Perceptions Of General Practitioners Research Articles

The great boundary crossing: Perceptions on training pharmacists as supplementary prescribers in the UK

Objective: To explore the perceptions of General Medical Practitioners and pharmacist supplementary prescribers of the training provided for qualification as a pharmacist supplementary prescriber, and the experience of pharmacist supplementary prescribers of subsequent continuing professional development in practice. Design: A qualitative study of pharmacists from the first wave of those trained to become pharmacist supplementary prescribers, comprising interviews, focus groups and documentary analysis of recorded critical incidents. Setting: The research was conducted in three general practices located in two primary care trusts in the UK Midlands. Each practice had a pharmacist supplementary prescriber. Eight pharmacist supplementary prescribers participated, seven of whom were prescribing, all in a general practice setting. Method: A practice-specific focus group was held in each of the three general practices. Two focus groups were held for pharmacists and seven pharmacists were interviewed, six of whom provided two or more critical incidents. Results: Pharmacists were critical of some aspects of the academic training but were unanimous in acknowledging the value of the period of learning in practice and the input of their Designated Medical Practitioner. Learning was recognized by both parties as being reciprocal. Pharmacists’ accounts illustrated a variety of ways in which they undertook continuing professional development, with learning on the job a key component. There was little consensus between General Practitioner partners in two of the practices on the appropriateness of pharmacist supplementary prescribing, discussion focusing on the acquisition of clinical skills. Some partners, particularly those who were Designated Medical Practitioners, saw potential benefits. Conclusion: The coaching relationship between General Practitioner Designated Medical Practitioners and pharmacists served to embed skills and enhance confidence.The reflection skills gained by the pharmacist supplementary prescribers during their academic learning period appear to be important in their subsequent work-based learning.

What Information Do General Practitioners Need to Care for Patients with Lung Cancer? A Survey of General Practitioners Perceptions

General practitioners (GPs) are an integral part of the multidisciplinary team that care for patients with lung cancer. It is essential that patient information including results of tests, management plans, treatment, and follow-up arrangements are communicated between hospital-based carers and the community-based GP. The aim of this study was to explore GPs' views about the information they need from hospital-based health professionals in the management of their patients with lung cancer. This exploration is undertaken within the context of a multidisciplinary model of care, a relatively new concept in service delivery for cancer patients. Data were collected using a questionnaire that was distributed to the population of 433 GPs from one Australian regional Division of General Practice. Questions related to from whom, what, when and how GPs would like to receive information from the multidisciplinary hospital-based lung cancer team. GPs reported that they wanted information from all members of the multidisciplinary hospital-based lung cancer team, not just physicians. The key triggers for communication included: any change in the patient's condition; following initial outpatient visit; at admission and discharge; and following treatment milestones. Both medical and social information were seen as important to GPs and there was strong support to receive information electronically. This study illustrates the desire by GPs to receive information from all members of the hospital-based lung cancer team if it is relevant to the ongoing care of their patient. Technology-enabled solutions, such as an electronic multidisciplinary discharge summary, the electronic health record and the person-controlled electronic health record, offer strategies to improve both timeliness and access to information.

Opportunity or threat? General practitioner perceptions of pharmacist prescribing

Abstract Objective In recent years prescribing rights have been extended beyond doctors and dentists in the UK, first to nurses and subsequently to pharmacists. The aim of the study was to explore general practitioner (GP) perceptions of the advantages and disadvantages of pharmacist supplementary prescribing and the future introduction of independent prescribing. Method A qualitative study was conducted with GPs from three practices, in each of which a pharmacist prescriber was regularly working. Key findings The prescribing pharmacists, all of whom were already working in the practice when they qualified as prescribers, had negotiated new areas of work. Not all GPs in the practices referred patients to the prescribing pharmacists. Those GPs who did refer patients generally described benefits from the service, with some ambivalence. There was evidence that the GPs had, to some extent, redefined their professional boundaries, and delegated some routine work which involved no diagnosis and only limited decision making. In this way the GPs exercised control over the interprofessional boundaries. Conclusion The study findings indicate selective acceptance of pharmacist prescribing by GPs.

