Perceptions Of General Practitioners Research Articles

Developing a condition-specific measure of health for patients with dyspepsia and ulcer-related symptoms

A patient-administered instrument for dyspepsia and symptoms suggestive of duodenal or gastric ulcer, based on the type of questions asked when taking a patient's history, was developed and tested using the following steps: literature reviews, devising the questions, testing the responses to the questions using factor analysis and internal consistency, assessing test—retest reliability, and validating the questionnaire by comparing patient responses to the SF-36 health survey questionnaire. The main sample consisted of 135 patients referred to an outpatient clinic with dyspepsia, and 152 patients in general practice who were not referred to a specialist. The final instrument produced a Cronbach's α of 0.72 and an intraclass correlation coefficient of 0.69. Patient scores on the dyspepsia questionnaire had small to moderate correlations with the SF-36 health survey, the largest correlation being with the SF-36 scale of pain. Patient scores were significantly related to general practitioner perceptions of symptom severity, family history of gastric ulcer disease, and whether the patient was referred. The questions asked in taking a clinical history from a patient with dyspepsia and other symptoms suggestive of ulcer disease can be used to construct a valid and reliable measure of the effect of dyspepsia on health.

Characteristics of referrals to an inpatient hospice and a survey of general practitioner perceptions of palliative care.

In order to determine symptoms, drug prescribing and physical problems of patients referred to an inpatient hospice, case notes from 130 consecutive first admissions (95 general practitioner (GP) referrals, 35 consultant referrals) were analysed. GP referrals were more likely to be constipated, require care and be discharged to home. Consultant referrals were more gravely ill, dependent and more likely to die in the hospice. On admission 76 (58%) patients were receiving opiates with co-prescription of opiate and laxative occurring in 41% (31/76) of the cases. The prescription of laxatives with the symptoms of constipation occurred in 62% (26/42) of the cases on admission. A telephone survey of 79 referring GPs revealed that 37% had attended neither a course nor a lecture relevant to palliative care in the past 3 years. GPs experienced difficulties frequently or always in: (a) managing pain (8/79); (b) managing other symptoms (25/79); (c) helping patients and relatives cope with their emotional distress (18/79); and (d) coping with their own emotional responses to death and dying (5/79). In conclusion, the differences demonstrated between the GP and consultant referrals have implications for purchasers. The high incidence of possible opiate-induced side-effects and the difficulties with symptom control expressed by some GPs indicate a continuing need for effective educational input.

Patient education for low back pain in general practice

This comparative study of patient and general practitioner perceptions of patient education for low back pain (LBP) revealed significant differences in perspective. It suggests that although some general practitioners recognise the importance of patient education, they blame patients for its assumed failure as a management strategy. The patients in this study identified a range of reasons which explain their difficulties in following prevention advice which relate to not only limitations in themselves, but also to broader contextual factors over which they have little control. It is argued that both the inadequacy of current professional assumptions and the contextual factors that influence patients' prevention behaviours need to be acknowledged as a first step towards improving patient education for LBP in general practice.

Challenges to professional autonomy in the United Kingdom? The perceptions of general practitioners.

Theoretical analysis has suggested that so-called threats to professional autonomy in the United States might also be manifesting themselves in the United Kingdom through the introduction of market principles and the new "managerialism" into the National Health Service by the government and through the emergence of complementary medicine and the role of the "articulate" consumer. The authors explore these issues by focusing on how a sample of the "rank and file" of general practitioners perceive these potential challenges from "above and below." The evidence suggests that the social, economic, and clinical freedoms of general practitioners remain intact although these external influences appear to have changed the style of clinical practice, which is a source of concern and dissatisfaction to some general practitioners.

Expanding access to coronary artery bypass surgery: who stands to gain?

To determine the perceptions of general practitioners (GPs) about the benefits of coronary artery bypass surgery, in terms of gains in life expectancy, for different groups of patients. A questionnaire survey of all GPs in Northern Ireland. A survey conducted collaboratively by the departments of public health medicine in each of the four health boards in the province, serving a total population of 1.5 million. The median and mean gain in life expectancy perceived by groups of doctors for smoking and non-smoking male and female 55 year old patients. The percentage of 50 year old and 70 year old non-smoking patients considered likely to have their lives extended with bypass surgery. Differences were assessed using the Mann-Whitney U test for unpaired samples and the Wilcoxon signed rank tests for paired. 541 GPs replied (response rate 56%). The median (and mean) perceived gain in life expectancy after cardiac surgery for non-smoking 55 year old subjects was 120 (104) months for men and 120 (112) months for women (z = 6.42; P < 0.0001; Wilcoxon signed rank test). For male and female smokers of the same age, the perceived gains were 48 (47) and 60 (52) months respectively (z = 6.72; P < 0.0001; Wilcoxon signed ranks test), both figures being significantly different than for non-smokers. The median (and mean) percentage of patients that the doctors considered would have their lives extended by bypass surgery was 70 (64) of every 100 "young" patients and 40 (42) of every 100 "old" patients, (z = 16.2; P < 0.0001). These results point to a significant overestimation of the benefits of coronary artery bypass surgery by GPs in Northern Ireland and to a need to develop guidelines for referral.

