Cent Of General Practitioners Research Articles

Stage IA melanoma follow-up: Exploring the level of confidence of South Australian general practitioners in undertaking surveillance skin checks including considerations for shared care.

The literature highlights the role of Australian general practitioners (GP) in the management of skin cancers. With melanoma incidences on the rise, there have been discussions into whether lower-risk stage IA patients could safely be followed up by their GPs for annual surveillance full skin examinations (FSE). This study explores the level of confidence of South Australian (SA) GPs in undertaking FSEs including factors that could support discussions around shared care between GPs and dermatology units for lower-risk patients. An online survey was designed and distributed to SA GPs via email, newsletters and social media between 5 December 2021 and 30 January 2022. Descriptive statistics were used to describe survey responses. Pearson's Chi-squared analysis was used to investigate associations between key variables of interest and explanatory variables. Logistic regression analysis was used to model odds ratios for associations between the dependent variable and independent variables. A total of 135 responses were obtained. Forty-four per cent of GPs were comfortable undertaking annual FSEs, 41% were uncomfortable and 15% were unsure. Scope of work, >20 years experience and additional training had statistically significant relationships (p < 0.05). Dermoscopy and detecting melanoma recurrences were reported to be skills with lower levels of confidence. With regards to shared care, 77% indicated that they would feel supported undertaking FSEs if rapid access referral pathways were allocated for patients who developed suspicious lesions. Preferred upskilling modalities included, face-to-face sessions in a dermatology unit (39%), dermatologist run webinars (25%) and certificate courses (20%). At present, there is a subset of SA GPs who are comfortable undertaking FSEs and therefore could be engaged in shared care with specialists. Further considerations have to be made in the areas of upskilling and supporting the workforce to enhance engagement in shared care.

ENT training amongst general practitioners: results from a questionnaire.

To evaluate the level of undergraduate and post-graduate ENT exposure amongst general practitioners and their perceived quality of this training. A secondary aim was to examine whether general practitioners believe ENT department based rotations should remain in the undergraduate curriculum. An online questionnaire-based survey was sent to general practices in England. A total of 417 general practitioners completed the questionnaire. Sixty-seven per cent had completed an ENT rotation at medical school whereas 27 per cent had undertaken a postgraduate placement in ENT. Fifty-one per cent had received post-graduate teaching in ENT, mainly in the form of lectures. The majority of general practitioners were not satisfied with their training in ENT at undergraduate and post-graduate levels. Eighty-five per cent of general practitioners believed formal hospital-based ENT training should remain in the undergraduate curriculum. General practitioners reported insufficient exposure to ENT during both post-graduate and undergraduate training. Proposals to outsource undergraduate ENT teaching to affiliated departments such as general practice are of concern.

Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort.

Although migraine is the second most disabling condition worldwide, there is poor awareness of it. The objective was to assess the awareness of migraine and previous diagnostic and therapeutic consultations and treatments in a large international population of migraineurs. This was a multicentre study conducted in 12 headache centres in seven countries. Each centre recruited up to 100 patients referred for a first visit and diagnosed with migraine. Subjects were given a structured clinical questionnaire-based interview about the perceptions of the type of headache they suffered from, its cause, previous diagnoses, investigations and treatments. In all, 1161 patients completed the study. Twenty-eight per cent of participants were aware that they suffered from migraine. Sixty-four per cent called their migraine 'headache'; less commonly they used terms such as 'cervical pain' (4%), tension headache (3%) and sinusitis (1%). Eight per cent of general practitioners and 35% of specialists (of whom 51% were neurologists and/or headache specialists) consulted for migraine formulated the correct diagnosis. Before participating in the study, 50% of patients had undergone X-ray, computed tomography and/or magnetic resonance imaging of the cervical spine and 76% underwent brain and/or cervical spine imaging for migraine. Twenty-eight per cent of patients had received symptomatic migraine-specific medications and 29% at least one migraine preventive medication. Although migraine is a very common disease, poor awareness of it amongst patients and physicians is still an issue in several countries. This highlights the importance of the promotion of migraine awareness to reduce its burden and limit direct and indirect costs and the risk of exposure to useless investigations.

