General Practitioner Satisfaction Research Articles

Matching needs to services: the quick response. Case study: St George Hospital and Community Health Services Best Practice Project.

A Quick Response Program (QRP) was developed and implemented at St George Hospital during 1995 and 1996. The program sought to improve the service provided to elderly people presenting to the emergency department by offering a new rapid response service pathway to community-based care. Emergency department discharge planning and crisis intervention evolved as important QRP functions during the program's life. Evaluation findings indicated that QRP penetration into the elderly sub-acute emergency department patient population was high, and that hospital admissions were avoided without affecting emergency department process times. Health outcomes were not compromised by the program, and patient and general practitioner satisfaction were high. The program grappled with the inherent conflict of interest between the aims of the hospital (acute care services) and those of the community service (support and maintenance). The program sought to bridge the gap between these service parameters in the name of meeting patient needs.

User satisfaction of general practitioners with HIOS+, a medical decision support system

In this article, a user satisfaction study is described. The Formal Interpreter (FI) and the Free-text Formalizer (FF) are modules of the medical DSS HIOS+. With FF, medical experts can formalize topics selected from free-text ICHPPC-II-defined criteria into queries. FI gives decision support to GPs in their daily work by interpreting queries belonging to entered ICPC codes and presenting advice/warnings concerning the validity (correctness) of the diagnoses in patient cases. In the study, FI was used in field and laboratory test situations by GPs. User satisfaction was assessed using questionnaires consisting of an adapted version of the Bailey questionnaire. Answers given were analysed using Bailey's approach and the ‘two-sample t-test’. The most important result of the FI evaluation was that users given active decision support were more satisfied with FI than users given none or only textual decision support.

Outcome following discharge from an ENT out-patient clinic: patient and general practitioner satisfaction

Fifty consecutive patients discharged from clinic were assessed by questionnaire at the time of discharge and 6 months later. Each patient's practitioner (GP) was sent a questionnaire at 6 months. On discharge, 12.5% of patients would have preferred another appointment and 7.5% were unhappy at being discharged. After 6 months 14% would have preferred ENT follow-up. Twenty-six per cent of patients said they saw their GP within 6 months of discharge with symptoms related to their initial ENT complaint. From the GP questionnaire the proportion was 31.5%. General practitioners were happy to manage the patients themselves and only one patient was seen again in the ENT department within 6 months. In no case did the GP feel discharge to be premature. Pre-reading of notes leading to an increase in the proportion of patients discharged from ENT clinics does not result in more discharges being premature or inappropriate. The majority of patients and general practitioners are happy for ongoing medical care to be continued without further ENT appointments if the nature of the condition and its long-term management is explained clearly.

Ophthalmic Primary Care: The Warrington Model

OBJECTIVE: To set up and monitor ‘Open Access’ clinics for Ophthalmic Primary Care, with the facility to place patients directly on the consultant's waiting list for cataract surgery and other surgical procedures. SETTING: Warrington Hospital and Halton Hospital (NHS Trusts). Daily Primary Care Clinics including two evening clinics a week. PATIENTS: All new patients referred to the Department of Ophthalmic Surgery, at Warrington Hospital, between 1 April and 30 September 1993. MAIN OUTCOME MEASURES: This 6-month audit includes an analysis of patients listed for cataract surgery, and other procedures (25%), and the resultant reduction in waiting times for out-patient appointments. The proportion of patients examined/treated in Primary Care and discharged back to their GPs (41%), together with an analysis of the patients requiring more detailed examination or monitoring in the general and special ophthalmic clinics (34%) is presented. The patient satisfaction questionnaire showed that 54% of the patients felt that the service was excellent, 21% good and 25% satisfactory. There were no unsatisfactory responses. A general practitioner satisfaction questionnaire revealed an average satisfaction of between good and excellent. CONCLUSION: Ophthalmic Primary Care Clinics are an effective method of delivering a quick and efficient service to General Practitioners, all patients being seen and where appropriate listed within 2 weeks of their GPs referral (93% of patients within 1 week).

Electronic communication between providers of primary and secondary care.

