of GPs who had experienced work related violence answered an open question about its effect on their work performance. The effect was negative for most, respondents citing poor concentration, difficulty listening to patients, rumination and intrusive thoughts when in an enclosed space in subsequent consultations, particularly in consultations with the patient who had perpetrated the violence, or their families or coworkers, or with similar patients. General practitioners have reported that work related violence has a continuing impact on their work performance. Future research should include psychometric testing of cognitive functioning and mental health testing to quantify this.

Factors Influencing the Location of Rural General Practitioners

PubMed Central

Cordes, Sam M.

1978-01-01

Data on (1) personal background, (2) place of medical education and training, (3) reasons for selecting the present place of practice and (4) previous practice location were gathered and analyzed from 41 general practitioners in rural Washington state. The analysis was done to isolate factors influencing the choice of location by physicians. Results show that most of the physicians had spent at least some of their preadulthood years in small communities and that most had some exposure to the state of Washington before establishing their practices in the state. In addition to the apparent importance of previous exposure to small communities and Washington state, the physicians were also influenced in their locational choice by (1) the professional advantages or appeal of the community, (2) recruitment efforts by persons within the community and (3) economic reasons. The physicians were rather immobile. Most had never practiced in another community and only two of the 41 physicians planned to move to another community. PMID:625975

Barriers, motivators and enablers for dispensing multifocal contact lenses in Mumbai, India.

PubMed

Thite, Nilesh; Shah, Ukti; Mehta, Jasmin; Jurkus, Janice

2015-01-01

To understand the potential barriers, motivators and enablers in dispensing multifocal contact lenses (MFCL). Two focus group discussions were conducted to design questionnaires regarding the prescribing habits for multifocal contact lenses (MFCL). Questions on potential barriers and motivators were included. The questionnaires were distributed among 133 eye care practitioners across Mumbai, India. Practitioners fitting one or less patient per month with MFCL completed the survey describing potential barriers, while those who prescribed more MFCL's per month completed the survey describing enablers and motivators. Responses from 102 practitioners were received. Most common potential barriers in prescribing MFCL were increased chair time (75%), lack of readily available trials (69%) and limitation in power range (63%). Lack of awareness among patients (90%) was the most common barrier from patients' outlook. Professional satisfaction (88%) and better business proposition (82%) were observed as main motivators while availability of the trials (84%) and correct patient selection (82%) were the major enablers. Graduate Optometrists felt dispensing MFCL did not offer a good business proposition (p=0.02). Experienced practitioners were observed to be least motivated (p=0.01) and believed that their patients found these lenses expensive (p=0.02). To enhance the MFCL practice, barriers like lack of awareness and limitations in power range must be addressed. Trial lens availability may motivate practitioners to prescribe MFCL. Further probing is required to understand lack of motivation among experienced practitioners. Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

Reported Knowledge and Management of Acute Low Back Pain by United States Army Nurse Practitioners as Compared to Clinical Practice Guidelines Published by the Agency for Health Care Policy and Research

DTIC Science & Technology

1999-05-01

evidence - based medicine curriculum. The authors selected adult learning theory for this purpose based on its ability to encompass self-initiation, self...Impact of an evidence - based medicine curriculum based on adult learning theory. Journal of General Internal Medicine, 12(12), 742-750. Hart, L. G

Building a composite score of general practitioners' intrinsic motivation: a comparison of methods.

PubMed

Sicsic, Jonathan; Le Vaillant, Marc; Franc, Carine

2014-04-01

Pay-for-performance programmes have been widely implemented in primary care, but few studies have investigated their potential adverse effects on the intrinsic motivation of general practitioners (GPs) even though intrinsic motivation may be a key determinant of quality in health care. Our aim was to compare methods for developing a composite score of GPs' intrinsic motivation and to select one that is most consistent with self-reported data. A postal survey. French GPs practicing in private practice. Using a set of variables selected to characterize the dimensions of intrinsic motivation, three alternative composite scores were calculated based on a multiple correspondence analysis (MCA), a confirmatory factor analysis (CFA) and a two-parameter logistic model (2-PLM). Weighted kappa coefficients were used to evaluate variation in GPs' ranks according to each method. The three methods produced similar results on both the estimation of the indicators' weights and the order of GP rank lists. All weighted kappa coefficients were >0.80. The CFA and 2-PLM produced the most similar results. There was little difference regarding the three methods' results, validating our measure of GPs' intrinsic motivation. The 2-PLM appeared theoretically and empirically more robust for establishing the intrinsic motivation score. Code JEL C38, C43, I18.

21 CFR 1311.120 - Electronic prescription application requirements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... the practitioner to sign multiple prescriptions for a single patient at one time using a single... practitioners, a practitioner authorized to sign controlled substance prescriptions must approve logical access... application must require the practitioner or his agent to select the DEA registration number to be included on...

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

Code of Federal Regulations, 2014 CFR

2014-10-01

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

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

Code of Federal Regulations, 2013 CFR

2013-10-01

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

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

PubMed

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

2016-07-01

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

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

ERIC Educational Resources Information Center

Manasse, Robert J.; Dooley, Raynard J.

1980-01-01

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

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

PubMed

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

2009-04-01

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

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

PubMed

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

2015-04-01

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

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

PubMed

Barnett, J R

1991-08-14

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

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

PubMed Central

Carlsen, Benedicte; Norheim, Ole Frithjof

2005-01-01

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

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

PubMed

Helms, Christopher; Crookes, Jo; Bailey, David

2015-04-01

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

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

PubMed

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

2014-01-01

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

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

Code of Federal Regulations, 2014 CFR

2014-10-01

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

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

Code of Federal Regulations, 2013 CFR

2013-10-01

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

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

Code of Federal Regulations, 2013 CFR

2013-10-01

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

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

Code of Federal Regulations, 2014 CFR

2014-10-01

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

Computers in general practice: the patient's voice

PubMed Central

Potter, A. R.

1981-01-01

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

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

PubMed

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

2016-10-01

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

The practice of optometry: National Board of Examiners in Optometry survey of optometric patients.

PubMed

Soroka, Mort; Krumholz, David; Bennett, Amy

2006-09-01

A study commissioned by the National Board of Examiners in Optometry was designed to obtain information about patients seen in general practice. Providers completed an encounter form for patients seen during a 2-day sample. Data were obtained from 11,012 patients in rural, urban, and suburban environments from a diverse population of 480 optometrists representative of profession-wide practitioners in terms of geographic distribution and practice settings. Although practitioners were selected randomly, the response rate among those who were invited to participate was only 17.7%. Optometrists who specialized and did not classify themselves as general practitioners were excluded from the study. The study provides insights into the most common diagnostic and therapeutic procedures performed, medications prescribed, and referrals made in general practices. Seventy-one percent of all examinations were categorized as comprehensive, approximately 13% were because of disease, and 11% were for contact lens care. Almost 17% of all patients received a formal visual field test (Goldmann or automated). Refractive error was the most prevalent diagnosis, reflective of the ocular problems found in the general population, and systemic conditions were the second largest category. Although 12% of all patients were referred to an ophthalmologist for further care, other types of referrals were infrequent. Referrals to a primary care physician, laboratory, and imaging or for refractive surgery accounted for only 8% of all referrals. Ocular disease treatment was found to be an integral part of the optometrist's practice. Prescribing topical medications, both legend and "over-the-counter," was a primary treatment option. The most common medications prescribed were for glaucoma, with antibiotics, anti-inflammatory and anti-allergy drops making up the remainder, in descending order.

General practitioners uses and perceptions of voluntary electronic feedback on treatment outcomes - a qualitative study.

PubMed

Lippert, Maria Laura; Kousgaard, Marius Brostrøm; Bjerrum, Lars

2014-11-30

Currently, there is a strong focus on the diffusion and implementation of indicator-based technologies for assessing and improving the quality of care in general practice. The aim of this study was to explore how and for what purposes indicator-based feedback is used by the general practitioners (GPs) and how they perceive it to contribute to their work. Qualitative interviews with nine GPs in two regions in Denmark. The main selection criterion was that the informants had experience with retrieving electronic feedback. The data generation was explorative and open-ended and the analysis took an iterative approach with continuous refinement of themes that emerged from the data. The study identified two main uses of feedback: i) Administration of a regular disease control schedule for patients with chronic disease and ii) Routine monitoring of outcomes for purposes of resource prioritisation and medication management. Both uses were deemed valuable by the GPs, but also as an additional extra to the clinical core task. All the GPs experienced the feedback to be of limited relevance to the most central and challenging aspects of clinical work understood as the care for individuals. This led to different reactions: Some GPs would use the feedback as a point of departure for broader deliberations about individual patient needs and treatment approaches. For others, the perceived limitations decreased their overall motivation to seek feedback. The study points to the importance of clarifying limitations as well as possibilities with respect to different aspects of clinical quality when introducing indicator-based technologies to practitioners. The results also emphasize that an indicator-based approach to quality improvement should not stand alone in general practice since some of the most central and challenging aspects of clinical work are not covered by this approach.

Practice Research: General practitioners' awareness of colorectal cancer

PubMed Central

Nichols, Sally

1986-01-01

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

Who do people talk to about healthy lifestyles? A South Australian survey.

PubMed

Moorhead, R G

1992-12-01

To investigate who people talk to about healthy lifestyle a personal interview of people in a representative sample of South Australians was carried out. The information was collected by interview from all occupants of selected private dwellings who were aged 15 years or older. The interviewer used a prompt card with nine possible responses and the question asked was "which one of these would you be most likely to talk about healthy lifestyle changes?" Forty-four per cent nominated the general practitioner and 22% a family member. People who were either married or in a de facto relationship (30%) significantly chose a general practitioner more than others (14%) (P < 0.05). In the 30-59 age group more men (12%) than women (6%) chose a family member as a healthy lifestyle adviser (P < 0.05). There was no statistically significant difference in interest in healthy lifestyle in people born in Australia and outside Australia, or in the employed or unemployed. It is suggested that further attention needs to be paid to training in preventive medicine at all levels of general practice education and more needs to be known about the role of family members as healthy lifestyle advisers.

The characteristics of doctors receiving medical complaints: a cross-sectional survey of doctors in New Zealand.

PubMed

Cunningham, Wayne; Crump, Raewyn; Tomlin, Andrew

2003-10-10

To analyse the incidence and characteristics of medical complaints received by doctors in New Zealand. A cross-sectional survey of New Zealand doctors randomly selected from each of three groups from the New Zealand medical register: vocationally registered general practitioners; vocationally registered hospital-based specialists; and general registrants. Nine hundred and seventy one doctors (11% of registered New Zealand doctors) indicated that 34% had ever received a medical complaint, and 66% had never received one. The rate of complaint in New Zealand is rising. The annual rate of complaint in 2000 was 5.7%, with doctors in the 40-60 age group receiving 68% of complaints. Doctors who were male, vocationally registered general practitioners, and holding higher postgraduate qualifications were more likely to receive a complaint. Time to resolution of a complaint is long, with 74% of dismissed and 59% of upheld complaints being resolved within 12 months. This study finds a high incidence of complaint in New Zealand. It finds differences between doctors based on gender, qualification, and field of practice, and suggests that responsibility for patient care may be an important determinant of the risk of receiving a complaint.

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

PubMed

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

2016-07-01

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

Should general practitioners call patients by their first names?

PubMed

McKinstry, B

1990-10-06

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

General practitioners' experiences as nursing home medical consultants.

PubMed

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

2017-03-01

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

Career orientation and burnout in French general practitioners.

PubMed

Truchot, Didier

2008-12-01

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

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

PubMed Central

Chesson, R A; Sutherland, A M

1992-01-01

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

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

PubMed

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

2014-01-01

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

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

PubMed Central

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

1993-01-01

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

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

Code of Federal Regulations, 2011 CFR

2011-10-01

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

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

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

PubMed

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

2012-03-01

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

[Clinical safety audits for primary care centers. A pilot study].

PubMed

Ruiz Sánchez, Míriam; Borrell-Carrió, Francisco; Ortodó Parra, Cristina; Fernàndez I Danés, Neus; Fité Gallego, Anna

2013-01-01

To identify organizational processes, violations of rules, or professional performances that pose clinical levels of insecurity. Descriptive cross-sectional survey with customized externally-behavioral verification and comparison of sources, conducted from June 2008 to February 2010. Thirteen of the 53 primary care teams (PCT) of the Catalonian Health Institute (ICS Costa de Ponent, Barcelona). Employees of 13 PCT classified into: director, nurse director, customer care administrators, and general practitioners. Non-random selection, teaching (TC)/non-teaching, urban (UC)/rural and small/large (LC) health care centers (HCC). A total of 33 indicators were evaluated; 15 of procedures, 9 of attitude, 3 of training, and 6 of communication. Level of uncertainty: <50% positive answers for each indicator. no collaboration. A total of 55 professionals participated (84.6% UC, 46.2% LC and 76.9% TC). Rank distribution: 13 customer care administrators, 13 nurse directors, 13 HCC directors, and 16 general practitioners. Levels of insecurity emerged from the following areas: reception of new medical professionals, injections administration, nursing weekend home calls, urgent consultations to specialists, aggressive patients, critical incidents over the agenda of the doctors, communication barriers with patients about treatment plans, and with immigrants. Clinical safety is on the agenda of the health centers. Identified areas of uncertainty are easily approachable, and are considered in the future system of accreditation of the Catalonian Government. General practitioners are more critical than directors, and teaching health care centers, rural and small HCC had a better sense of security. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Prosthodontic decision-making relating to dentitions with compromised molars: the perspective of Swedish General Dental Practitioners.

PubMed

Korduner, E-K; Collin Bagewitz, I; Vult von Steyern, P; Wolf, E

2016-12-01

The aim of this investigation was to study the clinical prosthodontic decision-making process relating to dentitions with compromised molars among Swedish general dental practitioners (GDPs). Eleven Swedish GDPs were purposively selected, and all agreed to participate. Then, in-depth, semi-structured interviews were conducted and covered treatment considerations concerning two authentic patient cases, initially with complete dental arches, and later, a final treatment based on a shortened dental arch (SDA) was discussed. The cases involved patients with compromised teeth situated mainly in the molar regions. One patient suffered from extensive caries and the other from severe periodontal disease. Qualitative content analysis was used to analyse the data. In the systematic analysis, two main categories were identified: holistic and functional approach. Among the interviewed GDPs, focus was put on patients' needs, background history and motivation for treatment as well as the preservation of molar support. Within the limitations of this study, the following can be concluded: keeping a dental arch with molars seems to be important to Swedish general dental practitioners. The SDA concept does not seem to have a substantial impact on the prosthodontic decision-making relating to dentitions with compromised molars. The dentist's experiences, as well as colleagues' or consulting specialist advice together with aetiological factors and the patient's individual situation, influence the decision-making more than the SDA concept. The conflicting results in the prosthetic decision-making process concerning the relevance of age and the need for molar support need further investigation, for example based on decisions made in the dentist's own clinical practice. © 2016 John Wiley & Sons Ltd.

Developing Theory to Guide Building Practitioners' Capacity to Implement Evidence-Based Interventions.

PubMed

Leeman, Jennifer; Calancie, Larissa; Kegler, Michelle C; Escoffery, Cam T; Herrmann, Alison K; Thatcher, Esther; Hartman, Marieke A; Fernandez, Maria E

2017-02-01

Public health and other community-based practitioners have access to a growing number of evidence-based interventions (EBIs), and yet EBIs continue to be underused. One reason for this underuse is that practitioners often lack the capacity (knowledge, skills, and motivation) to select, adapt, and implement EBIs. Training, technical assistance, and other capacity-building strategies can be effective at increasing EBI adoption and implementation. However, little is known about how to design capacity-building strategies or tailor them to differences in capacity required across varying EBIs and practice contexts. To address this need, we conducted a scoping study of frameworks and theories detailing variations in EBIs or practice contexts and how to tailor capacity-building to address those variations. Using an iterative process, we consolidated constructs and propositions across 24 frameworks and developed a beginning theory to describe salient variations in EBIs (complexity and uncertainty) and practice contexts (decision-making structure, general capacity to innovate, resource and values fit with EBI, and unity vs. polarization of stakeholder support). The theory also includes propositions for tailoring capacity-building strategies to address salient variations. To have wide-reaching and lasting impact, the dissemination of EBIs needs to be coupled with strategies that build practitioners' capacity to adopt and implement a variety of EBIs across diverse practice contexts.

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

PubMed Central

Merriman, Eileen; Corwin, Paul; Ikram, Rosemary

2002-01-01

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

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

PubMed

Chambers, R; Wright, D; Taylor, H

1995-05-01

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

How do Australian patients rate their general practitioner? A descriptive study using the General Practice Assessment Questionnaire.

PubMed

Potiriadis, Maria; Chondros, Patty; Gilchrist, Gail; Hegarty, Kelsey; Blashki, Grant; Gunn, Jane M

2008-08-18

To report patient responses to the General Practice Assessment Questionnaire (GPAQ) as a measure of satisfaction with health care received from Australian general practitioners. A clustered cross-sectional study involving general practice patients from 30 randomly selected general practices in Victoria. Between January and December 2005, a screening survey, including a postal version of the GPAQ, was mailed to 17 780 eligible patients. Scores on the six GPAQ items. We analysed data from 7130 patients who completed the screening survey and fulfilled our eligibility criteria. Levels of patient satisfaction with general practice care were generally high: mean GPAQ scores ranged from 68.6 (95% CI, 66.1-71.0) for satisfaction with access to the practice to 84.0 (95% CI, 82.2-85.4) for satisfaction with communication. Intracluster correlations for the GPAQ items ranged from 0.016 for overall satisfaction with the practice to 0.163 for satisfaction with access to the practice. Compared with national benchmarks in the United Kingdom, the GPs and practices participating in our study were rated higher on all six GPAQ items. Multivariable mixed effects linear regression showed that patients who were older, rated their health more highly, visited their GP more frequently and saw the same GP each time tended to express greater satisfaction with their care. Generally patients reported high levels of satisfaction with GP care. Greater satisfaction with care was associated with older patients, good health, more frequent contact with the GP, and seeing the one GP consistently.

Pediatric dental sedation: challenges and opportunities

PubMed Central

Nelson, Travis M; Xu, Zheng

2015-01-01

High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of sedation to patients, and focus instead on careful case selection for lighter in-office sedation techniques. PMID:26345425

Pediatric dental sedation: challenges and opportunities.

PubMed

Nelson, Travis M; Xu, Zheng

2015-01-01

High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of sedation to patients, and focus instead on careful case selection for lighter in-office sedation techniques.

MRI brain imaging.

PubMed

Skinner, Sarah

2013-11-01

General practitioners (GPs) are expected to be allowed to request MRI scans for adults for selected clinically appropriate indications from November 2013 as part of the expansion of Medicare-funded MRI services announced by the Federal Government in 2011. This article aims to give a brief overview of MRI brain imaging relevant to GPs, which will facilitate explanation of scan findings and management planning with their patients. Basic imaging techniques, common findings and terminology are presented using some illustrative case examples.

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

PubMed

Vanagas, Giedrius; Bihari-Axelsson, Susanna

2005-06-10

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

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

PubMed

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

2014-06-03

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

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

PubMed

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

1995-04-01

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

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

PubMed

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

2017-10-01

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

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

PubMed

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

2015-05-01

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

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

PubMed

Barsanti, Sara; Bonciani, Manila

2018-01-01

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

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

PubMed

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

2018-03-21

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

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

PubMed Central

2014-01-01

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

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

PubMed

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

2014-01-09

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

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

PubMed

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

2018-05-04

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

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

PubMed

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

2017-08-01

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

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

PubMed

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

2015-01-01

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

Use of Rapid, Point-of-Care Assays by Private Practitioners in Chennai, India: Priorities for Tuberculosis Diagnostic Testing.

PubMed

Bronner Murrison, Liza; Ananthakrishnan, Ramya; Sukumar, Sumanya; Augustine, Sheela; Krishnan, Nalini; Pai, Madhukar; Dowdy, David W

2016-01-01

Private practitioners are frequently the first point of healthcare contact for patients with tuberculosis (TB) in India. As new molecular tests are developed for point-of-care (POC) diagnosis of TB, it is imperative to understand these individuals' practices and preferences for POC testing. To evaluate rapid testing practices and identify priorities for novel POC TB tests among private practitioners in Chennai. We conducted a cross-sectional survey of 228 practitioners practicing in the private sector from January 2014 to February 2015 who saw at least one TB patient in the previous year. Practitioners were randomly selected from both the general community and a list of practitioners who referred patients to a public-private mix program for TB treatment. We used standardized questionnaires to collect data on current practices related to point-of-care diagnosis and interest in hypothetical POC tests. We used multivariable Poisson regression with robust estimates of standard error to calculate measures of association. Among 228 private practitioners, about half (48%) utilized any rapid testing in their current practice, most commonly for glucose (43%), pregnancy (21%), and malaria (5%). Providers using POC tests were more likely to work in hospitals (56% vs. 43%, P = 0.05) and less likely to be chest specialists (21% vs. 54%, P<0.001). Only half (51%) of providers would use a hypothetical POC test for TB that was accurate, equipment-free, and took 20 minutes to complete. Chest specialists were half as likely to express interest in performing the hypothetical POC TB test in-house as other practitioners (aPR 0.5, 95%CI: 0.2-0.9). Key challenges to performing POC testing for TB in this study included time constraints, easy access to local private labs and lack of an attached lab facility. As novel POC tests for TB are developed and scaled up, attention must be paid to integrating these diagnostics into healthcare providers' routine practice and addressing barriers for POC testing.

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

PubMed

Bertelsen, Pernille; Stub Petersen, Lone

2015-01-01

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

Advances in diagnostic ultrasonography.

PubMed

Reef, V B

1991-08-01

A wide variety of ultrasonographic equipment currently is available for use in equine practice, but no one machine is optimal for every type of imaging. Image quality is the most important factor in equipment selection once the needs of the practitioner are ascertained. The transducer frequencies available, transducer footprints, depth of field displayed, frame rate, gray scale, simultaneous electrocardiography, Doppler, and functions to modify the image are all important considerations. The ability to make measurements off of videocassette recorder playback and future upgradability should be evaluated. Linear array and sector technology are the backbone of equine ultrasonography today. Linear array technology is most useful for a high-volume broodmare practice, whereas sector technology is ideal for a more general equine practice. The curved or convex linear scanner has more applications than the standard linear array and is equipped with the linear array rectal probe, which provides the equine practitioner with a more versatile unit for equine ultrasonographic evaluations. The annular array and phased array systems have improved image quality, but each has its own limitations. The new sector scanners still provide the most versatile affordable equipment for equine general practice.

Factors related to consultation time: Experience in Slovenia

PubMed Central

Petek Šter, Marija; Švab, Igor; Živčec Kalan, Gordana

2008-01-01

Objective Consultation time has a serious impact on physicians’ work and patient satisfaction. No systematic study of consultation time in general practice in Slovenia has yet been carried out. The aim of the present study was to measure consultation time, to identify the factors influencing it, and to study the influence of the workload of general practitioners on consultation time. Design A total of 42 general practitioners participated in this cross-sectional study. Each physician collected data from 300 consecutive consultations and measured the length of the visit. Setting Forty-two randomly selected general practices in Slovenia. Subjects Patients of 42 general practices. Main outcome measures Average consultation time in general practice in Slovenia; factors influencing consultation time in Slovenia. Results Data from 12 501 visits to the surgery were collected. A quarter of all visits (25.5%) were administrative. The mean consultation time was 6.9 minutes (median 6.0 minutes, 5%–95% interval: 1.0–16.0 minutes). Longer consultation time was predicted by: patient-related factors (female gender, higher age, higher level of education, higher number of health problems, change of physician within the last year), physician-related factors (higher age), physicians’ workload (absence of high workload), and the type of visit (consultation and/or clinical examination). Conclusion Consultation time in general practice is short, and depends on the characteristics of the patient and the physician, the physician's workload, and the type of visit. A reduction of high workload in general practice should be one of the priorities of the healthcare system. PMID:18297560

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

PubMed Central

Siriwardena, A N

1995-01-01

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

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

PubMed Central

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

2014-01-01

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

Hypertension control and management in Slovenia, Yugoslavia.

PubMed

Jezersek, P; Dolenc, P; Kralj, Z

1990-08-01

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

[Impact of consensus conferences of hypercholesterolemia and hypertension in Spain].

PubMed

Brotons, C; Server, M; Pintó, X; Roura, P; Martín-Zurro, A

1997-01-11

In May 1989 and June 1990, consensus conferences of treatment of hypertension and hypercholesterolemia respectively were held in Spain, at the General Division of Health Planning from the Ministry of Health. The objective of this article is to assess the effect of such conferences of physicians' knowledge, attitudes and practices. Cross-sectional telephone survey was carried out in physicians of general medicine, family practice, internal medicine and cardiology specialties. 807 physicians were selected, 347 family physicians, 177 general practitioners, 156 cardiologists and 128 internists. A questionnaire of 30 items was designed to obtain information about demographic and professional characteristics, knowledge of the consensus conferences and attitudes related to a case of an otherwise healthy asymptomatic 48-years-old man. The response rate was 57% (463 physicians), and 60% of physicians had knowledge about the conferences, being general practitioners the ones who had less knowledge of the conferences. The items about recommendations of diet and pharmacological treatment were property answered (about 50% of the physicians answered correctly). The mean of serum cholesterol when diet and drugs are recommended was 232 mg/dl (SD 23) (6.01 mmol/l) and 260 mg/dl (SD 25) (6.7 mmol/l) respectively. The first-choice cholesterol lowering drugs were statines. A patient was considered as hypertensive it the mean of systolic blood pressure was 149 mmHg (9.4) and the mean for diastolic blood pressure was 92 mmHg (3.8). The mean of diastolic blood pressure considered for drug treatment was 96.7 mmHg (SD 4.6). The first-choice antihypertensive drugs were angiotensin conversive enzyme inhibitors. Diffusion of the conferences has been unequal, being general practitioners less knowledgeable about the content of the conferences. Although physicians know reasonably well the recommendations about diet and drug treatments, the attitude in practice is more aggressive than recommended. Globally, the knowledge of the contents of the conferences was acceptable, although there were differences between specialties; however the effect on clinical practice is still low.

