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Giorgi, Daniela, Livia Giordano, Carlo Senore, Giuseppe Merlino, Rossella Negri, Maurizio Cancian, Manuela Lerda, et al. "General Practitioners and Mammographic Screening Uptake: Influence of Different Modalities of General Practitioner Participation." Tumori Journal 86, no. 2 (March 2000): 124–29. http://dx.doi.org/10.1177/030089160008600203.
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Aims and background To compare the impact of different modalities of general practitioner (GP) involvement, including the introduction of target payments, on the attendance rate of organized population-based screening programs for breast cancer in Italy. Study design The study was conducted between 1994 and 1996 in four Italian cities where mammographic screening programs are active: Caltanissetta (CL), Firenze (Fl), Modena (MO) and Torino (TO). The impact on attendance rate of different invitation strategies based on active GP involvement was tested in each center. The additional effect of economic incentives was also assessed. The incentives were proportional to the level of compliance attained by each GP and weighted by the size of his eligible patients’ list. Results In the Firenze project, an invitation signed by the GP and the project co-ordinator attained a statistically significant higher participation (difference: 4.2%, χ2 = 7.42, P = 0.006). In Caltanissetta and Torino there was a significant increase of about 7% in the response rate to the postal reminder in the groups contacted by the GPs. No difference was observed in the Modena project between the two groups. Conclusions The main contributions of GP involvement can be: “cleaning up'’ the invitation lists, especially when computerized archives with the mammographic history of the target population are not available; increasing the women's participation by signing the invitation letter, by counseling and active participation in the invitation phase; co-operating in the reminder phase by recalling women non responders at first invitation. The offer of target payment had a certain impact on the screening uptake, but not easily distinguishable from GP signature of the invitation letter; further studies of appropriate design should be planned. Organizational factors, such as availability of a list of non-responders, might be crucial in order to enhance the effect of the GPs’ action.
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Lakhani, Ali, David P. Watling, Ross Duncan, Peter Grimbeek, Peter Harre, Jos Stocker, and Sanjoti Parekh. "General practitioner identification and retention for people with spinal cord damage: establishing factors to inform a general practitioner satisfaction measure." Australian Journal of Primary Health 26, no. 3 (2020): 234. http://dx.doi.org/10.1071/py20017.
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People with spinal cord damage (SCD) report a high level of GP use. There is a dearth of research investigating factors that contribute to GP identification and retention for people with SCD. Furthermore, a GP satisfaction measure developed specifically for people with SCD is non-existent. This preliminary study sought to identify factors contributing to GP identification and retention. A total of 266 people with SCD primarily based in Queensland, Australia, completed a cross-sectional survey that aimed to fill these knowledge gaps. Descriptive statistics and correlational analyses clarified the factors contributing to GP identification and GP retention respectively. An exploratory factor analysis utilising the principal components analysis method clarified a set of items that could underpin key domains for a SCD-specific GP satisfaction measure. The findings confirm that knowledge about SCD, physically accessible services, and trust are seminal considerations aligned with GP identification and retention for people with SCD.
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Zhang, Tao, and Xiaohe Wang. "Association of Continuity of General Practitioner Care with Utilisation of General Practitioner and Specialist Services in China: A Mixed-Method Study." Healthcare 9, no. 9 (September 13, 2021): 1206. http://dx.doi.org/10.3390/healthcare9091206.
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Background: Continuity of general practitioner (GP) care, widely known as the core value of high-quality patient care, has a positive association with health outcomes. Evidence about the relationship between continuity and health service utilisation has so far been lacking in China. This study aimed to analyse the association of continuity of GP care with utilisation of general practitioner and specialist services in China. Method: A cross-sectional mixed methods study was conducted in 10 urban communities in Hangzhou. Quantitative data were collected from a random sample of 624 residents adopting the self-developed questionnaire. Measurement of continuity of GP care included informational continuity (IC), managerial continuity (MC) and relational continuity (RC). With adjustment for characteristics of residents, multivariate regression models were established to examine the association of continuity of GP care with the intention to visit GP, frequency of GP and specialist visitations. Qualitative data were collected from 26 respondents using an in-depth interview, and thematic content analysis for qualitative data was conducted. Results: Quantitative analysis showed that the IC was positively associated with the intention to visit GP and frequency of GP visitations. Those people who gave a high rating for RC also used GP services more frequently than their counterparts. MC was negatively associated with frequency of specialist visitations. Qualitative analysis indicated that service capabilities, doctor–patient interaction and time provision were regarded as three important reasons why patients chose GPs or specialists. Conclusions: Overall, high IC and RC are independently associated with more GP service utilisation, but a high MC might reduce specialist visitations. Continuity of GP care should be highlighted in designing a Chinese GP system.