Illness behaviour of general practitioners-a cross-sectional survey.

BackgroundInternational guidelines recommend that physicians should be registered with a general practitioner (GP) and should avoid self-treatment. Adherence to these recommendations is mixed.AimsTo describe illness behaviour and chronic medical conditions of GPs in Germany.MethodsCross-sectional, observational questionnaire study. We contacted 1000 GPs by mail in April 2014. We asked about registration with a GP, chronic conditions and self-treatment. We undertook descriptive statistical analysis and analysed associations using t-tests and chi-square test.ResultsTwo hundred and eighty-five responses (29%) were eligible for analysis. Nineteen per cent of GPs were registered as patients of a GP, 58% reported at least one chronic condition, 68% disclosed self-diagnosis and 60% self-treatment. Self-therapy for chronic conditions was inversely correlated with subjective severity of the disease (r = −0.159; P < 0.05).ConclusionsThe high rates of self-treatment and the low rate of registration with a GP of German GPs are in contrast to international guideline recommendations. Further research is needed to analyse specific reasons.

Stalking, harassment and aggressive/intrusive behaviours towards general practitioners: (2) associated factors, motivation, mental illness and effects on GPs

Seventy per cent of general practitioners (GPs) were found in an earlier study to have been subject to aggressive/intrusive behaviours by patients, with nearly 20% stalked and 20% harassed. Using the same sample, an exploration was undertaken of patterns of behaviour, patient characteristics, including mental illness and motivation, GP characteristics, and effects upon them of aggression/intrusion. There were significant differences in patterns of behaviour between stalking and harassment. Nearly half the patients involved were suspected to be mentally ill, including 54.5% of stalking cases. Stalking was significantly associated with intimacy-seeking motivation, and harassment with resentful motivation. No significant associations emerged between sex of patients or GPs and aggressive/intrusive behaviours. Measures of GP time-at-risk were associated with higher prevalence of individual behaviours. GPs’ responses to aggressive/intrusive behaviours included increasing security and changing routines, with small minorities afraid to go out or be at home alone, and a proportion experiencing adverse effects on personal relationships.

Views of general practitioners and head and neck surgeons on the referral system for suspected cancer: a survey.

The two-week wait referral system for suspected cancer was introduced in the National Health Service in 2000. This study aimed to identify areas for improvement to the two-week wait system by seeking the opinions of doctors working in primary and secondary care. A questionnaire was distributed to general practitioners and head and neck surgeons within North West England with ethical consent. Twenty-seven general practitioners and 15 head and neck surgeons responded. Of the general practitioners, 59.3 per cent declared that they never attend training on referrals in this specialty. Overall, 59.3 per cent of general practitioners and 86.7 per cent of head and neck surgeons felt that the two-week wait system could be improved. The main areas for further work are development of pre-referral communication between primary and secondary care along with development of practical educational measures for general practitioners.

Influenza and pneumococcal vaccinations in dialysis patients in a London district general hospital

BackgroundPatients on dialysis mount reduced immune responses compared with the general population. The Department of Health advises that these patients receive influenza and pneumococcal vaccinations at regular intervals—once yearly and every five years, respectively. This article investigates the uptake of these vaccinations in this patient population and seeks to examine factors that may influence vaccination status such as patient's language and presence of a general practitioner (GP) electronic vaccination reminder system. It also explores preferred site of vaccination for patients and GPs as these are primary care vaccinations yet patients have more frequent contact with their dialysis unit than their GP, blurring the boundaries between primary and specialized care.MethodsThis is a retrospective study of all patients registered as dialysing at the North Middlesex University Hospital NHS Trust (NMUH) in September 2011. Information was obtained through GP letters, GP and patient questionnaires.ResultsOf 154 patients, 133 were included in the data analysis. Nineteen per cent were up-to-date with both vaccinations and 67% with their influenza vaccination. Fifty per cent had received the influenza vaccination in the last two consecutive years. Thirty per cent were not up-to-date with either vaccination. There was no evidence of a difference in uptake in 2009 (P = 0.7564) and in 2010 (P = 0.7435) among those who could and could not speak English. Twenty-five per cent of GPs and 58.6% of patients preferred vaccination to occur in the dialysis unit. Unfortunately a high number of GPs did not provide information on whether they used an electronic vaccination reminder but the analysis from the information provided by the few respondents did not reveal any correlation between the presence of an electronic reminder and vaccination status.ConclusionMost dialysis patients were not up-to-date with both vaccinations. They were, however, more up-to-date with their influenza than their pneumococcal vaccination. Non-English speakers did not appear to be disadvantaged. GP electronic reminder systems may have influenced influenza uptake but this study did not demonstrate a correlation and this is likely due to the lack of GP respondents; the effectiveness of electronic reminders merits further studies as a tool to improve vaccination rates in at-risk populations. Most patients visited their GP at least annually but preferred to receive their vaccinations at the hospital. Vaccinating in the dialysis unit and maintaining an electronic record accessible to GPs or generating a letter for GPs may help fill the vaccination gap in these patients. Overall, more evidence is required for the effectiveness of such vaccinations and their frequency, but in the meantime UK national guidelines were not being followed with a large proportion of patients remaining unvaccinated against influenza and in particular pneumococcal disease. This audit highlights the importance of local data collection, discussions around correlations influencing outcomes and publication of results to improve standards of care at a national level.

