Sample Of General Practitioners Research Articles

An evaluation of cervical screening in general practice

To identify the technical practices of general practitioners (GPs) in relation to Papanicolaou (Pap) smear screening, and the differences in screening practices between male and female practitioners; to determine the cellular content of smears taken; and to correlate screening practices and demographic variables with smear results. During February-May 1992, a sample of Melbourne GPs filled in a questionnaire concerning their screening practices, and the results were correlated retrospectively with results of Pap smears taken in March and October 1991. Melbourne metropolitan general practice. One hundred and seventy-nine GPs (72% participation rate among eligible practitioners) from a sample obtained from the register of the Medical Board of Victoria. Female doctors took significantly more smears than male doctors. An opportunistic approach to cervical screening was most commonly practised, with the patient being asked to ring for her results and the practice staff only contacted her if the result was abnormal. Only 43% of doctors indicated the use of a specific reminder system when rescreening was due. Endocervical cells were present in 79% of smears. The presence of endocervical cells was found to be related to the year of a doctor's graduation (with both very recent and older graduates [pre-1960s] having lower endocervical cell rates), and to be positively correlated with more postgraduate training. Our study suggests that further education and training in cervical screening is needed for some GPs, in particular, male doctors, graduates of less than four or greater than 20 years, and those without postgraduate training.

"Perimenopausal" Complaints in Women and Men: A Comparative Study

The objective of this investigation was to study the hormonal aspects of aspecific (psychomatic) complaints during the perimenopausal period. Data from health interviews with 8,679 women and men (age 25->75 years) belonging to a sample of general practitioners' practices, with respect to the occurence of complaints usually associated with the perimenopause and with respect to mental health (as evaluated through standardized questionnaires) were analysed. Except for excessive transpiration, a typical perimenopausal symptom related to decreased estrogen secretion, none of the other complaints usually attributed to the climateric increased more in women than in men during the perimenopausal period. This lack of correlation was observed also for the mental health status. It is concluded that psychosomatic complaints usually attributed to the climacteric are neither gender nor age specific and that, therefore, a hormonal cause for these complaints seems unlikely. (aut.ref.)

Coronary heart disease prevention in general practice: the practices and views of a national sample of general practitioners

THE Health of the Nation white paper has prescribed an important role for primary health care in the key priority area of coronary heart disease prevention. One of the recommendations is to explore ways of developing existing health promotion arrangements in primary care in response to the national strategy. This study aimed to discover what these existing arrangements were through a postal survey and in- depth interviews with a random sample of general practitioners (GPs) in England during 1991 and 1992. The results show GPs' involvement was mainly con fined to risk factor assessment and management in the consultation, although there was little evidence of systematic risk assessment. The majority of the practices had well-person clinics, usually run by a practice nurse, where there was a greater likelihood of systematic tests and measurements. The impli cations of these findings are discussed.

The views of singlehanded general practitioners: a qualitative study.

To examine the concerns of singlehanded general practitioners working in an inner London area and to compare the views of general practitioners in partnerships. Qualitative analysis of semistructured interviews with a random sample of singlehanded general practitioners and a sample of general practitioners from partnerships matched for age and sex. The area covered by Lambeth, Southwark, and Lewisham Family Health Services Authority. The singlehanded general practitioners were more likely to be older, male, and first qualified abroad than general practitioners in partnerships. Their major concerns were inadequate premises, maintaining their singlehanded status, and coping with recent changes to their contract. Most were very satisfied with their solo status and did not see the provision of 24 hour care as stressful. Singlehanded general practitioners saw themselves as providing a unique service for patients, and their status as an alternative for general practitioners who were unhappy in partnerships. Such practices are unlikely to wither away as a pattern of provision. Any comprehensive development of primary care must take their needs into account.

Death certification by House Officers and General Practitioners — practice and performance