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Hemphill, Elizabeth, and Carol T. Kulik. "Segmenting a general practitioner market to improve recruitment outcomes." Australian Health Review 35, no. 2 (2011): 117. http://dx.doi.org/10.1071/ah09802.
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Recruitment is an ongoing challenge in the health industry with general practitioner (GP) shortages in many areas beyond rural and Indigenous communities. This paper suggests a marketing solution that identifies different segments of the GP market for recruitment strategy development. In February 2008, 96 GPs in Australia responded to a mail questionnaire (of which 85 questionnaires were useable). A total of 350 GPs were sent the questionnaire. Respondents considered small sets of attributes in the decision to accept a new job at a general practice and selected the most and least important attribute from each set. We identified latent class clusters (cohorts) of GPs from the most–least important data. Three cohorts were found in the GP market, distinguishing practitioners who emphasised job, family or practice attributes in their decision to join a practice. Few significant demographic differences exist between the cohorts. A segmented GP market suggests two alternative recruitment strategies. One option is for general practices to target members of a single cohort (family-, job-, or practice-focussed GPs). The other option is for general practices to diversify their recruitment strategies to target all three cohorts (family-, job- and practice-focussed GPs). A single brand (practice) can have multiple advertising strategies with each strategy involving advertising activities targeting a particular consumer segment. What is known about the topic? Recruitment is an ongoing challenge in the health industry. A wide range of government strategies and incentives have sought to increase GP numbers in areas of need, especially rural and Indigenous communities. However, declining GP to patient ratios in such sectors suggest new recruitment strategies are needed. To know how effective new strategies might be, it would also be useful to know whether practices have already adopted such strategies in their recruitment advertising. What does this paper add? This paper reports results from an empirical study showing that the overall GP market can be segmented into cohorts of GPs who similarly value attributes of a GP position. The research finds three discrete cohorts in the GP market: practitioners who have job, family or practice dominant preferences. This finding can be used to improve GP recruitment by designing recruitment strategies targeting the cohorts. The study also demonstrates that rural (and urban) practices have, either intentionally or unintentionally, been attracting only one of the three GP cohorts. What are the implications for practitioners? A segmented GP market suggests two alternative strategies. One option is for general practices to design recruiting strategies that target members of a single cohort (family-, job-, or practice-focussed GPs). The other option suggested by our research is for general practices to diversify their recruitment strategies to target all three cohorts (family-, job- and practice-focussed GPs).
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Hillen, Jodie B., Agnes Vitry, and Gillian E. Caughey. "Trends in general practitioner services to residents in aged care." Australian Journal of Primary Health 22, no. 6 (2016): 517. http://dx.doi.org/10.1071/py15119.
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To date, access to appropriate and timely GP services for those in aged care has been described as limited, in part due to inadequate models of care and remuneration. As the Australian population ages and more Australians become dependent on aged-care services, the need for good quality medical care that meets the needs of residents will continue to grow. The purpose of this study was to provide a current analysis of trends in GP services in residents in Australian aged-care facilities. Longitudinal population data (2005–2014) was used to describe the changing population demographics and calculate annual rates for GP services specific to this population. Total population and age-group strata (<85 years and 85+ years) rates were calculated for standard consultations, after-hours consultations, contribution to a care plan and collaborative medication review. For the period 2005–2014 there was an increase of 1.5 million GP services to this population, which had simultaneously grown by 19800 residents, aged (6% increase in residents aged 85+ years) and become more dependent (14% increase is high-care residents). Significant increases in all GP service rates were observed, with a shift towards after-hours consultations. Residents aged <85 years received significantly more services than residents aged 85+ years. GP service delivery to the whole aged-care population continues to be heavily weighted towards standard and after-hours consultations, while collaborative GP services remain a very small proportion of services accessed by this population. There is scope to increase collaborative GP services, which have been linked to improved outcomes for this population.
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Naccarella, Lucio. "General practitioner networks matter in primary health care team service provision." Australian Journal of Primary Health 15, no. 4 (2009): 312. http://dx.doi.org/10.1071/py08071.