What so Medical Students Need to Know About Trauma and Orthopaedics ? A Cross-Sectional, Multispecialty Study of the Views of Senior Doctors

Recent years have seen repeated calls for improved education in musculoskeletal medicine both for medical students and doctors, with organisations ranging from individual medical schools to the World Health Organization raising concern. A study in ireland, for example, found that 88 per cent of medical students and 71 per cent of general practitioners (GPs) failed a validated musculoskeletal examination, and only 26 per cent of students at harvard medical school attained competency by their fourth year of study. At the same time, there have been calls to ensure that medical school curricula are better aligned with community needs.

Training general practitioners in remote Western Australia in a method of screening and brief intervention for harmful alcohol use: A pilot study

High levels of alcohol-related harm are a salient feature of many rural communities in Australia. General practitioners (GPs) are uniquely placed to identify and treat patients with harmful alcohol use in remote settings, yet corresponding opportunities for education in effective brief psychological interventions for harmful alcohol use are limited. This study piloted a training model for alcohol screening and brief intervention for GPs working in Kalgoorlie-Boulder, a remote Western Australian community facing significant alcohol-related problems. Observational pilot study. Primary care. Perceived role in responding to harmful alcohol use, and confidence and knowledge of alcohol screening and brief intervention; satisfaction with a short training session focused on alcohol screening and brief intervention; and impact of training on implementation of screening and brief intervention for harmful alcohol use. Fifty per cent of GPs took up the training opportunity. GPs recognised their professional responsibility for conducting brief intervention but reported comparatively lower confidence and skills in implementing screening and intervention prior to training. The training improved knowledge and confidence in conducting alcohol screening and brief intervention. All GPs increased their frequency of alcohol screening, and 88% of GPs reported increasing the frequency of brief intervention at 6 months. Preliminary findings suggest that among participating GPs, subsequent compliance with identification and management of harmful alcohol use was improved. Further work examining methods to improve rural and remote GP participation in alcohol-related harm prevention training is required, as the potential impact on communities with disproportionately high alcohol-related difficulties is significant.

Do we need education on right-to-die issues? Medical perspectives from Australia

Introduction An increasing demand for physicians’ involvement in life-ending decisions has led to extensive debate on euthanasia and right-to-die issues by social, political and medical groups. The Commonwealth Department of Health and Aged Care commissioned an evaluation of the need to educate undergraduate medical students on suicide prevention, euthanasia and life-ending issues. Methods Semi-structured interviews were conducted on samples of medical school coordinators, medical students and general practitioners (GPs). Key academics in Curriculum and/or Accreditation Committees from 10 of 15 Australian Medical Schools (AMS) participated in a survey on the possible implementation of suicide prevention, euthanasia and life-ending issues in undergraduate courses. Medical students (n = 373) were asked to rate their attitude toward the same issues. Twenty-four GPs from six different states (rural/urban environments) were asked to rate the level of importance of a specific curriculum on suicide prevention, euthanasia and life-ending issues. Results Medical students showed high interest in learning about euthanasia and life-ending issues (76.8%), quality of life and quality of death (85.1%), and different types of euthanasia and physician-assisted suicide (70%). They reported that physicians should be involved in ending-life decisions (89%). Forty per cent of AMS thought education on euthanasia and life-ending issues was essential. Fifty-four per cent of GPs considered education in euthanasia and related issues a high priority. Discussion The increasing aging population and the high prevalence of chronic illness call for a growing involvement of physicians in this difficult area of medical practice. Globally, the need for undergraduate education on these matters is perceived as important and urgent.