Follow-up survey of general practitioners' perceptions of UK allergy services

A UK survey of general practitioners (GPs) in 2002 found that they perceived allergy care throughout the UK National Health Service (NHS) to be poor. We conducted a follow-up survey in 2009 to see if GPs' perceptions had changed. To determine GP perceptions of allergy care in the NHS in the wake of recent Government reports into allergy care, and to compare the findings of this survey to a similar survey conducted in 2002. A cross-sectional postal survey of 500 UK GPs was conducted, using an adapted version of the 2002 questionnaire, modified to reflect recent developments in primary care. We obtained valid responses from 149 GPs, 87% of whom were based in England. 74% were GP principals and 63% worked in training practices. Most GPs (71%; 95%CI 63-79) rated overall NHS allergy care as poor, expressing concern about both primary care and access to allergy specialists. There were no significant differences in GPs' perceptions of the quality of allergy care provided in primary (p=0.33) and secondary care (p=0.97) or access to specialists (p=0.37), between 2002 and 2009. This survey suggests that recent professional and parliamentary reviews have not led to any notable improvements in GP perceptions of UK NHS allergy services between 2002 and 2009.

Synergy and sustainability in rural procedural medicine: Views from the coalface

The practice of rural and remote medicine in Australia entails many challenges, including a broad casemix and the remoteness of specialist support. Many rural practitioners employ advanced procedural skills in anaesthetics, surgery, obstetrics and emergency medicine, but the use of these skills has been declining over the last 20 years. This study explored the perceptions of rural general practitioners (GPs) on the current and future situation of procedural medicine. The qualitative results of data from a mixed-method design are reported. Free-response survey comments and semistructured interview transcripts were analysed by a framework analysis for major themes. General practices in rural and remote Queensland. Rural GPs in Rural and Remote Metropolitan Classification 4-7 areas of Queensland. The perceptions of rural GPs on the current and future situation of rural procedural medicine. Major concerns from the survey focused on closure of facilities and downgrading of services, cost and time to keep up skills, increasing litigation issues and changing attitudes of the public. Interviews designed to draw out solutions to help rectify the perceived circumstances highlighted two major themes: 'synergy' between the support from medical teams and community in ensuring 'sustainability' of services. This article presents a model of rural procedural practice where synergy between staff, resources and support networks represents the optimal way to deliver a non-metropolitan procedural service. The findings serve to remind educators and policy-makers that future planning for sustainability of rural procedural services must be broad-based and comprehensive.

A study on the perception of general practitioners of a locality in Kolkata regarding RNTCP and DOTS

The Revised National Tuberculosis Control Program (RNTCP), based on the internationally recommended directly observed treatment, short course (DOTS) strategy, was initially implemented mainly through the network of healthcare facilities under the public health departments of the state governments. Studies have shown that the private sector is the first point of contact for more than half of the TB patients. In most countries with a significant burden of TB, DOTS implementation is limited largely to public sector services under the tuberculosis program. In reality, however, many patients with symptoms of TB, including the very poor, do seek and receive care from a wide variety of healthcare providers outside the network of the tuberculosis program and these providers do not always coordinate with the national program or apply to DOTS. In order to address this apparent weakness in global TB control, efforts have been under way within and outside the World Health Organization’s (WHO’s) Public-Private Mix (PPM) initiative. The obvious goal of developing PPM is to promote access to quality TB care worldwide. The RNTCP has recognized the Indian Medical Association (IMA) as a major partner in expanding PPM DOTS service in this country. Therefore, the contribution of the general practitioners for the control and management of tuberculosis must not be overlooked or neglected. To bring their method of treatment under the umbrella of RNTCP is the need of the hour. For this, a baseline data, to assess their knowledge and practice regarding RNTCP/DOTS is urgently required. With this background a study has been conducted to find out the perception of the general practitioners, of a locality in Kolkata, regarding RNTCP and DOTS.