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Australia is undergoing significant primary health care policy reforms in response to concerns about quality of care, increasing burden of complex and chronic diseases, and workforce shortages. Governments are encouraging multidisciplinary teamwork between general practitioners (GP) and other primary health care service providers. Essential elements of teamwork have been addressed in policy initiatives, yet important dimensions of the way GP develop and use their work-related relationships in their practice remain unrecognised. This paper draws upon a doctoral thesis that explored the types and the qualities of GP work-related relationships. A qualitative research methodology combined with a relational perspective was used. Data were collected from a pilot, main and a validation study. Fifty interviews were conducted, including: GP, clinic staff, service providers, support organisation personnel and policymakers. A complex web of interdependent work-related relationships exist between GP and other health care providers. Four main types of GP work-related relationships emerged: clinical problem solving, obtaining metaknowledge, obtaining legitimisation, and validation. Key qualities of GP work-related relationships included the nominated providers’ competence, accessibility, goodwill, honesty, consistency and communication styles. A validation study verified research findings. The research provides evidence that the nature of GP work-related relationships have implications for other practitioners who need to work with GP. The findings challenge the current primary health care policy emphasis on using structural reforms such as prescribed service delivery processes and financial incentives to encourage teamwork.
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Sims, Andrew. "General practitioner fundholding and psychiatric practice." Psychiatric Bulletin 17, no. 4 (April 1993): 193–95. http://dx.doi.org/10.1192/pb.17.4.193.
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This is a personal view on the implications for mental health services of the Executive Letter of the National Health Service Management Executive (NHSME), published in July 1992 (EL (92) 48): ‘Guidance on the extension of the Hospital and Community Health Services elements of the GP Fundholding Scheme from 1st April, 1993’.
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Claridge, Rosemary, Lesley Gray, Maria Stubbe, Lindsay Macdonald, Rachel Tester, and Anthony Dowell. "General practitioner opinion of weight management interventions in New Zealand." Journal of Primary Health Care 6, no. 3 (2014): 212. http://dx.doi.org/10.1071/hc14212.
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INTRODUCTION: Internationally, a number of studies have investigated general practitioner (GP) opinion of weight management interventions. To date there have been no similar studies carried out in New Zealand. This study aimed to explore GP opinion of weight management interventions in one region of New Zealand. Understanding GP opinion is important, as rates of obesity are increasing and GPs are front-line health care service providers. The data collected could be used to guide health service development in New Zealand, and to inform training and support of GPs in obesity management. METHODS: A qualitative study using inductive thematic analysis of a series of 12 semi-structured interviews with GPs in the Wellington region of New Zealand. FINDINGS: Five key themes were identified: 1) GP perceptions of what the GP can do; 2) the roots of the obesity problem; 3) why the GP doesnt succeed; 4) current primary care interventions; and 5) bariatric surgery. CONCLUSION: The GPs interviewed felt responsible for treatment of obesity in their patients. They expressed a sense of disempowerment regarding their ability to carry this out, identifying multiple barriers. These included: a society where overweight is seen as normal; complex situations in which weight management is rooted in personal issues; stigma associated with overweight and its management; lack of efficacious interventions; and low resource availability. Bariatric surgery was viewed cautiously in general, though some examples of positive results were reported, as well as a desire for increased access to this treatment option. KEYWORDS: Body weight change; general practice; obesity; primary health care; therapy
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O'Brien, Emer, Barbara Clyne, Susan M. Smith, Noirin O'Herlihy, Velma Harkins, and Emma Wallace. "A scoping review protocol of evidence-based guidance published by general practitioner professional organisations." HRB Open Research 4 (May 18, 2021): 53. http://dx.doi.org/10.12688/hrbopenres.13268.1.
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Introduction: General practitioners (GPs) strive to use a patient centred approach to achieve shared decision making by integrating clinical evidence, clinical judgement, and patient priorities. This protocol outlines a scoping review to identify what evidence-based guidance is produced by general practitioner professional organisations internationally to support general practice clinical decision making. Methods: This scoping review will be conducted using the framework proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR), will be used to guide the reporting. Two researchers will search electronic databases (Medline, Embase, Cochrane Library and Scopus), grey literature sources and contact international GP professional organisations directly to identify appropriate studies for inclusion. Key information will be categorised and classified to generate a summary of the methods used internationally to develop and implement evidence-based guides for general practitioners and a narrative synthesis will be conducted. Conclusions: This scoping review will identify the role of GP professional organisations in generating, endorsing and/or disseminating evidence-based guidance for supporting general practitioner’s clinical decision making to benefit patient care.