The objective of this study was to assess the knowledge, attitudes and behaviour of House Officers and General Practitioners (GPs) in relation to death certification, to determine the scope for future intervention. A postal questionnaire was used to survey all House Officers (174) and a 10 per cent random sample of GPs (131) in Mersey Region. The main outcome measures were: death certification experience; knowledge, attitudes and behaviour in relation to data uses and coding; and acceptability of Cause of Death statements. Response rates were comparable-119/174 House Officers (68.4 per cent) and 95/131 GPs (72.5 per cent). Most House Officers (78.8 per cent) and GPs (85.3 per cent) reported that they made the best possible Cause of Death statement but, respectively, 62.4 per cent and 59.3 per cent of these might modify a statement in some circumstances. Significantly more House Officers (70.3 per cent) than GPs (44.2 per cent) acknowledge room for improvement and were amenable to more training (86.6 per cent versus 52.5 per cent), but significantly fewer felt sufficiently instructed (23.7 per cent versus 52.6 per cent). Most respondents (> 90 per cent) considered accurate death certification important, but 46.2 per cent of House Officers had not read the death certificate book instructions. Knowledge was variable, especially concerning Underlying Cause of Death. Written Cause of Death statements were broadly similar in style and standard between groups. Experience did not appear to improve death certification practice. Better and co-ordinated undergraduate and early post-graduate education (which should be continuing and audited), and practical accessible guidance on death certificate completion, might improve standards of practice and performance within the existing framework. Alternative methods of presenting guidance on death certificate completion should be explored.

Coronary heart disease prevention: the role of the general practitioner.

The objectives of the study were to identify the level of general practitioner (GP) involvement in activities aimed at coronary heart disease prevention and to explain variations in involvement. These questions were explored through a postal survey of a random sample (n = 1696) of GPs in England of whom 64% completed questionnaires. Ninety-four per cent of GPs reported that they were involved in risk factor assessment in the consultation although these assessments most commonly involved blood pressure testing and identification of smoking. Ninety-one per cent of practices were reported by the GP to have a lifestyle risk assessment clinic where there was more evidence of systematic risk assessment. These clinics were usually run by a practice nurse as were lifestyle risk factor management clinics although GPs were more involved in hypertension and cholesterol clinics. Positive attitudes to prevention and training in health promotion were associated with higher GP involvement, and higher practice involvement was associated primarily with the number of practice nurses employed. The implication of these findings are discussed.

Policies and practices for the assessment and management of risk factors for coronary heart disease prevention

Recent government policy in the United Kingdom has prescribed an important role for primary health care In the key priority area of coronary heart disease prevention. One of the recommendations was to explore ways of developing existing health promotion arrangements in primary care in response to the national strategy. We sought to identify what these existing arrangements were. Information was collected through a survey and in-depth interviews with a random sample of general practitioners (GPs) in England during 1991 and 1992. General practitioners' policies and practices in relation to risk factor assessment and management as well as the policies employed in health promotion clinics were examined. General practitioners' involvement was confined to opportunistic risk assessment and management in the consultation. However, there was little evidence of systematic opportunistic risk factor assessment as emphasis was placed primarily upon blood pressure and smoking. The majority of the general practices had well-person clinics, which were usually run by nurses. There was a greater likelihood of systematic tests and measurements and assessment of risk factors in well-person clinics than in the context of the normal GP consultation.

Dry chemistry instruments in primary care. II. Comparison of users with non-users.

One way of studying the impact of dry chemistry desk-top instruments in primary care is by comparing users and non-users of this technology with respect to practice setting and changes in everyday practice, as well as to elucidate reasons for not implementing this technology. We therefore mailed a similar questionnaire to all users of the most-used dry chemistry instruments in Norway (n = 298) and to a 14% random sample of general practitioners (n = 381), and a 40% random sample of doctors in occupational health care units (n = 181). The response rate was 77-79% and 200 users and 281 non-users could be included. In general practice, more users were solo practitioners and more users had a cell counter in the office laboratory; fewer occupational health care users kept computerized records. Users reported improvement in diagnosis and treatment and claimed that patient satisfaction had improved. In general, an increase in the number of tests was estimated. Non-users were more pessimistic with regard to improvements in office laboratory service, and stated perceived problems regarding cost, workload and analytical quality as well as good service from the hospital laboratory as reasons for not implementing such instruments in their practice.

The distribution of medical X-ray doses amongst individuals in the British population

This study has estimated the distribution of diagnostic X-ray doses amongst individuals in the British population by sampling the records kept by general practitioners (GPs) on their patients and the records held by the radiology department of a district general hospital. Deceased patients were chosen in the former case in order to evaluate the dose acquired over a complete lifetime. In each case, several hundred records were sampled. The GP data obtained have enabled an estimate to be made of the likelihood of reaching various dose levels in a lifetime. It is estimated that about 1% of the population has received a lifetime effective dose-equivalent of more than 100 mSv. The largest cumulative dose revealed by the samples of GP and radiology department records was about 200 mSv. The GP data have also shown that the last year of life sees a four-fold increase in the number of X-ray examinations experienced compared with the previous 9 years. The hospital data have allowed an estimate to be made of current rates of dose acquisition amongst the population of a District Health Authority.

