General Practitioners In Management Research Articles

Self-managed anticoagulation after mechanical heart valve replacement is superior to general practitioner management in health related quality of life

Self-managed anticoagulation after mechanical heart valve replacement is superior to general practitioner management in health related quality of life

The role of the General Practitioner in weight management in primary care – a cross sectional study in General Practice

BackgroundObesity has become a global pandemic, considered the sixth leading cause of mortality by the WHO. As gatekeepers to the health system, General Practitioners are placed in an ideal position to manage obesity. Yet, very few consultations address weight management. This study aims to explore reasons why patients attending General Practice appointments are not engaging with their General Practitioner (GP) for weight management and their perception of the role of the GP in managing their weight.MethodsIn February 2006, 367 participants aged between 17 and 64 were recruited from three General Practices in Melbourne to complete a waiting room self – administered questionnaire. Questions included basic demographics, the role of the GP in weight management, the likelihood of bringing up weight management with their GP and reasons why they would not, and their nominated ideal person to consult for weight management. Physical measurements to determine weight status were then completed. The statistical methods included means and standard deviations to summarise continuous variables such as weight and height. Sub groups of weight and questionnaire answers were analysed using the χ2 test of significant differences taking p as < 0.05.ResultsThe population sample had similar obesity co-morbidity rates to the National Heart Foundation data. 74% of patients were not likely to bring up weight management when they visit their GP. Negative reasons were time limitation on both the patient's and doctor's part and the doctor lacking experience. The GP was the least likely person to tell a patient to lose weight after partner, family and friends. Of the 14% that had been told by their GP to lose weight, 90% had cardiovascular obesity related co-morbidities. GPs (15%) were 4th in the list of ideal persons to manage weight after personal trainerConclusionPatients do not have confidence in their GPs for weight management, preferring other health professionals who may lack evidence based training. Concurrently, GPs target only those with obesity related co-morbidities. Further studies evaluating GPs' opinions about weight management, effective strategies that can be implemented in primary care and the co-ordination of the team approach need to be done.

A guideline-based computerised decision support system (CDSS) to influence general practitioners management of chronic heart failure

To explore the influence of a guideline-based computerised decision support system (CDSS) on general practitioners' (GPs') management of patient cases of chronic heart failure in a pragmatic clinical situation. We assessed changes in the GPs' confidence in the diagnosis, their considerations about investigations and medications and the support they perceived from using the CDSS. Five GPs assessed the medical records of 48 of their own authentic patient cases using a guideline-based CDSS accessible on the internet for the diagnosis and treatment of chronic heart failure, and completed a questionnaire for each case. Number of cases where the GP reported a change in confidence in the diagnosis, where the GP considered further investigations or changes in medication and the perceived support marked on a visual analogue scale. The GPs' confidence in the diagnosis changed in 25% of the cases, with equal numbers of increases and decreases in confidence. The GPs considered further investigations in 31% of the cases and medication changes in 19%. Fourteen of the 31 considered investigations and four of the ten considered changes in medications which were in agreement with the CDSS's suggestions. The GPs tended to consider further investigations more often in cases when the CDSS found the diagnosis uncertain. There was a wide range in the values for perceived support, but it could be described as substantial in 35% of the cases. Using a guideline-based CDSS for the GPs' own patient cases had an impact on the GPs' confidence in the diagnosis of chronic heart failure and their considerations about investigations and medications: they also perceived substantial support in every third case. Applying a CDSS developed using evidence-based guidelines for chronic heart failure in primary care could have a significant influence on GPs' disease management.

An interactive workshop plus locally adapted guidelines can improve general practitioners asthma management and knowledge: a cluster randomised trial in the Australian setting.