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

PubMed

Kaur, Supreet; Khurana, Pankaj; Kaur, Harjit

2015-01-01

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

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

PubMed Central

Kaur, Supreet; Khurana, Pankaj; Kaur, Harjit

2015-01-01

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

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

PubMed

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

2008-12-06

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

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

PubMed

van de Kerkhof, P C M

2006-08-26

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

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

PubMed

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

2013-09-01

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

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

PubMed

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

2016-01-01

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

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

PubMed

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

2013-01-01

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

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

PubMed Central

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

2014-01-01

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

Job and Career Satisfaction among Advertising Practitioners.

ERIC Educational Resources Information Center

Jugenheimer, Donald W.

A questionnaire survey of 300 advertising practitioners was used to determine the degree of job and career satisfaction among advertising practitioners. The subjects were separated according to whether they worked for advertising agencies, advertisers, or advertising media; 100 subjects in each area were selected from the prestigious directories…

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

ERIC Educational Resources Information Center

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

2008-01-01

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

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

PubMed

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

2015-08-10

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

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

PubMed Central

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

2015-01-01

Background: In 2012, a pilot health policy of contractual service relations between general practitioners and patients was implemented in China. Due to the decline in body and cognitive function, as well as the lack of family care and narrow social support networks, the demand of health services among the elderly is much higher than that among the general population. This study aims to probe into the empty nesters’ willingness-to-pay for general practitioners using a contractual service policy, investigating empty nesters’ payment levels for the service, and analyze the main factors affecting the willingness of empty-nesters’ general practitioners using contractual service supply cost. Methods: This cross-sectional study adopted a multistage stratified sampling method to survey 865, city empty nesters (six communities in three districts of one city) aged 60–85 years. A condition value method was used to infer the distribution of the willingness-to-pay; Cox’s proportional hazards regression model was used to analyze the influencing factors of willingness-to-pay. Results: More than seventy percent (76.6%) of the empty nesters in this city were willing to pay general practitioners using contract service in Chongqing. The level of willingness-to-pay for the surveyed empty nesters was 34.1 yuan per year. The median value was 22.1 yuan per year, which was below the Chongqing urban and rural cooperative medical insurance individual funding level (60 yuan per year) in 2013. Cox’s proportional hazards regression model analysis showed that the higher the education level was, the worse the self-reported health status would be, accompanied by higher family per capita income, higher satisfaction of community health service, and higher willingness-to-pay empty nesters using a contract service. Women had a higher willingness-to-pay than men. Conclusions: The willingness-to-pay for general practitioners by contractual service is high among city empty nesters in Chongqing, thus, individual financing is feasible. However, people are willing to pay less than half of the current personal financing of cooperative medical insurance of urban and rural residents. Education level, family per capita income, and self-reported health status are the main factors affecting the cost sharing intention for general practitioners using contract service supply. According to the existing situation of different empty nesters, it is important to perfect the design of general practitioners using a contractual service policy system, according to differentiated personal financing levels. PMID:26266416

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

Code of Federal Regulations, 2011 CFR

2011-04-01

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

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

Code of Federal Regulations, 2014 CFR

2014-04-01

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

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

Code of Federal Regulations, 2012 CFR

2012-04-01

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

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

Code of Federal Regulations, 2010 CFR

2010-04-01

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

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

Code of Federal Regulations, 2013 CFR

2013-04-01

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

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

PubMed

Duffaud, Sylvain; Liébart, Sandra

2014-01-01

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

Near patient testing in general practice: a review.

PubMed Central

Hilton, S

1990-01-01

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

Accessibility of general practitioners and selected specialist physicians by car and by public transport in a rural region of Germany.

PubMed

Stentzel, Ulrike; Piegsa, Jens; Fredrich, Daniel; Hoffmann, Wolfgang; van den Berg, Neeltje

2016-10-19

The accessibility of medical care facilities in sparsely populated rural regions is relevant especially for elderly people which often represent a large segment of the population in such regions. Elderly people have higher morbidity risks and a higher demand for medical care. Although travelling with private cars is the dominating traffic mode in rural regions, accessibility by public transport is increasingly important especially because of limited mobility of elderly people. The aim of this study was to determine accessibility both by car and public transport to general practitioners (GP) and selected specialist physicians for a whole region and to detect areas with poor to no access in the county Vorpommern-Greifswald, which is a rural and sparsely populated region in the very northeast of Germany. Accessibility of medical care facilities by car was calculated on the basis of a network analysis within a geographic information system (GIS) with routable street data. Accessibility by public transport was calculated using GIS and a network analysis based on the implementation of Dijkstra's algorithm. The travelling time to general practitioners (GP) by car in the study region ranges from 0.1 to 22.9 min. This is a significant difference compared to other physician groups. Traveling times to specialist physicians are 0.4 to 42.9 min. A minority of 80 % of the inhabitants reach the specialist physicians within 20 min. The accessibility of specialist physicians by public transport is poor. The travel time (round trip) to GPs averages 99.3 min, to internists 143.0, to ophthalmologists 129.3 and to urologists 159.9 min. These differences were significant. Assumed was a one hour appointment on a Tuesday at 11 am. 8,973 inhabitants (3.8 %) have no connection to a GP by public transport. 15,455 inhabitants (6.5 %) have no connection to specialist internists. Good accessibility by public transport is not a question of distance but of transport connections. GIS analyses can detect areas with imminent or manifest deficits in the accessibility of health care providers. Accessibility analyses should be established instruments in planning issues.

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

PubMed

Espeland, Ansgar; Baerheim, Anders

2003-03-24

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

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

PubMed Central

Espeland, Ansgar; Baerheim, Anders

2003-01-01

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

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

PubMed

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

2018-02-01

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

Treating Tooth Surface Loss: Adhesive Restoration of the Worn Anterior Dentition.

PubMed

Patel, Mahul

2016-08-01

The treatment of tooth surface loss (TSL) is becoming more common in primary health care and a diverse variety of patients are presenting with this condition are often being treated by general dental practitioners. This article highlights the importance of comprehensive planning and adept execution that can enhance the patient's outcome and experience. Stages of clinical planning and treatment approaches using a selection of restorative materials utilising various established adhesive clinical techniques will be presented and discussed.

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

PubMed

Moorhead, R G

1989-01-01

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

Payment mechanism and GP self-selection: capitation versus fee for service.

PubMed

Allard, Marie; Jelovac, Izabela; Léger, Pierre-Thomas

2014-06-01

This paper analyzes the consequences of allowing gatekeeping general practitioners (GPs) to select their payment mechanism. We model GPs' behavior under the most common payment schemes (capitation and fee for service) and when GPs can select one among them. Our analysis considers GP heterogeneity in terms of both ability and concern for their patients' health. We show that when the costs of wasteful referrals to costly specialized care are relatively high, fee for service payments are optimal to maximize the expected patients' health net of treatment costs. Conversely, when the losses associated with failed referrals of severely ill patients are relatively high, we show that either GPs' self-selection of a payment form or capitation is optimal. Last, we extend our analysis to endogenous effort and to competition among GPs. In both cases, we show that self-selection is never optimal.

49 CFR 1103.1 - Register of practitioners.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

Treatment of basal cell carcinomas by general practitioners in Australia.

PubMed

Streeton, Catherine L; Gospodarevskaya, Elena; Harris, Anthony

2006-04-01

Basal cell carcinomas (BCCs) are a relatively common form of skin damage in Australians, involving approximately 1 in 200 general practice encounters per year. To determine current treatments and the associated healthcare resource costs of BCC therapy in Australia. A retrospective survey was undertaken relating to the treatment of patients presenting to their doctor with previously untreated BCCs. Data were collected from a sample of general practitioners who were asked to randomly select two BCC patients from their medical records and complete a questionnaire. Information about treatment types, number of doctor visits, treatment complications, and specialist referrals was extracted from the patient records. One hundred and sixty-four patients were recruited into the study (59% male), who were treated for a total of 244 BCCs (average of 1.5 lesions per patient). Twenty-two per cent of patients were referred to a specialist, most being referred to a general surgeon (45%) or plastic surgeon (25%). Excision was the preferred therapy; second choices were cryosurgery or curettage and cautery. Few adverse events were recorded. The typical number of doctor visits varied from 3.2 to 7.4, with a range of total cost per patient of 146.60-496.20 AUS dollars, depending on complexity and the need for referral. With a reported incidence in Australia of approximately 788 per 100,000 persons, BCCs are not inexpensive to treat for such a relatively common condition.

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

PubMed Central

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

1986-01-01

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

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

PubMed Central

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

1989-01-01

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

Psychological determinants of the intention to educate patients about benzodiazepines

PubMed Central

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

2007-01-01

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

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

PubMed Central

While, Alison E

2014-01-01

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

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

PubMed Central

McColl, E; Newton, J; Hutchinson, A

1994-01-01

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

[Developing patient information sheets in general practice. Proposal for a methodology].

PubMed

Sustersic, Mélanie; Meneau, Aurélia; Drémont, Roger; Paris, Adeline; Laborde, Laurent; Bosson, Jean-Luc

2008-12-15

Health information is patients' wish and right. For general practitioners, it is a duty, a legal obligation and a pre-requisite in any preventive approach. Written information must complete oral information since it improves health care quality. However, in general practice, there are no patient documents which are scientifically valid, understandable and efficient in terms of communication. To develop a method for creating patient information sheets and to experiment its feasibility through the development of 125 sheets focused on the most common clinical conditions in general practice. Research and literature review pour the development of specifications, and creation of 125 sheets following these specifications. The specifications developed consist of the 10 following steps: selection of the topic and the objectives, literature review, selection of the sections, drafting, validation of the scientific contents, assessment among patients, validation of the layout, selection of the media, delivery to patients and update. Following these specifications, we developed 125 information sheets. Each of these was reviewed by several physicians and assessed with R. Flesh readability test (the established acceptable threshold value was 40). The 30 sheets associated with the lowest scores were selected and reviewed to improve their overall readability. Even though some difficulties cannot be avoided when developing patient information sheets, each physician or physician association can create its own documents following the proposed specifications and thus deliver a customized message.

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

Code of Federal Regulations, 2010 CFR

2010-04-01

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

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

PubMed

Groenewegen, Peter

2016-01-01

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

Assessment of publication output in the field of general practice and family medicine and by general practitioners and general practice institutions.

PubMed

Jelercic, Stasa; Lingard, Heide; Spiegel, Wolfgang; Pichlhöfer, Otto; Maier, Manfred

2010-10-01

The discipline of family medicine (FM) lacks a comprehensive methodology, which can be applied as a standard for assessing overall research output in both the field of FM and by general practitioners (GPs)/general practice institutions. It was the aim of this study to develop a sensitive search strategy for assessing publication output in the field of FM independent of the author's profession or affiliation and by GPs/general practice institutions independent of their field of scientific interest. Literature searches limited to the year 2005 were conducted in PubMed and ISI Web of Sciences (ISI WoS). In PubMed, all relevant MeSH terms were used. Search terms possibly contained in the author's affiliations have been collected. In ISI WoS, the same entry terms including their abbreviations and plural forms were applied. The final queries were validated by manual review and matching results with selected FM journals. A comprehensive list of combined search terms could be defined. For the field of general practice/FM more publications could be retrieved in PubMed. Almost twice as many publications by GPs/general practice institutions could be retrieved in ISI WoS, where--in contrast to PubMed--the affiliation is documented for all authors. To quantitatively assess publication output in the field of FM, PubMed was identified as the preferable database. To assess publication output by GPs/general practice institutions, the ISI WoS is recommended as the preferable database. Apparently, the ISI WoS is more suitable to compare the research productivity of different countries, authors or institutions.

Randomised trial of three approaches for marketing smoking cessation programmes to Australian general practitioners.

PubMed

Cockburn, J; Ruth, D; Silagy, C; Dobbin, M; Reid, Y; Scollo, M; Naccarella, L

1992-03-14

To compare three approaches for marketing a quit smoking intervention kit to general practitioners. Randomised trial of (a) personal delivery and presentation by an educational facilitator with a follow up visit six weeks later; (b) delivery to the receptionist by a friendly volunteer courier with a follow up phone call six weeks later, or (c) postal delivery with a follow up letter six weeks later. Melbourne, Australia. 264 randomly selected general practitioners. A research assistant visited each doctor four months after delivery and measured use of components of the kit. A questionnaire measuring perceptions of aspects of the kit and its delivery was completed by doctors. Costs of each approach were calculated. Doctors receiving the educational facilitator approach were significantly more likely than those receiving the other two approaches to have seen the kit, to rate the method of delivery as engendering motivation to try the kit, to have used one of the "intensive intervention" components from the kit, to report that they found the kit less complicated, and to report greater knowledge of how to use the kit. There were no significant differences in use of "minimal intervention" components of the kit, ratings of overall acceptability of delivery, perceptions of cultural and structural barriers to using the kit, and ratings of the overall acceptability of the kit. The cost of the educational facilitator approach ($A142/doctor) was 24 times that of the mailed approach. The volunteer courier approach ($A14) was twice the cost of the mailed approach. Educational facilitators and volunteer couriers do not seem to be cost effective strategies for distributing smoking interventions.

The perspective of patients with congenital heart disease: does health care meet their needs?

PubMed

Schoormans, Dounya; Sprangers, Mirjam A G; Pieper, Petronella G; van Melle, Joost P; van Dijk, Arie P J; Sieswerda, Gertjan Tj; Hulsbergen-Zwarts, Mariët S; Plokker, Thijs H W M; Brunninkhuis, Leo G H; Vliegen, Hubert W; Mulder, Barbara J M

2011-01-01

A first step in the delivery of tailored care is answering the following question: does health care meet the needs of patients? Therefore patients' perspective on health care use and their needs was examined. The design used was cross-sectional questionnaire study. A total of 1109 adult congenital heart defect (CHD) patients attending one of eight Dutch hospitals were randomly selected from a national database (10% of all registered patients). Patient reported questionnaires on in- and outpatient health care use during the past year and need for additional care. A total of 66% and 40% of patients had contact with their cardiologist and general practitioner, respectively. Six to 10 percent were hospitalized, operated upon, or visited the emergency room. For the majority, the amount of contact was sufficient. Most patients indicated that the communication skills and expertise of the cardiologist and general practitioner were sufficient, and health care improvements were not necessary. Frequent health care users had a poor functional status and frequent contact with their cardiologist and general practitioner. Patients who want more contact with their cardiologist rated the communication skills of the cardiologist as insufficient. For most patients, the amount and quality of care are both sufficient. Patients who rate the communication skills of the cardiologist as insufficient have need more contact. In addition to the recommended training program as described in the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) guidelines, we recommend the incorporation of communication training. This is the first study to provide insight into health care use and needs of CHD patients in countries with a compulsory health insurance system from the patient perspective. © 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.

[Tests and scales: restrains to use them by general practitioners. Descriptive transversal study].

PubMed

Cario, Camille; Levesque, Jean-Louis; Bouche, Gauthier

2010-12-20

Tests, even though recommended, are only few used by general practitioners (GP's). The aim of this study was to understand the reasons of this underuse. Descriptive transversal study, to explore knowledge, use and restrains to using ten tests related in the first 50 results of consultation in general practice. We questioned 121 GP's from Charente, selected ad random. The oldest tests (MMS, MNA, Fagerström, mini-GDS, IPSS, depression) are known by more than half of the GP's. Only one third is familiar with more recent tests devoted to ambulatory care (TSTS, FACE, venous thromboembolic risk), which are also used less (20% at most). Systematic use of all tests mixed up, never exceeds 30% of all GP's. The principal restrain to use these tests is lack of training (53%), which seems indeed to be inefficient in this domain; 20 to 60% of GP's who know the tests, do not use them, mainly because of doubts regarding their usefulness (38%). What really is the utility of these tests in ambulatory care? Their validity in general practice shows some gaps: their validation results seldom on studies conducted in primary care, impact studies to evaluate the benefits for patients are lacking, and tests designed for specific use by GP's are rare and lacking in validity. Development of research in primary care in this field would be desirable in order to develop relevant, feasible and acceptable tools to help decision making in general practice.

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

PubMed

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

1996-03-16

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

Guidance of eruption for general practitioners.

PubMed

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

2003-04-01

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

Personality Factors Related to Career Satisfaction among General Practitioners.

ERIC Educational Resources Information Center

Schwartz, Robert H.; Shenoy, Sunil

1994-01-01

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

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

PubMed

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

2017-12-01

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

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

PubMed

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

2009-01-01

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

Professional Development of HR Practitioners--A Phenomenographic Study

ERIC Educational Resources Information Center

Bailey, Moira

2015-01-01

Purpose: The purpose of this paper is an investigation into the experiences of professional development of human resource (HR) practitioners in the North of Scotland, and the use of non-formal learning in that development. Design/methodology/approach: In-depth semi-structured interviews from a purposively selected sample of HR practitioners were…

Transforming School and Society: Examining the Theoretical Foundations of Scholar-Practitioner Leadership

ERIC Educational Resources Information Center

Hampton, Keri

2010-01-01

The purpose of this paper is to examine, using the tenets of cultural theory, critical theory, constructivist theory, and transformational theory as a lens, selected theoretical foundations of the scholar-practitioner. These foundations form the framework for understanding the nature of the scholar-practitioner construct and provide insight into…

Developing Theory to Guide Building Practitioners' Capacity to Implement Evidence-Based Interventions

ERIC Educational Resources Information Center

Leeman, Jennifer; Calancie, Larissa; Kegler, Michelle C.; Escoffery, Cam T.; Herrmann, Alison K.; Thatcher, Esther; Hartman, Marieke A.; Fernandez, Maria E.

2017-01-01

Public health and other community-based practitioners have access to a growing number of evidence-based interventions (EBIs), and yet EBIs continue to be underused. One reason for this underuse is that practitioners often lack the capacity (knowledge, skills, and motivation) to select, adapt, and implement EBIs. Training, technical assistance, and…

Training conservation practitioners to be better decision makers

USGS Publications Warehouse

Johnson, Fred A.; Eaton, Mitchell J.; Williams, James H.; Jensen, Gitte H.; Madsen, Jesper

2015-01-01

Traditional conservation curricula and training typically emphasizes only one part of systematic decision making (i.e., the science), at the expense of preparing conservation practitioners with critical skills in values-setting, working with decision makers and stakeholders, and effective problem framing. In this article we describe how the application of decision science is relevant to conservation problems and suggest how current and future conservation practitioners can be trained to be better decision makers. Though decision-analytic approaches vary considerably, they all involve: (1) properly formulating the decision problem; (2) specifying feasible alternative actions; and (3) selecting criteria for evaluating potential outcomes. Two approaches are available for providing training in decision science, with each serving different needs. Formal education is useful for providing simple, well-defined problems that allow demonstrations of the structure, axioms and general characteristics of a decision-analytic approach. In contrast, practical training can offer complex, realistic decision problems requiring more careful structuring and analysis than those used for formal training purposes. Ultimately, the kinds and degree of training necessary depend on the role conservation practitioners play in a decision-making process. Those attempting to facilitate decision-making processes will need advanced training in both technical aspects of decision science and in facilitation techniques, as well as opportunities to apprentice under decision analysts/consultants. Our primary goal should be an attempt to ingrain a discipline for applying clarity of thought to all decisions.

What do plastic surgeons do?

PubMed

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

1998-06-01

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

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

PubMed Central

Vanagas, Giedrius; Bihari-Axelsson, Susanna

2005-01-01

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

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

PubMed Central

2014-01-01

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

Violence against General Practitioners in Turkey

ERIC Educational Resources Information Center

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

2009-01-01

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

An Evaluation of a Clerkship In Cardiology

ERIC Educational Resources Information Center

Edson, John N.; and others

1969-01-01

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

Informal and Formal Learning of General Practitioners

ERIC Educational Resources Information Center

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

2016-01-01

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

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

PubMed

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

2013-05-01

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

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

PubMed

Meyer, R L; Marty, F

2007-03-07

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

Autoclave performance and practitioner knowledge of autoclave use: a survey of selected UK practices.

PubMed

Burke, F J; Coulter, W A; Cheung, S W; Palenik, C J

1998-04-01

It is essential that the dental surgery autoclave be tested regularly to ensure that it is operating at a temperature and pressure that will kill all microorganisms. The aims of this study were to investigate the knowledge of general dental practitioners on aspects of autoclave use, to examine their autoclaving routines, and to test the effectiveness of the sterilization cycle of their practice's autoclave. A 35-question questionnaire was distributed to 840 dental practitioners in the United Kingdom. They were also sent three spore test ampules with details of their function and instructions on their use. The practitioners were asked to use the spore test ampules in their own practice's autoclave and to return these for testing. Four hundred one questionnaires and associated spore test ampules were returned for analysis, a 47.7% response rate. Eight practice autoclaves (2.0%) failed to sterilize the spores. These practices were offered a retest following counseling. A total of 77.8% of respondents had received formal training in infection control. Of the 71.3% of respondents who stated that they check the performance of their autoclave routinely, 31.5% use a chemical strip every cycle, 17.5% use it once per day, and 30.4% use it once per week. However, only five respondents (1.2%) use a spore test; two of these respondents use it every cycle, one once per day, and two once per week. Further education of practitioners may be necessary to enhance their awareness of the need for routine checking of autoclave effectiveness.

Why does it run in families? Explaining family similarity in help-seeking behaviour by shared circumstances, socialisation and selection.

PubMed

Cardol, Mieke; Groenewegen, Peter P; Spreeuwenberg, Peter; Van Dijk, Liset; Van Den Bosch, Wil J H M; De Bakker, Dinny H

2006-08-01

Why do contact frequencies with general practice of family members resemble each other? Many aspects related to the clustering of health-care utilisation within families have been studied, but the underlying mechanisms have not been addressed. This article considers whether family similarity in contact frequency with general practice can be explained as (a) a result of shared circumstances, (b) through socialisation, and (c) through homogeneity of background characteristics. Data from the second Dutch national survey of general practice were used to test these mechanisms empirically. This survey recorded all consultations in 2001 for 104 general practices in the Netherlands, serving 385,461 patients. Information about socio-demographic characteristics was collected by means of a patient survey. In a random sample, an extended health interview took place (n=12,699). Overall, we were able to show that having determinants in common through socialisation and shared circumstances can explain similarity in contact frequencies within families, but not all hypotheses could be confirmed. In specific terms, this study shows that resemblances in contact frequencies within families can be best explained by spending more time together (socialisation) and parents and children consulting a general practitioner simultaneously (circumstances of the moment). For general practitioners, the mechanisms identified can serve as a framework for a family case history. The importance of the mechanism of socialisation in explaining similarities in help-seeking behaviour between family members points to the significance of knowledge and health beliefs underlying consultation behaviour. An integrated framework including these aspects can help to better explain health behaviour.

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

PubMed Central

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

1986-01-01

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

A general causal model to guide alcohol, tobacco, and illicit drug prevention: assessing the research evidence.

PubMed

Birckmayer, Johanna D; Holder, Harold D; Yacoubian, George S; Friend, Karen B

2004-01-01

The problems associated with the use of alcohol, tobacco, and other drugs (ATOD) extract a significant health, social, and economic toll on American society. While the field of substance abuse prevention has made great strides during the past decade, two major challenges remain. First, the field has been disorganized and fragmented with respect to its research and prevention practices; that is, there are often separate ATOD prevention "specialists." Second, both the prevention researchers who test the efficacy of specific prevention strategies and the practitioners who implement prevention efforts often lack an overall perspective to guide strategy selection. To address these limitations, we present an ATOD causal model that seeks to identify those variables (Domains) that are theoretically salient and empirically connected across alcohol, tobacco, and illicit drugs. For the researcher, the model demonstrates important commonalities, as well as gaps, in the literature. For the practitioner, the model is a means to recognize both the complexity of the community system that produces ATOD problems and the multiple intervention points that are possible within this system. Researchers and practitioners are thus challenged to work synergistically to find effective and cost-effective approaches to change or reduce ATOD use and associated problems.

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.

Sharing psychological skills in the general practice setting.

PubMed

Weinman, J; Medlik, L

1985-09-01

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

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

PubMed

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

2013-09-01

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

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

PubMed

MacCarthy, Dan; Hollander, Marcus J

2014-01-01

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

42 CFR 424.11 - General procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

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

Code of Federal Regulations, 2012 CFR

2012-10-01

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

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

Code of Federal Regulations, 2013 CFR

2013-10-01

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

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

Code of Federal Regulations, 2011 CFR

2011-10-01

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

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

Code of Federal Regulations, 2014 CFR

2014-10-01

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

Evidence Valued and Used by Health Promotion Practitioners

ERIC Educational Resources Information Center

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

2015-01-01

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

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

ERIC Educational Resources Information Center

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

1998-01-01

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

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

PubMed

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

2016-12-01

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

Management recommendations for knee osteoarthritis: how usable are they?

PubMed

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

2010-10-01

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

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

PubMed

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

1998-01-24

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

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

ERIC Educational Resources Information Center

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

2010-01-01

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

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

ERIC Educational Resources Information Center

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

2004-01-01

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

Adolescents' Suicidal Thinking and Reluctance to Consult General Medical Practitioners

ERIC Educational Resources Information Center

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

2010-01-01

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

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

ERIC Educational Resources Information Center

Zambrano, Sofia C.; Barton, Christopher A.

2011-01-01

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

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

ERIC Educational Resources Information Center

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

2007-01-01

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

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

ERIC Educational Resources Information Center

Aoun, Samar; Johnson, Lyn

2002-01-01

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

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

ERIC Educational Resources Information Center

Nilsen, Line Lundvoll

2011-01-01

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

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

ERIC Educational Resources Information Center

Kirby, Amanda; Davies, Rhys; Bryant, Amy

2005-01-01

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

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

PubMed

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

2012-03-28

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

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

PubMed

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

2015-01-01

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

The Impact of a Postgraduate Learning Experience on the Confidence of General Dental Practitioners.