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Zhong, Chenwen, Zhuojun Luo, Cuiying Liang, Mengping Zhou, and Li Kuang. "An overview of general practitioner consultations in China: a direct observational study." Family Practice 37, no. 5 (April 20, 2020): 682–88. http://dx.doi.org/10.1093/fampra/cmaa039.
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Abstract Background General practitioner (GP) consultation has long been considered an important component of general practice, but few studies have focused on its characteristics in China. Objective This study aimed to explore the content and elucidate the characteristics of GP consultations in general practice in China. Methods A multimethod investigation of GP consultations in eight community health centres in Guangzhou and Shenzhen, China was conducted between July 2018 and January 2019. Data from 445 GP consultations were collected by direct observation and audio tape and analysed by a modified Davis Observation Code with indicators for frequencies and detailed time durations. GP and patient characteristics were collected by post-visit surveys. Results The mean visit duration was approximately 5.4 minutes. GPs spent the most time on treatment planning, history taking, negotiating, notetaking and physical examination and less time on health promotion, family information collecting, discussing substance use, procedures and counselling. The time spent on procedures ranked first (66 seconds), followed by history taking (65 seconds) and treatment planning (63 seconds). Besides, patients were very active in the consultation, specifically for topics related to medicine ordering and drug costs. Conclusions This study described the profile of GP consultations and illustrated the complexity of care provided by GPs in China. As patient activation in GP consultations becomes increasingly important, future studies need to explore how to promote the engagement of patients in the whole consultation process other than just requesting for medicine.
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Arnone, G., A. Bianchi, B. Della Pietra, R. Sernicola, E. Sparacino, and R. Vitolo. "Easy Medic: an Internet application for the general practitioner." Journal of Telemedicine and Telecare 4, no. 1_suppl (March 1998): 93–94. http://dx.doi.org/10.1258/1357633981931623.
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A research project has been carried out to develop a client server application which supplies the general practitioner (GP) with a ‘personal digital assistant’ (hand-held mobile computer)to connect to Web servers at a hospital site through the Internet. This allows the doctor to book medical examinations, hospital admissions and manage patient data. The application used advanced object-oriented techniques, on both the client and the server side. The connection to a Web server was achieved through GSM wireless cellular telephones using standard Internet protocols (HTTP, TCP/IP and CGI). Conventional telephone lines can be used as well. Other application modules on the client side provided patient medical record supervision, GP schedule management, general information about hospitals and clinics, and pharmacy consultation. These services should help GPs in their daily work. Moreover, the quality of health-care resource management and cost supervision should improve, since each GP ‘transaction’ is automatically entered in realtime into a database at the server. The services are under test in the health-care system of an urban area in southern Italy.
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Wangler, Julian, and Michael Jansky. "Dementia diagnostics in general practitioner care." Wiener Medizinische Wochenschrift 170, no. 9-10 (December 6, 2019): 230–37. http://dx.doi.org/10.1007/s10354-019-00722-4.
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SummaryGeneral practitioner (GP) treatment of dementia is often criticized as being ineffective and not implemented consistently enough. The causes and specific standpoints of GPs have not previously been thoroughly investigated. This paper focuses on the reasons and the criticisms levelled at GPs with regard to diagnosing dementia, and identifies approaches to enable optimization. The analysis is based on 41 semi-structured interviews with GPs in Hesse, Germany, in 2018. During the course of a content analysis, the interviewees’ attitudes and behavioral patterns towards dementia diagnostics were to be analyzed. The results of the study show various challenges and problems of primary care in this field. The majority of the sample showed skepticism and reluctance with regard to the diagnosis of dementia. Six key problem areas were extracted from the interviews, which can be seen as root causes for the distance kept by GPs: 1) early delegation of patients due to role understanding, 2) attitude of pessimism towards dementia, 3) differential diagnosis perceived as an obstacle, 4) insufficient remuneration, 5) fear of patient stigmatization, and 6) lack of application. Some GPs demonstrated personal initiative with the aim of optimizing dementia diagnostics. Three approaches can be derived which could be used to improve the GP-based care of dementia: 1) self-efficacy, 2) differential diagnostics and treatment pathways, and 3) physician–patient communication.
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Goodwin, Belinda C., Fiona Crawford-Williams, Michael J. Ireland, and Sonja March. "General practitioner endorsement of mail-out colorectal cancer screening: The perspective of nonparticipants." Translational Behavioral Medicine 10, no. 2 (March 11, 2019): 366–74. http://dx.doi.org/10.1093/tbm/ibz011.