BackgroundA cluster randomised trial was conducted to determine the effectiveness of locally adapted practice guidelines and education about paediatric asthma management, delivered to general practitioners (GPs) in small group interactive workshops.MethodsTwenty-nine practices were randomly allocated to one of three study arms. Australian asthma management guidelines were adapted to accommodate characteristics of the local area. GPs in the intervention arm (Group 1, n = 18 GPs) participated in a small group based education program and were provided with the adapted guidelines. One control arm (Group 2, n = 18 GPs) received only the adapted guidelines, while the other control arm (Group 3, n = 15 GPs) received an unrelated education intervention. GPs' knowledge, attitudes and management of paediatric asthma was assessed.ResultsPost intervention, intervention arm GPs were no more likely to provide a written asthma action plan, but were better able to assess the severity of asthma attack (Group 1vs Group 2 p = 0.05 and Group 1 vs Group 3 p = 0.01), better able to identify patients at high risk of severe attack (Group 1vs Group 3 p = 0.06), and tended to score higher on the asthma knowledge questionnaire (Group 1 vs Group 2 p = 0.06 and Group 1 vs Group 3 p = 0.2). Most intervention arm GPs felt more confident than control GPs to manage acute asthma attack and ongoing management of infrequent episodic asthma.ConclusionUsing interactive small group workshops to disseminate locally adapted guidelines was associated with improvement in GP's knowledge and confidence to manage asthma, but did not change GP's self-reported provision of written action plans.

How do patients with urinary incontinence perceive care given by their general practitioner? A cross-sectional study

Urinary incontinence (UI) is a widespread problem, affecting quality of life and leading to high costs, mainly caused by incontinence pads. It seems that, despite guidelines, many UI patients get pads from their general practitioner (GP) without adequate diagnostics or treatment. To assess what further treatment UI patients receive from their GP next to pads and to measure patient satisfaction with care. A postal survey among UI patients who started pad use in the past 12 months. Satisfaction with UI care. We analysed 208 questionnaires. 29.3% of pad users had no direct contact with their GP for a pad prescription. Of 147 UI patients who visited their GP 50.3% only got pads. 25% of patients was not satisfied with the information on UI received from their GP, especially younger patients, women, less healthy patients and patients with urgency UI. Dutch UI patients using pads experience suboptimal GP care and management. Factors identified through patient feedback should be used to improve quality of care for UI in primary care.

Asthma management in primary care: does increasing patient medication improve symptoms?

We set out to observe the General Practitioner (GP) management of a cohort of asthma patients over a 2-year period by comparing asthma health status, spirometry, British Thoracic Society treatment step, inhaled medication uptake and psychological status. Changes in these parameters were assessed over the 2-year period. One hundred fourteen subjects were recruited from four GP practices, two in the inner city and two in suburbia. Subjects were assessed at baseline and at 2 years using the Juniper asthma quality of life questionnaire, the locally devised Q score (a simple patient-focused morbidity index) and the hospital anxiety and depression (HAD) scale. Spirometry (forced expiratory volume in 1 s, forced vital capacity and peak expiratory flow) was recorded using a Micro Medical portable spirometer (Micro Medical Ltd, Chatham, UK); the best values from three acceptable attempts were recorded. Data for 90 subjects reviewed at baseline and at 24 months were compared to the original cohort of 114 subjects. Patients who had the treatment increased showed no apparent benefit over 2 years. They had similar physiology and symptom scores at baseline but had higher HAD scores (particularly depression element P < 0.05) initially. The picture remained constant over the 2 years. Asthma guidelines define the aim of treatment to minimise or abolish symptoms. We suggest that if the symptoms are not measured, they remain unrecognised. This is something that could and should be incorporated routinely into clinical practice because this is morbidity that is largely treatable.

Effect of general practitioner education on adherence to antihypertensive drugs: cluster randomised controlled trial

Objective To determine the impact of a simple educational package for general practitioners on adherence to antihypertensive drugs.Design Cluster randomised controlled trial.Setting Six randomly selected communities in Karachi, Pakistan.Participants 200...