PubMed

Fine, Peter; Louca, Chris; Leung, Albert

2017-04-26

This study aimed to explore the relationship between participating in a learning experience and the ensuing changes in confidence. A self-selected group of General Dental Practitioners (GDPs) entered a five-year, part-time postgraduate master's training programme in restorative dentistry. Confidence in communication with patients and technical skills were measured at the start of the programme by questionnaire and at the conclusion of the programme by questionnaire and personal interview. A total of 72 clinicians started the programme; 27% ( n = 20) completed the master's degree. Assessment of confidence revealed a spread from 4/10 to 10/10 for communication with patients and clinical skills in restorative dentistry before the programme started. A total of 15% ( n = 11) volunteered for interview. Analysis of qualitative data revealed (i) a perceived increase in confidence from all clinicians; (ii) a perceived greater ability to treat patients; (iii) an increase in treatment options being offered to patients; (iv) a perceived increase in treatment uptake by patients; and (v) greater job opportunities. The study showed a positive relationship between the learning experience and the perceived increase in confidence of clinicians. The increase in confidence manifested itself in better communication and clinical skills.

Anxiety and dysthymia: local prevalence estimates based on drug prescriptions by general practitioners in Turin (Italy).

PubMed

Mamo, C; Farina, E; Cicio, R; Fanì, M

2014-01-01

The aim of the study was to obtain local estimates of the prevalence of anxiety and dysthymic disorders among attendees of primary care at local level, useful to pursue a better management of the health care services. The study was conducted in the Health District no. 2 of Turin (industrial town in northwest Italy). The criteria for identification of cases were based on the drugs prescriptions made by general practitioners (GPs), selected in order to assure high specificity. The study involved 86 physicians (with 87,885 attendees). As expected, the crude and standardized prevalences were higher in women (anxiety: 2.9% vs 1.3% in men; dysthymia: 3.8% vs 1.7% in men), with a peak in women aged over 75 yrs (anxiety: 4.8%; dysthymia: 6.2%). In comparison to male GPs, female GPs had an higher prevalence of patients with anxious disorders, whereas the prevalences of dysthymia were similar. Despite the discussed limitations, the used methodology allows to obtain sufficiently reliable estimates of prevalence of common mental disorders at local level, providing informations useful for organizing the primary care in the Health district.

The Impact of a Postgraduate Learning Experience on the Confidence of General Dental Practitioners

PubMed Central

Fine, Peter; Louca, Chris; Leung, Albert

2017-01-01

This study aimed to explore the relationship between participating in a learning experience and the ensuing changes in confidence. A self-selected group of General Dental Practitioners (GDPs) entered a five-year, part-time postgraduate master’s training programme in restorative dentistry. Confidence in communication with patients and technical skills were measured at the start of the programme by questionnaire and at the conclusion of the programme by questionnaire and personal interview. A total of 72 clinicians started the programme; 27% (n = 20) completed the master’s degree. Assessment of confidence revealed a spread from 4/10 to 10/10 for communication with patients and clinical skills in restorative dentistry before the programme started. A total of 15% (n = 11) volunteered for interview. Analysis of qualitative data revealed (i) a perceived increase in confidence from all clinicians; (ii) a perceived greater ability to treat patients; (iii) an increase in treatment options being offered to patients; (iv) a perceived increase in treatment uptake by patients; and (v) greater job opportunities. The study showed a positive relationship between the learning experience and the perceived increase in confidence of clinicians. The increase in confidence manifested itself in better communication and clinical skills. PMID:29563422

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

PubMed

Murray, Marylou; Murray, Lois; Donnelly, Michael

2015-09-22

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

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

PubMed

Müller, M; Meyer, H; Stummer, H

2011-07-01

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

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

PubMed

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

2018-06-22

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

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

PubMed

Tait, Lynda; Michail, Maria

2014-12-15

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

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

PubMed Central

Knox, Stephanie A; Britt, Helena

2004-01-01

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

Clinical Considerations in Treating BDSM Practitioners: A Review.

PubMed

Dunkley, Cara R; Brotto, Lori A

2018-03-15

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

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

Code of Federal Regulations, 2010 CFR

2010-04-01

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

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

Code of Federal Regulations, 2010 CFR

2010-01-01

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

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

PubMed

Barlow, Ian M

2008-01-01

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

Workload: Measurement and Management

NASA Technical Reports Server (NTRS)

Gore, Brian Francis; Casner, Stephen

2010-01-01

Poster: The workload research project has as its task to survey the available literature on: (1) workload measurement techniques; and (2) the effects of workload on operator performance. The first set of findings provides practitioners with a collection of simple-to-use workload measurement techniques along with characterizations of the kinds of tasks each technique has been shown reliably address. This allows design practitioners to select and use the most appropriate techniques for the task(s) at hand. The second set of findings provides practitioners with the guidance they need to design for appropriate kinds and amounts of workload across all tasks for which the operator is responsible. This guidance helps practitioners design systems and procedures that ensure appropriate levels of engagement across all tasks, and avoid designs and procedures that result in operator boredom, complacency, loss of awareness, undue levels of stress, or skill atrophy that can result from workload that distracts operators from the tasks they perform and monitor, workload levels that are too low, too high, or too consistent or predictable. Only those articles that were peer reviewed, long standing and generally accepted in the field, and applicable to a relevant range of conditions in a select domain of interest, in analogous "extreme" environments to those in space were included. In addition, all articles were reviewed and evaluated on uni-dimensional and multi-dimensional considerations. Casner & Gore also examined the notion of thresholds and the conditions that may benefit mostly from the various methodological approaches. Other considerations included whether the tools would be suitable for guiding a requirement-related and design-related question. An initial review of over 225 articles was conducted and entered into an EndNote database. The reference list included a range of conditions in the domain of interest (subjective/objective measures), the seminal works in workload, as well as summary works

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

PubMed

Boyle, Eileen; Saunders, Rosemary; Drury, Vicki

2016-07-01

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

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

PubMed Central

Grol, R

1990-01-01

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

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

PubMed Central

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

1994-01-01

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

Problem solving therapy - use and effectiveness in general practice.

PubMed

Pierce, David

2012-09-01

Problem solving therapy (PST) is one of the focused psychological strategies supported by Medicare for use by appropriately trained general practitioners. This article reviews the evidence base for PST and its use in the general practice setting. Problem solving therapy involves patients learning or reactivating problem solving skills. These skills can then be applied to specific life problems associated with psychological and somatic symptoms. Problem solving therapy is suitable for use in general practice for patients experiencing common mental health conditions and has been shown to be as effective in the treatment of depression as antidepressants. Problem solving therapy involves a series of sequential stages. The clinician assists the patient to develop new empowering skills, and then supports them to work through the stages of therapy to determine and implement the solution selected by the patient. Many experienced GPs will identify their own existing problem solving skills. Learning about PST may involve refining and focusing these skills.

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

ERIC Educational Resources Information Center

Gladman, Justin; Perkins, David

2013-01-01

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

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

ERIC Educational Resources Information Center

Usher, Wayne

2009-01-01

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

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

ERIC Educational Resources Information Center

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

2008-01-01

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

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

ERIC Educational Resources Information Center

Koritsas, Stella; Iacono, Teresa; Davis, Robert

2012-01-01

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

Primary care--opportunities and threats. The changing meaning of the GP contract.

PubMed Central

Lewis, J.

1997-01-01

The meaning of the GP contract has changed since the last major upheaval in the mid-1960s. The government has always dealt with general practitioners as independent contractors, but the way in which it treated them in 1990 was entirely different from the way in which they were treated in 1966. In 1966, the profession's independent contractor status effectively served to protect professional autonomy. In 1990, with the change in the form of government towards a "contract state," general practitioners were treated as independent contractors more in the sense of business entrepreneurs. The article finishes by raising the issue of how general practitioners can gain control over the medicopolitical agenda in the future. PMID:9093110

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

PubMed

Colton, Caroline

2015-03-01

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

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

PubMed

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

2013-06-01

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

Health care of female outpatients in south-central India: comparing public and private sector provision.

PubMed

Bhatia, Jagdish; Cleland, John

2004-11-01

The object of this study was to compare components of quality of care provided to female outpatients by practitioners working in the private and public sectors in Karnataka State, India. Consultations conducted by 18 private practitioners and 25 public-sector practitioners were observed for 5 days using a structured protocol. Private practitioners were selected from members of the Indian Medical Association in a predominantly rural sub-district of Kolar District. Government doctors were selected from a random sample of hospitals and health centres in three sub-districts of Mysore District. A total of 451 private-sector and 650 public-sector consultations were observed; in each sector about half involved a female practitioner. The mean length of consultation was 2.81 minutes in the public sector and 6.68 minutes in the private sector. Compared with public-sector practitioners, private practitioners were significantly more likely to undertake a physical examination and to explain their diagnosis and prognosis to the patient. Privacy was much better in the private sector. One-third of public-sector patients received an injection compared with two-thirds of private patients. The mean cost of drugs dispensed or prescribed were Rupees 37 and 74 in public and private sectors, respectively. Both in terms of thoroughness of diagnosis and doctor-patient communication, the quality of care appears to be much higher in the private than in the public sector. However, over-prescription of drugs by private practitioners may be occurring.

[Use of health services for immigrants and native population: a systematic review].

PubMed

Carmona, Rocío; Alcázar-Alcázar, Raimundo; Sarria-Santamera, Antonio; Regidor, Enrique

2014-01-01

Spain was among the top immigration destinations globally between 1990 and 2005, becoming in 2006 in the European country with the highest net migration. As a result of the migration process and the living conditions in the host countries, immigrants' health may be affected. Limited research has investigated access and use of health services for this population. The aim of this study was to describe the scientific evidence on the use of general and specialist medical services for the immigrant population compared to the native. Systematic review. It has carried out a search of the national and international scientific literature of comparative studies on the use of general and specialist medical services among immigrant and native since 1994-2013. It was used the MEDLINE database as well as a manual search, no language limit or type of study. The methodological quality of the 29 studies included was evaluated. Subject, context, methodological and extrinsic characteristics were collected for comparison of the included studies. We selected 29 studies on the general practitioners' (9 from Spain) and 15 of specialist physician (7 from Spain), they mainly used health surveys as a source of information. Analyze both the attendance and contact with the general practitioner / specialist by nationality or country of birth (among others), mostly by adjusting variables of need and / or socioeconomic. Overall, the immigrant population in Spain have a similar use of general medical services than the native population, and less or similar use of the specialist physician services. These results are in line with studies in other countries.

A feasibility study for a clinical decision support system prompting HIV testing.

PubMed

Chadwick, D R; Hall, C; Rae, C; Rayment, Ml; Branch, M; Littlewood, J; Sullivan, A

2017-07-01

Levels of undiagnosed HIV infection and late presentation remain high globally despite attempts to increase testing. The objective of this study was to evaluate a risk-based prototype application to prompt HIV testing when patients undergo routine blood tests. Two computer physician order entry (CPOE) systems were modified using the application to prompt health care workers (HCWs) to add an HIV test when other tests selected suggested that the patient was at higher risk of HIV infection. The application was applied for a 3-month period in two areas, in a large London hospital and in general practices in Teesside/North Yorkshire. At the end of the evaluation period, HCWs were interviewed to assess the usability and acceptability of the prompt. Numbers of HIV tests ordered in the general practice areas were also compared before and after the prompt's introduction. The system was found to be both useable and generally acceptable to hospital doctors, general practitioners and nurse practitioners, with little evidence of prompt/alert fatigue. The issue of the prompt appearing late in the patient consultation did lead to some difficulties, particularly around discussion of the test and consent. In the general practices, around 1 in 10 prompts were accepted and there was a 6% increase in testing rates over the 3-month study period (P = 0.169). Using a CPOE-based clinical decision support application to prompt HIV testing appears both feasible and acceptable to HCWs. Refining the application to provide more accurate risk stratification is likely to make it more effective. © 2016 British HIV Association.

Improving general practitioner clinical records with a quality assurance minimal intervention.

PubMed Central

Del Mar, C B; Lowe, J B; Adkins, P; Arnold, E; Baade, P

1998-01-01

BACKGROUND: Although good medical records have been associated with good care, there is considerable room for their improvement in general practice. AIM: To improve the quality of general practice medical records at minimal cost. METHOD: A total of 150 randomly sampled general practitioners (GPs) in suburban Brisbane, Australia, were randomized in a controlled trial to receive or not receive an intervention. The intervention consisted of 6 to 12 one-hour monthly meetings when the pairs of GPs assessed samples of each other's medical records using a 12-item instrument. This was developed previously by a process of consensus of general practice teachers. Mean scores of 10 medical records selected at random from before the intervention started and one year later were compared. RESULTS: After the intervention, the increase in the total score (for which the maximum possible was 18) for the intervention GPs (from a baseline of 11.5 to 12.3) was not significantly greater than for the controls (from 11.4 to 11.7). Legibility and being able to determine the doctor's assessment of the consultation were significantly improved. The post-intervention increase of 1.06 (9.3%) of the total scores of the 47% of intervention GPs who complied with the intervention was significantly greater than that for the controls. CONCLUSION: The quality assurance activity improved some components of the quality of GPs' clinical records. However, the improvement was small, and the search for activities for Australian GPs that demonstrate an improvement in the quality of their practice must continue. Images p1311-a PMID:9747547

Sick notes, general practitioners, emergency departments and fracture clinics

PubMed Central

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

2007-01-01

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

Alcoholism and its treatment approach from a citizen perspective.

PubMed

Gual, Antoni; Arbesú, José Ángel; Zarco, José; López Pelayo, Hugo; Miquel, Laia; Bobes, Julio

2016-06-14

The main objective of the study is to describe alcohol consumption in the general Spanish population, to discover citizens' opinion on their alcohol consumption, on alcoholism and on treatment approaches.   In 2015 a cross-sectional study was carried out by means of a telephone survey. A representative sample was selected. Participants were asked about their alcohol consumption, their perception of risk regarding their pattern of alcohol consumption, about their opinion on alcoholism, alcohol consequences and the treatment approach. A questionnaire was designed. The Alcohol Use Disorders Identification Test-C was used to define the pattern of alcohol intake. A descriptive and an statistical inference analysis were done. 22.1% were classified as risky drinkers, with a higher proportion in young males. The majority of individuals think that alcoholism is an illness, and more than 75% agree that alcohol has negative consequences on health, social functioning, occupational functioning and family relationships. Furthermore, the perception of risk that citizens have regarding their own drinking pattern is high (37.6%). 67.7% considered that the general practitioner can manage alcoholism, with females and older people believing this most strongly. Alcohol consumption is very prevalent in the Spanish population, especially in young people (31.8%). The perception of alcohol risk is high. The majority agree with the fact that general practitioners are well prepared for treating alcohol problems.

21 CFR 1311.135 - Requirements for creating a controlled substance prescription.

Code of Federal Regulations, 2011 CFR

2011-04-01

... practitioner holds multiple DEA registrations, the practitioner or his agent must select the appropriate... chapter. (c) If required by State law, a supervisor's name and DEA number may be listed on a prescription...

A practitioner’s guide to interpersonal communication theory: An overview and exploration of selected theories

PubMed Central

Bylund, Carma L.; Peterson, Emily B.; Cameron, Kenzie A.

2011-01-01

Objective To provide a brief overview of selected interpersonal theories and models, and to present examples of their use in healthcare communication research. Results Nine interpersonal communication theories and their application to healthcare communication are discussed. Conclusion As healthcare communication interactions often occur at an interpersonal level, familiarity with theories of interpersonal communication may reinforce existing best practices and lead to the development of novel communication approaches with patients. Practice Implications This article serves as an introductory primer to theories of interpersonal communication that have been or could be applied to healthcare communication research. Understanding key constructs and general formulations of these theories may provide practitioners with additional theoretical frameworks to use when interacting with patients. PMID:22112396

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

PubMed

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

2001-10-27

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

Paediatric dental chair sedation: An audit of current practice in Gauteng, South Africa.

PubMed

Bham, F; Perrie, H; Scribante, J; Lee, C-A

2015-06-01

Procedural sedation and analgesia (PSA) is often required to perform dental procedures in children. Serious adverse outcomes, while rare, are usually preventable. To determine the proportion of dental practitioners making use of paediatric dental chair PSA in Gauteng Province, South Africa, describe their PSA practice, and determine compliance with recommended safety standards. A prospective, contextual, descriptive study design was used, with 222 randomly selected dental practitioners contacted to determine whether they offered paediatric dental chair PSA. Practitioners offering PSA were then asked to complete a web-based questionnaire assessing their practice. Of the 213 dental practitioners contacted, 94 (44.1%; 95% confidence interval 37 - 51) provided PSA to children. Most patients were 1 - 5 years old, although there were practices that offered PSA to infants. While most procedures were performed under minimal to moderate sedation, deep sedation and general anaesthesia were also administered in dental rooms. Midazolam was the most frequently used sedative agent, often in conjunction with inhaled nitrous oxide; 28.1% of PSA providers administered a combination of three or more agents. Presedation patient assessment was documented in 83.0% of cases, and informed consent for sedation was obtained in 75.6%. The survey raised several areas of concern regarding patient safety: 41.3% of dental practices did not use any monitoring equipment during sedation; the operator was responsible for the sedation and monitoring of the patient in 41.3%; 43.2% did not keep any recommended emergency drugs; and 19.6% did not have any emergency or resuscitation equipment available. Most respondents (81.8%) indicated an interest in sedation training. Paediatric dental chair PSA was offered by 44.1% of dental practitioners interviewed in Gauteng. Modalities of PSA provided varied between practices, with a number of safety concerns being raised.

Effects of Knowledge, Attitudes, and Practices of Primary Care Providers on Antibiotic Selection, United States

PubMed Central

Roberts, Rebecca M.; Albert, Alison P.; Johnson, Darcia D.; Hicks, Lauri A.

2014-01-01

Appropriate selection of antibiotic drugs is critical to optimize treatment of infections and limit the spread of antibiotic resistance. To better inform public health efforts to improve prescribing of antibiotic drugs, we conducted in-depth interviews with 36 primary care providers in the United States (physicians, nurse practitioners, and physician assistants) to explore knowledge, attitudes, and self-reported practices regarding antibiotic drug resistance and antibiotic drug selection for common infections. Participants were generally familiar with guideline recommendations for antibiotic drug selection for common infections, but did not always comply with them. Reasons for nonadherence included the belief that nonrecommended agents are more likely to cure an infection, concern for patient or parent satisfaction, and fear of infectious complications. Providers inconsistently defined broad- and narrow-spectrum antibiotic agents. There was widespread concern for antibiotic resistance; however, it was not commonly considered when selecting therapy. Strategies to encourage use of first-line agents are needed in addition to limiting unnecessary prescribing of antibiotic drugs. PMID:25418868

Tips from the toolkit: 1 - know yourself.

PubMed

Steer, Neville

2010-01-01

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

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

ERIC Educational Resources Information Center

Hillier, Yvonne

2010-01-01

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

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

PubMed

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

2009-08-01

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

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

PubMed

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

2015-05-01

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

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

PubMed

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

2005-04-01

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

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

PubMed

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

2015-07-12

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

[General practitioner and palliative sedation].

PubMed

Schweitzer, Bart

2014-01-01

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

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

PubMed

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

2013-05-01

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

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 post-fracture care was relatively high. Compared to baseline survey, patient-related barriers, patient non-adherence in particular, were more common. Prescribing conditions are still an important issue. Among GPs, education should be focused on calcium and vitamin D intake, doses, sources, and supplements.

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

ERIC Educational Resources Information Center

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

2018-01-01

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

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

ERIC Educational Resources Information Center

Usher, Wayne

2011-01-01

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

General practitioners and learning by audit

PubMed Central

Freeling, P.; Burton, R. H.

1982-01-01

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

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

ERIC Educational Resources Information Center

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

2011-01-01

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

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

ERIC Educational Resources Information Center

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

2016-01-01

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

The Unmet Need for Interpreting Provision in UK Primary Care

PubMed Central

Gill, Paramjit S.; Beavan, Jacqueline; Calvert, Melanie; Freemantle, Nick

2011-01-01

Background With increasing globalisation, the challenges of providing accessible and safe healthcare to all are great. Studies show that there are substantial numbers of people who are not fluent in English to a level where they can make best use of health services. We examined how health professionals manage language barriers in a consultation. Methods and Findings This was a cross-sectional study in 41 UK general practices . Health professionals completed a proforma for a randomly allocated consultation session. Seventy-seven (63%) practitioners responded, from 41(59%) practices. From 1008 consultations, 555 involved patients who did not have English as a first language; 710 took place in English; 222 were in other languages, the practitioner either communicating with the patient in their own language/using an alternative language. Seven consultations were in a mixture of English/patient's own language. Patients' first languages numbered 37 (apart from English), in contrast to health practitioners, who declared at least a basic level of proficiency in 22 languages other than English. The practitioner's reported proficiency in the language used was at a basic level in 24 consultations, whereas in 21, they reported having no proficiency at all. In 57 consultations, a relative/friend interpreted and in 6, a bilingual member of staff/community worker was used. Only in 6 cases was a professional interpreter booked. The main limitation was that only one random session was selected and assessment of patient/professional fluency in English was subjective. Conclusions It would appear that professional interpreters are under-used in relation to the need for them, with bilingual staff/family and friends being used commonly. In many cases where the patient spoke little/no English, the practitioner consulted in the patient's language but this approach was also used where reported practitioner proficiency was low. Further research in different setting is needed to substantiate these findings. PMID:21695146

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

PubMed

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

2014-01-01

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

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

PubMed

Gangler, Anne; Delva, Rémy; Gamelin, Eric

2013-04-01

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

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

PubMed

2009-01-01

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

[Gaining new knowledge in clinical practice].

PubMed

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

1999-01-30

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

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

PubMed

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

2004-03-01

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

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

PubMed Central

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

2016-01-01

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

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

PubMed Central

Armour, A.; Bharucha, H.

1997-01-01

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kreis, I.A.; Zihm, C.G.M.; Slob, W.

We evaluated an association between episodes of high SO{sub 2} pollution of the air and school absenteeism during a 2-y period. Data on absenteeism were collected from 84 elementary schools in the first year and 111 schools in the second year. The schools were selected for their proximity to air pollution monitoring stations. The data were used as a nonspecific, but sensitive health indicator. Sulfur dioxide was selected because it was almost continuously available. The correlation between SO{sub 2} and absenteeism was assessed using the Box-Jenkins approach for the analysis of time series to correct for autocorrelation within the timemore » series. Next, the data were recalculated to a weekly figure to correct for influenza epidemics, as indicated by a countrywide monitoring program of general practitioners. The country was divided into four regions in accordance with data on influenza. We used a first-order moving-average transfer model, which assumed the absenteeism due to influenza was in proportion to the data on influenza reported for the whole population. Using this model, absenteeism was estimated and subtracted from the observed absenteeism. The residuals were correlated with the data on air pollution after correction for autocorrelation. We found a relationship between absenteeism and air pollution, with a delay of 1 to 2 wk. There is a clear relationship between influenza as registered by the general practitioners and air pollution as indicated by the level of SO{sub 2}. After correction for influenza by the transfer model, the correlation between air pollution and school absenteeism is reduced to being barely significant.« less

Helping or hindering: the role of nurse managers in the transfer of practice development learning.

PubMed

Currie, Kay; Tolson, Debbie; Booth, Jo

2007-09-01

This paper reports selected findings from a recent PhD study exploring how graduates from a BSc Specialist Nursing programme, with an NMC-approved Specialist Practitioner Qualification, engage in practice development during their subsequent careers. The UKCC (1998) defines specialist practice as requiring higher levels of judgement, discretion and decision-making, with leadership in clinical practice development forming a core dimension of this level of practice. However, there is little evidence in the published literature that describes or evaluates the practice development role of graduate specialist practitioners. This study applied a modified Glaserian approach to grounded theory methods. A preliminary descriptive survey questionnaire was posted to all graduates from the programme, response rate of 45% (n=102). From these respondents, theoretical sampling decisions directed the selection of 20 participants for interview, permitting data saturation. The grounded theory generated by this study discovered a basic social process labelled 'making a difference', whereby graduate specialist practitioners are increasingly able to impact in developing patient care at a strategic level by coming to own the identity of an expert practitioner (Currie, 2006). Contextual factors strongly influence the practitioner journey, with organizational position and other people presenting enabling or blocking conditions. The line manager plays a crucial role in helping or hindering graduate specialist practitioners to transfer their learning to the clinical setting and become active in practice development. Recommendations to enhance managerial support for the practice development role of graduate specialist practitioners are proposed. ADDING TO CURRENT KNOWLEDGE: This work adds to currently limited knowledge of the graduate specialist practitioners' role in the leadership of clinical practice development. In addition, the findings emphasize the potential influence of the workplace environment by analyzing organizational factors in the specific context of the graduate specialist practitioner attempting to develop practice.

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

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

PubMed

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

2018-05-01

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

Work of female rural doctors.

PubMed

Wainer, Jo

2004-04-01

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

The Business Management Preceptorship within the Nurse Practitioner Program.

ERIC Educational Resources Information Center

Wing, Donna Marie

1998-01-01

A nurse practitioner business preceptorship provides students with knowledge of basic business, accounting, finance, economics, marketing, and reimbursement. A lack of qualified faculty can be offset with adjunct business faculty. Selection of placement sites should provide challenging management experiences. (SK)

The state of racial/ethnic diversity in North Carolina's health workforce.