General practitioner perceptions of clinical medication reviews undertaken by community pharmacists

Delivery of current health care services focuses on interdisciplinary teams and greater involvement of health care providers such as nurses and pharmacists. This requires a change in role perception and acceptance, usually with some resistance to changes. There are few studies investigating the perceptions of general practitioners (GPs) towards community pharmacists increasing their participation in roles such as clinical medication reviews. There is an expectation that these roles may be perceived as crossing a clinical boundary between the work of the GP and that of a pharmacist. Thirty-eight GPs who participated in the General Practitioner-Pharmacists Collaboration (GPPC) study in New Zealand were interviewed at the study conclusion. The GPPC study investigated outcomes of a community pharmacist undertaking a clinical medication review in collaboration with a GP, and potential barriers. The GPs were exposed to one of 20 study pharmacists. The semi-structured interviews were recorded and transcribed verbatim then analysed using a general inductive thematic approach. The GP balanced two themes, patient outcomes and resource utilisation, which determined the over-arching theme, value. This concept was a continuum, depending on the balance. Factors influencing the theme of patient outcomes included the clinical versus theoretical nature of the pharmacist recommendations. Factors influencing resource utilisation for general practice were primarily time and funding. GPs attributed different values to community pharmacists undertaking clinical medication reviews, but this value usually balanced the quality and usefulness of the pharmacist's recommendations with the efficiency of the system in terms of workload and funding.

A survey exploring knowledge and perceptions of general practitioners towards the use of generic medicines in the northern state of Malaysia

The objective of this study was to evaluate the general practitioners' (GPs') knowledge and perceptions towards generic medicines in a northern state of Malaysia. A postal cross-sectional survey involving registered GPs in Penang, Malaysia was undertaken. A 23-item questionnaire was developed, validated and administered on the GPs. Eighty-seven GPs responded to the survey (response rate 26.8%). The majority of the respondents (85.1%) claimed that they actively prescribed generic medicines in their practice. On the other hand, only 4.6% of the respondents correctly identified the Malaysia's National Pharmaceutical Control Bureau's bioequivalence standard for generic products. There were misconceptions among the respondents about the concepts of "bioequivalence", "efficacy", "safety", and "manufacturing standards" of generic medicines. GPs in this survey believed that a standard guideline on brand substitution process, collaboration with pharmacists, patient education and information on safety and efficacy of generic medicines were necessary to ensure quality use of generics. Furthermore, advertisements and product bonuses offered by pharmaceutical companies, patient's socio-economic factors as well as credibility of manufacturers were factors reported to influence their choice of medicine. Although it appeared that GPs have largely accepted the use of generic medicines, they still have concerns regarding the reliability and quality of such products. GPs need to be educated and reassured about generic products approval system in Malaysia concerning bioequivalence, quality, and safety. The current findings have important implications in establishing generic medicines policy in Malaysia.

Roles of General Practitioners in the Provision of Health Care Services for People with Intellectual Disabilities: A National Census in Taiwan

Aims The aims of the present study were to explore the perceptions of general practitioners (GPs) in the provision of health care services for people with intellectual disabilities and to analyse GPs’ priorities in the delivery of health care services to this group of people in Taiwan.Methods The study employed a cross‐sectional design and was conducted by a census method, the aim being to collect information from all GPs in Taiwan. A questionnaire was mailed out, between 10 April 2006 and 16 June 2006, and the responses provided by 331 GPs (response rate = 16) were included in the analysis.Results The results showed that most of the respondents did not have sufficient experience to deal with patients with intellectual disabilities and lacked adequate knowledge about intellectual disabilities. Indeed, respondents expressed the need for on‐the‐job training in the field of intellectual disabilities and generally agreed that their role in providing health care services for people with intellectual disabilities was important. However, they were generally not satisfied with the achievements of their role on health care issues. The study highlighted that many issues need to be prioritized for people with intellectual disabilities in relation to policy planning at different health care stages (primary, secondary and tertiary health care). The results also revealed that those senior GPs with considerable experience in treating people with intellectual disabilities were more likely satisfied with their role in providing health care for this group of people.Conclusions It is concluded that Taiwanese health and welfare authorities need to focus more carefully on issues concerning deficiencies in the training of GPs, and to employ appropriate strategies to address health care issues raised in the present study so as to improve the quality of care for people with intellectual disabilities.