Improving the continuity of care between general practitioners and public hospitals

To improve the quality of clinical care through better continuity of services between the public hospital and general practitioners (GPs), focusing on expediting discharge of patients from hospital through improved use of resources provided by GPs. Stage 1: Participant observation during ward rounds and unstructured interviews to gain an understanding of the perceptions of hospital staff and GPs of the GP's role in the discharge process. Stage 2: Semi-structured interviews with registrars and GPs of 30 patients (who were admitted to a medical ward and discharged to the care of their GP) to get the participants' views of each other's roles in providing continuity of care. There was a general lack of trust on both sides, and poor communication owing to several structural and perceptual problems. Registrars focused on specialist care and outpatient follow-up, being almost oblivious to GP functions, apart from monitoring the management plan developed in the hospital; they made no use of GPs' knowledge of the case or their experience in treating patients within their families and social milieu, and frequently wished to do everything within the hospital. GPs, on the other hand, often felt alienated from the hospital system, although they had much to offer by being able to contribute details of the patient's background and by using their special skills, which went well beyond passively monitoring progress. 1. Information about the patient's GP should be made available to hospital staff. 2. Interns should make telephone calls to GPs after admission and when the discharge date is known. 3. Early-discharge summaries should be forwarded and include: (i) reasons for giving or altering medications; (ii) specific plans after discharge; (iii) information conveyed to the patient and family about the illness; and (iv) a summary of the case by the consultant. 4. Registrars and interns should be educated about the appropriate involvement of GPs in the discharge process and throughout the patient's stay in hospital. 5. Direct involvement of the GP with the patient during hospital stay should be encouraged. 6. A pilot study should be set up to investigate the role of a liaison person in overcoming problems of the transition of care of hospitalised patients to the community.

Canadian family physicians' and general practitioners' perceptions of their effectiveness in identifying and treating wife abuse.

The authors attempted to determine the perceptions of Canadian family physicians and general practitioners regarding their effectiveness in identifying and treating abused female patients. A national sample of 963 family physicians and general practitioners were surveyed by questionnaire concerning their knowledge, attitudes, detection, treatment, and continuing medical education needs regarding this issue. Most respondents estimated that 15% of their female patients are victims of wife abuse; more than 50% believed that they failed to identify 30% of cases or more. Physician age and sex differences did not correlate with detection rates, but did correlate with treatment options. Finally, although the most common reasons cited for failing to detect cases were patients' unresponsiveness, lack of initiative, or infrequent visits, a majority of the physicians wanted more continuing education concerning wife abuse.

Management and attitudes of epilepsy by a group of Sydney general practitioners.

Previous surveys of general practitioners (GPs) have shown stereotypic attitudes and management of persons with epilepsy (PWE). We mailed a questionnaire to 107 GPs in the Sydney and Illawarra regions of Australia to evaluate changes in knowledge and management of epilepsy and attitudes of GPs toward PWE as compared with results of a similar study made 10 years previously. Most GPs referred patients with epilepsy to a neurologist for initial management in preference to initiating investigation and treatment themselves. GPs were very satisfied with their sharing of care with neurologists, but indicated their high level of dissatisfaction with other health care therapists because of impractical advice and lack of empathy. The GPs' objectives of continuing management were mainly to prevent seizures, monitor of medication and its effects, and reduce the impact of patients' epilepsy on their daily life. Although many GPs believed that PWE were more likely to have emotional and relationship problems, most also believed that such persons contribute equally to society and can have normal quality of life (QOL). Although the GPs prefer to use a neurologist for initial management of PWE, they see themselves as having a role in continuing care and providing psychosocial support. The stereotyped perceptions of GPs indicated in the previous study have improved, although in some respects they remain negative. This study offers an audit of the outcome of a decade of educational promotion regarding epilepsy.