PubMed

McGee, Victoria; Fraher, Erin

2012-01-01

Increasing the racial and ethnic diversity of the health care workforce is vital to achieving accessible, equitable health care. This study provides baseline data on the diversity of health care practitioners in North Carolina compared with the diversity of the state's population. We analyzed North Carolina health workforce diversity using licensure data from the respective state boards of selected professions from 1994-2009; the data are stored in the North Carolina Health Professions Data System. North Carolina's health care practitioners are less diverse than is the state's population as a whole; only 17% of the practitioners are nonwhite, compared with 33% of the state's population. Levels of diversity vary among the professions, which are diversifying slowly over time. Primary care physicians are diversifying more rapidly than are other types of practitioners; the percentage who are nonwhite increased by 14 percentage points between 1994 and 2009, a period during which 1,630 nonwhite practitioners were added to their ranks. The percentage of licensed practical nurses who are nonwhite increased by 7 percentage points over the same period with the addition of 1,542 nonwhite practitioners to their ranks. Nonwhite health professionals cluster regionally throughout the state, and 79% of them practice in metropolitan counties. This study reports on only a selected number of health professions and utilizes race/ethnicity data that were self-reported by practitioners. Tracking the diversity among North Carolina's health care practitioners provides baseline data that will facilitate future research on barriers to health workforce entry, allow assessment of diversity programs, and be useful in addressing racial and ethnic health disparities.

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

Building foundations for the future: the NHS Scotland advanced practice succession planning development pathway.

PubMed

Currie, Kay; Grundy, Maggie

2011-10-01

To highlight implications for managers from the implementation of a national advanced practice succession planning development pathway within Scotland. Internationally, advanced practice posts have often developed in an ad-hoc manner, with little organizational attention to succession planning. Evaluation of a pilot national succession planning development pathway identified mechanisms which facilitate or hamper effective planning for advanced practice roles. A responsive evaluation design incorporating semi-structured questionnaires to pathway participants (n = 15) and semi-structured telephone interviews with case-site pathway participants (n = 7) and their line managers. Managers believed the development pathway was worthwhile; however, there was limited strategic planning to match individuals' development to service need. Practitioners generally perceived managers as interested in their development, although levels of practical support varied. There is concern from both managers and practitioners regarding ongoing funding for advanced practice development. The present evaluation study reiterates the need for organizational commitment to succession planning including robust service needs analysis mechanisms and adequate funding for development processes. Nurse managers are viewed as the 'gatekeepers' to opportunities for developing advanced nurse practitioners; scare resources must be targeted effectively to support succession planning through the development of selected individuals for future advanced practice posts, justified by service need. © 2011 Blackwell Publishing Ltd.

The use of instruments by Iranian endodontics and general practioners.

PubMed

Elham, Farokh Gisour; Sedigheh, Zarmehi

2012-01-01

The current clinical practice of endodontics involves utilization of a variety of new technological advances and materials. Technologies available for use in endodontic offices today include battery or electric motors using NiTi rotary file systems, new generation of electronic apex locators (EALs), improved digital radiographic sensors, surgical microscopes, and ultrasonic units. The aim of this study was to determine the prevalence and use of newer technologies among Iranian dental practitioners. The population under study included the dental practitioners participating in the 49th and 50(th) Congress of Dentistry, who were selected with a simple sampling method. Data was collected by questionnaires which were completed by the participants in an anonymous manner. The contingency table and chi-squared test were used for data analysis by SPSS 13.5 software. A total of 700 dental practitioners participated in the study; NiTi rotary systems were used by 50.1%; electronic apex locators were often employed by 46.3%; 21.7% reported that ultrasonic units were often used. Only 1.1% frequently used surgical microscopes. Males and females differed with respect to the use of newer technologies (P<0.05). Based on the results of the present study, it seems necessary for dentists to take part in continuing dental education programs related to the newer technologies to improve their knowledge and practice.

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

Code of Federal Regulations, 2010 CFR

2010-04-01

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

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

PubMed

Ruston, Annmarie; Tavabie, Abdol

2011-01-01

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

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

PubMed

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

2018-05-01

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

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

PubMed

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

2018-01-01

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

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

PubMed Central

McIntosh, Jim; Horobin, Gordon

1978-01-01

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

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

PubMed

Daehli, B

1993-09-20

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

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

PubMed

Greenwood, M; Meechan, J G

2014-06-13

Dental practitioners need knowledge of the diagnosis and management of medical emergencies. This paper deals with the general aspects of emergency treatment including basic management principles which are applicable to all emergencies. The next paper in this series, part 3, deals with more specific aspects of medical emergency management.

Perceptions of interprofessional collaboration of general practitioners and community pharmacists - a qualitative study.

PubMed

Löffler, Christin; Koudmani, Carolin; Böhmer, Femke; Paschka, Susanne D; Höck, Jennifer; Drewelow, Eva; Stremme, Martin; Stahlhacke, Bernd; Altiner, Attila

2017-03-21

Despite numerous evidences for the positive effect of community pharmacists on health care, interprofessional collaboration of pharmacists and general practitioners is very often limited. Though highly trained, pharmacists remain an underutilised resource in primary health care in most western countries. This qualitative study aims at investigating pharmacists' and general practitioners' views on barriers to interprofessional collaboration in the German health care system. A total of 13 narrative in-depth interviews, and two focus group discussions with 12 pharmacists and general practitioners in Mecklenburg-Western Pomerania, a predominantly rural region of North-Eastern Germany, were conducted. The interviews aimed at exploring general practitioners' and pharmacists' attitudes, views and experiences of interprofessional collaboration. At a second stage, two focus group discussions were performed. Fieldwork was carried out by a multi-professional team. All interviews and focus group discussions were audio taped and transcribed verbatim. The constant comparative method of analysis from grounded theory was applied to the data. There are three main findings: First, mutual trust and appreciation appear to be important factors influencing the quality of interprofessional collaboration. Second, in light of negative personal experiences, pharmacists call for a predefined, clear and straightforward way to communicate with physicians. Third, given the increasing challenge to treat a rising number of elderly patients with chronic conditions, general practitioners desire competent support of experienced pharmacists. On the ground of methodological triangulation the findings of this study go beyond previous investigations and are able to provide specific recommendations for future interprofessional collaboration. First, interventions and initiatives should focus on increasing trust, e.g. by implementing multi-professional local quality circles. Second, governments and health authorities in most countries have been and still are reluctant in advancing political initiatives that bring together physicians and pharmacists. Proactive lobbying and empowerment of pharmacists are extremely important in this context. In addition, future physician and pharmaceutical training curricula should focus on comprehensive pharmacist-physician interaction at early stages within both professional educations and careers. Developing and fostering a culture of continued professional exchange and appreciation is one major challenge of future policy and research.

Medicines information provided by pharmaceutical representatives: a comparative study in Australia and Malaysia

PubMed Central

2010-01-01

Background Pharmaceutical representatives provide medicines information on their promoted products to doctors. However, studies have shown that the quality of this information is often low. No study has assessed the medicines information provided by pharmaceutical representatives to doctors in Malaysia and no recent evidence in Australia is present. We aimed to compare the provision of medicines information by pharmaceutical representatives to doctors in Australia and Malaysia. Methods Following a pharmaceutical representative's visit, general practitioners in Australia and Malaysia who had agreed to participate, were asked to fill out a questionnaire on the main product and claims discussed during the encounter. The questionnaire focused on provision of product information including indications, adverse effects, precautions, contraindications and the provision of information on the Pharmaceutical Benefit Scheme (PBS) listings and restrictions (in Australia only). Descriptive statistics were produced. Chi-square analysis and clustered linear regression were used to assess differences in Australia and Malaysia. Results Significantly more approved product information sheets were provided in Malaysia (78%) than in Australia (53%) (P < 0.001). In both countries, general practitioners reported that indications (Australia, 90%, Malaysia, 93%) and dosages (Australia, 76%, Malaysia, 82%) were frequently provided by pharmaceutical representatives. Contraindications, precautions, drug interactions and adverse effects were often omitted in the presentations (range 25% - 41%). General practitioners in Australia and Malaysia indicated that in more than 90% of presentations, pharmaceutical representatives partly or fully answered their questions on contraindications, precautions, drug interactions and adverse effects. More general practitioners in Malaysia (85%) than in Australia (60%) reported that pharmaceutical representatives should have mentioned contraindications, precautions for use, drug interaction or adverse effects spontaneously (P < 0.001). In 48% of the Australian presentations, general practitioners reported the pharmaceutical representatives failed to mention information on PBS listings to general practitioners. Conclusions Information on indications and dosages were usually provided by pharmaceutical representatives in Australia and Malaysia. However, risk and harmful effects of medicines were often missing in their presentations. Effective control of medicines information provided by pharmaceutical representatives is needed. PMID:21118551

The modernisation of general practice in the UK: 1980 to 1995 and beyond. Part I.

PubMed Central

Iliffe, S.

1996-01-01

The UK is unusual in providing universal free healthcare in which access to specialists is largely controlled by general practitioners with 24-hour responsibility, throughout the year, for a defined list of patients of all ages. It is generally considered that this gatekeeper function has contributed to the relatively low cost of the National Health Service, but major changes in the organisation and clinical role of general practitioners have occurred, culminating in a new contract that aims to re-orientate general practice towards health promotion, disease prevention and the management of chronic disease. The implications of these changes are discussed. PMID:8733525

[Assessment of patient care needs in general practice].

PubMed

Laubach, W; Schmidt, R; Fischbeck, S; Röhrig, B; Jansky, M

2012-02-01

In the German health system general practice has changed drastically in the past few years and patients' opportunities to get medical informations have increased significantly. In light of this, patients' needs in general practice should be re-assessed. 279 patients from 16 practices mainly in Hessen and Rhineland-Palatinate were interviewed. Using principal factor analysis, 51 questions about doctors were analyzed regarding possible dimensions of patient care needs. The dimensions of patient care needs could be described with four scales: (1) social situation and emotional support, (2) the practitioner's expertise, explanations and information, (3) empathy and esteem for patients and (4) availability of the practitioner and care to chronic patients. In older age groups the importance of psychosocial care was emphasized as well as the practitioner's availability and care for patients with chronic diseases. Patient care needs are concentrated in four scales, which include psychosocial and continuous care and availability for patients with chronic diseases. These tasks should be further emphasized in medical education and also represented in the remuneration of practitioners. © Georg Thieme Verlag KG Stuttgart · New York.

Specialization and competition in dental health services.

PubMed

Grytten, Jostein; Skau, Irene

2009-04-01

The number of specialists within dental health services has increased over the last few years. This raises the issue of how the services should be organized and funded. We describe the effect of one way of organizing the services, which is by relying on competition. In Norway, some oral specialists face real competition with general dental practitioners for the same patients (prosthetists, periodontists and endodontists), while other specialists do not (orthodontists and oral surgeons). The latter specialists have skills that give them exclusive possibilities to practice their profession. We find that competition can be effective for the specialists who experience real competition with general dental practitioners for patients. In situations where real competition does not exist, specialists can obtain market power and raise their fees. Our results are based on an analysis of a representative set of data from general dental practitioners and specialists in Norway. The specialities in which practitioners can exercise market power raise challenges related to the type of public policy that can reduce this market power in an appropriate way, and without involving too large costs for the authorities. (c) 2008 John Wiley & Sons, Ltd.

Social Case-work in General Practice: An Alternative Approach

PubMed Central

Ratoff, L.; Pearson, Barbara

1970-01-01

During a two-year period a senior case-worker was seconded by a voluntary family case-work agency, the Liverpool Personal Service Society, to work with three general practitioners. The commonest reasons for referral of the 157 new patients to the social worker over this study period were extreme poverty; housing, matrimonial, and psychiatric problems; and problems of fatherless families. The successful and valuable co-operation between the general practitioners, case-worker, and various specialist professional and financial services of the Society have proved that a professional social worker has an important role in the general-practice team. PMID:5420213

Randomised clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow up.

PubMed Central

Koes, B. W.; Bouter, L. M.; van Mameren, H.; Essers, A. H.; Verstegen, G. M.; Hofhuizen, D. M.; Houben, J. P.; Knipschild, P. G.

1992-01-01

OBJECTIVE--To compare the effectiveness of manipulative therapy, physiotherapy, treatment by the general practitioner, and placebo therapy in patients with persistent non-specific back and neck complaints. DESIGN--Randomised clinical trial. SETTING--Primary health care in the Netherlands. PATIENTS--256 patients with non-specific back and neck complaints of at least six weeks' duration who had not received physiotherapy or manipulative therapy in the past two years. INTERVENTIONS--At the discretion of the manipulative therapists, physiotherapists, and general practitioners. Physiotherapy consisted of exercises, massage, and physical therapy (heat, electrotherapy, ultrasound, shortwave diathermy). Manipulative therapy consisted of manipulation and mobilisation of the spine. Treatment by general practitioners consisted of drugs (for example, analgesics), advice about posture, home exercises, and (bed)rest. Placebo treatment consisted of detuned shortwave diathermy (10 minutes) and detuned ultrasound (10 minutes). MAIN OUTCOME MEASURES--Changes in severity of the main complaint and limitation of physical functioning measured on 10 point scales by a blinded research assistant and global perceived effect measured on a 6 point scale by the patients. RESULTS--Many patients in the general practitioner and placebo groups received other treatment during follow up. Improvement in the main complaint was larger with manipulative therapy (4.5) than with physiotherapy (3.8) after 12 months' follow up (difference 0.9; 95% confidence interval 0.1 to 1.7). Manipulative therapy also gave larger improvements in physical functioning (difference 0.6; -0.1 to 1.3). The global perceived effect after six and 12 months' follow up was similar for both treatments. CONCLUSIONS--Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months. PMID:1532760

Physician-reported practices on continuous deep sedation until death: A descriptive and comparative study.

PubMed

Papavasiliou, Evangelia Evie; Chambaere, Kenneth; Deliens, Luc; Brearley, Sarah; Payne, Sheila; Rietjens, Judith; Vander Stichele, Robert; Van den Block, Lieve

2014-06-01

Research on continuous deep sedation until death has focused on estimating prevalence and describing clinical practice across care settings. However, evidence on sedation practices by physician specialty is scarce. To compare and contrast physician-reported practices on continuous deep sedation until death between general practitioners and medical specialists. A secondary analysis drawing upon data from a large-scale, population-based, retrospective survey among physicians in Flanders, Belgium in 2007. Symptom prevalence and characteristics of sedation (drugs used, artificial nutrition and hydration administered, intentions, and decision-making) were measured. Response rate was 58.4%. The frequency of continuous deep sedation until death among all deaths was 11.3% for general practitioners and 18.4% for medical specialists. General practitioners reported significantly higher rates of severity and mean intensity of pain, delirium, dyspnea, and nausea in the last 24 h of life for sedated patients and a higher number of severe symptoms than medical specialists. No differences were found between groups in the drugs used, except in propofol, reported only by medical specialists (in 15.8% of all cases). Artificial nutrition and hydration was withheld or withdrawn in 97.2% of general practitioner and 36.2% of medical specialist cases. Explicit life-shortening intentions were reported by both groups (for 3%-4% of all cases). Continuous deep sedation until death was initiated without consent or request of either the patient or the family in 27.9% (medical specialists) and 4.7% (general practitioners) of the cases reported. Considerable variation, often largely deviating from professional guidelines, was observed in physician-reported performance and decision-making, highlighting the importance of providing clearer guidance on the specific needs of the context in which continuous deep sedation until death is to be performed. © The Author(s) 2014.

[Hospitalisation Rates and Duration of Hospital Stays of Patients from an Ambulatory Health Centre Compared to Traditional General Practices - A Practical Example].

PubMed

Woebkenberg, J; Schneider, N

2015-06-01

The reduction of treatment costs in the health-care system is a great challenge for all participating persons and institutions in Germany. In particular, we notice an evident increase in the costs of hospitalisation treatment in the last 20 years. The reduction of a further increase in stationary treatment costs by reducing the hospitalisation rate and the duration of stationary treatment as managed by cooperation of general practitioners and medical specialists could be an important possibility. Is it possible to reduce the hospitalisation rate and the duration of the hospital treatment by cooperation of general practitioners and internal specialists in an ambulatory health centre? The hospitalisation rate and the average duration of the stationary treatment of the "Praxisgemeinschaft" (PG) of the "Gesundheitscentrum Damme" (GCD) at the local hospital were retrospectively analysed for the years 2002 up to 2011 and compared with the data of the remaining general practitioner offices and the data of the "Deutsche Krankenhausstatistik" (German Hospital statistics). We did indeed find a slight increase for the hospitalisation rate from 0.012 to 0.019% of all the ambulant treated patient cases of the PG; but this increase was statistically significantly lower compared with the results of the remaining practitioner offices of the local area as well the data of the "Deutsche Krankenhausstatistik". Similarly, the duration of hospital treatment for the patients of the PG could be significantly more reduced from 10.80 to 6.49 days compared to the results of the 2 other above-mentioned groups. Both the hospitalisation rate as well as the duration of hospital treatment can significantly reduced by cooperation of general practitioner and internal specialist in an ambulatory health centre. © Georg Thieme Verlag KG Stuttgart · New York.

[The relationships between the general practitioner and the oncological radiotherapist. A preliminary study by telephone interviews].

PubMed

Baio, A; Cavallini Francolini, D; Corbella, F; De Vecchi, P; Ragone, L; Tinelli, C; Franchini, P

1999-11-01

We addressed the issue of the relationship between the general practitioner (GP) and the radiotherapist to improve the quality of care of cancer patients. The study consisted in evaluating medical requests and phone interviews, with a questionnaire with yes/no and multiple choice answers to the following 5 questions: 1) Do you think a cancer diagnosis is always a hopeless death sentence? 2) Is it professionally rewarding to cure a cancer patient? 3) Are you satisfied with your relationship, as a general practitioner, with oncologic reference centers? 4) Is it more wearing for a general practitioner to manage a cancer than a noncancer patient? 5) Would you answer a questionnaire about the relationship between the general practitioner, the cancer patient and the oncologist? We evaluated 1590 medical requests and made 401 phone interviews; 255 colleagues (70%) answered the questionnaire. Medical requests were correctly and completely formulated by GPs in 45% of cases. A cancer diagnosis was not considered a hopeless death sentence in 90.9% of cases and 76% of GPs considered it professionally rewarding to cure a cancer patient. 75.6% of GPs considered it more wearing to manage a cancer than a noncancer patient, and female GPs felt this more strongly than their male counterparts. Irrespective of gender, GPs over 50 years of age tend to consider cancer a hopeless and fatal disease. The relationship with oncologic centers was considered satisfactory in 86.2% of cases. However, since cancer patients need greater medical care, GPs would like a closer cooperation with oncologists. The great interest GPs took in this study encourages further investigation through a more in depth questionnaire designed with the help of GPs themselves and interested statisticians.

Challenges for IT-supported shared care: a qualitative analyses of two shared care initiatives for diabetes treatment in Denmark “I'll never use it” (GP5).

PubMed Central

Granlien, Maren Fich; Simonsen, Jesper

2007-01-01

Purpose To investigate the circumstances as to why it is so difficult in the primary care sector to implement IT based infrastructures supporting shared care. Case study The qualitative analysis includes two separate case studies of IT-supported shared care implemented in two different regions of Denmark throughout 2005. The study comprises 21 interviews and 35 hours of observations. The data were analysed through a coding process that led to the emergence of three main challenges impeding the organisational implementation of IT-supported shared care. Discussion and conclusion The two cases faced the same challenges that led to the same problem: The secondary care sector quickly adopted the system while the primary sector was far more sceptical towards using it. In both cases, we observe a discrepancy of needs satisfied, especially with regard to the primary care sector and its general practitioners which hinder bridging the primary sector (general practitioners) and the secondary sector (hospitals and outpatient clinics). Especially the needs associated with the primary sector were not being satisfied. We discovered three main challenges related to bridging the gap between the two sectors: (1) Poor integration with the general practitioners' existing IT systems; (2) low compatibility with general practitioners' work ethic; (3) and discrepancy between the number of diabetes patients and the related need for shared care. We conclude that development of IT-supported shared care must recognise the underlying and significant differences between the primary and secondary care sectors: If IT-supported shared care does not meet the needs of the general practitioners as well as the needs of the secondary care sector the initiative will fail. PMID:17627300

The working hours of general practitioners 2000-2008.

PubMed

Aasland, Olaf G; Rosta, Judith

2011-06-03

There is little reliable information available on the working hours of general practitioners (GPs). The purpose of our study is to describe the development of weekly working hours of Norwegian general practitioners in the period from 2000 to 2008, as well as the length of their patient lists and their perceived workload. General practitioners in the reference panel of the Research Institute of the Norwegian Medical Association have reported their weekly working hours for 2000, 2002, 2004, 2006 and 2008, and the length of their patient lists for 2002 and 2008. We used non-overlapping 95 per cent confidence intervals for testing inter-group differences in interval variables and proportions. From 227 to 316 general practitioners responded to each survey round. Average weekly working hours constituted 45.1 hours (95 per cent CI: 43.6-46.5 hours) in 2000 and 46.4 hours (95 per cent CI: 45.2-47.6 hours) in 2008. The number of hours increased for women GPs, while the number of hours remained basically unchanged for men from 2000 to 2008. Average length of the patient lists in 2002 and 2008 constituted 1,325 and 1,278 for men, and 1,155 and 1,144 for women GPs respectively. The proportion of GPs who responded that they perceived their workload as unacceptable decreased significantly, from 38.1 per cent in 2000 to 25.5 per cent in 2008. Average weekly working hours for GPs increased by approximately one hour from 2000 to 2008, and this increase is found mainly among women GPs. We believe that the reduction in the proportion reporting to have an unacceptable workload can be explained by the introduction of the list-patient system, which has given the doctors better control of their own workload.

Attitudes towards treatment among patients suffering from sleep disorders. A Latin American survey.

PubMed

Blanco, Margarita; Kriguer, Norberto; Pérez Lloret, Santiago; Cardinali, Daniel P

2003-11-20

Although sleep disorders are common, they frequently remain unnoticed by the general practitioner. Few data are available about the willingness and reasons of patients with sleep disturbances to seek for medical assistance. The results of a cross-sectional community-based multinational survey in three major Latin American urban areas, i.e. Buenos Aires, Mexico City and Sao Paulo, are reported. Two-hundred subjects suffering sleep disturbances and 100 non-sufferers were selected from the general population in each city (total number: 600 sufferers vs. 300 non-sufferers). A structured interview was conducted, sleep characteristics, feelings about sleep disturbances and strategies to cope with those problems being recorded. Data were analyzed by employing either t-test or analysis of variance (ANOVA) to the Z-transformed proportions. 22.7 +/- 3.5 % (mean +/- SEM) of subjects reported to suffer from sleep disturbances every night. About 3 out of 4 (74.2 +/- 2.0 %) considered their disorder as mild and were not very concerned about it. Only 31 +/- 2 % of sufferers reported to have sought for medical help. Although 45 +/- 2 % of sufferers reported frequent daily sleepiness, trouble to remember things, irritability and headaches, they did not seek for medical assistance. Among those patients who saw a physician with complaints different from sleep difficulties only 1 out of 3 (33 +/- 2 % of patients) were asked about quality of their sleep by the incumbent practitioner. Strategies of patients to cope with sleep problems included specific behaviors (taking a warm bath, reading or watching TV) (44 +/- 1.6 %), taking herbal beverages (17 +/- 1.2 %) or taking sleeping pills (10 +/- 1.1 %). Benzodiazepines were consumed by 3 +/- 0.6 % of sufferers. Public educational campaigns on the consequences of sleep disorders and an adequate training of physicians in sleep medicine are needed to educate both the public and the general practitioners about sleep disorders.

Acupuncture in Australian general practice: trends in reimbursed acupuncture services from 1995 to 2011.

PubMed

Wardle, Jonathan Lee; Adams, Jon; Sibbritt, David William

2013-03-01

To ascertain the extent of and trends in the use of acupuncture in Australian general practice and the characteristics of patients receiving publicly subsidised acupuncture services from general practitioners (GPs). Secondary analysis of national patient Medicare data for claims by all non-specialist medical practitioners for Medicare Benefits Schedule items for an attendance where acupuncture was performed by a medical practitioner from 1995 to 2011. Use of acupuncture by GPs, patients' sex and age and the socioeconomic disadvantage index of GP's practice. There has been a 47.7% decline in the number of acupuncture claims by GPs per 100 000 population in the period from 1995 to 2011. Acupuncture claims were made by 3.4% of GPs in 2011. Women were almost twice as likely to receive acupuncture from a GP as men, and patients in urban areas were more than twice as likely to receive acupuncture from a GP as patients in rural areas. Acupuncture claims were highest in areas that were socioeconomically advantaged. Claims for reimbursement for acupuncture by GPs have declined significantly in Australian general practice even though the use of acupuncture by the Australian public has increased. This may be due to increased use of referrals or use of non-medical practitioners, barriers to acupuncture practice in general practice or non-specific factors affecting reimbursement for non-vocationally registered GPs.

A novel adjuvant to the resident selection process: the hartman value profile.

PubMed

Cone, Jeffrey D; Byrum, C Stephen; Payne, Wyatt G; Smith, David J

2012-01-01

The goal of resident selection is twofold: (1) select candidates who will be successful residents and eventually successful practitioners and (2) avoid selecting candidates who will be unsuccessful residents and/or eventually unsuccessful practitioners. Traditional tools used to select residents have well-known limitations. The Hartman Value Profile (HVP) is a proven adjuvant tool to predicting future performance in candidates for advanced positions in the corporate setting. No literature exists to indicate use of the HVP for resident selection. The HVP evaluates the structure and the dynamics of an individual value system. Given the potential impact, we implemented its use beginning in 2007 as an adjuvant tool to the traditional selection process. Experience gained from incorporating the HVP into the residency selection process suggests that it may add objectivity and refinement in predicting resident performance. Further evaluation is warranted with longer follow-up times.

A Novel Adjuvant to the Resident Selection Process: the Hartman Value Profile

PubMed Central

Cone, Jeffrey D.; Byrum, C. Stephen; Payne, Wyatt G.; Smith, David J.