Enquête sur la prise en charge des patients dépressifs en soins primaires : les médecins généralistes ont des difficultés et des solutions

Depression is a quite common condition, and its treatment is mainly provided by General Practitioner (GP). It is already known that detection and treatment requires significant improvement. The well known and high consumption of antidepressant drugs in France, the highest of all other European countries, requires specific studies. The causes of this situation are not clear and seem to be numerous: Patient's demands, social claims; lack of initial and continuous medical education, bad GP demographic trends, and lack of them in rural areas; pharmaceutical company pressure; and organisation of the health care system. GP are the main medical actors of the primary care system in France. The aim of this study was to survey GP perceptions on secondary care services, seek the views and barriers to the provision of good services, and ask them about perceptions and solutions they could suggest. A structured postal questionnaire was sent to all GP of the north-west region of France, asking physicians about obstacles perceived when taking care of depressive patients; factors influencing the use of services, specialised advice, treatments, access to psychiatrists and psychological care. Their psychiatric knowledge and demographic data were also assessed. Quantitative data were analysed using Epi-Info software, and qualitative data were transcribed and coded manually. A total of 25% of the GP returned the questionnaire (n=2097 in 8709). The sample profile was the same as the studied population. Less than a third of the GP (28%) were aware of the clinical guidelines on depression, and less than a fifth (18%) had clinical experience of psychiatry during their studies. Lack of time was not the main obstacle assessed by the GP. Their complaints were about lack of mental health services, difficulty in accessing services, and about general liaison between primary and secondary health care services: they reported difficulties obtaining quick and good response from the specialist either for emergency or non emergency cases. Regarding secondary care, they mainly referred to the psychiatrist, rather than to the psychologist, probably because this second option is not reimbursed by the social security system. Not surprisingly, medication was cited as the most frequently used treatment, followed by psychotherapy and cognitive behavioral therapy (CBT), and almost never self help literature and self help groups. Trained GP considered they were much more comfortable coping with depressed patients, less frequently using secondary care providers, and easily alternative solutions rather than antidepressant drugs. This situation suggests the usefulness of medical education, and is attested by many qualitative answers. It is not sure that the low rate of knowledge of the guidelines should be judged only as a lack of professionalism. According to the "French Society of Primary Care", clinical guidelines need updating, and it is known that those available could be useful only for half of the situations encountered in primary care. Operational propositions urgently need to be proposed. Recent questioning of the real interest of pharmaceutical options in the treatment of depression is another argument. Nor can we wait for a hypothetic rise in the demographic situation. The GP have several propositions to improve these problems, e.g. continuous medical education (CME) focusing on "patient centred therapy", dedicated hotline or circuit for depressed people, and an adapted sociomedical directory. They also feel that political awareness about lack of physicians is required, but say that improving quality of care does not rely only on improving demographics. They ask for funds for psychological care. When thinking about the circuit of care, the role of all care providers, and their communication, a global vision appears unavoidable, which would get rid of the divisions between out-patients and the hospital. Despite an unavoidable questioning on the dysfunctions of the health care system, quality of care and probably pharmaceutical consumption for the depressed patient might be improved by simple tools, such as adapted CME for primary care physicians, and communication improvement between secondary and primary care systems.

GP and nurses' perceptions of how after hours care for people receiving palliative care at home could be improved: a mixed methods study

BackgroundPrimary health care providers play a dominant role in the provision of palliative care (PC) in Australia but many gaps in after hours service remain. In some rural areas only 19% of people receiving palliative care achieve their goal of dying at home. This study, which builds on an earlier qualitative phase of the project, investigates the gaps in care from the perspective of general practitioners (GPs) and PC nurses.MethodsQuestionnaires, developed from the outcomes of the earlier phase, and containing both structured and open ended questions, were distributed through Divisions of General Practice (1 urban, 1 rural, 1 mixed) to GPs (n = 524) and through a special interest group to palliative care nurses (n = 122) in both rural and urban areas.ResultsQuestionnaires were returned by 114 GPs (22%) and 52 nurses (43%). The majority of GPs were associated with a practice which provided some after hours services but PC was not a strong focus for most. This was reflected in low levels of PC training, limited awareness of the existence of after hours triage services in their area, and of the availability of Enhanced Primary Care (EPC) Medicare items for care planning for palliative patients. However, more than half of both nurses and GPs were aware of accessible PC resources.Factors such as poor communication and limited availability of after hours services were identified the as most likely to impact negatively on service provision. Strategies considered most likely to improve after hours services were individual patient protocols, palliative care trained respite carers and regular multidisciplinary meetings that included the GP.ConclusionWhile some of the identified gaps can only be met by long term funding and policy change, educational tools for use in training programs in PC for health professionals, which focus on the utilisation of EPC Medicare items in palliative care planning, the development of advance care plans and good communication between members of multidisciplinary teams, which include the GP, may enhance after hours service provision for patients receiving palliative care at home. The role of locums in after PC is an area for further research