Self‐reported confidence and skills of general practitioners in management of mental health disorders

To identify the predictors of self-reported confidence and skills of GPs in management of patients with mental health problems. Cross-sectional survey, with questionnaire presented to 246 GPs working in 62 practices throughout Gippsland. Rural general practices in Gippsland. One hundred and thirty-four GPs across Gippsland. GPs completed a questionnaire assessing self-perception of knowledge and skills in recognition and management of common mental health problems. Of 134 GPs, 45% reported that they have a specific interest in mental health, and 39% of GPs reported that they had previous mental health training. Only 22% of GPs describe having both an interest and prior training in mental health care. Age and years since graduation are not significantly related to self-reported confidence and skills. The results of this study highlight that self-professed interest and prior training in mental health are associated. Self-professed interest in mental health care predicts confidence and self-perceived skills in recognition, assessment and management of common mental health disorders. Similarly, prior training in mental health care predicts confidence and self-perceived skills in recognition, assessment and management of common mental health problems. Self-professed interest in mental health issues is also associated with hours of participation in continuing medical education related to mental health care. Unfortunately, only a minority described having both interest and prior training in mental health care.

Effect of spirometry on COPD management in primary care: where are the studies that we really need?

To the Editors: In the November 2006 issue of the European Respiratory Journal , Walker et al. 1 reported on the effects of the use of spirometry to diagnose chronic obstructive pulmonary disease (COPD) in primary care and the resulting benefits for patient management. In patients referred to an open-access spirometry service by their general practitioner, the diagnosis and current management of the patients was assessed before and after spirometry testing. Walker et al. 1 observed a change of diagnosis after spirometry in: 71% of patients who had no respiratory diagnosis at the time of the referral; 48% of patients who had previously been diagnosed with asthma; and 23% of patients with a COPD diagnosis. Drug prescription changed in 49% of the COPD patients, with a …

Promoting Best Practice in General Practitioner Management of Osteoarthritis of the Hip and Knee: Arthritis and Musculoskeletal Quality Improvement (AMQuIP) Program

This paper reports on the outcomes of a pilot study to optimise general practitioner (GP) management of patients with osteoarthritis (OA) of the hip and knee by identifying gaps between their current practice and best practice. The Breakthrough Series collaborative methodology with several Plan-Do-Study-Act (PDSA) cycles was employed. Participants comprised two Victorian Divisions of General Practice (one rural, one metropolitan), 12 general practitioners/practices (GPs/practices), 10 patients per GP/practice. GPs/practices attended an orientation and three learning workshops and a videoconference. GPs/practices completed PDSA cycles between workshops and reported results at the workshops. GPs/practices reported use of guidelines, change in patient management and change in practice management/systems. All recruited patients completed the SF-12v2 Health survey and WOMAC Osteoarthritis Index questionnaire twice; nine patients participated in face-to-face interviews twice. Follow-up activities including focus groups and face-to-face interviews were held six months after the final workshop. All GPs/practices used the guidelines/key messages, introduced "new" management strategies to patients, and made positive changes to their practice management/systems. Patients reported positive changes and outcomes. There was little difference between rural and metropolitan results. By using a structured methodology and evidence-based guidelines/key messages, GPs can introduce new patient management strategies, and by identifying gaps in practice management/systems, positive change can be achieved.

The Effectiveness of Treatment provided by Physiotherapists compared to General Practitioners in the management of acute Low Back Pain: a systematic review