2012-01-01

Objectives: The goal of resident selection is twofold: (1) select candidates who will be successful residents and eventually successful practitioners and (2) avoid selecting candidates who will be unsuccessful residents and/or eventually unsuccessful practitioners. Traditional tools used to select residents have well-known limitations. The Hartman Value Profile (HVP) is a proven adjuvant tool to predicting future performance in candidates for advanced positions in the corporate setting. Methods: No literature exists to indicate use of the HVP for resident selection. Results: The HVP evaluates the structure and the dynamics of an individual value system. Given the potential impact, we implemented its use beginning in 2007 as an adjuvant tool to the traditional selection process. Conclusions: Experience gained from incorporating the HVP into the residency selection process suggests that it may add objectivity and refinement in predicting resident performance. Further evaluation is warranted with longer follow-up times. PMID:22720114

The medical profession and changing attitudes towards advertising and competition.

PubMed

Bell, J D; Fay, M T

1991-02-27

This paper examines the attitudes of general medical practitioners towards competition and advertising and the changes that have occurred between 1985 and 1988. The data was derived from a self completion questionnaire, 1500 of which were evenly distributed among the members of five professions; doctors, dentists, lawyers, accountants and veterinarians. General practitioners are now favourably disposed towards advertising by the profession as a whole in an effort to increase awareness of medical services (70% in favour in 1988 compared to only 53% in 1985), but the perceived need for increased business efficiency has lessened (70% in 1988 compared to 78% in 1985). Collegiality continues to be the dominant ideology but this position has weakened slightly. In 1988 only 65% of general practitioners regarded other members of the profession as colleagues rather than competitors, compared to 73% in 1985.

[Hyperkalemia - what the general practitioner must know].

PubMed

Schnyder, Aurelia; Hüsler, Carina; Binet, Isabelle

2015-03-25

Hyperkalemia can be a challenge for the general practitioner as it can prove to be benign as well as life-threatening. From a diagnostic point of view, four possibilities have to be differenciated: a pre-analytical cause, potassium release through cell lysis, a potassium shift, a reduced renal excretion of potassium. The first differential diagnosis can often be carried out by a thorough medical history, in particular the medication intake. Also, the first clinical and laboratory investigations can take place at the general practitioner's clinic. If the hyperkalemia proves to be a true hyperkalemia or cannot be explained by poly-medication and known diseases of the patient, not yet identified renal, endocrine or cardiac diseases should be searched for. If a serious condition is identified as the cause of hyperkalemia the patient should be referred to a specialized clinic.

Interest in dental implantology and preferences for implant therapy: a survey of Victorian dentists.

PubMed

Cheung, M C; Kao, Plh; Lee, N; Sivathasan, D; Vong, C W; Zhu, J; Polster, A; Darby, I

2016-12-01

The purpose of this study was to gauge dentists' interest, knowledge and training in implantology, and to compare their treatment preferences with current literature. Subsequently, this information may be used to evaluate implantology education pathways. A cross-sectional postal survey of 600 randomly selected dentists registered with the Dental Practice Board of Victoria was conducted. Respondents were asked about background, interest and training in implantology, and implant treatment preferences. Results were analysed according to primary practice location, decade of graduation and attendance at continuing professional development (CPD) programmes. One hundred and seventy-six questionnaires were included for analysis. In general, dentists rate their implant knowledge, interest and enjoyment in restoring implants favourably. No differences were found between city and country practitioners, and different graduation decades. The level of CPD significantly influenced treatment preferences. Practitioners were generally unwilling to treat patients taking bisphosphonates, or to perform grafting procedures. Most dentists provide common services to treat peri-implant conditions. Direct-to-fixture is the most popular fixture-abutment connection. Overall, there is a high level of implant knowledge corresponding to current evidence in the literature. Level of CPD attendance is the most important factor in dentists' willingness to provide more implant therapy options. © 2016 Australian Dental Association.

Rural anaesthetic audit 2006 to 2010.

PubMed

Mills, P D; Newbury, J

2012-03-01

In order to review anaesthetic morbidity in our remote rural hospital, a retrospective audit of all anaesthetic records was undertaken for a five-year period between 2006 and 2010. Eight hundred and eighty-nine anaesthetic records were reviewed. The patients were all American Society of Anaesthesiologists physical status I to III. Ninety-eight percent of the anaesthetics were performed by general practitioner (non-specialist) anaesthetists. There were no anaesthetic deaths or serious adverse outcomes reported over this period. Sixteen intraoperative and seven postoperative problems were documented, but all were resolved uneventfully. The most common problems documented were difficult intubation (n=9) and respiratory depression (n=3). Within the limitations of this retrospective audit, these findings indicate that general practitioner anaesthetists provided safe anaesthesia in a remote rural hospital. It is our opinion that the case selection, prior experience of anaesthetic and theatre staff, stable nursing workforce and the use of protocols were important factors in determining the low rate of adverse events. However, we caution against over-interpretation of the data, given its retrospective nature, relatively small sample size, reliance on case records and the absence of agreed definitions for adverse events. We would also like to encourage all anaesthetic services, however remote, to audit their results as part of ongoing quality assurance.

Strength of primary care service delivery: a comparative study of European countries, Australia, New Zealand, and Canada.

PubMed

Pavlič, Danica R; Sever, Maja; Klemenc-Ketiš, Zalika; Švab, Igor; Vainieri, Milena; Seghieri, Chiara; Maksuti, Alem

2018-05-01

AimWe sought to examine strength of primary care service delivery as measured by selected process indicators by general practitioners from 31 European countries plus Australia, Canada, and New Zealand. We explored the relation between strength of service delivery and healthcare expenditures. The strength of a country's primary care is determined by the degree of development of a combination of core primary care dimensions in the context of its healthcare system. This study analyses the strength of service delivery in primary care as measured through process indicators in 31 European countries plus Australia, New Zealand, and Canada. A comparative cross-sectional study design was applied using the QUALICOPC GP database. Data on the strength of primary healthcare were collected using a standardized GP questionnaire, which included 60 questions divided into 10 dimensions related to process, structure, and outcomes. A total of 6734 general practitioners participated. Data on healthcare expenditure were obtained from World Bank statistics. We conducted a correlation analysis to analyse the relationship between strength and healthcare expenditures.FindingsOur findings show that the strength of service delivery parameters is less than optimal in some countries, and there are substantial variations among countries. Continuity and comprehensiveness of care are significantly positively related to national healthcare expenditures; however, coordination of care is not.

Family physician practice visits arising from the Alberta Physician Achievement Review

PubMed Central

2013-01-01

Background Licensed physicians in Alberta are required to participate in the Physician Achievement Review (PAR) program every 5 years, comprising multi-source feedback questionnaires with confidential feedback, and practice visits for a minority of physicians. We wished to identify and classify issues requiring change or improvement from the family practice visits, and the responses to advice. Methods Retrospective analysis of narrative practice visit reports data using a mixed methods design to study records of visits to 51 family physicians and general practitioners who participated in PAR during the period 2010 to 2011, and whose ratings in one or more major assessment domains were significantly lower than their peer group. Results Reports from visits to the practices of family physicians and general practitioners confirmed opportunities for change and improvement, with two main groupings – practice environment and physician performance. For 40/51 physicians (78%) suggested actions were discussed with physicians and changes were confirmed. Areas of particular concern included problems arising from practice isolation and diagnostic conclusions being reached with incomplete clinical evidence. Conclusion This study provides additional evidence for the construct validity of a regulatory authority educational program in which multi-source performance feedback identifies areas for practice quality improvement, and change is encouraged by supplementary contact for selected physicians. PMID:24010980

Integrated care for asthma: a clinical, social, and economic evaluation. Grampian Asthma Study of Integrated Care (GRASSIC)

PubMed Central

1994-01-01

OBJECTIVES--To evaluate integrated care for asthma in clinical, social, and economic terms. DESIGN--Pragmatic randomised trial. SETTING--Hospital outpatient clinics and general practices throughout the north east of Scotland. PATIENTS--712 adults attending hospital outpatient clinics with a diagnosis of asthma confirmed by a chest physician and pulmonary function reversibility of at least 20%. MAIN OUTCOME MEASURES--Use of bronchodilators and inhaled and oral steroids; number of general practice consultations and hospital admissions for asthma; sleep disturbance and other restrictions on normal activity; psychological aspects of health including perceived asthma control; patient satisfaction; and financial costs. RESULTS--After one year there were no significant overall differences between those patients receiving integrated asthma care and those receiving conventional outpatient care for any clinical or psychosocial outcome. For pulmonary function, forced expiratory volume was 76% of predicted for integrated care patients and 75% for conventional outpatients (95% confidence interval for difference -3.6% to 5.0%). Patients who had experienced integrated care were more likely to select it as their preferred course of future management (75% (251/333) v 62% (207/333) (6% to 20%)); they saved 39.52 pounds a year. This was largely because patients in conventional outpatient care consulted their general practitioner as many times as those in integrated care, who were not also visiting hospital. CONCLUSION--Integrated care for moderately severe asthma patients is clinically as effective as conventional outpatient care, cost effective, and an attractive management option for patients, general practitioners, and hospital consultants. PMID:8148678

Are We in Sync? How Industry Practitioners and Academics Profile Managerial Competencies: A Study of an Association to Advance Collegiate Schools of Business-Accredited Business School in Hong Kong

ERIC Educational Resources Information Center

Ko, Stephen; Chan, Simon C. H.

2017-01-01

The authors draw on the taxonomy of managerial competencies to assess the alignment of perceptions between industry practitioners and business academics when profiling managerial competencies required for effective performance in workplaces. Findings show that the set of managerial competency profiles, as viewed by practitioners, generally fit…

Coalition of attitude and practice behaviors among dental practitioners regarding pregnant patient's oral health and pregnant patient's perception toward oral health in and around Pondicherry.

PubMed

Jeelani, S; Khader, K Abdul; Rangdhol, R Vishwanath; Dany, A; Paulose, Swetha

2015-08-01

This study aims to evaluate the knowledge, attitude, practice behaviors among general dental practitioners and assess the perception toward oral health by pregnant patients in and around Puducherry. A self-designed and structured questionnaire was used to obtain information from the dental practitioner and the pregnant patients. The majority of the dental practitioners had a lack of knowledge, attitude, practice behaviors regarding pregnant patient's oral health and similarly majority of pregnant patient's perception toward oral health was poor. Drowning and dilemmatic attitude and practice behavior of dentists to be streamlined to render right care to the pregnant women at the right time. Perplexing perception toward oral health care by pregnant women to be overcome to orient them to understand the impact of oral health on their general systemic health.

Continuous-time discrete-space models for animal movement

USGS Publications Warehouse

Hanks, Ephraim M.; Hooten, Mevin B.; Alldredge, Mat W.

2015-01-01

The processes influencing animal movement and resource selection are complex and varied. Past efforts to model behavioral changes over time used Bayesian statistical models with variable parameter space, such as reversible-jump Markov chain Monte Carlo approaches, which are computationally demanding and inaccessible to many practitioners. We present a continuous-time discrete-space (CTDS) model of animal movement that can be fit using standard generalized linear modeling (GLM) methods. This CTDS approach allows for the joint modeling of location-based as well as directional drivers of movement. Changing behavior over time is modeled using a varying-coefficient framework which maintains the computational simplicity of a GLM approach, and variable selection is accomplished using a group lasso penalty. We apply our approach to a study of two mountain lions (Puma concolor) in Colorado, USA.

The pattern of clinical advice sought by general practitioners from a medical consultant in clinical biochemistry.

PubMed Central

Bhatnagar, D

1997-01-01

Clinical biochemistry departments can be a valuable source of clinical advice for further investigations and the need for referral to specialist clinics. This paper outlines the pattern of clinical advice sought by general practitioners in a district hospital setting, and addresses some of the issues regarding seeking such advice and the implications for continuing medical education and training. PMID:9196966

The specialty of family dentistry: a future for general dental practitioners?

PubMed

Li, R W; Chow, T W

2004-01-01

A new Specialty in dentistry, Family Dentistry, has been established to provide a structured, co-ordinated training for general dental practitioners who are the major oral health service providers. The training emphasizes the importance of continuing and comprehensive care, the interface between primary and secondary care, the relationship between the patient and his/her family and the community, and a holistic approach in treatment planning and delivery.

Roles of General Practitioners in the Provision of Health Care Services for People with Intellectual Disabilities: A National Census in Taiwan

ERIC Educational Resources Information Center

Lin, Jin-Ding; Hsu, Shang-Wei; Yen, Chia-Feng; Chou, Ying-Ting; Wu, Chia-Ling; Chu, Cordia M.; Loh, Ching-Hui

2009-01-01

Aims: The aims of the present study were to explore the perceptions of general practitioners (GPs) in the provision of health care services for people with intellectual disabilities and to analyse GPs' priorities in the delivery of health care services to this group of people in Taiwan. Methods: The study employed a cross-sectional design and was…

Does Media Use Result in More Active Communicators? Differences Between Native Dutch and Turkish-Dutch Patients in Information-Seeking Behavior and Participation During Consultations With General Practitioners.

PubMed

Schinkel, Sanne; Van Weert, Julia C M; Kester, Jorrit A M; Smit, Edith G; Schouten, Barbara C

2015-08-01

This study investigates differences between native Dutch and Turkish-Dutch patients with respect to media usage before and patient participation during medical consultations with general practitioners. In addition, the authors assessed the relation between patient participation and communication outcomes. The patients were recruited in the waiting rooms of general practitioners, and 191 patients (117 native Dutch, 74 Turkish-Dutch) completed pre- and postconsultation questionnaires. Of this sample, 120 patients (62.8%; 82 native Dutch, 38 Turkish-Dutch) agreed to have their consultations recorded to measure patient participation. Compared with Turkish-Dutch patients of similar educational levels, results showed that native Dutch patients used different media to search for information, participated to a greater extent during their consultations and were more responsive to their general practitioner. With respect to the Turkish-Dutch patients, media usage was related to increased patient participation, which was correlated with having fewer unfulfilled information needs; however, these relations were not found in the native Dutch patient sample. In conclusion, interventions that enhance participation among ethnic minority patients will better fulfill informational needs when such interventions stimulate information-seeking behavior in that group before a medical consultation.

Coding of procedures documented by general practitioners in Swedish primary care-an explorative study using two procedure coding systems

PubMed Central

2012-01-01

Background Procedures documented by general practitioners in primary care have not been studied in relation to procedure coding systems. We aimed to describe procedures documented by Swedish general practitioners in electronic patient records and to compare them to the Swedish Classification of Health Interventions (KVÅ) and SNOMED CT. Methods Procedures in 200 record entries were identified, coded, assessed in relation to two procedure coding systems and analysed. Results 417 procedures found in the 200 electronic patient record entries were coded with 36 different Classification of Health Interventions categories and 148 different SNOMED CT concepts. 22.8% of the procedures could not be coded with any Classification of Health Interventions category and 4.3% could not be coded with any SNOMED CT concept. 206 procedure-concept/category pairs were assessed as a complete match in SNOMED CT compared to 10 in the Classification of Health Interventions. Conclusions Procedures documented by general practitioners were present in nearly all electronic patient record entries. Almost all procedures could be coded using SNOMED CT. Classification of Health Interventions covered the procedures to a lesser extent and with a much lower degree of concordance. SNOMED CT is a more flexible terminology system that can be used for different purposes for procedure coding in primary care. PMID:22230095

Collaboration of occupational physicians with national health system and general practitioners in Italy

PubMed Central

PERSECHINO, Benedetta; FONTANA, Luca; BURESTI, Giuliana; RONDINONE, Bruna Maria; LAURANO, Patrizia; FORTUNA, Grazia; VALENTI, Antonio; IAVICOLI, Sergio

2016-01-01

A good cooperation between occupational physicians and other healthcare professionals is essential in order to achieve an overall improvement of workers/patients’ well-being. Unfortunately, collaboration between occupational physicians and other physicians is often lacking or very poor. In this context, using a self-administered questionnaire, we investigated the cooperation of Italian occupational physicians with the National Health System (NHS) facilities and with the general practitioners in order to identify any potential critical issues that may hinder an effective and collaborative relationships between these professionals. The survey was conducted from October 2013 to January 2014. Nearly all of the interviewed occupational physicians have had contacts with colleagues of the Departments for Prevention and Occupational Health and Safety of the NHS. Regarding the relationship between occupational physicians and general practitioners findings showed that their cooperation is quite difficult and it would not seem a two-way collaboration. Cooperation between occupational physicians and NHS would benefit from the development of communication strategies and tools enhancing the support and assistance functions of the NHS facilities. The elaboration and subsequent application of operational guidelines and standardized procedures of communication would also improve collaboration between occupational physicians and general practitioners that is currently considered rather insufficient and incomplete. PMID:27733729

Rival perspectives in health technology assessment and other economic evaluations for investing in global and national health. Who decides? Who pays?

PubMed Central

Culyer, Anthony; Chalkidou, Kalipso; Teerawattananon, Yot; Santatiwongchai, Benjarin

2018-01-01

There seems to be a general agreement amongst practitioners of economic evaluations, including Health Technology Assessment, that the explicit statement of a perspective is a necessary element in designing and reporting research. Moreover, there seems also to be a general presumption that the ideal perspective is “societal”. In this paper we endorse the first principle but dissent from the second. A review of recommended perspectives is presented. The societal perspective is frequently not the one recommended. The societal perspective is shown to be less comprehensive than is commonly supposed, is inappropriate in many contexts and, in any case, is in general not a perspective to be determined independently of the context of a decision problem. Moreover, the selection of a perspective, societal or otherwise, is not the prerogative of analysts. PMID:29904588

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

PubMed Central

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

2013-01-01

A questionnaire was administered to 22 veterinary practitioners and 17 veterinary pathologists to investigate the methods used for diagnosis of Clostridium perfringens type A enteritis in neonatal pigs. Practitioners generally diagnosed C. perfringens type A associated enteritis by age of onset of diarrhea (between 1 to 7 days of age). Most practitioners (95%) were moderately to very confident in their diagnosis. Pathologists generally diagnosed C. perfringens type A associated enteritis by combinations of isolation of the organism, genotyping or detecting the toxins of the organism, and ruling out other pathogens through histopathology. Almost half (41%) of the pathologists were not confident of their diagnosis. This study reports that the current diagnostic method for C. perfringens type A enteritis is not specific, and although many pathologists expressed reservations about making a diagnosis of C. perfringens type A enteritis, most practitioners were confident in their diagnosis, even though reported clinical signs of clostridial diarrhea are similar to those of a number of other enteric diseases. PMID:24155437

Reducing variation in general practitioner referral rates through clinical engagement and peer review of referrals: a service improvement project.

PubMed

Evans, Elizabeth; Aiking, Harry; Edwards, Adrian

2011-01-01

General practitioner (GP) referral rates to hospital services vary widely, without clearly identified explanatory factors, introducing important quality and patient safety issues. Referrals are rising everywhere year on year; some of these may be more appropriately redirected to lower technology services. To use peer review with consultant engagement to influence GPs to improve the quality and effectiveness of their referrals. Service development project. Ten out of 13 GP practices in Torfaen, Gwent; consultants from seven specialties in Gwent Healthcare NHS Trust; project designed and managed within Torfaen Local Health Board between 2008 and 2009. GPs discussed the appropriateness of referrals in selected specialties, including referral information and compatibility with local guidelines, usually on a weekly basis and were provided with regular feedback of 'benchmarked' referral rates. Six-weekly 'cluster groups', involving GPs, hospital specialists and community health practitioners discussed referral pathways and appropriate management in community based services. Overall there was a reduction in variation in individual GP referral rates (from 2.6-7.7 to 3.0-6.5 per 1000 patients per quarter) and a related reduction in overall referral rate (from 5.5 to 4.3 per 1000 patients per quarter). Both reductions appeared sustainable whilst the intervention continued, and referral rates rose in keeping with local trends once the intervention finished. This intervention appeared acceptable to GPs because of its emphasis on reviewing appropriateness and quality of referrals and was effective and sustainable while the investment in resources continued. Consultant involvement in discussions appeared important. The intervention's cost-effectiveness requires evaluation for consideration of future referral management strategies.

Exploring the potential role of the advanced nurse practitioner within a care path for patients with chronic fatigue syndrome.

PubMed

Ryckeghem, Hannah; Delesie, Liesbeth; Tobback, Els; Lievens, Stefaan; Vogelaers, Dirk; Mariman, An

2017-07-01

To explore the experiences and expectations of patients with chronic fatigue syndrome and general practitioners to develop the potential role of an advanced nurse practitioner at the diagnostic care path of abnormal fatigue developed for regional transmural implementation in the Belgian provinces of East and West Flanders. Patients with chronic fatigue syndrome experience an incapacitating chronic fatigue that is present for at least 6 months. Since many uncertainties exist about the causes and progression of the disease, patients have to cope with disbelief and scepticism. Access to health care may be hampered, which could lead to inappropriate treatments and guidance. Qualitative design. Individual semi-structured interviews were conducted with patients with chronic fatigue syndrome and general practitioners in Belgium. Data were collected over 9 months in 2014-2015. All interviews were audio recorded and transcribed for qualitative analysis using open explorative thematic coding. Fifteen patients and 15 general practitioners were interviewed. Three themes were identified: mixed feelings with the diagnosis, lack of one central intermediator and insufficient coordination. Participants stressed the need for education, knowledge and an intermediator to provide relevant information at the right time and to build up a trust relationship. This qualitative exploration underscores some clear deficiencies in the guidance of patients suffering from chronic fatigue syndrome and abnormal fatigue. An advanced nurse practitioner as a central intermediator in the transmural care of these patients could promote interdisciplinary/multidisciplinary collaboration and effective communication, provide education and ensure a structured and coordinated approach. © 2016 John Wiley & Sons Ltd.

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

PubMed Central

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

2012-01-01

Objectives: In developing countries out-of-pocket payments (OOP) are as high as 80% of healthcare spending. Generic medicines can be instrumental in reducing this expenditure. The current study is aimed to explore the knowledge, perception, and attitude of general practitioners towards generic medicines in Karachi, Pakistan. Methods: This exploratory, descriptive study was conducted on a sample of 289 randomly selected general practitioners who were dispensing at their private clinics in Karachi, Pakistan. The questionnaires were distributed and collected by hand. Data was entered to SPSS version 17. Fischer’s exact test was applied to see the association between variables. Results: A total of 206 questionnaires were included in the study. A response rate of 71.3% was achieved. Out of 206 respondents, 139 (67.5%) were male while 67 (32.5%) respondents were female. Close to three quaters of the respondents (n= 148; 71.8%) showed correct knowledge about generic medicines being a ‘copy of the brand name medicines’ and ‘interchangeable with brand name medicines’ (n= 148; 71.8%). In terms of safety, the majority of respondents (n=85; 41.26%) incorrectly understood that the generic medicines are less safe than brand name medicines. The total percentage of correct responses was seen in 53% of the respondents. More than half of the respondents agreed that locally manufactured medicines are of the same effectiveness as brand name medicines (n=114; 55.4%). Male practitioners with practice experience of 11-15 years showed positive perception towards the quality of multinational products. The Majority of respondents believed that their prescribing decision is influenced by medical representatives (n=117; 56.8%). More than three-quarters of the respondents expressed their wish to prescribe low cost medicines in their practice (n=157; 76.2%). More than one third of the respondents expressed their uneasiness to prescribe products from all local manufacturers (n=72; 35%). Conclusion: There were gaps identified in the knowledge of respondents. Although good perception and attitude were noted among the respondents, dissemination of information regarding generic medicines may perhaps strengthen generic prescribing. There is a need to introduce ‘Quality by Design’ concept in local manufacturing units. This, in turn, can inculcate confidence in prescribers towards locally manufactured generic medicines. PMID:23093896

Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost.

PubMed

van der Heijden, J P; de Keizer, N F; Bos, J D; Spuls, P I; Witkamp, L

2011-11-01

Teledermatology, the application of telemedicine in the field of dermatology, has similar accuracy and reliability as physical dermatology. Teledermatology has been widely used in daily practice in the Netherlands since 2005 and is fully reimbursed. This study prospectively investigated the effect of teledermatology on efficiency, quality and costs of care when integrated in daily practice and applied following patient selection by the general practitioner (GP). Teledermatology consultations between GP and regional dermatologist were performed in daily GP practice in the Netherlands. Efficiency of care was measured by the decrease in the number of physical referrals to the dermatologist. Quality of care was measured by the percentage of teleconsultations for second opinion, physical referrals resulting from these teleconsultations, the response time of the dermatologists and educational effect experienced by the GP. Costs of conventional healthcare without teledermatology were compared with costs with teledermatology. One thousand, eight hundred and twenty GPs and 166 dermatologists performed teledermatology, and 37,207 teleconsultations performed from March 2007 to September 2010 were included. In the group of patients where the GP used teleconsultation to prevent a referral (n =26,596), 74% of physical referrals were prevented. In the group of patients where the GP used teleconsultation for a second opinion (n =10,611), 16% were physically referred after teleconsultation. The prevented referral rate in the total population was 68%. The mean response time of dermatologists was 4·6 h (median 2·0). GPs indicated that there was a beneficial educational effect in 85% of the teleconsultations. The estimated cost reduction was 18%. Teledermatology can lead to efficient care probably at lower cost. We are therefore of the opinion that teledermatology following GP selection should be considered as a possible pathway of referral to secondary care. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.

[Midazolam sedation in the general dental practice].

PubMed

Bertens, J; Abraham-Inpijn, L; Meuwissen, P J

1994-03-01

The general dental practitioner is occasionally confronted with patients who, on the basis of psychological--and often somatic--criteria, are difficult to treat. Medicinal sedation in combination with anxiety reduction may be deemed appropriate for such patients. In the Netherlands inhalation sedation by means of a combination of oxygen and nitrous oxide is generally used. The limitations and disadvantages of this method have directed attention towards sedation by means of midazolam, a quick-acting benzodiazepine. In view of the complications which may accompany the administration of midazolam, the general practitioner working alone or in a group practice is advised against using midazolam sedation. Such use should be reserved for a dentist working in a hospital setting, who is able to consult with a physician regarding the advisability of administering midazolam. Even then, the safety of the patient requires that the practitioners have a proper insight into the physical state of the patient, work according to a protocol and in accordance with clearly defined responsibilities, and provide adequate accommodation during and after treatment.