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Abstract Despite the health and economic benefits associated with mail-out colorectal cancer (CRC) screening, participation in programs across the world is suboptimal. A letter from the recipient’s general practitioner (GP) endorsing program participation has been shown to have a consistent, but modest, effect on screening uptake; however, the mechanisms by which GP endorsement is effective have not been investigated. The purpose of the present study was to evaluate the potential utility of GP endorsement letters or SMS in the context of facilitating bowel cancer screening in previous nonparticipants and to identify mechanisms underlying responses. A cross-section of nonparticipants in the Australian National Bowel Cancer Screening Program (N = 110) was randomly assigned to view a letter or SMS from a GP endorsing participation via an online survey. Ordinal responses reflecting effectiveness of, and influences on, GP endorsement were collected along with open questions regarding other potential endorsers. Percentages, means, and 95% confidence intervals were calculated and compared. Fifty-two percent of the sample agreed that GP endorsement would encourage their future participation. Responses did not differ between SMS and letter formats. Trust in the GP had significantly more influence on response to GP endorsement than the credibility or medical knowledge. Other health professionals and cancer survivors were commonly suggested as alternative sources of endorsement. Interventions to improve CRC screening participation could benefit from the routine implementation of GP endorsement from GPs, other trusted health professionals, or cancer survivors, particularly by encouraging people who forget or procrastinate over collecting a stool sample.
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McRae, Ian S., and Francesco Paolucci. "The global financial crisis and Australian general practice." Australian Health Review 35, no. 1 (2011): 32. http://dx.doi.org/10.1071/ah09830.
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Objective. To explore the potential effects of the global financial crisis (GFC) on the market for general practitioner (GP) services in Australia. Design. We estimate the impact of changes in unemployment rates on demand for GP services and the impact of lost asset values on GP retirement plans and work patterns. Combining these supply and demand effects, we estimate the potential effect of the GFC on the market for GP services under various scenarios. Results. If deferral of retirement increases GP availability by 2%, and historic trends to reduce GP working hours are halved, at the current level of ~5.2% unemployment average fees would decline by $0.23 per GP consultation and volumes of GP services would rise by 2.53% with almost no change in average GP gross earnings over what would otherwise have occurred. With 8.5% unemployment, as initially predicted by Treasury, GP fees would increase by $0.91 and GP income by nearly 3%. Conclusions. The GFC is likely to increase activity in the GP market and potentially to reduce fee levels relative to the pre-GFC trends. Net effects on average GP incomes are likely to be small at current unemployment levels. What is known about the topic? Although the broad directions of the impact of the global financial crisis on the demand for and supply of GP services have been the subject of public discussion, the overall impact on the GP market has not been formally assessed. What does this paper add? Drawing on existing supply and demand models, we estimate the likely effect of the global financial crisis on GP activity levels, GP earnings, and the fees to be faced by patients. What are the implications for practitioners? Practitioners on average are likely to work harder to recover losses in the investments they have made for their retirements. They may face lower fees than would have been the case due to the increasing supply of GPs as some defer retirement, but average incomes are likely to be minimally affected.
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Taleb, Alexandre Chater, György M. Böhm, Marcos Avila, and Chao Lung Wen. "The efficacy of telemedicine for ophthalmology triage by a general practitioner." Journal of Telemedicine and Telecare 11, no. 1_suppl (July 2005): 83–85. http://dx.doi.org/10.1258/1357633054461958.
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Although there are enough ophthalmologists for the Brazilian population, they are not evenly distributed throughout the country. Tele-ophthalmology may therefore be a useful tool. We have examined the feasibility of ophthalmology triage, performed by a general practitioner (GP) with remote support from an ophthalmologist. Forty patients with a variety of external and internal eye disorders were examined by the GP and also reassessed by an ophthalmologist, face to face, and then remotely by another ophthalmologist. There was agreement in 95% of the diagnoses between face-to-face and distant evaluation. The use of a digital camera and slit-lamp allowed greater accuracy of telediagnosis than the use of a digital camera alone. The GP would have referred 36 patients to an ophthalmologist, while both the local and the remote ophthalmologist saw the need for referral in 31 cases, i.e. assessment by tele-ophthalmology resulted in a 14% decrease in referrals. GP triage therefore appears to be feasible after appropriate training.
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Lyle, Greg, and Delia Hendrie. "Predicting general practitioner utilisation at a small area level across Western Australia." Australian Journal of Primary Health 25, no. 6 (2019): 570. http://dx.doi.org/10.1071/py19084.