Review Objective: The main objective of the review is to evaluate the effectiveness of physiotherapy care compared to general practitioner care in outcomes (i.e. pain experienced, function and economic cost) for adults with acute LBP. Review Questions: The specific review questions are: • Is general practitioner care (prescription of non-steroidal anti-inflammatory drugs, analgesics, muscle relaxants, bed rest and advice) more effective in decreasing pain compared to physiotherapy care (mobilization/manipulation, education and exercise therapy) in the management of adults with acute LBP? • Is general practitioner care (prescription of non-steroidal anti-inflammatory drugs, analgesics, muscle relaxants, bed rest and advice) more effective at improving function compared with physiotherapy care (mobilization/manipulation, education and exercise therapy) in the management of adults with acute LBP? • Is general practitioner care (prescription of non-steroidal anti-inflammatory drugs, analgesics, muscle relaxants, bed rest and advice) more economically cost effective compared with physiotherapy care (mobilization/ manipulation, education and exercise therapy) in the management of adults with acute LBP Criteria for considering studies for this review: Type of participants: This review will consider studies that examine male and female participants over the age of eighteen years of age with non-specific acute low back pain. Studies that include subjects presenting with low back pain recognized as a specific pathology such as pain due to nerve root involvement or serious spinal pathology including skeletal infections, tumors, osteoporosis, ankylosing spondylitis, fractures, inflammatory process, nerve root involvement or cauda equina syndrome, will be excluded. Types of interventions: The interventions most commonly administered by a physiotherapist in the management of acute LBP will include mobilizations/manipulations, exercises and education9. Types of Comparison: The comparison interventions will include the most common general practitioner management strategies for acute LBP, which will include medication or non-steroidal anti-inflammatory drugs (administered orally, via intramuscular injections, and topically), and advice7. Types of outcome measures: The outcomes of interest will include, but are not confined to: • Severity of pain (visual analogue scale) • Activity impairments (limitations in activities of daily living) and participation impairments (limitations in ability to work) as measured with standardized outcome measures. • Economic cost-effectiveness.

Participation in a clinical trial influences the future management of patients with gastro‐oesophageal reflux disease in general practice

The long-term effects of participation in trials has not been reported. A randomized-controlled trial (the ONE study) reported on the management of gastro-oesophageal reflux disease with esomeprazole in primary care, testing on-demand treatment vs. treatment courses. To evaluate the impact of participation in a trial on General Practitioners management and patient behaviour. Management of gastro-oesophageal reflux disease was compared between General Practitioners who participated in ONE (ONE-GPs) and a random sample of General Practitioners who did not participate in ONE (Other-GPs). Symptom presentation and satisfaction with treatment was compared between patients who had participated in ONE (ONE-patients) and patients who had not (Other-patients). ONE-GPs prescribed on-demand treatment with proton-pump inhibitors to 47% of the patients, Other-GPs to 27%. ONE-patients consulted for significantly less symptoms compared with Other-patients. ONE-patients reported significantly higher patient satisfaction compared with Other-patients. ONE-patients used 98 doses during 6 months whereas Other-patients used 76 doses. Participation in a clinical trial influenced both doctors and patients. Treatment modalities introduced by the trial were used in daily practice by the General Practitioners. Patients who had participated in the trial consulted for less symptoms and used more medication, compared with patients who did not participate.

Recognition and management of childhood overweight and obesity by clinicians

(i) To determine the ability of general practitioners (GPs) and paediatricians to correctly identify children as overweight or obese by visual cues alone; (ii) to describe the current management practices of overweight and obese children by these practitioners; and (iii) to compare these with National Health and Medical Research Council (NHMRC) Clinical Practice Guidelines. Forty-four GPs and 29 paediatricians participated in the study. Respondents completed a questionnaire based on a series of body images, rating the size of the child as acceptable weight, overweight or obese and indicating the likelihood of carrying out a series of management options. There was considerable variation in ability to rate images correctly with the total number of correct responses being 72% and 68%, respectively, for GPs and paediatricians. There were statistically significant differences in management between GPs and paediatricians in terms of conducting appropriate anthropometry and screening for co-morbidities, with paediatricians performing closer to the NHMRC Clinical Practice Guidelines. GPs and paediatricians have the opportunity to screen children for overweight and obesity during their everyday practice. Accurate determination of weight status cannot be performed by visualisation alone and all children should have height and weight measured and correctly interpreted. Some areas of current GP and paediatrician management of overweight and obese children fall short of the NHMRC clinical guidelines and areas for improvement are highlighted in this paper.