The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

PubMed Central

Varley, Anna; Warren, Fiona C.; Richards, Suzanne H.; Calitri, Raff; Chaplin, Katherine; Fletcher, Emily; Holt, Tim A.; Lattimer, Valerie; Murdoch, Jamie; Richards, David A.; Campbell, John

2016-01-01

Background Nurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings. Objective To investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition. Design Questionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage. Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a general practitioner or nurse. Settings 15 general practices and 7012 patients receiving the nurse triage intervention in four regions of the UK. Participants 45 nurse practitioners and practice nurse trained in the use of clinical decision support software. Methods We investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling. Results Valid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio 0.19, 95% confidence interval 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more likely to recommend patients for follow-up (OR 3.17, 95% CI 1.18–5.55). Conclusion Nurse characteristics were associated with disposition of triage calls to within practice follow-up. Nurse practitioners or those who reported feeling ‘more prepared’ for the role were more likely to manage the call definitively. Practices considering nurse triage should ensure that nurses transitioning into new roles feel adequately prepared. While standardised training is necessary, it may not be sufficient to ensure successful implementation. PMID:27087294

Chronic psychiatric patients without psychiatric care: a pilot study.

PubMed

Längle, G; Welte, W; Rösger, U; Günthner, A; U'Ren, R

2000-10-01

The study is based on the hypothesis that in any catchment area there are patients with chronic mental illness who are unknown to a comprehensive psychiatric/psychosocial care system. A standardized questionnaire was sent to all general practitioners in a circumscribed catchment area in southwestern Germany in an attempt to identify such a group, to ascertain what the practitioners considered to be the needs of these patients, and to find out why the patients were not receiving specialized psychiatric care. Of 97 general practitioners contacted, 62 returned the questionnaire. Within a study period of 3 months, 89 patients were identified as having a significant psychiatric disorder, of whom 53% were older than 60 years and 15% were schizophrenic. General practitioners most frequently said that provision of specialized psychiatric care was the most pressing need of these patients, followed by a need for psychosocial services. They also said that the major reason patients did not participate in the mental health system was patient refusal of such services. Having identified the existence of a group of chronic psychiatric patients who are not receiving specialized psychiatric care, further in-depth field studies to pursue some of the issues raised in this pilot study will be necessary to determine whether further efforts to reach psychiatric patients without defined psychiatric care would be worthwhile. These issues include estimates of the prevalence of such patients in a defined population, patients' more specific reasons for refusal of psychiatric care, and the quality of psychiatric care they receive from general practitioners in comparison with patients who receive more conventional psychiatric care.

Planning for transit-supportive development : a practitioner's guide. Section 2 : general transit-supportive development planning topics.

DOT National Transportation Integrated Search

2014-06-01

Planning for Transit-Supportive Development: A Practitioners Guide is a toolkit of practical and innovative measures to help : Metropolitan Planning Organizations (MPOs), regional planners, transit agencies, and local government elected o...

Patterns and predictors of help-seeking contacts with health services and general practitioner detection of suicidality prior to suicide: a cohort analysis of suicides occurring over a two-year period.

PubMed

Leavey, Gerard; Rosato, Michael; Galway, Karen; Hughes, Lynette; Mallon, Sharon; Rondon, Janeet

2016-04-30

Contact with primary care and psychiatric services prior to suicide may be considerable, presenting opportunities for intervention. However, there is scant knowledge on the frequency, nature and determinants of contact. Retrospective cohort study-an analysis of deaths recorded as suicide by the Northern Ireland Coroner's Office linked with data from General Practice patient records over a 2 year period Eighty-seven per cent of suicides were in contact with General Practice services in the 12 months before suicide. The frequency of contact with services was considerable, particularly among patients with a common mental disorder or substance misuse problems. A diagnosis of psychiatric problems was absent in 40% of suicides. Excluding suicide attempts, the main predictors of a noted general practitioner concern for patient suicidality are male gender, frequency of consultations, diagnosis of mental illness and substance misuse. Despite widespread and frequent contact, a substantial proportion of suicidal people were undiagnosed and untreated for mental health problems. General Practitioner alertness to suicidality may be too narrowly focused.

[Medical opinion leaders conflict of interests: effects of disclosures on the trust of the public and general practitioners].

PubMed

Chakroun, R; Milhabet, I

2011-08-01

Key medical opinion leaders influence the behaviors of physicians and patients. By law, they have to disclose their interests with pharmaceutical companies when they communicate in the media. Up to now, it appears that no study has explored the effect of opinion leaders' disclosures despite their potential impact on public health and economy. The study objective was to assess the effects of opinion leaders' disclosures of interest on the public and general practitioners' trust in opinion leader by comparison with the overall medical community. In an experimental setting, three opinion leader profiles were built that differed only by the disclosure of their interests (hidden vs. weak vs. strong interests). One of the three profiles was randomly assigned to the subjects of two groups: 67 students and 60 general practitioners. According to an Anova analysis, the main effects and interactions of the disclosure of interests, of the message recipients, and of the assessed targets on the level of trust were measured. The results show that the average level of trust expressed by general practitioners was lower than that expressed by the general public. The level of trust in the opinion leader was lower than that of the overall medical community. The level of trust of exposed subjects fell much lower with stronger disclosed interests. While the general public did not distinguish trust between opinion leaders and the overall medical community, practitioners showed a significantly lower level of trust in opinion leaders with increasingly strong levels of disclosed interests. These study results refute the assertion that public trust would be reduced by the disclosure of interests. They reinforce the importance of the "who judges who" and "which kind of disclosure impacts who ?" effects and draw attention to further research on the role of social interactions in both mass and group communications. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

21 CFR 1311.120 - Electronic prescription application requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... Except for institutional practitioners, a practitioner authorized to sign controlled substance... agent to select the DEA registration number to be included on the prescription. (8) The electronic... written in accordance with the requirements of § 1306.12(b) of this chapter, the earliest date on which a...

Developing Common Competencies for Southeast Asian General Dental Practitioners.

PubMed

Chuenjitwongsa, Supachai; Poolthong, Suchit; Bullock, Alison; Oliver, Richard G

2017-09-01

Current policy in Southeast Asian dental education focuses on high-quality dental services from new dental graduates and the free movement of dental practitioners across the region. The Southeast Asian Nations (ASEAN) Dental Councils have proposed the "Common Major Competencies for ASEAN General Dental Practitioners" to harmonize undergraduate dental education. This article discusses how the ASEAN competencies were developed and established to assist the development of general dental practitioners with comparable knowledge, skills, and attitudes across ASEAN. The competencies were developed through four processes: a questionnaire about current national oral health problems, a two-round Delphi process that sought agreement on competencies, a panel discussion by representatives from ASEAN Dental Councils, and data verification by the representatives after the meeting. Key themes of the ASEAN competencies were compared with the competencies from the U.S., Canada, Europe, Australia, and Japan. A total of 33 competency statements, consistent with other regions, were agreed upon and approved. Factors influencing the ASEAN competencies and their implementation include oral health problems in ASEAN, new knowledge and technology in dentistry, limited institutional resources, underregulated dental schools, and uneven distribution of dental practitioners. The ASEAN competencies will serve as the foundation for further developments in ASEAN dental education including policy development, curriculum revision, quality assurance, and staff development. Collaboration amongst stakeholders is essential for successful harmonization of ASEAN dental education.

The description of physical signs of illness in photographs by physicians with abnormal colour vision.

PubMed

Campbell, John L; Spalding, J Anthony B; Mir, Fraz A

2004-07-01

Physicians with congenital colour vision deficiency (CCVD) have reported difficulties recognising certain physical signs of illness, for example, jaundice, red rashes and pallor, and interpreting coloured charts, diagrams and slide projections. However, there has been little study of the effects of CCVD on the performance of medical practitioners. The aim of this study was to look for evidence of the effect of CCVD on the ability of physicians to recognise and describe physical signs of illness that have colour as either the main or an important feature. Twenty-three general practitioners with CCVD were shown 11 colour photographs depicting colour signs of illness and were asked to describe the signs they saw and rate their confidence in making their descriptions. Their responses were compared to those of 23 age-matched general practitioners with normal colour vision. General practitioners with CCVD compared to those with normal colour vision had less ability and confidence in detecting physical signs in the photographs and naming the colours. The results of this study support other evidence that physicians with CCVD have difficulties detecting some colour signs of illness and naming the colours. Because of the use of photographs the extent of the problem in clinical practice is unknown but medical practitioners with CCVD should be aware of the possibility of failing to detect or correctly assess physical signs that are characterised by colour.

The Effect of a Surgical Skills Course on Confidence Levels of Rural General Practitioners: An Observational Study.

PubMed

Byrd, Pippa; Ward, Olga; Hamdorf, Jeffrey

2016-10-01

Objective  To investigate the effect of a short surgical skills course on general practitioners' confidence levels to perform procedural skills. Design  Prospective observational study. Setting  The Clinical Evaluation and Training Centre, a practical skills-based educational facility, at The University of Western Australia. Participants  Medical practitioners who participated in these courses. Nurses, physiotherapists, and medical students were excluded. The response rate was 61% with 61 participants providing 788 responses for pre- and postcourse confidence levels regarding various surgical skills. Intervention  One- to two-day surgical skills courses consisting of presentations, demonstrations, and practical stations, facilitated by specialists. Main Outcome Measures  A two-page precourse and postcourse questionnaire was administered to medical practitioners on the day. Participants rated their confidence levels to perform skills addressed during the course on a 4-point Likert scale. Results  Of the 788 responses regarding confidence levels, 621 were rated as improved postcourse, 163 were rated as no change, and 4 were rated as lower postcourse. Seven of the courses showed a 25% median increase in confidence levels, and one course demonstrated a 50% median increase. All courses showed statistically significant results ( p  < 0.001). Conclusion  A short surgical skills course resulted in a statistically significant improvement in the confidence levels of rural general practitioners to perform these skills.

Adult Dental Trauma: What Should the Dental Practitioner Know?

PubMed

Chauhan, Ravi; Rasaratnam, Lakshmi; Alani, Aws; Djemal, Serpil

2016-05-01

The management of adult dental trauma can be a daunting challenge for practitioners at any level. Like medical emergencies, initial management can have a large influence on prognosis. It is important that practitioners understand the basic principles of managing the acute presentations of dental trauma. This article aims to illustrate a step-by-step approach in order to improve the management within general dental practice for better outcomes for patients.

Parents' preferred child health information sources: implications for nursing practice.

PubMed

Keatinge, Diane

2006-01-01

To ascertain parents' preferences in sources of health information concerning their children's general health care needs, and caring for their children when they are sick. Exploratory/descriptive design. A telephone survey secured data for the study and qualitative content analysis and descriptive statistics were used for analysis. Part 2 of a larger study in which Part I evaluated parents' satisfaction with a paediatric telephone triage service. One hundred of the 101 parents who were recruited for Part 1 of the study participated in Part 2, an examination of parents' preferences in information sources relating to their child's health. Parents' preferences in child health information sources varied according to the perceived severity of their child's illness. Parents frequently selected more than one item on a list of health information sources provided. In a non-urgent situation when children were sick a total of 170 selections were made by parents, with 'telephone advice line' the source most frequently selected (58, 34%), followed by general practitioner (27, 15.8%). In an emergency situation the most frequently selected information source was again 'telephone advice line' (74, n=129, 57.4%), followed by 'other' (31, n=129, 24.3%) often identified as relating to dialing '000' (Australia's emergency services number). Finally, when parents required information about the general health care needs of their child, 'other' (most frequently identified as books) was selected on 40 (n=185, 21.6%) occasions, followed by child health clinic (35, n= 185, 18.9%). Parents prefer to receive information about the health care needs of their child from another person rather than a printed or audio-visual source.

Participation rates in the selection of population controls in a case-control study of colorectal cancer using two recruitment methods.

PubMed

Castaño-Vinyals, Gemma; Nieuwenhuijsen, Mark J; Moreno, Víctor; Carrasco, Estela; Guinó, Elisabet; Kogevinas, Manolis; Villanueva, Cristina M

2011-01-01

Low participation rates in the selection of population controls are an increasing concern for the validity of case-control studies worldwide. We conducted a pilot study to assess two approaches to recruiting population controls in a study of colorectal cancer, including a face-to-face interview and blood sample collection. In the first approach, persons identified through a population roster were invited to participate through a telephone call by an interviewer telephoning on behalf of our research center. In the second approach, individuals were identified from the lists of selected family practitioners and were telephoned on behalf of the family practitioner. When the second method was used, participation rates increased from 42% to 57% and the percentage of refusals decreased from 47% to 13%. The reasons for refusing to participate did not differ significantly between the two methods. Contact through the family practitioner yielded higher response rates in population controls in the study area. 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

Income-related inequalities and inequities in Irish healthcare utilization.

PubMed

Bourke, Jane

2009-08-01

The aim of this article is to determine the extent of and changes in horizontal inequity in general practitioner and medical specialist utilization in Ireland from 1997 to 2001. Horizontal equity refers to people in equal need of treatment receiving similar treatment regardless of income. After accounting for the differences in the need for such care, this study reports relatively low pro-poor horizontal inequity with respect to general practitioner utilization, increasing slightly between 1997 and 2001. This study finds that a generally pro-rich horizontal inequity distribution in 1997 is replaced by a generally pro-poor distribution in 2001 with respect to medical specialist utilization.

Could measuring of perceived risk among general practitioners have helped anticipate the French BSE crisis?

PubMed

Setbon, Michel; Fischler, Claude; Lukasiewicz, Esther; Raude, Jocelyn; Flahault, Antoine

2004-01-01

In October of 2000, a second BSE crisis caught French public authorities unprepared and caused a collapse in beef consumption as well as considerable political turmoil. Data collected between May and July, 2000, among a group of general practitioners (GPs), while national consumption of beef was back to pre-BSE levels, paradoxically showed high latent risk perception, suggesting a new crisis was possible or likely.

The fundholding fandango.

PubMed Central

Bowie, C; Harris, T

1994-01-01

General practitioner fundholding allows flexible use of resources at the coal-face, provides incentives to alter practice such as prescribing within cash limits and forces hospitals to be more responsive to general practitioner demands. However, the additional administrative costs both in time and money, the fragmentation of purchasing power compounded by a lack of expertise and experience in contracting, and the poor information and financial systems which exist in the National Health Service are severe constraints. A suggested way forward is to delegate responsibility for running the scheme, including the contracting and billing, to district health authorities offering more flexible budgets to all practices and extending the scheme as local information systems allow. This will reduce fragmentation of purchasing power and administrative costs and re-establish local accountability. It will also give the general practitioner more time to see and treat patients, who will see the system as being fairer. PMID:8312038

Paperless migrants and Norwegian general practitioners.

PubMed

Aarseth, Svein; Kongshavn, Trygve; Maartmann-Moe, Kjell; Hjortdahl, Per

2016-06-01

In Norway, the rights of paperless migrants are restricted. We wished to investigate the extent to which Norwegian general practitioners give treatment to this group and their grounds for doing so, as well as to identify the health problems that were presented. In 2010, an online questionnaire was distributed to 3 994 general practitioners who were members of the Norwegian Medical Association. Altogether 1 027 GPs responded. Of these, 237 (23 %) reported to have treated paperless migrants. Mental problems, pregnancy-related issues and respiratory ailments were the most frequently reported reasons for contact. Of the 237 GPs who reported to have treated paperless migrants, altogether 166 (70 %) stated that they would continue to receive these patients. The fact that most of the GPs who had treated paperless migrants would continue to receive this patient group and thus provide health services beyond this group’s entitlements, we regard as a wish to comply with the Code of Ethics for Norwegian doctors.

[Possibilities and limitations of telemedicine in general practitioner practices].

PubMed

van den Berg, N; Meinke, C; Hoffmann, W

2009-09-01

According to the AGnES concept (general-practitioner-supporting, community-based, e-health-assisted systemic intervention), general practitioners (GPs) can delegate certain components of medical care in the context of home visits by qualified AGnES employees. Within the framework of six AGnES projects, different telemedical applications have been implemented. Telemedical monitoring of patients was implemented to analyse the feasibility and acceptance within GP practices. One hundred sixty-two patients used a telemedical monitoring system (e.g. scale/sphygmomanometer and intraocular pressure measurement system). Regarding communication in cases of acutely necessary GP consultations, telephone calls and videoconferences between the GP and the AGnES employee were analysed. Unscheduled telephone calls or videoconferences were necessary for only a few home visits; the reasons included pain, anomalous values, and medication problems. The main result of the analysis was that implementation of telemedicine in GP practices is feasible and is accepted both by patients and GPs.

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

ERIC Educational Resources Information Center

Derouesne, C.; Salamon, R.

1977-01-01

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

Assessment of knowledge and practice of private practitioners regarding tuberculosis control in Ethiopia.

PubMed

Yimer, Solomon A; Holm-Hansen, Carol; Bjune, Gunnar

2012-01-12

Ethiopia has a growing private health sector. In recent years, the directly observed treatment short course (DOTS) strategy was initiated in selected private health facilities in the country. The objective of the present study was to assess knowledge and practice of private practitioners in tuberculosis (TB) control in Amhara Region, Ethiopia. An institution-based cross-sectional study was conducted among 112 private practitioners selected from all private health facilities in the region. The study was conducted between May and August 2008 and data was collected using a semi-structured questionnaire. Group differences were analyzed using the chi-square test. Fifty-nine (52.7%) of the private practitioners suspected TB in patients with three weeks' duration of cough. Only 37 (33.0%) of the private practitioners were able to precisely list the correct treatment regimens for all categories as recommended in the National Tuberculosis and Leprosy Control Program guidelines. The correct frequency of TB treatment monitoring was provided by 44 (50%) of the respondents. Overall 44 (39.3%) of the private practitioners did not have satisfactory knowledge about the directly observed treatment short course (DOTS) strategy. Those who attended DOTS training during the two years prior to the survey were more likely to have satisfactory knowledge compared to those who did not receive training (OR 4.45, 95% CI: 1.33, 14.87, p < 0.02). A significant proportion of private practitioners did not have satisfactory knowledge and practice about DOTS. The provision of regular DOTS refresher courses improves TB management for patients in the region.

Treating knee pain: history taking and accurate diagnoses.

PubMed

Barratt, Julian

2010-07-01

Prompt and effective diagnosis and treatment for common knee problems depend on practitioners' ability to distinguish between traumatic and inflammatory knee conditions. This article aims to enable practitioners to make accurate assessments, carry out knee examinations and undertake selected special tests as necessary before discharging or referring patients.

Evolution of a Family Nurse Practitioner Program to Improve Primary Care Distribution

ERIC Educational Resources Information Center

Andrus, Len Hughes; Fenley, Mary D.

1976-01-01

Describes a Family Nurse Practitioner Program that has effectively improved the distribution of primary health care manpower in rural areas. Program characteristics include selection of personnel from areas of need, decentralization of clinical and didactic training sites, competency-based portable curriculum, and circuit-riding institutionally…

Spiritually Modified Cognitive Therapy: A Review of the Literature

ERIC Educational Resources Information Center

Hodge, David R.

2006-01-01

A paucity of research exists on the effectiveness of spiritual interventions, despite their wide use by practitioners and the acknowledged importance of evidence-based practice. To assist practitioners in their selection of spiritual interventions, the author reviewed research on the effectiveness of spiritually modified cognitive therapy. The…

Different views of dentists and general medical practitioners on dental care for patients with diabetes mellitus and coronary heart diseases: results of a questionnaire-based survey in a district of Germany.

PubMed

Ziebolz, Dirk; Reiss, Lucie; Schmalz, Gerhard; Krause, Felix; Haak, Rainer; Mausberg, Rainer F

2018-06-01

The aim of this questionnaire-based study was to evaluate the views of dentists (Ds) and general medical practitioners (GPs) on different aspects of dental care for patients with diabetes mellitus (DM) or coronary heart disease (CHD). Reliable and comparable questionnaires for Ds and GPs, with 23 questions, were sent to 1,000 randomly selected Ds and 1,000 randomly selected GPs. Questions were asked about patients with DM or CHD regarding their dental care and potentially related issues (e.g. antibiotic prophylaxis). The responses received within 12 weeks were evaluated and statistically analysed using chi-square and Mann-Whitney U tests (P < 0.05). The response rate was 39% (n = 391) for Ds and 18% (n = 181) for GPs. Both groups stated that they used the medical history as well as patient interviews to assess patients. However, only 55% of Ds assumed correct identification of every at-risk patient compared with 100% of GPs (P < 0.01). Furthermore, Ds speculated that they inform their patients more often about their at-risk status than do GPs (P < 0.01). Neither Ds nor GPs appeared to be confident in their knowledge about adequate antibiotic prophylaxis. Interdisciplinary collaboration was considered insufficient, although Ds had a higher rate of regular collaboration (68% for Ds vs. 40% for GPs; P < 0.01). Ds and GPs have differing views on dental care of patients with DM or CHD, and Ds showed more interest in this issue. These results might partially explain the insufficient collaboration between Ds and GPs. © 2017 FDI World Dental Federation.

Identifying plant traits: a key aspect for suitable species selection in ecological restoration of semiarid slopes

NASA Astrophysics Data System (ADS)

Bochet, Esther; García-Fayos, Patricio

2017-04-01

In the context of ecological restoration, one of the greatest challenges for practitioners and scientists is to select suitable species for revegetation purposes. In semiarid environments where restoration projects often fail, little attention has been paid so far to the contribution of plant traits to species success. The objective of this study was to (1) identify plant traits associated with species success on four roadside situations along an erosion-productivity gradient, and (2) to provide an ecological framework for selecting suitable species on the basis of their morphological and functional traits, applied to semiarid environments. We analyzed the association of 10 different plant traits with species success of 296 species surveyed on the four roadside situations in a semiarid region (Valencia, Spain). Plant traits included general plant traits (longevity, woodiness) and more specific root-, seed- and leaf-related traits (root type, sprouting ability, seed mucilage, seed mass, seed susceptibility to removal, specific leaf area and leaf dry matter content). All of them were selected according to the prevailing limiting ecogeomorphological processes acting along the erosion-productivity gradient. We observed strong shifts along the erosion-productivity gradient in the traits associated to species success. At the harshest end of the gradient, the most intensely eroded and driest one, species success was mainly associated to seed resistance to removal by runoff and to resistance to drought. At the opposite end of the gradient, the most productive one, species success was associated to a competitive-ruderal plant strategy (herbaceous successful species with high specific leaf area and low leaf dry matter content). Our study provides an ecologically-based approach for selecting suitable native species on the basis or their morphological and functional traits and supports a differential trait-based selection of species as regards roadslope type and aspect. In conclusion, these new insights from basic ecology and practical management guidance represent a great opportunity for practitioners to move forward with the success of roadslope restoration in semiarid environments.

How safe is deep sedation or general anesthesia while providing dental care?

PubMed

Bennett, Jeffrey D; Kramer, Kyle J; Bosack, Robert C

2015-09-01

Deep sedation and general anesthesia are administered daily in dental offices, most commonly by oral and maxillofacial surgeons and dentist anesthesiologists. The goal of deep sedation or general anesthesia is to establish a safe environment in which the patient is comfortable and cooperative. This requires meticulous care in which the practitioner balances the patient's depth of sedation and level of responsiveness while maintaining airway integrity, ventilation, and cardiovascular hemodynamics. Using the available data and informational reports, the authors estimate that the incidence of death and brain injury associated with deep sedation or general anesthesia administered by all dentists most likely exceeds 1 per month. Airway compromise is a significant contributing factor to anesthetic complications. The American Society of Anesthesiology closed claim analysis also concluded that human error contributed highly to anesthetic mishaps. The establishment of a patient safety database for anesthetic management in dentistry would allow for a more complete assessment of morbidity and mortality that could direct efforts to further increase safe anesthetic care. Deep sedation and general anesthesia can be safely administered in the dental office. Optimization of patient care requires appropriate patient selection, selection of appropriate anesthetic agents, utilization of appropriate monitoring, and a highly trained anesthetic team. Achieving a highly trained anesthetic team requires emergency management preparation that can foster decision making, leadership, communication, and task management. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

8 CFR 1003.105 - Notice of Intent to Discipline.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Section 1003.105 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE GENERAL PROVISIONS EXECUTIVE OFFICE FOR IMMIGRATION REVIEW Professional Conduct for Practitioners-Rules... authority to practice before the Board or the Immigration Courts also apply to the practitioner's authority...

[Trends among medical students towards general practice or specialization].

PubMed

Breinbauer K, Hayo; Fromm R, Germán; Fleck L, Daniela; Araya C, Luis

2009-07-01

A 60/40 ratio has been estimated as a country's ideal proportion between general practitioners and specialists. In Chile this proportion was 36/ 64 in 2004, exactly the opposite of the ideal. Trends towards specialization or general practice among medical students have not been thoughtfully studied. To assess trends among medical students towards becoming general practitioners or specialists, exploring associated factors. Descriptive survey of 822 first to seventh year medical students at the University of Chile, School of Medicine. Desired activity to pursue (general practice or specialization) after graduation and general orientations within clinical practice were explored. Fifty three percent of students desired to enter a specialization program. Only 20% would work as a general practitioner (27% were still indecisive). Furthermore, a trend in early years of medical training towards an integral medicine is gradually reversed within later years. Seventh year students give significantly more importance to specialization than to integral medicine (p <0.01). Ten percent of this opinion change is related to the emphasis given to specialized medicine in the teaching environment. Most students prefer to enter a specialization program immediately after finishing medical school. Moreover, there is a social trend, at least within the teacher-attending environment, promoting not only the desire to specialize, but a pro-specialist culture.

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

2001 Volvo Award Winner in Clinical Studies: Effects of a media campaign on back pain beliefs and its potential influence on management of low back pain in general practice.