Prescribing Medication Versus Promoting Behavioural Change: A Trial of the Use of Lifestyle Management to Replace Drug Treatment of Hypertension in General Practice

Antihypertensive drug therapy may reverse the cardiac and vascular structural changes associated with sustained hypertension. This may enable appropriate blood pressure levels to be maintained with milder forms of therapy (such as lifestyle interventions) which will minimise any potential adverse effects of pharmacological therapy. The HEART project was conducted in the general practice setting and aimed to determine whether lifestyle strategies, such as increased physical activity and dietary modification, could be substituted for drug therapy in patients who had been well controlled on antihypertensive medication. In addition to objective measures of blood pressure and risk factor outcomes, attitudes and perceptions of general practitioners (GPs) and patients involved in the trial were assessed through focus group discussion and personal interviews. Of the 44 patients recruited to the trial, 41 (93%) participated in structured interviews of 20–40 minutes duration conducted in person or by telephone. Of 78 GPs working in the western suburbs of Melbourne who were approached about the trial, 50% were willing to participate. Of these, 13 (34%) recruited study patients. Of these 13, 10 (77%) participated in a 2-hour focus group discussion which was audiotaped for later transcription and analysis. Despite being enthusiastic about lifestyle interventions in principle, nearly all of these GPs felt resistant to the concept of withdrawing medication in well-controlled subjects. They were generally surprised to see that many patients (15 of 20 patients: 75%) were able to maintain appropriate blood pressure levels following drug therapy withdrawal and adoption of minimal lifestyle changes. GPs felt that the patients' eagerness to come off medication was the major incentive for patients to participate in the trial. This was corroborated by many patients indicating a desire not to be taking any medication. The majority of patients reported making minor changes in lifestyle behaviours leading to most being able to remain off therapy or to have drug dosage requirements reduced. The major barriers to maintaining lifestyle change were family and work stresses and the perception of the intervention not being treated as a therapy thus not at the same level of importance as a treatment method as drug therapy. It appears that a select group of hypertensive patients, highly motivated by the prospect of drug therapy withdrawal, were interested in and willing to trial a lifestyle behaviour change approach for their blood pressure management. The majority reported that they had been able to adopt small but meaningful changes in exercise and dietary habits through the provision of stand-alone self-help materials and support from their GP. Of these patients, 75% remained normotensive without drug therapy after a 9-month follow-up period.

Community and participation for general practice: Perceptions of general practitioners and community nurses

A central theme of health policy has concerned the public's participation in primary health care services, both as individual consumers and collectively as communities. In the U.K. primary care increasingly centres on general practice. This paper reports an exploratory study undertaken with practice teams in inner city Sheffield about community participation. The study design was influenced by a grounded theory approach to data collection and analysis. The main data collected was from interviews of 23 general practitioners, 20 practice nurses, 11 health visitors and 7 district nurses. Concepts of community and participation were explored by interview with these primary care workers. Typologies of community and participation for general practice are presented in the findings, along with associated strategic positions and political tensions. The discussion highlights a number of tensions and issues concerning community participation when primary care is organized around general practice.

Patient and general practitioner perceptions of patient-held health records.

The objective of this study was to describe the attitudes of general practitioners (GPs) and their patients to patient-held health records (PHR). The study was set in a general practice in South Australia. It consisted of a descriptive study using a mail questionnaire. A stratified random sample, based on socioeconomic indicators for areas in South Australia, of GPs (n = 315) and their patients (n = 500) was used. The indices for contents, problems and benefits of the PHR showed adequate internal consistency and reliability. Patients mostly perceived the PHR as a personal document for reference while GPs perceived it as a management and communication tool. The solo GP who scored high on the 'PHR benefits' and low on the 'PHR problems' indices, and doubted that GPs were influential in changing patient behaviour would let patients keep full copies of their records. The younger female rural GP who scored high on the 'PHR benefits' and low on the 'PHR problems' indices favoured a patient summary. The more entrepreneurial GPs who scored high on both the 'PHR benefits' and 'PHR problems' indices favoured a 'censored summary'. Awareness of smart cards was high and opinions on their use guarded. It was concluded that patients and doctors have different attitudes to and expectations of PHRs. Significant sociodemographic, educational and attitude correlations with PHRs were found. The 'PHR benefits' and 'PHR problems' indices were consistent, useful and may have a wider applicability in quantifying the opinion of patients and providers before implementing PHR programmes.

Violence to General Practitioners and Fear of Violence

This paper describes the perception of general practitioners of violence to which they are subject, and also their fears of violence. It is based on interviews, and a written questionnaire. The outcome suggests that violence is a formidable problem. Some coping strategies are described. On the whole the subject has been little ventilated, but its recognition is an urgent matter.

Rheumatology at the general practitioner/hospital interface: a study of prevalence and access to specialist care.

Four general practices with a combined population of 23,300 in the west of Scotland participated in a record research and questionnaire assessment of 551 patients with rheumatic diseases. The study describes the prevalence, levels of disability found, and the types of service used. Even with this number of patients it was not possible to detect any significant differences in disability levels, use of second line drugs, or aids/appliances when comparing practices with adequate or inadequate access to rheumatological facilities (general practitioner perception). General practice is an appropriate setting in which to investigate the effect of service provision, but larger studies will be needed to reach more definite conclusions.