The General Practitioner's Management of Patients With a New Diagnosis of Irritable Bowel Syndrome

The General Practitioner's Management of Patients With a New Diagnosis of Irritable Bowel Syndrome

IMPROVING OSTEOPOROSIS MANAGEMENT IN AT‐RISK FRACTURE CLINIC PATIENTS

To the Editor: We would like to draw your attention to an important but preventable bone health and healthcare delivery dilemma that we believe can be improved with a simple, low-cost intervention. In 1982, researchers at the Mayo Clinic reported that history of a previous low-trauma or fragility fracture was associated with a 1.3 relative risk of subsequent hip fracture1 and this was likely an underestimation of the risk.2-4 In response, national guidelines in the United States and Canada emphasized that low-trauma fractures should not merely be treated orthopedically,5 but should also prompt a family physician evaluation to assess osteoporosis risk and manage it appropriately. Despite this ideal opportunity for secondary prevention of osteoporosis, numerous publications have highlighted the continual low investigation (∼20%) rates after a sentinel fracture.6–9 Even fewer patients received adequate therapy, highlighting the “knowledge-care gap.” In a review of the largest series of wrist fractures to date, only 23% of “at risk” patients were treated for osteoporosis,9 whereas one study10 reported from a retrospective review of a large database that only 9.8% of the women and 2.9% of the men were screened for osteoporosis. Yet another study11 suggests that screening for these “sentinel fractures” would reduce hip fractures 9%. Despite increasing awareness of this problem, few controlled studies have tested interventions to improve diagnosis and management. There have been recent publications that have tested interventions aimed at changing physician practice patterns.12 Recently, a simple four-part intervention using a diagnosis/management questionnaire and counting “osteoporosis best practices” offered by the family physician to patients with a wrist fragility fracture was tested.12 Participants who volunteered for this study were allocated into one of two groups (intervention or control). Each participant in the intervention group received an information sheet explaining that she or he had suffered a low-trauma fracture diagnostic of osteoporosis, a request to take a letter from the orthopedic surgeon who was managing the fracture to show to the family physician alerting her or him to the recent low-trauma fracture, and a follow-up telephone call at 4 to 6 weeks to remind the participant to visit her or his family physician. The fourth element of the intervention was a facsimile from the orthopedic surgeon to the family physician specifically requesting general practitioner assessment and management of osteoporosis. In the control group, participants were not given any additional information on risk of osteoporosis by the researchers. Control group patients received usual care, defined as treatment for the fracture by the hospital staff and routine notification to the family physician of the fracture and any follow-up plans. Both groups were telephoned at 6 months to administer the diagnosis management questionnaire. This questionnaire was developed specifically to ascertain the osteoporosis investigation rate and osteoporosis “best practices” as recommended by the 2002 Osteoporosis Consensus.5 The original distal radius fracture “WristWatch” study was expanded to include humeral fractures. Sixty-two participants were enrolled in this study (36 control and 26 intervention). (See Table 1 for participant characteristics.) In this multicomponent quality-improvement intervention of a patient-education and physician-alerting system, 73% of participants in the intervention group were investigated for osteoporosis. The absolute difference was 54%, and the relative risk was 3.8 (95% confidence interval=1.9–7.6) Once again, investigation for osteoporosis was significantly higher in the intervention group (P<.001). It is tempting to speculate that there might be at least two ways that this study could be translated into clinical practice. Standing orders contained within the orthopedic surgeon's follow-up note to the family physician would ensure that patients and family physicians instigate optimum osteoporosis care. Alternatively, a healthcare worker could liaise between potential patients at risk and the healthcare services to initiate the care pathway (fracture liaison service). One group of providers13 tested such a model in their clinical practice, and a designated team member performed case finding and initiated appropriate investigation. This can be an effective service for larger facilities with adequate funding. Although it can be seen as the criterion standard, there are people and regions who are not able to access such services. Although the current study showed that family physicians investigated at-risk patients for osteoporosis when an orthopedic surgeon prompted them to do so, future studies could investigate the use of clinical pathways that use the expertise of other health professionals (e.g., physical therapist, nurse) at the fracture clinic or emergency department level to systematically initiate family physician follow-up regarding osteoporosis. Osteoporosis is a serious medical condition and at-risk patients need to be identified. A fragility fracture is a sentinel event and can be used to effectively initiate investigation. A simple intervention can influence physician behaviors. Larger studies should further refine this intervention by testing the effectiveness of its individual components.