General practitioners' versus consultants' perspective on indications for paediatric tonsillectomy: current trends

We undertook a study to ascertain what factors general practitioners consider important when referring children for tonsillectomy, and to compare these views with those of consultant ENT surgeons. Web-based questionnaire study. A total of 141 general practitioners and 146 consultants responded. Tonsillectomy in children was regarded as a useful operation by 65 per cent of general practitioners and 98 per cent of consultant ENT surgeons. This difference was statistically significant (p < 0.001, chi-square test). In 1994, Donnelly et al. found that 92 per cent of general practitioners considered tonsillectomy in children a useful operation; our results were significantly different (p < 0.001, chi-square test). There is a good level of awareness and agreement on the currently accepted indications for paediatric tonsillectomy in both groups. However, there were important areas of difference between the two groups with regard to 'glue ear', recurrent ear infections and snoring. Standardised indications for tonsillectomy should be effectively disseminated to general practitioners.

The profile of general practitioners (GPs) who publish in selected family practice journals

BackgroundProviding support for research is one of the key issues in the ongoing attempts to improve Primary Care. However, when patient care takes up a significant part of a GP's time, conducting research is difficult. In this study we examine the working conditions and profile of GPs who publish in three leading medical journals and propose possible remedial policy actions.FindingsThe authors of all articles published in 2006 and 2007 in three international Family Medicine journals - Annals of Family Medicine, Family Practice, and Journal of Family Practice - were contacted by E-mail. They were asked to complete a questionnaire investigating the following variables: availability of specific time for research, time devoted to research, number of patients attended, and university affiliation. Only GPs were included in the study. Three hundred and ten relevant articles published between 2006 and 2007 were identified and the authors contacted using a survey tool. 124 researchers responded to our questionnaire; 45% of respondents who were not GPs were excluded. On average GPs spent 2.52 days per week and 6.9 hours per day on patient care, seeing 45 patients per week. Seventy-five per cent of GPs had specific time assigned to research, on average 13 hours per week; 79% were affiliated to a university and 69% held teaching positions.ConclusionsMost GPs who publish original articles in leading journals have time specifically assigned to research as part of their normal working schedule. They see a relatively small number of patients. Improving the working conditions of family physicians who intend to investigate is likely to lead to better research results.

Fibromyalgia and the Therapeutic Relationship: Where Uncertainty Meets Attitude

Fibromyalgia remains underdiagnosed and suboptimally treated even though it affects an estimated 3.3% of Canadians. The present study examines knowledge and attitudinal challenges affecting optimal care. A mixed-methods approach was employed. Discussion groups, semistructured interviews and a quantitative online survey (five-point scale) were conducted (June 2007 to January 2008). Participants included 189 general practitioners (GPs) and 139 specialists (anesthesiologists, neurologists, physiatrists, psychiatrists and rheumatologists) distributed across Canada. Participants included 18 patients to enrich the scope of the findings. GPs reported insufficient knowledge and skill in diagnosing fibromyalgia, with not all believing it to be a diagnosable condition (mean 3.74/5). Twenty-three per cent of GPs and 12% of specialists characterized fibromyalgia patients as malingerers. They further reported a lack of knowledge and skill in treating fibromyalgia (mean 2.73/5), including the pain, sleep disorders and mood disorders related to the condition (mean 3.32/5). Specialists shared these challenges, although to a lesser degree - "We are not trained to treat distress and suffering" (Specialist). Attitudinal issues centred around frustration (mean 3.91⁄5) and negative profiling of fibromyalgia patients (mean 3.06/5 and 1.99/5). Findings revealed the presence of GP attitudinal and confidence challenges in caring for fibromyalgia patients. As care of fibromyalgia patients moves to general practices, these fundamental competencies must be addressed to assure that all patients receive the quality of care necessary to manage their disease and to empower physicians to be more professionally effective. As stated by one patient, "Why are we being penalized for having this disability?"