General practitioners' and pharmacists' perceptions of the role of community pharmacists in delivering clinical services

Background Because community pharmacists are encouraged to provide clinical services, there is a need to determine the role perceptions of both community pharmacists and general practitioners (primary care physicians). Differing role perceptions are likely to result in barriers to pharmacists expanding their roles in health care. Objectives The purpose of this study was to investigate whether community pharmacists' and general practitioner's perceptions of the role of community pharmacists may be a barrier to pharmacists increasing their role in medication management. Other potential barriers were also explored that could provide a framework for future research. Methods A postal survey to 900 and 1000 randomly selected community pharmacists and general practitioners, respectively, elicited the perceptions of these groups toward the role of community pharmacists. Likert scales were used to quantify the results. Results The results revealed a gap in perceptions regarding the role of the community pharmacist, with general acceptance of the technical roles but less acceptance of clinical roles by general practitioners. Barriers to increased involvement of community pharmacists in clinical services included a perceived lack of mandate, legitimacy, adequacy, and effectiveness by both groups. Also observed was a lack of readiness to change by community pharmacists. Conclusions This study suggests that there are significant barriers to community pharmacists increasing clinical services, both from the community pharmacists themselves and from the general practitioners. Attention to change management in a complex environment will be necessary if community pharmacists are to change their role toward more clinical services.

Evolution of breast cancer screening in France from 2005 to 2008: results of the EDIFICE survey.

Abstract Abstract #5010 Background: In 2005, a first EDIFICE survey was aimed to provide a better understanding of population s adherence to the screening tests available in France and results pertaining to breast cancer are reported (Int. J. Med. Sci. 2008, 5: 106-112). In 2008, EDIFICE survey is performed again to assess the evolution 3 years later. Taking into account that the Implementation of breast cancer screening has been generalized in France since 2003: All women aged between 50 and 74 years are systematically invited to perform a mammography every two years.
 Methods: This second nationwide observational survey was carried out from December 12, 2007 to January 07, 2008 among a representative samples of 1802 French people aged between 40 and 85 years and 600 general practitioners (GPs). Information collected included socio-demographic characteristics, attitude towards cancer screening and actual experience of cancer screening, as well as GPs practice regarding screening. The precision of the results is 4.3% for a 95% confidence interval.
 Results: In EDIFICE–1 and -2, 501 and 488 participating women aged between 50 and 74 years are assessed, respectively.
 
 In EDIFICE-2, there was a significant relationship (p<0.05) between the existence of a first mammography screening on women s own initiative and age (odd ratio 0.35; 95%CI 0.13 – 0.95). Main factors associated with performing the screening test every two years were: knowledge of screening process (odd ratio 3.59 ; 95%CI 1.54 – 8.38), Own motivation (odd ratio 5.03; 95%CI 1.6 – 15.8), First mammography performed in the organized screening (odd ratio 6.53 ; 95%CI 1.15 – 37.3), and gynecologist consultation (odd ratio 8.68; 95%CI 2.21 – 34.11).
 Of the 600 participating GPs, 68% systematically recommended a mammography to their patients in the screening national plan. GPs perceptions of the reasons for women s avoidance of the screening test were unwillingness to be aware of mammography results (46%) and négligence (24%).
 Conclusion: The main result of this second EDIFICE Survey is to stress the impact of the breast cancer screening in France. Between 2005 and 2008 the rate of women s attendance at mammography screening has increased and the proportion of women who repeat the test every two years has been dramaticaly improve. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5010.