PubMed

Buchbinder, R; Jolley, D; Wyatt, M

2001-12-01

Quasi-experimental, nonrandomized, nonequivalent, parallel group-controlled study involving before and after telephone surveys of the general population and postal surveys of general practitioners was conducted, with an adjacent state used as a control group. To evaluate the effectiveness of a population-based intervention designed to alter beliefs about back pain, influence medical management, and reduce disability and workers' compensation-related costs. A multimedia campaign begun during 1997 in Victoria, Australia, positively advised patients with back pain to stay active and exercise, not to rest for prolonged periods, and to remain at work. The campaign's impact on population beliefs about back pain and fear-avoidance beliefs was measured in telephone surveys, and the effect of the campaign on the potential management of low back pain by general practitioners was assessed by eliciting their likely approach to two hypothetical scenarios in mailed surveys. Demographically identical population groups in Victoria and the control state, New South Wales, were surveyed at three times: before, during, and after intervention in Victoria. The studies were completed by 4730 individuals in the general population and 2556 general practitioners. There were large statistically significant improvements in back pain beliefs over time in Victoria (mean scores on the Back Beliefs Questionnaire, 26.5, 28.4, and 29.7), but not in New South Wales (26.3, 26.2, and 26.3, respectively). Among those who reported back pain during the previous year, fear-avoidance beliefs about physical activity improved significantly in Victoria (mean scores on the Fear-Avoidance Beliefs Questionnaire for physical activity, 14, 12.5, and 11.6), but not in New South Wales (13.3, 13.6, and 12.7, respectively). General practitioners in Victoria reported significant improvements over time in beliefs about back pain management, as compared with their interstate colleagues. There were statistically significant interactions between state and time for 7 of 10 responses on management of acute low back pain, and for 6 of 10 responses on management of subacute low back pain. A population-based strategy of providing positive messages about back pain improves the beliefs of the general population and general practitioners about back pain and appears to influence medical management.

The Use of Instruments by Iranian Endodontics and General Practioners

PubMed Central

Elham, Farokh Gisour; Sedigheh, Zarmehi

2012-01-01

Aim: The current clinical practice of endodontics involves utilization of a variety of new technological advances and materials. Technologies available for use in endodontic offices today include battery or electric motors using NiTi rotary file systems, new generation of electronic apex locators (EALs), improved digital radiographic sensors, surgical microscopes, and ultrasonic units. The aim of this study was to determine the prevalence and use of newer technologies among Iranian dental practitioners. Materials and methods: The population under study included the dental practitioners participating in the 49th and 50th Congress of Dentistry, who were selected with a simple sampling method. Data was collected by questionnaires which were completed by the participants in an anonymous manner. The contingency table and chi-squared test were used for data analysis by SPSS 13.5 software. Results: A total of 700 dental practitioners participated in the study; NiTi rotary systems were used by 50.1%; electronic apex locators were often employed by 46.3%; 21.7% reported that ultrasonic units were often used. Only 1.1% frequently used surgical microscopes. Males and females differed with respect to the use of newer technologies (P<0.05). Conclusion: Based on the results of the present study, it seems necessary for dentists to take part in continuing dental education programs related to the newer technologies to improve their knowledge and practice. PMID:22833772

Causal explanations of distress and general practitioners' assessments of common mental disorder among punjabi and English attendees.

PubMed

Bhui, Kamaldeep; Bhugra, Dinesh; Goldberg, David

2002-01-01

The literature on the primary care assessment of mental distress among Indian subcontinent origin patients suggests frequent presentations to general practitioner, but rarely for recognisable psychiatric disorders. This study investigates whether cultural variations in patients' causal explanatory models account for cultural variations in the assessment of non-psychotic mental disorders in primary care. In a two-phase survey, 272 Punjabi and 269 English subjects were screened. The second phase was completed by 209 and 180 subjects, respectively. Causal explanatory models were elicited as explanations of two vignette scenarios. One of these emphasised a somatic presentation and the other anxiety symptoms. Psychiatric disorder was assessed by GPs on a Likert scale and by a psychiatrist on the Clinical Interview Schedule. Punjabis more commonly expressed medical/somatic and religious beliefs. General practitioners were more likely to assess any subject giving psychological explanations to vignette A and English subjects giving religious explanations to vignette B as having a significant psychiatric disorder. Where medical/somatic explanations of distress were most prevalent in response to the somatic vignette, psychological, religious and work explanations were less prevalent among Punjabis but not among English subjects. Causal explanations did not fully explain cultural differences in assessments. General practitioners' assessments and causal explanations are related and influenced by culture, but causal explanations do not fully explain cultural differences in assessments.

Characteristics of career advisors for general practice--a qualitative study of UK GPs.

PubMed

Thornett, Andrew; Thorley, Judith; Chambers, Ruth

2006-01-01

Career support needs of general practitioners are poorly described in the literature. Semi-structured interviews of 26 practising GPs from two United Kingdom counties. General practitioners believed they would benefit from the provision of career advice and guidance provided by trained peers. They were looking for advisors to whom they could relate and who understood their professional and personal needs, in particular: listening skills, life experience, credibility, protected time, ability to challenge, give careful consideration, trustworthiness, knowledge about GP careers, facilitation skills, and empathy. A strategy put in place in Australia might enable GPs to implement career plans.

Oral and maxillofacial surgery: what are the French specificities?

PubMed

Herlin, Christian; Goudot, Patrick; Jammet, Patrick; Delaval, Christophe; Yachouh, Jacques

2011-05-01

Oral and maxillofacial surgery has expanded rapidly over the past century. Recognition in France has grown since the first face transplantation in the world performed by Professor Bernard Devauchelle. This speciality, which seems to correspond to a narrow scope of services, actually involves oral, plastic, reconstructive, and cosmetic surgeries of the face. French training for maxillofacial surgeons differs from the Anglo-Saxon course of study. After examining surveys carried out in Great Britain, the United States, and Brazil, the perception of this speciality in the general public and among regular correspondents (general practitioners and dental practitioners) was ascertained. More than 4,000 questionnaires were sent to health care workers and patients attending dental practices. The returned questionnaires concerning recognition of this profession in France were analyzed. Evaluating awareness of maxillofacial surgery among practitioners and the public was of particular interest because it can overlap with several other specialities (ear, nose, and throat; plastic surgery; odontology). The questionnaire included the 20 items used in other similar studies so the results could be compared. Several fields of expertise were identified in maxillofacial surgery, in particular traumatology, surgery for facial birth defects, and orthognathic surgery. Moreover, dental practitioners were found to be the most regular correspondents of maxillofacial surgeons compared with general practitioners. Compared with Anglo-Saxon and Brazilian peers, French recognition of maxillofacial surgery was better. Despite encouraging results, maxillofacial surgery remains a somewhat obscure speciality for health care workers and the general public. Better awareness is necessary for this speciality to become the reference in facial surgery. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Selecting public relations personnel of hospitals by analytic network process.

PubMed

Liao, Sen-Kuei; Chang, Kuei-Lun

2009-01-01

This study describes the use of analytic network process (ANP) in the Taiwanese hospital public relations personnel selection process. Starting with interviewing 48 practitioners and executives in north Taiwan, we collected selection criteria. Then, we retained the 12 critical criteria that were mentioned above 40 times by theses respondents, including: interpersonal skill, experience, negotiation, language, ability to follow orders, cognitive ability, adaptation to environment, adaptation to company, emotion, loyalty, attitude, and Response. Finally, we discussed with the 20 executives to take these important criteria into three perspectives to structure the hierarchy for hospital public relations personnel selection. After discussing with practitioners and executives, we find that selecting criteria are interrelated. The ANP, which incorporates interdependence relationships, is a new approach for multi-criteria decision-making. Thus, we apply ANP to select the most optimal public relations personnel of hospitals. An empirical study of public relations personnel selection problems in Taiwan hospitals is conducted to illustrate how the selection procedure works.

Diagnosis of dementia by medical practitioners: a national study among older adults in Singapore.

PubMed

Chong, Siow Ann; Abdin, Edimansyah; Vaingankar, Janhavi; Ng, Li Ling; Subramaniam, Mythily

2016-12-01

Dementia is inevitably associated with an ageing population which has tremendous public health, social and economic implications. Yet the extant evidence suggests that the diagnosis of dementia in general is neither timely nor accurate. The aim of this present study was to establish the prevalence of dementia as diagnosed by medical practitioners in Singapore and its associated factors. The analysis is based on a national epidemiological study of older adults in Singapore which had established the prevalence of dementia using the 10/66 protocol. It was a community based survey, and face-to-face interviews were conducted with 2565 respondents (a response rate of 66%) and 2421 informants. In all, 3% of the respondents were diagnosed by a medical practitioner to have dementia of which 11.5% were diagnosed by general practitioners. Only 30.3% were prescribed medications specifically for dementia. Those with comorbid depression were more likely to be diagnosed to have dementia. The apparent low rate of diagnosis by medical practitioners is in line with studies done in the West. There is a need to elucidate the reasons underlying this under-diagnosis in order to better address this gap.

Resources for the Practitioner.

ERIC Educational Resources Information Center

Hackeling, Joan, Comp.

2003-01-01

This list of print and electronic resources is designed to act as a springboard to assist practitioners in finding information to start implementing sustainability efforts on their campuses. The resources are listed in the following categories: general, international, K-12, policy/partnerships, campus environmental assessments, green building,…

Physician Assistants and Nurse Practitioners as a Usual Source of Care

ERIC Educational Resources Information Center

Everett, Christine M.; Schumacher, Jessica R.; Wright, Alexandra; Smith, Maureen A.

2009-01-01

Purpose: To identify characteristics and outcomes of patients who use physician assistants and nurse practitioners (PA/NPs) as a usual source of care. Methods: Cross sectional analysis using the telephone and mail surveys of the Wisconsin Longitudinal Study (WLS), a prospective cohort study of Wisconsin high school graduates and selected siblings…

History taking and clinical examination of the shoulder.

PubMed

Barratt, Julian

2009-04-01

Prompt and effective diagnosis and treatment for common shoulder problems depends on the ability of practitioners to distinguish between traumatic and non-traumatic shoulder conditions. This article aims to enable practitioners to make accurate assessments and carry out shoulder examinations, including the undertaking of selected special tests, before discharging or referring patients.

Characteristics and Professional Concerns of Organization Development Practitioners.

ERIC Educational Resources Information Center

Patten, Thomas H., Jr.; And Others

A study was undertaken of organization development (OD) programs, from the point of view of the organization members who plan and conduct them, to gain information for meaningful planning by the American Society for Training and Development (ASTD). A questionnaire was returned by 103 of 450 randomly selected OD practitioners. Most respondents had…

Factors Influencing Successful Use of Information Retrieval Systems by Nurse Practitioner Students

PubMed Central

Rose, Linda; Crabtree, Katherine; Hersh, William

1998-01-01

This study examined whether a relationship exists between selected Nurse Practitioner students' attributes and successful information retrieval as demonstrated by correctly answering clinical questions using an information retrieval system (Medline). One predictor variable, attitude toward current computer technology, was significantly correlated (r =0.43, p ≤ .05) with successful literature searching.

Geography of primary mental health care through the Better Access initiative in South Australia 2006-2010.

PubMed

Carson, Dean; Bidargaddi, Niranjan; Schrader, Geoffrey; Allison, Stephen; Jones, Gabrielle Margaret; Bastiampillai, Tarun; Strobel, Jörg

2016-06-01

To examine how the rates of the use of particular face-to-face primary mental health care services changed in the first 4 years (2006-2010) of the Better Access initiative in both urban and rural regions of South Australia. Time-series analysis of the number of psychology session, psychiatry assessment and general practitioner care plan services recorded in Medicare Australia data. South Australia. Pre-existing data set of South Australian residents who accessed Medicare between 2006 and 2010 MAIN OBJECTIVE MEASURE: Number of services per 100 000 population (service rate). Psychology session service rates increased in all regions, but continued to follow a 'location gradient', being higher in areas closer to Adelaide and lower in areas more distant from Adelaide. Psychiatry assessment service rates increased in Adelaide but did not change in other regions. Rates in remote areas were subject to substantial variation over time. General practitioner care plan service rates increased in Adelaide and in the Riverland, but declined in the Murray Mallee region. Overall, service rates increased in Adelaide and nearby regions, but the results for rural and remote regions were mixed. Possible explanations for the geographical variability include population characteristics (such as socio-economic status), methods of service delivery (visiting practitioners, telepsych), the relative proportion of total health services provided by general practitioners versus other practitioners, or real variations in the need for primary mental health services. © 2015 National Rural Health Alliance Inc.

[Interdisciplinary teleconsultation: first practical experiences with 100 patients].

PubMed

Gollnick, I; Frehiwot, M; Krause, E M; Schaller, S; Limpert, E; Strauß, G; Lipp, T; Scherz, M; Injac, Z

2013-06-01

PROBLEM DEFINITION: Increasing specialization can be observed in the various medical fields and as a consequence there is little professional exchange between ear nose and throat (ENT) specialists and general practitioners. At the same time there has been significant technological development in telemedicine over the last 5 years; however, this potential is not being sufficiently exploited. The objective of this project is to implement a practicable solution for teleconsulation between ENT specialists and general practitioners. The connection is based on a secure broadband internet connection, the corresponding server structure and a video endoscopic system. In the period from 01 January 2011 to 30 June 2012 (18 months) a total of 102 patients were included in the study in which 4 general practitioners and 5 ENT specialists participated. The protocol comprised the following parameters: indications and typical questions, number of patients presenting to the ENT specialist due to the available teleconsultation service (CBO), number of patients referred to the ENT specialist after teleconsultation (CIO), assessment of the quality of the additional expert opinion (LOQ GP), assessment of the accuracy of the specialist physician tele-diagnosis (TDS-FA) and assessment of the impact of the expert physician diagnosis on the general medical treatment (COS). Teleconsultation was most frequently used for diagnostics on tonsils (37% of the presented cases), the external auditory canal (32%) and the inner nose (15%). Of the patients analyzed were 53.9% presented to the ENT specialist only because the teleconsultation service provided an effortless opportunity and after teleconsultation 40.1% of the patients were referred to the ENT specialist. General practitioners assessed the benefit from the specialist opinion with 64 points. Diagnostic certainty of the specialist opinion, i.e. the validity scale of the diagnosis made, was on average 2.0. In approximately 35.3% of the cases (36 out of 102 patients) participating general practitioners documented a considerable impact of teleconsultation on the diagnosis and/or therapy. Teleconsultation between general practitioners and ENT specialists can provide an advantage in treatment quality and patient comfort. According to the experience gained there is a very low risk of diminishing the professional competency of ENT medicine and the involvement of the expert group in the early project stage allows a greater leeway in project implementation. This could also have an impact on future medical performance specifications. According to the ENT experts involved in the project further applications of teleconsultation are very conceivable.

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

PubMed Central

Griffiths, Chris; Kaur, Gurmit; Gantley, Madeleine; Feder, Gene; Hillier, Sheila; Goddard, Jill; Packe, Geoff

2001-01-01

Objective To explore reasons for increased risk of hospital admission among south Asian patients with asthma. Design Qualitative interview study using modified critical incident technique and framework analysis. Setting Newham, east London, a deprived area with a large mixed south Asian population. Participants 58 south Asian and white adults with asthma (49 admitted to hospital with asthma, 9 not admitted); 17 general practitioners; 5 accident and emergency doctors; 2 out of hours general practitioners; 1 asthma specialist nurse. Main outcome measures Patients' and health professionals' views on influences on admission, events leading to admission, general practices' organisation and asthma strategies, doctor-patient relationship, and cultural attitudes to asthma. Results South Asian and white patients admitted to hospital coped differently with asthma. South Asians described less confidence in controlling their asthma, were unfamiliar with the concept of preventive medication, and often expressed less confidence in their general practitioner. South Asians managed asthma exacerbations with family advocacy, without systematic changes in prophylaxis, and without systemic corticosteroids. Patients describing difficulty accessing primary care during asthma exacerbations were registered with practices with weak strategies for asthma care and were often south Asian. Patients with easy access described care suggesting partnerships with their general practitioner, had better confidence to control asthma, and were registered with practices with well developed asthma strategies that included policies for avoiding hospital admission. Conclusions The different ways of coping with asthma exacerbations and accessing care may partly explain the increased risk of hospital admission in south Asian patients. Interventions that increase confidence to control asthma, confidence in the general practitioner, understanding of preventive treatment, and use of systemic corticosteroids in exacerbations may reduce hospital admissions. Development of more sophisticated asthma strategies by practices with better access and partnerships with patients may also achieve this. What is already known on this topicSouth Asian patients with asthma are at increased risk of hospital admission with asthma compared with white patientsNo consistent differences in severity or prevalence of asthma, prescribed drugs, or asthma education have been described, and interventions to reduce admission rates in Asian patients have met with variable successWhat this study addsCompared with white patients, south Asian patients admitted to hospital with asthma had less confidence to control asthma, were unfamiliar with the concept of preventive medication, and had less confidence in their general practitionersSouth Asian patients managed asthma attacks through family advocacy and without systematic changes in prophylaxis and without systemic corticosteroidsPatients reporting difficulty in accessing primary care during attacks were often south Asian PMID:11679384

Special care dentistry for general dental practice.

PubMed

Greig, Vicki; Sweeney, Petrina

2013-01-01

Although special care dentistry (SCD) is a fairly recent specialty, the principles and practice of SCD have been developed since the 1980s. Shared care of these patients with general dental practitioners remains vital to ensure that comprehensive care is provided. This article aims to discuss some of the patient groups commonly seen in SCD clinics and give an insight into the varied complex medical and social aspects of care which are managed as part of providing appropriate, safe and holistic care. Many patients who currently fall under the remit of special care dentistry could be treated safely in general dental practice. This article acts as an introduction to special care dentistry for general dental practitioners.

Organisational aspects of dental practices: do dental students think like patients or like general dental practitioners?

PubMed

Sonneveld, R E; Brands, W G; Bronkhorst, E M; Welie, J V M; Truin, G J

2013-02-01

In view of transparency in health care, the widespread desire for more patient-centred care, and in an attempt to facilitate educational programmes that effectively respond to these changes, two research questions are formulated: (i) How do dental students rate the importance of various organisational aspects of dental practices compared with dental patients and general dental practitioners (GDPs), and what prescripts, defined as specific operational responsibilities of GDPs in these matters, do dental students propose? and (ii) In doing so, do students resemble patients or GDPs? In two survey studies, dental students (n = 198), patients (n = 3127) and GDPs (n = 303) were asked to rate by questionnaire the importance of 41 organisational aspects of a general dental practice and proposed specific operational responsibilities ('prescripts'). Seven of 41 aspects were rated as important by the majority of the students. Although in a different rank order, three aspects were predominantly selected by all three groups: continuing education, accessibility by telephone and Dutch-speaking GDP. For most aspects, significant differences were found between the prescripts proposed by students and those proposed by patients, and few differences were found between students and GDPs. The findings do not permit the general conclusion that the views of dental students resemble those of patients or GPDs. Looking at the overall rank order, the three respondent groups showed a great resemblance although significant differences were found for specific aspects. With regard to the proposed prescripts, students showed realistic views and the majority wants to participate in continuing education and work with protocols and guidelines. In this, they tend to resemble GDPs more than they resemble patients. © 2012 John Wiley & Sons A/S.

A case-control study of acute respiratory tract infection in general practice patients in The Netherlands.

PubMed

van Gageldonk-Lafeber, Arianne B; Heijnen, Marie-Louise A; Bartelds, Aad I M; Peters, Marcel F; van der Plas, Simone M; Wilbrink, Berry

2005-08-15

Acute respiratory tract infections (ARTIs) are responsible for considerable morbidity in the community, but little is known about the presence of respiratory pathogens in asymptomatic individuals. We hypothesized that asymptomatic persons could have a subclinical infection and thus act as a source of transmission. During the period of 2000-2003, all patients with ARTI who visited their sentinel general practitioner had their data reported to estimate the incidence of ARTI in Dutch general practices. A random selection of these patients (case patients) and an equal number of asymptomatic persons visiting for other complaints (control subjects) were included in a case-control study. Nose and throat swabs of participants were tested for a broad range of pathogens. The overall incidence of ARTI was 545 cases per 10,000 person-years, suggesting that, in the Dutch population, an estimated 900,000 persons annually consult their general practitioner for respiratory complaints. Rhinovirus was most common in case patients (24%), followed by influenza virus type A (11%) and coronavirus (7%). Viruses were detected in 58% of the case patients, beta -hemolytic streptococci group A were detected in 11%, and mixed infections were detected in 3%. Pathogens were detected in approximately 30% of control subjects, particularly in the youngest age groups. This study confirms that most ARTIs are viral and supports the reserved policy of prescribing antibiotics. In both case and control subjects, rhinovirus was the most common pathogen. Of bacterial infections, only group A beta-hemolytic streptococci were more common in case patients than in control subjects. Furthermore, we demonstrated that asymptomatic persons might be a neglected source of transmission.

Case-finding for cognitive impairment among people with Type 2 diabetes in primary care using the Test Your Memory and Self-Administered Gerocognitive Examination questionnaires: the Cog-ID study.

PubMed

Koekkoek, P S; Janssen, J; Kooistra, M; Biesbroek, J M; Groeneveld, O; van den Berg, E; Kappelle, L J; Biessels, G J; Rutten, G E H M

2016-06-01

To evaluate two cognitive tests for case-finding for cognitive impairment in older patients with Type 2 diabetes. Of 1243 invited patients with Type 2 diabetes, aged ≥70 years, 228 participated in a prospective cohort study. Exclusion criteria were: diagnosis of dementia; previous investigation at a memory clinic; and inability to write or read. Patients first filled out two self-administered cognitive tests (Test Your Memory and Self-Administered Gerocognitive Examination). Secondly, a general practitioner, blinded to Test Your Memory and Self-Administered Gerocognitive Examination scores, performed a structured evaluation using the Mini-Mental State Examination. Subsequently, patients suspected of cognitive impairment (on either the cognitive tests or general practitioner evaluation) and a random sample of 30% of patients not suspected of cognitive impairment were evaluated at a memory clinic. Diagnostic accuracy and area under the curve were determined for the Test Your Memory, Self-Administered Gerocognitive Examination and general practitioner evaluation compared with a memory clinic evaluation to detect cognitive impairment (mild cognitive impairment or dementia). A total of 44 participants were diagnosed with cognitive impairment. The Test Your Memory and Self-Administered Gerocognitive Examination questionnaires had negative predictive values of 81 and 85%, respectively. Positive predictive values were 39 and 40%, respectively. The general practitioner evaluation had a negative predictive value of 83% and positive predictive value of 64%. The area under the curve was ~0.70 for all tests. Both the tests evaluated in the present study can easily be used in case-finding strategies for cognitive impairment in patients with Type 2 diabetes in primary care. The Self-Administered Gerocognitive Examination had the best diagnostic accuracy and therefore we would have a slight preference for this test. Applying the Self-Administered Gerocognitive Examination would considerably reduce the number of patients in whom the general practitioner needs to evaluate cognitive functioning to tailor diabetes treatment. © 2015 Diabetes UK.

Is the knowledge and attitude of physicians in Nigeria adequate for the diagnosis and management of obstructive sleep apnea?

PubMed

Ozoh, Obianuju B; Ojo, Oluwadamilola O; Iwuala, Sandra O; Akinkugbe, Ayesha O; Desalu, Olufemi O; Okubadejo, Njideka U

2017-05-01

The knowledge and attitude of doctors in Nigeria towards obstructive sleep apnea is not known. We evaluated the level of knowledge and attitude regarding OSA among resident doctors in Internal Medicine and general practitioners in Nigeria. A cross-sectional survey among doctors during continuing medical education programs was conducted. The Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) questionnaire was used to obtain information. Two hundred seventy-three doctors (235 resident doctors and 38 general practitioners) participated in the study. The mean knowledge score was 10.7 ± 2.6 (out of a maximum possible of 18) for all participants corresponding to 59 ± 14.4 % knowledge. There was no significant difference in the mean score of resident doctors (10.8 ± 2.5) compared to general practitioners (10.0 ± 2.8), (t = 2.6, p = 0.10). Over 70 % of the participants wrongly responded that uvuloplasty was an effective treatment and less than 40 % correctly answered that continuous positive airway pressure treatment was first line for severe obstructive sleep apnea. The mean score on the attitude segment was 3.4 ± 0.6 (maximum possible score of 5) for all participants and 3.4 ± 0.6 and 3.3 ± 0.5, respectively, for the residents and the general practitioners (p = 0.47). Increasing age was negatively associated with level of knowledge, while increasing number of years in medical practice and higher level of residency training was positively associated with higher knowledge scores. The knowledge of obstructive sleep apnea among resident doctors and general practitioners in Nigeria is inadequate. There is need to improve training on sleep disorders in Nigeria both at continuing medical education programs and during residency training.

Unconventional therapies in asthma: an overview.

PubMed

Lewith, G T; Watkins, A D

1996-11-01

Acupuncture, homoeopathy, mind-body therapies, and nutritional, herbal, and environmental medicine have all been used in the management of patients with asthma. This paper reviews the evidence base for the use of these unconventional or complementary therapies. Although there is a paucity of large randomized, controlled trials in this area, there is sufficient evidence to suggest that many of these therapies can produce objective and subjective benefit in selected groups of patients. In view of the increasing popularity of complementary medicine among patients and general practitioners, there is now an urgent need for high-quality research to determine how, or whether, these therapies may be interwoven with the more orthodox treatments currently available.

Club health: global perspectives, new directions.

PubMed

Measham, Fiona; Anderson, Tammy; Hadfield, Phil

2009-01-01

This editorial presents the views of the guest editors of this collection in summarising some of the general themes arising from a selection of papers presented at the 2008 Club Health Conference in Ibiza, Spain. Particular emphasis is placed upon the value of comparative approaches to club studies, youth culture and substance use so that researchers, policy-makers, and practitioners can gain new understanding of the interplay of local and global factors which shape club cultures, nightlife scenes, and individual lifestyles. By contextualizing the studies in this volume, the editorial outlines important themes and issues which will help promote Club Studies as an interdisciplinary field of endeavour well into the future.