Improving correspondence to general practitioners regarding patients attending the ENT emergency clinic: a regional general practitioner survey and audit

The ENT emergency clinic provides an important out-patient service; however, often, no correspondence is sent to the general practitioner. To conduct a general practitioner questionnaire audit in order to assess whether a standardised, computerised clinic letter template could improve communication between the ENT emergency clinic and patients' general practitioners. All ENT emergency clinic patients should have a summary letter sent to their general practitioner. One hundred general practitioner questionnaires were enclosed with the first 100 ENT emergency clinic template letters sent to patients' general practitioners. Seventy-two general practitioners responded (72 per cent). Of these respondents, only 7 per cent had previously received regular correspondence from the ENT emergency clinic before the introduction of the computerised letter template. Following its implementation, such a letter was sent to 100 per cent of the clinic patients' general practitioners. Ninety-seven per cent of the general practitioners valued the template letter, with a mean satisfaction score of 8.4 on a 10-point scale. Eighty-six per cent of the general practitioners stated that they would not prefer a dictated letter. The introduction of a simple, computerised clinic letter template improves communication with ENT emergency clinic patients' general practitioners.

Topical antibiotic ototoxicity: does it influence our practice?

We hypothesised that general practitioners and ENT specialists manage discharging ears differently. This study was designed to investigate this further. Postal questionnaires were sent to all general practitioners in the Birmingham area and all UK consultants on the British Association of Otolaryngology-Head and Neck Surgery address list. In the presence of an intact tympanic membrane, 99 per cent of consultants and 90 per cent of general practitioners would use topical antibiotics. In the presence of a perforated tympanic membrane, 97 per cent of consultants would continue to use topical antibiotics, compared with only 43 per cent of general practitioners. This was attributed to a fear of ototoxicity. If a topical non-ototoxic antibiotic of proven efficacy could be made available, 93 per cent of consultants and 88 per cent of general practitioners in this study would seriously consider using it as first line treatment. The majority of general practitioners would not use topical antibiotics in the presence of a perforated tympanic membrane. Most doctors would consider using a non-ototoxic topical antibiotic as first line treatment should one be made available.

Evaluation of a national quality use of medicines service in Australia: an evolving model

To describe the first phase of a global evaluation framework for the National Prescribing Service (NPS), with a focus on services for health professionals, and in particular highlight the lessons learnt from evaluation around the establishment and implementation of this national program. The agreed evaluation framework used mixed methods focused around a series of evaluation questions, aimed at measuring the overall effect of this new organization as well as the individual programs within it. The evaluation questions were determined a priori and were based on the objectives established by the organization in its first year of operation. A detailed analyses has been completed of: the process, scope and reach of program delivery using both quantitative and qualitative measures; changes in attitudes and knowledge measured through key informant interviews and surveys of professional groups and consumers; and changes in prescribing behaviour and savings to the Pharmaceutical Benefits Scheme (PBS) through analysis of prescription data. The evaluation period for this report was mid-1998 to mid-2004. The NPS has successfully implemented a complex, multi-faceted program across Australia. From 1998 to 2004, in addition to print material provided to all general practitioners (GPs) and pharmacists, 90% of all GPs have been actively involved in one or more educational activity; 116 of 120 divisions of general practice have coordinated local NPS programs; and 9% of pharmacists have actively participated in at least one educational activity. Sixty per cent of GPs and pharmacists rated the printed educational materials as good or very good. In the last three years, the NPS activities have generated savings in the range of $121-163 million to the PBS, owing to changes in prescribing practices. The national evaluation framework has informed program delivery and ongoing design and development. Continued refinement of existing evaluation methods and further exploration of new techniques will remain a priority for the organization.

Return to work after laparoscopic cholecystectomy.