GP management of community-acquired pneumonia in Italy: the ISOCAP study

Community-Acquired Pneumonia (CAP) is still a significant problem in terms of incidence, mortality rate, particularly in infants and the elderly, and socioeconomic burden. General Practitioners (GPs) are the first reference for patients with this disease, but there are few published studies regarding the outpatient treatment of CAP. The ISOCAP study aimed to identify the type and outcome of the diagnostic-therapeutic management of CAP by GPs in Italy, within the framework of developing a closer interrelationship between GPs and pulmonary specialists. Thirty-six Pulmonary Divisions throughout Italy each contacted 5 local GPs who agreed to recruit the first 5 consecutive patients who consulted them for suspected CAP within the study's 1-year observation period. A total of 183 GPs took part in the study and enrolled, by the end of the observation period, 763 CAP patients; of these, complete data was available for 737 patients [males=373, females=364, mean age (+/- SD) 58.8 +/- 19.6 years]. 64.4% of patients had concomitant diseases, mainly systemic arterial hypertension and COPD. Diagnosis of CAP was based by GPs on physical examination only in 41.6% of cases; in the remaining chest X-ray was also performed. In only 4.6% of patients were samples sent for microbiological analysis. All patients were treated with antibiotics: 76.7% in mono-therapy, 23.3% with a combination of antibiotics. The antibiotic class most prevalently used in mono-therapy was cephalosporin, primarily ceftriaxone; the most frequently used combinations were cephalosporin + macrolide and cephalosporin + quinolone. Mono-therapy was effective in 70% of cases, the combination of two or more antibiotics in 91.2% of patients. Overall treatment efficacy was 94.7%; hospitalisation was required in 8.5% of cases. Outpatient management of CAP by GPs in Italy is effective, hospitalisation being necessary only in the most severe cases due to age, co-morbidities or extent of pneumonia. This signifies a very significant savings in national health costs.

General practitioners' detection and management of patients with a dual diagnosis: Implications for education and training

General practitioners (GPs) are in a unique position to detect and manage patients with co-morbid mental health and substance use disorders (dual diagnosis). It has been estimated that over 30% of patients presenting to general practice have a diagnosable mental disorder and 12% have dual diagnosis. Unfortunately, between 30 and 50% of these problems go undetected in general practice. Limited GP education and training in mental health may account for this deficit, with a little over 8% of GPs receiving any formal postgraduate training in mental health. Prior to developing an educational resource for GPs, the present study aimed to establish baseline estimates of GP treatment practices with patients who have dual diagnosis. Two GP division-wide surveys of screening, assessment and treatment for dual diagnosis were conducted one year apart. In addition, five GPs conducted a clinical audit of 508 patient consultations. Results indicate that without ongoing targeted interventions, patient management activities such as GP counselling, use of screening devices, referral to specialist services, coordination and use of EPC items are not likely to improve and are at risk of declining.

Conservative treatment in patients with an acute lumbosacral radicular syndrome: design of a randomised clinical trial [ISRCTN68857256

BackgroundThe objective is to present the design of randomised clinical trial (RCT) on the effectiveness of physical therapy added to general practitioners management compared to general practitioners management only in patients with an acute lumbosacral radicular syndrome (also called sciatica).Methods/DesignPatients in general practice diagnosed with an acute (less than 6 weeks) lumbosacral radicular syndrome and an age above 18 years are eligible for participation. The general practitioners treatment follows their clinical guideline. The physical therapy treatment will consist of patient education and exercise therapy. The primary outcome measure is patients reported global perceived effect. Secondary outcome measures are severity of complaints, functional status, health status, fear of movement, medical consumption, sickness absence, costs and treatment preference. The follow-up is 52 weeks.DiscussionTreatment by general practitioners and physical therapists in this study will be transparent and not a complete "black box". The results of this trial will contribute to the decision of the general practitioner regarding referral to physical therapy in patients with an acute lumbosacral radicular syndrome.