Knowledge, skills and counselling behaviour of Belgian general practitioners on CPR-related issues.

General practitioners (GP) can identify potential cardiac arrest victims. They have the opportunity to inform cardiac patients and their families about the risk of sudden cardiac death and can motivate family members to attend a CPR-course. To study actual counselling practices concerning basic CPR-training a questionnaire was mailed to a representative sample of Belgian GPs (n = 1119). The level of CPR-training of the GPs was fairly good: 67% had received BLS training on a manikin and 63% had already attended a cardiac arrest event. A discrepancy was observed between the positive attitude towards CPR and the counselling of family members to attend a CPR-course (9%). GPs feared to inflict additional stress to the patient (32%) or the family (43%) or did not know where CPR courses were organised (37%). GPs are a primary target group for CPR-training and should learn how to counsel potential bystanders of a cardiac arrest to attend a CPR-course without inflicting additional anxiety on the patient or his family.

Pharmacy beyond the dispensary: general practitioners' views.

To ascertain general practitioners' attitudes to an extended role for community pharmacists. Postal questionnaire to a 1 in 6 sample of general practitioners in the Northern, West Midlands, and Oxford regions (total sample size 1087). Attitudes towards specific extended roles, pharmacist prescribing of particular drugs, the role of the pharmacist, and the relationship between the professions. 744 questionnaires were returned in a usable form, an overall response rate of 68.4%. Attitudes varied, from a majority in favour of pharmacists reporting adverse drug reactions to a majority against their supervising repeat prescriptions (81% and 36% in agreement respectively). A similar range of attitudes was shown to pharmacist prescribing, from 84% in agreement with their prescribing nicotine chewing gum (deregulated since the survey) to 11% agreeing to their prescribing cimetidine. About half the respondents thought general practitioners should be allowed to dispense and a third that pharmacists "should stick to dispensing." 27% agreed that pharmacists were too influenced by commercial pressures to give unbiased advice. Most doctors would favour an extension of the activities of community pharmacists but worry about their role in screening and counselling patients and in prescribing. Despite relationships being generally felt to be good, there may be a need for better communication and cooperation locally and for proper evaluation of initiatives to extend the role of the pharmacist.

General Practitioners and Wheelchair Prescribing

A random sample of general practitioners was surveyed by postal questionnaire to determine their knowledge of wheelchairs and wheelchair prescribing, and their opinion of the usefulness of the A0F5G for wheelchair prescribing. Seventy-four per cent considered their knowledge of wheelchairs to be ‘not very good’ or worse, and one-third found the A0F5G to be inadequate for prescribing and difficult to complete. Inadequacy of training was identified as the likely cause of these findings. Improved educational programmes for doctors at both an undergraduate and a postgraduate level would raise the standards of wheelchair prescribing.

Role modelling: a case study in general practice.

The effect of role modelling in medical education is frequently mentioned in the literature. This study addresses the issue of role modelling directly through questionnaires to students and interviews with practitioners. A sample of general practitioners taking students on the general practice attachment were asked to identify the attributes of their own role models, and to nominate in turn what attributes they hoped to role model for their students, and students returning from attachment were asked what they wished to emulate in their GP. Analysis of transcripts and questionnaires showed that while GPs mainly remembered personality and teaching ability in their role models, there was congruence between their desire to model good patient relationships to students and students' perceptions that this was the most desirable attribute they saw in GPs. Students also wished to be as skilled and knowledgeable as their GPs. The paper speculates about reasons for the differences and similarities in perception and memory of desirable role model attributes nominated by GPs and by students. It concludes that affect pervades the memory of positive and negative behaviours and attitudes of teachers, and that although role modelling may not be amenable to measurement, its importance in shaping behaviour and attitude and its power to influence students should be acknowledged in developmental programmes for medical teachers.

General Practitioners' Attitudes Towards Future Developments in Practice Computing—a Representative Survey in the North of Germany

A postal questionnaire was sent to a random sample of general practitioners in Lower Saxony, Germany to assess how general practitioners regard newly developed but not yet implemented options of practice computers and future applications such as expert systems and information retrieval systems. Replies were received from 276 (response rate 73.6%) general practitioners. Replying doctors were younger (P < 0.05) but they did not differ by sex, practice location, type of vocational training and grade of computerization from non-responding GPs. Twenty-eight per cent of the practices were computerized. Doctors who currently used a computer and those who intended to do so within the next 5 years were significantly younger than those doctors who did not intend to computerize their practice (P < 0.001). Female doctors were less willing to buy a computer than their male colleagues (P < 0.05). A computerized drug database and a medical library ranked best from 8 options given. Overall attitudes to all features were positive, except for an expert system giving criteria for referrals to specialist care. Doctors already working with a computer and those intending to buy one were significantly more positive about future options for computers than those doctors who do not intend to use a computer (P < 0.01). GPs' attitudes about new features of practice computers in general were positive but even more so about those options which are already available. Referral to a specialist seems to be a crucial point for GPs--they apparently do not want to be guided by a computer here.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of secondary prophylaxis against myocardial infarction in the north of England.