Exploring preferences for place of death with terminally ill patients: qualitative study of experiences of general practitioners and community nurses in England

Objective To explore the experiences and perceptions of general practitioners and community nurses in discussing preferences for place of death with terminally ill patients.Design Qualitative study using semistructured interviews and...

Cardiovascular risk assessment and management in mental health clients: Perceptions of mental health and general practitioners in New Zealand

People with mental illness have higher rates of morbidity and mortality, largely due to increased rates of cardiovascular disease (CVD). Metabolic syndrome is well recognised but rarely expressed as a need to assess and manage cardiovascular risk factors; furthermore there is confusion about whose role this is. This study explores health practitioners' knowledge, attitudes, barriers/solutions towards cardiovascular risk assessment and management in mental health patients. A survey of mental health practitioners (MHPs n = 421) and general practitioners (GPs n = 232) Three-quarters of respondents agreed mental illness predisposes to CVD. Fifty-five percent of MH doctors agreed they could effectively assess CVD risk compared to 67% of GPs. Only 21% of MH doctors agreed they could effectively manage CVD risk compared to 57% of GPs. Seventy-nine percent of MHPs believed that assessing CVD risk was a joint responsibility between GP and MHP, compared to 33% of GPs; 62% of GPs believed it was their sole responsibility. Forty-six percent of MHPs believed managing CVD risk was a joint responsibility compared with 29% of GPs; 58% of GPs saw this as their role. Only 13% of MHPs and fewer than 4% of GPs agreed that MH services were effectively assessing and managing CVD risk. MHPs identified lack of knowledge and skills (58%) and poor communication between primary-secondary care (53%) as the main barriers. GPs identified barriers of poor communication (64%) and patient compliance with health care management (71%). The top two solutions proposed by MHPs were provision of GP subsidies (47%) and training (43%). GPs also identified provision of a subsidy (66%) and collaborative management between GPs and MH (44%) as solutions. There is widespread recognition of increased risk of CVD in MH patients. MHPs do not believe they have the knowledge and skills to manage this risk. GPs believe this is their responsibility. Both groups recognise communication with, and access to, primary care for MH patients as key barriers.

The weight of opinion on childhood obesity: recognizing complexity and supporting collaborative action

The study investigated similarities and differences in the perceptions of parents, adolescents, General Practitioners (GPs) and education professionals regarding childhood overweight and obesity. The study used qualitative research methods in the form of focus groups and individual interviews with six target groups, comprising parents of preschool children, parents of primary and high school students, high school students, early childhood staff, school teachers and General Practitioners. Participants were recruited through early childhood centres, schools and Divisions of General Practice in four locations, including rural, low, medium and high socioeconomic areas in one state in Australia. Thematic analysis was conducted. A total of 26 focus groups and 17 individual interviews were conducted. There was a high degree of consistency between parents, young people and professional groups regarding awareness and understanding about childhood obesity. Parents were uniformly acknowledged as playing a pivotal role, although their control and links with professionals diminish as children get older. Respondents perceived weight as associated with health, social issues and moral judgments. All groups acknowledged the emotion associated with weight and food; by comparison, discussions about physical activity were straightforward and unemotional. The shared social, cultural and psychological themes illustrate the complexity of childhood obesity as a public health issue, and the need for interventions and communications to take account of perceptions if they are to be relevant and effective. However, the commonality of views also indicates the potential for health professionals, schools, childcare, parents and young people to collaborate on community initiatives.

Patient versus general practitioner perception of problems with treatment adherence in type 2 diabetes: From adherence to concordance

Objectives: To determine the prevalence of problems with treatment adherence among type-2 diabetic patients with regards to medication, dietary advice, and physical activity; to identify the associated clinical and psychosocial factors; and to investigate the degree of agreement between patient-perceived and GP-perceived adherence. Methods: Consecutive patients were solicited during visits to 39 GPs. In total, 521 patients self-reported on treatment adherence, anxiety and depression, and disease perception. The GPs reported clinical and laboratory data and patients' adherence. A multivariate analysis identified the factors associated with adherence problems. Results: Problems of adherence to medication, dietary advice, and physical activity recommendations were reported by 17%, 62%, and 47% of the patients, respectively. Six independent factors were found associated with adherence problems: young age, body-mass index (BMI) > 30 kg/m2, glycosylated haemoglobin (HbA1c) > 8%, single life, depression, and perception of medication as a constraint. Agreement between patients’ and GPs’ assessments of treatment problems reached 70%. Conclusion: In type 2 diabetes, problems with dietary advice or physical activity are far more frequent than problems with medication, and not all physicians are fully aware of patients’ problems. More active listening and shared decision-making should enhance adherence and improve outcomes.