Doctor-patient interaction for irritable bowel syndrome in primary care: a systematic perspective.

Irritable bowel syndrome (IBS) is defined by specific validated symptom criteria and encompasses several different underlying pathophysiological mechanisms that express a common set of symptoms. However, IBS is poorly understood by patients. We aimed to explore how a diagnosis of IBS affects the interaction between patients and their physicians. A comprehensive literature search for studies in the English language addressing this issue was conducted using Medline, PubMed, Cochrane Database, Psychinfo, Cinahl, Embase, Web of Science and manual recursive search of reference lists. Investigators reviewed and abstracted data from articles fulfilling our inclusion criteria: primary care patients, all ages, gender and ethnic groups diagnosed with IBS by a general practitioner (GP). Retrieval of 121 articles generated only four that met inclusion criteria. Research methods of three studies relied solely on qualitative subjective, anecdotal patient narratives, a bias in favor of patients' negative opinion, absence of objective physician diagnostic criteria, pre-testing questions for two studies, follow-up and patient verification of accounts for accuracy. The fourth study included objective physician diagnostic criteria, quantitative measures, a pre-testing questionnaire, and both patient and doctor perspectives. There was a disparity between patient and GP perception regarding the nature, severity and consequences of IBS in primary care, leading patients to perceive this interaction as one of dissatisfaction. The fourth study revealed GP management of IBS mostly meets patient's expectations areas of concern centered on etiology, diagnostic criteria and dietary advice. Disparity seems to lie with the physician, who needs to provide more trust, knowledge, and sympathy, create rapport and be forthcoming with information, while keeping information simple and understandable. Patient dissatisfaction stems from the actual information provided and how this is communicated. There is evidence that some IBS patients in primary care experience dissatisfaction and negative attitudes in GP interactions. Future research should take into account personality attributes and cross-situational stability in addition to methodological implications of studies. GPs may be the first avenue for IBS patients to vent their frustration, and appropriate education programs for optimal management of patients with IBS are needed in primary care.

The rates and management of psychological problems in Australian general practice

Objective: General practitioners (GPs) provide the majority of care for people's mental health problems. The recently introduced Better Outcomes in Mental Health Care initiative aims to improve the quality of mental health care in general practice. This study examines current GP management of psychological problems and any changes in their management in the decade leading up to this initiative. Method: Current practice was examined through a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) (2000–02) data. We compared BEACH data with the Australian Morbidity and Treatment Survey (1990–1991) to investigate management changes over the past decade. Results: Between April 2000 and March 2002, psychological problems were managed at a rate of 11.5/100 encounters. Problems most commonly managed were mood disorders, stress-related disorders, behavioural syndromes and disorders due to psychoactive substances. Prescriptions occurred at a rate of 69.5/100 contacts and clinical treatments at a rate of 50.0/100 contacts with psychological problems from 1990 to 1991. The management rate of psychological problems increased from 9683/100 000 encounters (95% CI = 9129–10 237) in 1990–1991 to 11 557 (11 136–11 977) in 2000–2002. Prescription rates (from 63.3, 95% CI = 60.5–66.1 to 69.1, 95% CI = 67.1–71.1) and clinical treatments (from 36.0, 95% CI = 33.4–38.7 to 53.1, 95% CI = 51.3–54.9) increased. Conclusions: This study shows that prior to the introduction of the Better Outcomes in Mental Health initiative changes had already occurred in rates and management of psychological problems in general practice. It also provides a baseline from which future research can measure the impact of the recent reforms on mental health care.