To study the effects of the introduction of electronic data interchange between primary and secondary care providers on speed of communication, efficiency of data handling, and satisfaction of general practitioners with communication. Comparison of traditional paper based communication for laboratory reports and admission-discharge reports between hospital and general practitioners and electronic data interchange. Twenty-seven general practitioners whose offices were equipped with a practice information system and two general hospitals. Paper based communication was evaluated by questionnaire responses from and interviews with care providers; electronic communication was evaluated by measuring time intervals between generation and delivery of messages and by assessing doctors' satisfaction with electronic data interchange by questionnaire. Via paper mail admission-discharge reports took a median of 2-4 days, and laboratory reports 2 days, to reach general practitioners. With electronic data interchange almost all admission-discharge reports were available to general practitioners within one hour of generation. When samples were analysed on the day of collection (as was the case for 174/542 samples in one hospital and 443/854 in the other) the laboratory reports were also available to the general practitioner the same day via electronic data interchange. Fifteen general practitioners (of the 24 who returned the questionnaire) reported that the use of electronic admission-discharge reports provided more accurate and complete information about the care delivered to their patients. Ten general practitioners reported that electronic laboratory reports lessened the work of processing the data. Electronic communication between primary and secondary care providers is a feasible option for improving communication.

Measure of satisfaction of general practitioners with the chemical pathology services in Leeds Western Health District.

The satisfaction of general practitioners with the District Chemical Pathology Services in Leeds Western Health District was assessed by means of a postal questionnaire. The areas of interest covered included communication, test turn-round times, format of reports, advice about tests undertaken in the practice and chemical pathology information services. Communication with the laboratory was the major area of dissatisfaction (21% GPs), followed by test turn-round times (14%) and format of reports (10%). More than half the respondents were interested in an offer of help in selecting equipment for their surgeries and subsequent quality control. Customer satisfaction will become an important issue as a result of the NHS reforms and laboratories may find this exercise useful.

Workload and job satisfaction among general practitioners: A review of the literature

The workload of general practitioners (GPs) is an important issue in health care systems with capitation payment for GPs services. This article reviews the literature on determinants and consequences of workload and job satisfaction of GPs. Determinants of workload are located on the demand side (list size and composition of the patient population) and the supply side (organization of the practice and personal characteristics of the GP). The effects of workload and job satisfaction on workstyle and quality of work have been reviewed. The length of consultations or booking intervals seems to be an important restriction for workstyle and quality of work.

Audit of terminal care in a general practice.

To determine satisfaction of relatives and general practitioners with care of patients during terminal illness and make recommendations on improving terminal care in general practice. Interviews with available relatives of patients who had had terminal illnesses and died in 1987, supplemented by questionnaires; questionnaire survey of general practitioners after review of case notes of all their patients who had died of terminal illnesses in 1987. One urban general practice. 34 Relatives of patients with terminal illnesses who died in 1987; five general practitioners from one practice. In six cases relatives were dissatisfied, mainly because of lack of communication; in eight cases doctors were dissatisfied because of communication, poor symptom control, and inadequate care. There is a need for improved communication between relatives and the health professionals involved in terminal care as well as better advice on services and benefits available to both patients and relatives. Bereavement counselling should be better organised.

Work satisfaction of general practitioners and the quality of patient care.

The emotional reactions of 57 general practitioners to three aspects of work was assessed by means of questionnaires. The quality of patient care was assessed by means of observations of general practice consultations, assessment of audiotaped consulting hour contacts and an analysis of the referral and prescription figures. A distinction was made between the degree of positive and the degree of negative feelings general practitioners have about their work. Many positive feelings (satisfaction, feeling at ease) correlated with more openness to patients, more attention to psychosocial aspects of the complaints but also with a higher rate of referral to medical specialists. On the other hand, many negative feelings (frustration, tension, lack of time) correlated with a high prescription rate and with giving little explanation to patients. To some extent the way that work is experienced by general practitioners correlated with the quality of care for the patients, but what constitutes cause and effect requires further study. A reflection of a doctor's own feelings about work should become part of training, continuing education and medical audit programmes.