Primary Care Survey Research Articles

Obstetrician/gynecologists: Primary care physicians for women

Health care reform has emerged as a major political issue. As a result changes in the delivery system, as originally proposed, would adversely affect access of patients to obstetrician/gynecologists. Because more than 60% of our members function as primary care providers and surveys of patients indicate more than half view their obstetrician/gynecologist as their primary care physician, active plans were undertaken to change this proposal. As a result, changes in education as well as some practice concepts will need to occur for obstetrician/gynecologists. Some of these are underway. Others are proposed.

Community asthma clinics: 1993 survey of primary care by the National Asthma Task Force.

To establish a baseline of work done in primary care asthma clinics in the United Kingdom and to assess the degree of clinical delegation to nurses and the appropriateness of their training. Prospective questionnaire survey of asthma care in general practices and a subsidiary survey of all family health services authorities (FHSAs) of the number of asthma clinics in their area. All 14,251 general practices in the United Kingdom and 117 FHSAs or health boards (Scotland and Northern Ireland). Questionnaires were returned by 4327 (30.4%) general practices, 54% being completed by practice nurses and 22% by general practitioners; in 24% profession was not stated. In all, 77.2% (3339/4327) of respondents ran an asthma clinic. 60 FHSAs state the number of asthma clinics at the time of the general practice survey (total 3653 clinics); within responding FHSAs 1702 (46.6%) practices running an asthma clinic replied to the general practice survey. Clinics exclusive for patients with asthma mostly occurred in practices with five or more general practitioners (70.2%), compared with single-handed practices (31.7%). The average number of asthma clinics run per practice was five a month; the average duration was 2 hours and 20 minutes. 1131 (48.8%) nurses ran clinics by themselves, 1180 (47.9%) with the doctor, and 39 (1.7%) had no medical input. Comprehensive questioning occurred other than for nasal (872, 26.1%) or oesophageal (335, 10.0%) symptoms and use of aspirin and non-steroidal drugs (1161, 33.4%). Growth in children was measured by only a third of respondents. Of the 1131 nurses who ran clinics alone, 251 (22.2%) did so without formal training entailing assessment. Asthma clinics are now common in general practice and much of their work is done by nurses, a significant minority of whom may not have had sufficient training. As this survey is probably biased toward the more asthma aware practices, greater deficiencies in training and standards may exist in other practices. Further evaluation of the effectiveness of asthma clinics is needed.

Pneumococcal vaccination after splenectomy: survey of hospital and primary care records.

Pneumococcal vaccination after splenectomy: survey of hospital and primary care records.

The clinical meaning of refractory depression: a review for the clinician

The authors' goal is to address the complex issue of treatment-refractory depression from a clinical perspective. They review the literature on the major clinical and methodological issues involved in the treatment and study of treatment-refractory depression as well as primary and tertiary care surveys of patients whose depression has not responded to treatment. There are methodological problems in defining treatment-refractory depression and in the tertiary care surveys of treatment-refractory depression. The authors define treatment-refractory depression as primarily involving diagnostic-treatment variables rather than patient variables. They articulate these variable as a series of questions the clinician may consider when confronted with patients who are considered refractory: 1) Is the diagnosis correct? 2) Has the patient received adequate treatment? 3) Was a rational stepped-care approach used? 4) How was outcome measured? 5) Is there a coexisting medical or psychiatric disorder that interferes with response to treatment? and 6) Are there factors in the clinical setting that are interfering with treatment? The problem of treatment-refractory depression has to do primarily with the diagnostic-treatment process than with patient variables. This has a number of implications in the areas of training, education, research, and public health. The evidence indicates that improvements in the recognition and treatment of depression are needed.

Health and poverty among elderly persons: a community-oriented primary care survey.

Providing health care for independent-living elderly persons is important, yet family physicians often lack accurate information about needs and access to care. The Community-Oriented Primary Care (COPC) approach and health status models from health services research provide a framework for assessing need and access to care. Personal interviews were conducted with 990 noninstitutionalized elderly persons in Youngstown, Ohio. Results showed that poverty, gender, and race were not strongly related to health status as measured by numbers of symptoms, functional status, or subjective health status. In addition, elderly persons had fewer health care needs and greater access to care than expected. Simple models of health status, need, and access do not seem to apply. The study shows the usefulness of COPC in planning health services; however, more effort is needed to refine measures of health status, need, and access.

Psychiatric morbidity in primary health care. A two-stage screening procedure in developing countries: choice of instruments and cost-effectiveness.

The use in two developing countries of a two-stage psychiatric screening procedure with an emphasis on minor morbidity is described. This was the first use of the Self-Reporting Questionnaire and Clinical Interview Schedule in conjunction. Health auxiliaries with limited training administered the first-stage screening instrument. In comparison with other psychiatric screening techniques used in developing countries, the procedure described may prove to be more cost-effective in primary care and community surveys, and more appropriate for assessing the wide range of minor psychiatric morbidity commonly encountered in such settings.