Perceptions and Competence in Evidence-Based Medicine: A Survey of the American Urological Association Membership

We investigated the attitudes and opinions of urologists toward evidence-based medicine to help guide future efforts of the American Urological Association and other organizations vested in the education and training of urologists. From August to November 2006 we performed a mail survey of a random sample of 2,000 members of the American Urological Association. Questions in the survey addressed the role of evidence-based medicine in urology, participants' self-assessed understanding of evidence-based medicine related terminology, their familiarity with and use of web based evidence-based medicine resources, as well as their evidence-based medicine competence based on their understanding of core concepts such as randomization and blinding. A total of 889 respondents completed the survey resulting in a response rate of 45%. There was widespread agreement that practicing evidence-based medicine improves patient care (median score 8; IQR 7, 10) and that every urologist should be familiar with critical appraisal techniques (median score 9; IQR 8, 10). The percentage of respondents who indicated that they "understand and could explain to others" the terms number needed to treat, power and level of evidence was 42%, 29% and 18%, respectively. The American Urological Association Guidelines were used regularly by 35% and on occasion by 51% of respondents. Of the participants 44% were unaware of the PubMed(R) search engine and only 14% used it regularly, while 76% were unaware of the Cochrane Database of Systematic Reviews and only 8% had ever used it. The mean evidence-based medicine competence score for all respondents was 67.2% +/- 17.0%. The findings of this survey confirm that urologists have a favorable attitude toward evidence-based medicine. However, understanding of evidence-based medicine terminology, concepts and use of related resources among American Urological Association members leaves room for improvement. Increased efforts to promote an understanding of evidence-based medicine through workshops, publications and web based resources specifically for a urological audience appear indicated.

General practitioners’ understanding of depression in young people: qualitative study

BackgroundDepression in young people is not necessarily self-limiting, and is frequently associated with affective disorders and impaired psychosocial functioning in adult life. Early recognition of and response to depression in teenagers could be an important task for general practitioners (GPs), but there are multiple obstacles to achieving this.ObjectivesTo explore GPs perceptions of the opportunities and difficulties of working with teenagers, and of specifically recognizing and responding to depression.Setting and participantsNine GPs who had taken part in a developmental project on diagnosing and treating depression in young people. All worked in an Inner London Medical Centre.MethodsSemi-structured interviews transcribed and analysed thematically.FindingsTwo over-arching themes that emerged from the interviews were that teenagers were perceived as being qualitatively different from adults in the ways they used general practice, and that GPs were uncomfortable with making a diagnosis of depression in young people. Within the first theme, we identified sub-themes, including failure of teenagers to engage with services, parental involvement, complex presentations and lack of time. Within the second theme, the sub-themes were surprise, normalization of depressed mood and challenge to the validity of psychiatric diagnosis in this age group.ConclusionsProfessional development in general practice that addresses this topic needs to modify two perceptions; that depressed mood is in some sense ‘normal’ in this age group, and that teenagers are so different in their use of services that the management of depression (if it is recognized at all) is problematic.

When trust defies common security sense

Primary care medical practices fail to recognize the seriousness of security threats to their patient and practice information. This can be attributed to a lack of understanding of security concepts, underestimation of potential threats and the difficulty in configuration of security technology countermeasures. To appreciate the factors contributing to such problems, research into general practitioner security practice and perceptions of security was undertaken. The investigation focused on demographics, actual practice, issues and barriers, and practitioner perception. Poor implementation, lack of relevant knowledge and inconsistencies between principles and practice were identified as key themes. Also the results revealed an overwhelming reliance on trust in staff and in computer information systems. This clearly identified that both cultural and technical attributes contribute to the deficiencies in information security practice. The aim of this research is to understand user needs and problems when dealing with information security practice.