To record the use of secondary prophylactic drugs in patients discharged from hospital having had a myocardial infarction. Prospective postal questionnaire survey of a random one in two sample of general practitioners in the region. The nine family practitioner committee areas within the Northern Regional Health Authority. Patients who had had a myocardial infarction and were discharged to their general practitioner. Whether beta blockers or aspirin, or both, were given on discharge. Of 267 patients, 158 (59%) were treated suboptimally in that they did not receive a secondary prophylactic drug to which they had no contraindication. For most patients this entailed underuse of one drug, but 17 (6%) of patients received no treatment. beta Blockers were 2.5 times less likely to be used than aspirin. Treatment was not associated with the age or sex of the patient, risk of further infarction, or hospital of discharge. Secondary prophylaxis after myocardial infarction is practised haphazardly. It should be offered to all patients who can tolerate it, after a trial period to assess any side effects of the drugs if necessary.

Patterns of preference for information sources in the adoption of new drugs by specialists

The present study investigated the adoption of new prescription drugs by specialists who treat serious disorders using relatively high risk drugs with potentially serious side effects. One-hundred and fifty-six specialists, primarily practicing in medical specialties, evaluated a number of drug information sources and reported their use of these sources both in their general drug adoption procedures and in the adoption of one of a number of target drugs. As predicted, the pattern of drug adoption among specialists is substantially different from that generally reported in earlier studies, which are usually based on samples of general practitioners or of general practitioners and specialists combined. Professional sources of information predominate throughout the process, both in adoption procedures generally used and in the adoption of target drugs. The majority of specialists reported contact with commercial sources at some stage in the adoption process for the target drugs, but these sources were not, as is often reported in the literature, the main sources of first news of a new drug, nor did they exert much influence at the prescribing stage. It is clear from these results that in future research on drug innovation, different classes of medical practitioners, such as specialists vs general practitioners, will need to be distinguished.

Doctors' beliefs about diabetes: A comparison of hospital and community doctors

A sample of general practitioners responded to a questionnaire measuring beliefs about diabetes and its management. The results are compared with those of a previous study concerning hospital doctors. GPs had a bleaker outlook on diabetes, perceiving the disease to carry more risks and having less confidence that achieving goals of treatment would reduce these risks. In accord with these beliefs their approach to treatment was far more lax than that of hospital-based doctors. The implications of these results for shared patient care, and interventions to maximize patient-health outcomes are discussed.

Personality characteristics of a sample of anaesthetists.

No published information on the personality characteristics of a significant proportion of any specialty of the medical profession has been available to date. The author presents the results from the application of a personality questionnaire (Cattell's 16 PF Form C) to sample of anaesthetists (n = 231). These show that this sample of anaesthetists differs from the general population in a number of dimensions. They are more reserved, intelligent, assertive, serious, conscientious, self-sufficient and tense and less socially bold and self-assured. They also differ from a sample of general practitioners. Within the sample of anaesthetists, there are significant differences on a cluster of factors relating to stability. Evidence is quoted, from part of the sample, of a significant relationship between personality profiles and behaviour and performance. The author puts forward a descriptive picture of the 'good' anaesthetists and the obverse and the possible implications for the assessment and selection of applicants for this shortage specialty.

Correlates of Frustration among British General Practitioners

This study deals with the correlates of three indices of frustration based on data obtained from a national sample of general practitioners in England and Wales. Thirty-five independent variables concerned with characteristics of the doctor and his educational background, the organization of doctors' practices and professional behavior and affiliations, and attitudinal orientations are investigated. Background and educational factors have little explanatory value. Indices describing organization of practice and professional behavior are poor predictors, with the exception of a variable defining the number of patients the doctor sees on a busy day. The doctors' attitudinal orientations account for from 12 to 28 per cent of the total variance in frustration. Frustration is negatively correlated with indices of quality of care. Implications of these findings are discussed.