Community views about the role of general practitioners in disease prevention.

The role of preventive medicine in reducing mortality and morbidity is now widely recognized. Although general practitioners appear to be in an excellent position to offer preventive care, there is evidence that they currently do not detect or intervene for common risk behaviours. One reason for this may be the general practitioner's perception that patients do not expect such preventive activities to be a part of the doctor's role. A postal survey of 309 people randomly selected from the community was undertaken to examine perceptions about the general practitioner's role in detection and intervention for smoking, alcohol abuse, emotional problems and hypertension. Responses to the survey from 264 usable questionnaires indicated that people in the community accepted the general practitioner's role in preventive care, with most respondents indicating that they would appreciate being asked about the risks examined, would like the offer of intervention and would try treatments in these areas offered by the doctor. Few respondents indicated that they would change doctors as a result of preventive activity.

Pharmaceutical Promotion Tools — Their Relative Importance

An investigation is described of the perceptions of general practitioners concerning the extent to which their decisions to prescribe scheduled pharmaceutical products are influenced by some of the promotion tools available to pharmaceutical marketers. Some practical implications and guidelines are offered by the results to pharmaceutical marketers, with reference to the relative effectiveness of various promotional tools and the appropriate emphasis that should be placed on them. The relationship between the effect of these prescription determinants and certain categorical variables is investigated. Some strategic implications for the marketing of pharmaceutical products are identified, as are areas for further research.

Survey of general practitioners' attitudes to AIDS in the North West Thames and East Anglian regions.

As the numbers of people suffering from human immunodeficiency virus infection and the acquired immune deficiency syndrome (AIDS) increase, so will the contribution to care required from general practice. A postal questionnaire survey was therefore carried out among general practitioners in the North West Thames and East Anglian regions to determine their attitudes to AIDS and the issues it raises for them. One hundred and thirty seven questionnaires were returned (response rate 57%) and four factors underlying the doctors' attitudes identified; these concerned disease control, general practitioner care, patient support, and perception of seriousness. There were wide divergences of attitude among the general practitioners, younger doctors being more in line with specialist thinking on AIDS than older colleagues, and evidence of important gaps between policies advocated by AIDS specialists and bodies of opinion in general practice. Attitudes to AIDS in general practice may partly be a function of personal experience; further study is required.

Women's perceptions of female general practitioners.

AbstractA telephone survey of 250 women, selected at random from the Melbourne telephone directory, was conducted to ascertain perceptions about female general practitioners (GP) by female patients. The three most important factors in choosing a new GP were recommendation, distance and ease of obtaining an appointment. The sex of the GP was only an important factor for a small group of the respondents. The preference for a female doctor was higher if a gynaecological examination or discussion of emotional/personal problems were involved. A majority of respondents perceived no difference in a number of professional attributes. of female and male GPs. Preference (or lack of it) for sex of a new GP was strongly related to sex of current GP. These results reveal a much more favourable disposition by female patients towards female GPs than has been earlier reported. They indicate that the increasing numbers of female GPs in the medical workforce are unlikely to experience any obstacle to their full participation in it arising from the perceptions of their female patients.

Referral to hospital: perceptions of patients, general practitioners and consultants about necessity and suitability of referral.

A sample of new referrals from general practitioners to hospital specialists was examined from the points of view of the patient, general practitioner and consultant concerned with regard to the adequacy of the general practitioners' performance before referral, his ability to have managed without referral and the suitability of the specialist seen. Little agreement was found between the opinions expressed by the three groups, although some of the opinions expressed within the groups were found to be associated with characteristics of the groups.

Reasons for referral to hospital: extent of agreement between the perceptions of patients, general practitioners and consultants.

A sample of referrals to hospital out-patient clinics by general practitioners was examined from the points of view of the patient, general practitioner and consultant with regard to the perceived reason for the referral. A considerable degree of disagreement was found between the opinions of the three parties involved. Possible explanations for, and the consequences of this lack of agreement are considered and certain remedies suggested.

General practitioners and mental disorders

This article presents the results of a mail survey about mental illness in general practice carried out in France in 1981 on a sample of 353 general practitioners. The research had two main objectives: The first was to understand the general practitioners perceptions of the manner in which they dealt with their patients suffering from psychiatric or psychologic disorders. The second was to test several hypothesis concerning the relationship between the frequency of diagnoses of mental disorders by the general practitioner and her or his links with the field of psychopathology and with the mental patients. The findings of the survey confirm the main hypothesis: the way general practitioners diagnose mental illness is significantly related to their interest in the subject of psychopathology and in their mental patients. Moreover, these results show how general practitioners claim that psychological problems are part of their field and that they do not feel at all uneasy when confronted with patients suffering from mental disorders. They frequently deal with these patients with mental disorders and believe that they are qualified to practice psychotherapy.