To assess whether the introduction of laparoscopic cholecystectomy has led to a change in attitude regarding the resumption of normal activities after operation, the views of 407 general practitioners (GPs) and 532 patients were analysed. Although 99 per cent of GPs thought that laparoscopic cholecystectomy represented an improvement on the open operation, 55 per cent advised significant restrictions in the postoperative period. For the 231 patients in employment who had an uncomplicated laparoscopic procedure the mean time of return to work was 3.3 weeks. Although 47 per cent of patients returned to work within 2 weeks, 19 per cent took more than 4 weeks. The self-employed returned significantly earlier than employees. Education through better communication among hospital, general practitioners and patients is required if prevailing attitudes towards the length of convalescence after laparoscopic cholecystectomy are to change.

Current approaches to obesity management in UK Primary Care: the Counterweight Programme.

Primary care is expected to develop strategies to manage obese patients as part of coronary heart disease and diabetes national service frameworks. Little is known about current management practices for obesity in this setting. The aim of this study is to examine current approaches to obesity management in UK primary care and to identify potential gaps in care. A total of 141 general practitioners (GPs) and 66 practice nurses (PNs) from 40 primary care practices participated in structured interviews to examine clinician self-reported approaches to obesity management. Medical records were also reviewed for 100 randomly selected obese patients from each practice [body mass index (BMI) >/=30 kg m(-2), n = 4000] to review rates of diet counselling, dietetic or obesity centre referrals, and use of anti-obesity medication. Computerized medical records for the total practice population (n = 206 341, 18-75 years) were searched to examine the proportion of patients with a weight/BMI ever recorded. Eighty-three per cent of GPs and 97% of PNs reported that they would raise weight as an issue with obese patients (P < 0.01). Few GPs (15%) reported spending up to 10 min in a consultation discussing weight-related issues, compared with PNs (76%; P < 0.001). Over 18 months, practice-based diet counselling (20%), dietetic (4%) and obesity centre (1%) referrals, and any anti-obesity medication (2%) were recorded. BMI was recorded for 64.2% of patients and apparent prevalence of obesity was less than expected. Obesity is under-recognized in primary care even in these 40 practices with an interest in weight management. Weight management appears to be based on brief opportunistic intervention undertaken mainly by PNs. While clinicians report the use of external sources of support, few patients are referred, with practice-based counselling being the most common intervention.

Who manages the care of students with Attention Deficit Hyperactivity Disorder (ADHD) in higher education?

To identify who provides medical support to students with Attention Deficit Hyperactivity Disorder (ADHD) while in higher education. A questionnaire pack was sent to 50 undergraduate student health centres attached to higher education colleges/universities. Eighty-two per cent of practices returned questionnaires. Forty-nine per cent had undergraduate students with ADHD, of those 76% were on methylphenidate. Fifty-two per cent saw only their general practitioner (GP) for follow up and the rest were jointly managed by GP with: psychiatrists, paediatricians, psychologists or physicians. Eighty-seven per cent of GPs had not attended recent courses or training on ADHD. Those caring for undergraduate students with ADHD are still largely unfamiliar with the condition. Guidelines need to be drawn up to establish handover from paediatric to adult care.

Varicose Veins in Pregnancy: A Health Professional's Questionnaire

Objective: To acertain the knowledge of varicose vein disease amongst health professionals dealing with pregnant women. Method: Postal questionnaire survey. Results: General practitioners (GPs) and midwives estimated an incidence of varicose veins in pregnancy of 20-50%. Factors associated with varicose veins included second and subsequent pregnancies, thrombophlebitis, family history and obesity, although obesity was thought to be less of an association by the vascular surgeons (57%). Half the respondents linked varicose veins to deep venous thrombosis. Support hosiery is the main management, with 10% of obstetricians asking for a vascular surgeon's opinion, but never vice versa. Surgical treatment was recommended on family completion but 38% of vascular surgeons will consider surgery between pregnancies. Eighty per cent of GPs and 91% of midwives would welcome guidelines. Fifty-seven per cent of vascular surgeons stated that they already have guidelines although these are the professionals least likely to deal with pregnant women. Conclusion: Knowledge amongst health professionals of varicose vein disease in pregnancy is generally good. However, guidelines would be welcomed.