Scottish GP Research Articles

The twinning of Scottish general practices and Malawian clinics: the provision of email and internet services

Many patients and health care professionals in the developed world are uncomfortable about doing nothing in the face of the glaring inequities in health care between their own environment and that of Africa. In an effort to 'think global, act local' a Scottish GP practice used personal contacts to build a twinning link with a clinic serving a township in Malawi. This article describes the experience of establishing e-mail and internet services for Malawian health care staff to afford them the same level of access as developed world staff enjoy in accessing educational materials and professional supports. Using our twin link as an exemplar we are now matching other Scottish General Practices to Malawian Clinics around a common theme of modern communication media.

Characteristics associated with reported CAM use in patients attending six GP practices in the Tayside and Grampian regions of Scotland: a survey

Objectives: To study the nature of CAM use in primary care attenders, the involvement of their NHS healthcare professionals in their CAM care and differences in characteristics between CAM users and non-users. Design: Postal questionnaire for primary care attenders and analysis of practice leaflets. Setting: Six Scottish GP practices with a range of practice size, CAM provision within practice, deprivation and rurality. Results: Five hundred and fourteen primary care attenders described 1194 incidences of CAM use and gave details about their main therapy. 37% had contact with a practitioner, the rest mainly self-prescribed. The perceived effectiveness of CAM was high. Patients used CAM for a variety of health problems, mainly as an adjuvant to orthodox medicine rather than an alternative. The involvement of the NHS in CAM delivery was small but there is a significant role to ensure patient safety, especially regarding herb–drug interactions. Disclosure rate of CAM use was low. CAM offered options in areas where the provision in the NHS is difficult, including musculo-skeletal and mental health problems. Provision of CAM by the GP is associated with higher CAM use in primary care attenders. Conclusions: It is recommended that healthcare professionals include patients’ use of CAM in history taking and clinical decision making.

Health care management: models for evidence-based practice.

Presents models suggesting how research evidence can best be operationalised within health care commissioning. Models were derived from data gathered from surveys of Scottish health board managers and GP fundholders regarding the use of information in commissioning from 1995 to 1997. Feedback on the models was obtained subsequently from practitioners in 1998. Two models, one for health board managers and the other for GPs, are presented. These include critical success factors in achieving evidence-based commissioning and factors that are likely to predispose and precipitate evidence-based practice. Given a culture demanding transparency, accountability and continuing improvement, the models provide tools for reflection, evaluation and planning. In addition, they identify a pragmatic role for managers in evidence-based commissioning and provide a framework for audit.

Nice lessons to be learned.

This study examined users' perceptions of the role and value of the Scottish Health Purchasing Information Centre (SHPIC) from 1995 to 1998. Questionnaires and interviews were used to gather data from Scottish GP fundholders and health board managers at two stages. Initially, purchasers sought help in identifying the most relevant information. By 1997, while some appreciated the clinical and cost-effectiveness information produced, others were critical of lack of timely production and apparent lack of cooperation between agencies. New U.K. agencies can learn from SHPIC's problems, specifically in producing clear, coordinated, timely, independent, and well-marketed information with implementation strategies. It is important to evaluate the impact of agencies to produce and disseminate evidence-based information, even if this has to be done pragmatically rather than as an outcomes-based assessment. Evidence from evaluations can inform direction and strategy for existing and new agencies.