Genetics on the World Wide Web.

PubMed

Trangenstein, P A; Hetteberg, C

1998-11-01

Since 1990, when the Human Genome Project was initiated, the amount of genetic information on the World Wide Web (WWW) has grown substantially. The WWW has become an important resource for current, accurate, and reliable genetic information for health care professionals and the general public. The purpose of this article is to provide a variety of genetics-related WWW sites that are useful for all levels of practitioners interested in genetics. In selecting sites to be included in this article, a number of evaluation tools were reviewed. The primary concern was that these sites be reputable and provide accurate, timely information. A table of the WWW sites is included for quick easy reference.

Origins of suicidality: compatibility of lay and expert beliefs - qualitative study.

PubMed

Zadravec, Tina; Grad, Onja

2013-06-01

Today there exist different views on origins of suicidal behaviour, which can influence the help-seeking behaviour and the adherence to the treatment of suicidal people. The beliefs lay people and patients have about the origins of suicidal behaviour as well as the compatibility of their beliefs with the views of the mental health personnel (general practitioners and psychiatrists) were assessed. 45 semi-structured interviews with the general population, suicide attempters, general practitioners and psychiatrists were conducted, audio typed, transcribed and a thematic analysis of the data was carried out. The results indicated the incompatibility of the views. The general population and the suicide attempters favoured psychological explanations of suicidal behaviour, whereas the general practitioners and psychiatrists promoted medical explanations. The only common theme was perception of the suicidal crisis as a crucial factor in suicidality. Lay people and experts believe that suicidal crisis is the main origin of suicidal behaviour. The awareness of this common denominator and also of the differences in opinions between lay people and experts should be kept in mind when planning and implementing prevention and treatment programmes if we wish to promote help-seeking behaviour and attain good adherence to treatment.

The reduction of occupational stress among elderly lawyers: the creation of a functional niche.

PubMed

Meltzer, M W

1981-01-01

The question of how older lawyers function in the context of what is generally a high stress occupation is examined from data drawn from a random stratified sample of 130 members of the legal profession. It is shown that elderly lawyers are able to reduce work stress (largely deriving from volume, responsibility, clients, and trials) by control over the quantity and focus of their work, as well as through client selection. Elderly lawyers are able to create a relatively stress free work role, which is in fact a functional niche for them within the profession. The result is high job satisfaction and low rates of retirement among elderly practitioners. Two factors: work role compensation and work role autonomy, are isolated from the legal data and proposed as important variables in a general theory of retirement behavior.

[Peroral and transdermal application of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of regional musculoskeletal pain syndromes].

PubMed

Hodinka, László; Bálint, Géza; Budai, Erika; Géher, Pál; Papp, Renáta; Somogyi, Péter; Szántó, Sándor; Vereckei, Edit

2017-12-01

In this review the available evidences regarding the most frequently applied medication (peroral and transdermal non-steroidal anti-inflammatory agents) for the most frequent musculoskeletal complaints (regional pain syndromes) have been collected for the appropriate medical professionals who are most frequently faced with these conditions (general practitioners, rheumatologists, orthopedics, occupational and sports medicine experts). The special population at risk (with repeated and high energy overuse because of occupational or sport activities) and the pathology of their syndromes are identified. Mode of action, pharmacological properties of the non-steroidal anti-inflammatory drugs and the unwanted effects of their application especially in infants and elderly are highlighted. Recommendations of the general and specific pain management guidelines have been selected and listed in the review. Orv Hetil. 2017; 158(Suppl. 3): 3-30.

Effect of educational intervention on adoption of new endodontic technology by general dental practitioners: a questionnaire survey.

PubMed

Koch, M; Eriksson, H G; Axelsson, S; Tegelberg, A

2009-04-01

To survey the clinical endodontic protocols of general dental practitioners (GDPs) in public dental clinics and to assess the effect of an educational intervention on the adoption of a nickel-titanium (Ni-Ti) rotary system. General dental practitioners in a Swedish Intervention County (IC), underwent an educational programme in endodontics. A follow-up questionnaire was posted to 98 GDPs in the IC and to 97 GDPs in a Control County (CC), where no specific training had been provided. The questionnaire concerned demographics, clinical endodontic protocols and instrumentation techniques. The response rate to the questionnaire was 87%. More than 90% of all GDPs reported they always or generally used rubber dam, determined working length, used the canal irrigant 0.5% buffered NaOCl and calcium hydroxide as an interappointment dressing. Two of three GDPs reported, they generally or always informed the patient of the prognosis. Every second GDP reported routines for postoperative recall and follow-up. The Ni-Ti rotary technique was reported to be completely adopted by 77% of the GDPs in the IC, significantly higher than in the CC (6%), P < 0.001. In the IC 79% of the GDPs reported they completed instrumentation in one treatment session, compared with only 32% in the CC, P < 0.001. The 'single-cone' mode of canal filling was reported to be significantly more frequent amongst GDPs in the IC, P < 0.001. General dental practitioners in both counties reported using contemporary clinical endodontic protocols. GDPs who had undergone an educational programme in Ni-Ti rotary instrumentation reported they had successfully integrated the technique into daily clinical practice.

[Day hospital in internal medicine: A chance for ambulatory care].

PubMed

Grasland, A; Mortier, E

2018-04-16

Internal medicine is an in-hospital speciality. Along with its expertise in rare diseases, it shares with general medicine the global care of patients but its place in the ambulatory shift has yet to be defined. The objective of our work was to evaluate the benefits of an internal medicine day-hospital devoted to general medicine. Named "Centre Vi'TAL" to underline the link between the city and the hospital, this novel activity was implemented in order to respond quickly to general practitioners having difficulties to synthesize their complex patients or facing diagnostic or therapeutic problems. Using preferentially email for communication, the general practitioners can contact an internist who is committed to respond on the same day and take over the patient within 7 days if day-hospital is appropriate for his condition. The other patients are directed either to the emergency department, consultation or full hospitalization. In 14 months, the center has received 213 (144 women, 69 men) patients, mean age 53.6, addressed by 88 general practitioners for 282 day-hospital sessions. Requests included problem diagnoses (n=105), synthesis reviews for complex patients (n=65), and treatment (n=43). In the ambulatory shift advocated by the authorities, this experience shows that internal medicine should engage in the recognition of day-hospital as a place for diagnosis and synthesis reviews connected with the city while leaving the general practitioners coordinator of their patient care. This activity of synthesis in day-hospital is useful for the patients and efficient for our healthcare system. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

45 CFR 60.22 - Immunity.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Immunity. 60.22 Section 60.22 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK Disclosure of Information by the National Practitioner Data Bank § 60.22 Immunity. Individuals, entities or their authorized...

45 CFR 60.22 - Immunity.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Immunity. 60.22 Section 60.22 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK Disclosure of Information by the National Practitioner Data Bank § 60.22 Immunity. Individuals, entities or their authorized...

Diversity Training in the Workplace Today: A Status Report.

ERIC Educational Resources Information Center

Jordan, Katrina

1998-01-01

Examines the status of diversity training in today's workplace from the perspective of organizational/human resources (HR) diversity practitioners and diversity consultants. Results show that HR practitioners generally expressed agreement that diversity training is a high priority and will be ongoing in their organizations. Provides…

Organization Development: A Critique

ERIC Educational Resources Information Center

Stephenson, T. E.

1975-01-01

Reviews the literature dealing with organization development (OD) and discusses the predominant concerns and attitudes of OD theorists and practitioners. Suggests that OD might be more aptly named "human development" and argues that OD practitioners generally act as missionaries who feel they must remedy the errors of their clients' behavior. (JG)

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.

Waiting in the surgery.

PubMed

Fry, F

1994-07-01

The concise Oxford English Dictionary defines 'dilemma' as an argument forcing one to choose one of two alternatives, both of which are unfavourable. This is a situation that frequently confronts the general practitioner. This paper will present one practitioner's view on the subject of patients waiting to see the doctor.

45 CFR 60.6 - Reporting errors, omissions, and revisions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Section 60.6 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS Reporting of Information § 60.6 Reporting errors, omissions, and revisions. (a) Persons and entities are responsible for...

Chlamydia trachomatis related knowledge and practices in medical practioners--a survey.

PubMed

Hashmi, Shahkamal; Ali, Syed Imtiaz; Tanwir, Farzeen; Shamsi, Taiba Yousuf; Ahmed, Farrukh Rafiq; Rai, Kelash

2014-01-01

Chlamydia trachomatis is a frequently encountered condition by general physicians, urologists and infectious diseases specialists. It can affect both genders and causes significant morbidity if not treated properly and promptly. In addition, it can cause ophthalmia neonatorum, which manifests as neonatal conjunctivitis in the newborns. The data was collected from fourteen tertiary care hospitals in two provinces of Pakistan during the time period of four months (September-December 2013). Inclusion criteria included all medical practitioners working at those hospitals and there were no limitations of age and gender to participate. The participants were approached through email which included a self administered questionnaire. Written consent was obtained from the participants and the study was approved by the ethical committee of all selected hospital. Overall 130 participants participated with a response rate of 65%. Females were 52.3% and males were 47.7%. In the study 17.7% of male and 29.4% of female participants proclaimed that they referred a patient to an infectious disease specialist in case the diagnosis of Chlamydia was dubious. 72.5% of the male and 55.8% of the female medical practitioners indicated that they yield detailed sexual history from the patients with Chlamydia. Regarding inquiring about the drugs history from the patient at risk of STDs, 22.6% male and 35.3% of female participants informed that they took a detailed drug history. Only 1.5% of the female medical practitioners notified Chlamydia to the partner of diseased patient themselves (provider referral). 24% male and 17.6% female participants had an understanding regarding the definite test of diagnosis for sexually transmitted Chlamydia. More sexual health skills development is required in medical practitioners working in Pakistan. The major deficient areas are sexual and drug history taking, management of sexually transmitted diseases and partner notification.

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.

Patients' priorities in assessing organisational aspects of a general dental practice.

PubMed

Sonneveld, Rutger E; Brands, Wolter G; Bronkhorst, Ewald M; Welie, Jos V M; Truin, Gert-Jan

2013-02-01

To explore which organisational aspects are considered most important by patients when assessing a general dental practice, and which patients' characteristics influence their views on these aspects by a paper questionnaire. The questionnaire was handed out to a sample of 5,000 patients in the Netherlands. The response rate was 63%. Six organisational aspects out of a list of 41 aspects were valued as most important by at least 50%. In decreasing order of importance, these were: accessibility by telephone; continuing education for general dental practitioners; Dutch-speaking general dental practitioners; in-office waiting times; information about treatments offered; and waiting lists. For four out of these six aspects, respondents' age and education significantly influenced their preferences. Aspects concerning the infrastructure of a general dental practice were chosen more often than aspects such as working to professional standards, working according to protocols and guidelines, quality assessment and guaranteed treatment outcomes. The findings will enable organisations to increase the transparency of health-care delivery systems to focus on those organisational aspects of dental practices that patients themselves consider most important. These findings can also assist general dental practitioners in adapting their organisational services to the preferences of patients or specific patient groups. © 2013 FDI World Dental Federation.

Psychosocial primary care – what patients expect from their General Practitioners A cross-sectional trial

PubMed Central

Fritzsche, Kurt; Armbruster, Ulrike; Hartmann, Armin; Wirsching, Michael

2002-01-01

Background Psychosocial Primary Care (PPC) is a model of service delivery for patients with mental disorders and psychosocial problems which was established in Germany in 1987. This study was performed as part of the evaluation of a PPC training program. We investigated patients' expectations of the psychosocial treatment offered by GPs trained in PPC. Methods Ten general practitioners trained in PPC were randomly selected. Two hundred and twenty patients were surveyed in the waiting room regarding their expectations concerning psychological treatment. Results Eighty-five per cent of patients could envisage making use of psychosocial treatments. Counselling by the GP was considered most important (65%). Fifty-four per cent of patients indicated that there was sufficient counselling, but further distinctions revealed dissatisfaction with both the extent and content of the counselling. Lack of time was the most frequent reason (53%) cited for insufficient counselling. A willingness to discuss the psychological aspects of illness was exhibited by between 55% (current illness) and 79% of patients. Two-thirds of patients believed that discussing psychological aspects and counselling by the doctor could exert a healing effect or contribute to symptomatic improvement in physical illnesses. Younger patients and patients with experience in psychotherapy expected referral to mental health services. Conclusions Primary care patients desire and accept psychological treatment from their GP. Training in psychosocial competence in primary care should be offered more frequently. PMID:12000687

Equity of access to elective surgery: reflections from NZ clinicians.

PubMed

McLeod, Deborah; Dew, Kevin; Morgan, Sonya; Dowell, Anthony; Cumming, Jackie; Cormack, Donna; McKinlay, Eileen; Love, Tom

2004-10-01

To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery. A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed. Data were analysed thematically. General practitioners described unequal opportunities for patients to access primary and secondary care and, in particular, private sector elective surgery. They felt that socio-economically disadvantaged patients were less able to advocate for themselves and were more vulnerable to being lost to the elective surgical booking system as well as being less able to access private care. Both GPs and secondary care clinicians described situations where they would personally advocate for individual patients to improve their access. Advocacy was related to clinicians' perceptions of the 'value' that patients would receive from the surgery and patients' needs for public sector funding. The structure of the health system contributes to inequities in access to elective care in New Zealand. Subjective decision making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions. Review of the potential structural barriers to equitable access, further public debate and guidance for clinicians on the relative importance of socio-demographic factors in deciding access to rationed services are required for allocation of services to be fair.

Knowledge of TIA among general practitioners and emergency department physicians. A questionnaire survey in a French semi-rural area.

PubMed

Massengo, Serge A; Cisse, M; Guiziou, C; Leray, E; Rajabally, Yusuf A; Edan, G

2013-08-01

Management of transient ischemic attacks (TIAs) is of vital importance in an attempt to prevent stroke. However, suboptimal management still raise concern among general practitioners (GPs) and emergency department (ED) physicians-the first medical contact of most TIA patients. This may relate to their poorly updated knowledge about TIA. The study was designed to assess knowledge of TIA among these non-neurologists. The study was a post-mailed questionnaire survey among GPs and ED physicians. The questionnaire related to selective clinical aspects on TIA. There were a total of 85 respondents for analysis, mostly GPs (n=64; 75.3%), out of 177 mailed physicians. Response rate was 52.7%. Many of these respondents were unaware of the newly proposed TIA definition (59%), unfamiliar with TIA mimics and predictors of post-TIA early stroke recurrence and therefore with the rationales underlying the need of emergency management of TIA. More than one third (39%) were unaware of the relevant national guidelines. Guidelines-aware respondents performed better in most part of the mailed questionnaire. Our results show that poorly updated knowledge about TIA among non-neurologists represents a potential contributing factor to the persisting sub-optimal management of the disorder. Although further studies are needed to confirm this, improved continuous medical education of this group of health care professionals appears warranted. Copyright © 2013 Elsevier B.V. All rights reserved.

The influential role of personal advice networks on general practitioners' performance: a social capital perspective.

PubMed

Calciolari, Stefano; González-Ortiz, Laura G; Lega, Federico

2017-08-08

In several health systems of advanced countries, reforms have changed primary care in the last two decades. The literature has assessed the effects of a variety of interventions and individual factors on the behavior of general practitioners (GPs). However, there has been a lack of investigation concerning the influence of the resources embedded in the GPs' personal advice networks (i.e., social capital) on GPs' capacity to meet defined objectives. The present study has two goals: (a) to assess the GPs' personal advice networks according to the social capital framework and (b) to test the influence of such relationships on GPs' capacity to accomplish organizational goals. The data collection relied on administrative data provided by an Italian local health authority (LHA) and a survey administered to the GPs of the selected LHA. The GPs' personal advice networks were assessed through an ad-hoc instrument and interpreted as egocentric networks. Multivariate regression analyses assessed two different performance measures. Social capital may influence the GPs' capacity to meet targets, though the influence differs according to the objective considered. In particular, the higher the professional heterogeneity of a GP personal advice network, the lower her/his capacity is to meet targets of prescriptive appropriateness. Our findings might help to design more effective primary care reforms depending on the pursued goals. However, further research is needed.

A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran

PubMed Central

2016-01-01

Objectives General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. Methods A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran’s health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. Results Iran’s medical education is faced with several challenges that were categorized in four main themes including student selection, medical students’ perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. Conclusions Challenges that were found could have negative effects on retention. Modification in student’s perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas. PMID:27951631

Are joint health plans effective for coordination of health services? An analysis based on theory and Danish pre-reform results

PubMed Central

Strandberg-Larsen, Martin; Bernt Nielsen, Mikkel; Krasnik, Allan

2007-01-01

Background Since 1994 formal health plans have been used for coordination of health care services between the regional and local level in Denmark. From 2007 a substantial reform has changed the administrative boundaries of the system and a new tool for coordination has been introduced. Purpose To assess the use of the pre-reform health plans as a tool for strengthening coordination, quality and preventive efforts between the regional and local level of health care. Methods A survey addressed to: all counties (n=15), all municipalities (n=271) and a randomised selected sample of general practitioners (n=700). Results The stakeholders at the administrative level agree that health plans have not been effective as a tool for coordination. The development of health plans are dominated by the regional level. At the functional level 27 percent of the general practitioners are not familiar with health plans. Among those familiar with health plans 61 percent report that health plans influence their work to only a lesser degree or not at all. Conclusion Joint health planning is needed to achieve coordination of care. Efforts must be made to overcome barriers hampering efficient whole system planning. Active policies emphasising the necessity of health planning, despite involved cost, are warranted to insure delivery of care that benefits the health of the population. PMID:17925882

The prevalence of bad headaches including migraine in a multiethnic community.

PubMed

Thomson, A N; White, G E; West, R

1993-11-10

Overall and ethnic specific prevalences of bad headache including migraine, for the New Zealand population, are unknown. A study was carried out in South Auckland to estimate prevalence and to explore ethnic differences in doctor attendance for the diagnosis and management of bad headaches. Telephone interviews were administered to respondents selected by random digit dialing of households. 40.6% of the respondents suffered from bad headaches. 54.5% of these had the characteristics of bad headache with features symptomatic of migraine. Trends in the prevalence of bad headache with features symptomatic of common migraine, peaked between the ages of 30-49 years in both men and women. A difference was seen in the prevalence of bad headache with aura, with or without common migraine features, when ethnic groups and gender were examined. The difference in prevalence of aura was particularly noticeable between Pacific Island men and women. Although there was no difference between ethnic groups in doctor attendance, headaches were more likely to be labelled as migraine in Europeans than in the Polynesian groups. Ways in which people perceive and report their bad headaches have a bearing on management by general practitioners. Although no overall ethnic predominance was seen, there was a gender difference amongst Pacific Island people in reporting bad headaches with aura. The labelling process, and thus the management by general practitioners does demonstrate likely ethnic differences.

Treatment of obstructive sleep apnoea patients in community dental care: knowledge and attitudes among general dental practitioners and specialist dentists.

PubMed

Vuorjoki-Ranta, T-R; Lobbezoo, F; Vehkalahti, M; Tuomilehto, H; Ahlberg, J

2016-12-01

Obstructive sleep apnoea (OSA) is an increasing problem worldwide. Yet, a large number of patients may remain undiagnosed. Dentists could suspect OSA, but little is known about their knowledge and attitudes towards the topic. An email questionnaire was sent to dentists working in Helsinki Health Centre, Helsinki, Finland (n = 226). It consisted of demographic data, items on dentists' overall knowledge of OSA and factors associated with it, and their possibilities and willingness to take part in the recognition and treatment of OSA patients. Altogether, 70·9% (n = 134) of dentists eligible for the study completed the questionnaire. Of them, 79·1% (n = 106) were general practitioners and 20·9% (n = 28) dentists with specialty training. Continuous positive airway pressure (CPAP) (99·3%) and weight control (99·3%) were both generally acknowledged as effective methods to treat OSA. Regarding the efficacy of other treatment modalities, significant differences were found between general practitioners' and specialists' opinions. For example, mandibular advancement devices (MAD) were less often reported by general practitioners (69·8%) than specialists (89·3%) (P < 0·05). The possible risk factors, signs and symptoms, and consequences of OSA were overall well recognised regardless the years in dental profession, but specialists saw more often that nocturnal sweating (P < 0·01) and snoring (P < 0·05) may signify OSA. Dentists could play an important role in suspecting OSA, but they may need more education to cope with that. © 2016 John Wiley & Sons Ltd.

Why are some evidence-based care recommendations in chronic obstructive pulmonary disease better implemented than others? Perspectives of medical practitioners

PubMed Central

Johnston, Kylie N; Young, Mary; Grimmer-Somers, Karen A; Antic, Ral; Frith, Peter A

2011-01-01

Background Clinical guidelines for management of patients with chronic obstructive pulmonary disease (COPD) include recommendations based on high levels of evidence, but gaps exist in their implementation. The aim of this study was to examine the perspectives of medical practitioners regarding implementation of six high-evidence recommendations for the management of people with COPD. Methods Semi-structured interviews were conducted with medical practitioners involved with care of COPD patients in hospital and general practice. Interviews sought medical practitioners’ experience regarding implementation of smoking cessation, influenza vaccination, pulmonary rehabilitation, guideline-based medications, long-term oxygen therapy for hypoxemia and plan and advice for future exacerbations. Interviews were audiotaped, transcribed verbatim and analyzed using content analysis. Results Nine hospital-based medical practitioners and seven general practitioners participated. Four major categories were identified which impacted on implementation of the target recommendations in the care of patients with COPD: (1) role clarity of the medical practitioner; (2) persuasive communication with the patient; (3) complexity of behavioral change required; (4) awareness and support available at multiple levels. For some recommendations, strength in all four categories provided significant enablers supporting implementation. However, with regard to pulmonary rehabilitation and plans and advice for future exacerbations, all identified categories that presented barriers to implementation. Conclusion This study of medical practitioner perspectives has indicated areas where significant barriers to the implementation of key evidence-based recommendations in COPD management persist. Developing strategies to target the identified categories provides an opportunity to achieve greater implementation of those high-evidence recommendations in the care of people with COPD. PMID:22259242

Sport Management Interns--Selection Qualifications.

ERIC Educational Resources Information Center

Cuneen, Jacquelyn; Sidwell, M. Joy

1993-01-01

Examines and rates the background qualifications and qualities, identified by sport management practitioners through an examination of paper credentials, that are desired in interviewees vying for selection into sport management internship positions. (GLR)

Learning Lean: A Survey of Industry Lean Needs

ERIC Educational Resources Information Center

Fliedner, Gene; Mathieson, Kieran

2009-01-01

The authors examined business practitioners' preferences for higher education curricula design in general and for what graduates should know about Lean, or waste-reduction efforts. The authors conducted a Web-based survey and found that practitioners are not as concerned about graduates' possessing specific technical skills as they are about them…

45 CFR 60.6 - Reporting errors, omissions, and revisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Reporting errors, omissions, and revisions. 60.6 Section 60.6 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS Reporting of...

45 CFR 60.4 - How information must be reported.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false How information must be reported. 60.4 Section 60.4 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS Reporting of...

45 CFR 60.5 - When information must be reported.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false When information must be reported. 60.5 Section 60.5 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS Reporting of...

45 CFR 60.14 - Fees applicable to requests for information.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Fees applicable to requests for information. 60.14 Section 60.14 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NATIONAL PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS Disclosure of...

42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Medical or other remedial care provided by licensed practitioners. 440.60 Section 440.60 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS...

42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medical or other remedial care provided by licensed practitioners. 440.60 Section 440.60 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS...

The Emergence of Ethics and Professionalism in the Early Advertising Business.

ERIC Educational Resources Information Center

Schultze, Quentin J.

In the pre-World War I era, advertising practitioners attempted to make their craft a profession. Generally agreeing that the creation of ethical codes was the most important step toward professionalism, practitioners organized the Associated Advertising Clubs of America (AACA). Early journal articles and AACA proceedings indicate that…

Student Complaints and Appeals: The Practitioner's View

ERIC Educational Resources Information Center

Buckton, Liz

2008-01-01

This article explores the issues facing practitioners working in the field of student complaints and appeals (including academic appeals). It is a reflective study which examines some general and historical issues, using anonymised case studies where appropriate and highlighting the diversity of practice across the sector. The author observes that…

Stormwater management criteria for on-site pollution control: a comparative assessment of international practices.

PubMed

Sage, Jérémie; Berthier, Emmanuel; Gromaire, Marie-Christine

2015-07-01

Over the last decade, a growing interest has been shown toward innovative stormwater management practices, breaking away from conventional "end of pipe" approaches (based on conveying water offsite to centralized detention facilities). Innovative strategies, referred to as sustainable urban drainage systems, low impact development (LID) or green infrastructures, advocating for management of runoff as close to its origin as possible, have therefore gained a lot of popularity among practitioners and public authorities. However, while the need for pollution control is generally well accepted, there is no wide agreement about management criteria to be given to developers. This article hence aims to compare these criteria through literature analysis of different state or local stormwater management manuals or guidelines, investigating both their suitability for pollution control and their influence on best management practices selection and design. Four categories of criteria were identified: flow-rate limitations, "water quality volumes" (to be treated), volume reduction (through infiltration or evapotranspiration), and non-hydrologic criteria (such as loads reduction targets or maximum effluent concentrations). This study suggests that hydrologic criteria based on volume reduction (rather than treatment) might generally be preferable for on-site control of diffuse stormwater pollution. Nonetheless, determination of an appropriate management approach for a specific site is generally not straightforward and presents a variety of challenges for site designers seeking to satisfy local requirements in addressing stormwater quantity and quality issues. The adoption of efficient LID solution may therefore strongly depend on the guidance given to practitioners to account for these management criteria.