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Equitable delivery of GP services is a key goal in universal healthcare systems. In Australia, information to evaluate equitable delivery is limited, especially at finer geographic scales, leaving an information void that needs to be filled to inform, prioritise and target interventions. To fill this void, GP utilisation was estimated by combining responses on GP utilisation from a national survey differentiated by demographic and area-based socioeconomic and remoteness characteristics with similar characteristics represented geographically at a fine scale. These estimates were then compared to actual GP utilisation to evaluate their predictive reliability. Comparable estimates were found in the greater metropolitan area, with 76% of areas having estimated GP utilisation within ±10% of actual utilisation. Larger discrepancies were found as areas became remoter, with 84% of areas reporting estimated utilisation that was higher than actual utilisation. Comparing the geographic differences between estimated and actual utilisation allowed us to examine the reliability of our methodology. Given the identified limitations, a proxy for GP utilisation at a small area level can be created, a dataset that is not currently published at this geography. This approach has the potential to be applied Australia-wide, providing another valuable tool to evaluate the equitable delivery of primary health care nationally.
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Ross, A. C. "Epidemiology in general practice." Epidemiology and Infection 102, no. 2 (April 1989): 163–74. http://dx.doi.org/10.1017/s0950268800029836.
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Epidemiology in Country Practiceby William N. Pickles, published in 1939, has been a source of continuing interest and challenge especially to general practitioners (Watson, 1982; Booth, 1987). Pickles worked for over 50 years as a general practitioner (GP) in rural Wensleydale where there were many isolated villages in which natural immunity against various infections was often lacking. And so the source of infection could usually be traced, and, with little or no immunity, spread was often rapid.
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Nørøxe, Karen Busk, Peter Vedsted, Flemming Bro, Anders Helles Carlsen, and Anette Fischer Pedersen. "Mental well-being and job satisfaction in general practitioners in Denmark and their patients’ change of general practitioner: a cohort study combining survey data and register data." BMJ Open 9, no. 11 (November 2019): e030142. http://dx.doi.org/10.1136/bmjopen-2019-030142.
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ObjectivesLow job satisfaction and poor well-being (eg, stress and burnout) among physicians may have negative consequences for patient experienced healthcare quality. In primary care, this could manifest in patients choosing another general practitioner (GP). The objective of this study was to examine change of GP (COGP) (unrelated to change of address) among patients in relation to their GPs’ job satisfaction, well-being and self-assessed work-ability.Design and settingData from a nationwide questionnaire survey among Danish GPs in May 2016 was combined with register data on their listed patients. Associations between patients’ COGP in the 6-month study period (from May 2016) and the job satisfaction/well-being of their GP were estimated as risk ratios (RRs) at the individual patient level using binomial regression analysis. Potential confounders were included for adjustment.ParticipantsThe study cohort included 569 776 patients aged ≥18 years listed with 409 GPs in single-handed practices.ResultsCOGP was significantly associated with occupational distress (burnout and low job satisfaction) in the GP. This association was seen in a dose-response like pattern. For burnout, associations were found for depersonalisation and reduced sense of personal accomplishment (but not for emotional exhaustion). The adjusted RR was 1.40 (1.10–1.72) for patients listed with a GP with the lowest level of job satisfaction and 1.24 (1.01–1.52) and 1.40 (1.14–1.72) for patients listed with a GP in the most unfavourable categories of depersonalisation and sense of personal accomplishment (the most favourable categories used as reference). COGP was not associated with self-assessed work-ability or domains of well-being related to life in general.ConclusionsPatients’ likelihood of changing GP increased with GP burnout and decreasing job satisfaction. These findings indicate that patients’ evaluation of care as measured by COGP may be influenced by their GPs’ work conditions and occupational well-being.
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Eefsting, J. A., F. Boersma, W. Van Den Brink, and W. Van Tilburg. "Differences in prevalence of dementia based on community survey and general practitioner recognition." Psychological Medicine 26, no. 6 (November 1996): 1223–30. http://dx.doi.org/10.1017/s0033291700035947.
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SynopsisA study was conducted, which simultaneously used GPs and epidemiological assessment procedures (MMSE, CAMDEX), to identify individuals with DSM-III-R dementia in the same population. In addition, a 1-year follow-up assessment was conducted in patients with a CAMDEX-diagnosis of dementia. In the non-institutionalized group, which was assessed both by the GP and with the epidemiological test battery, the prevalence of dementia according to the GP was 2·2%, whereas the prevalence based on the epidemiological approach amounted to 5·2%. In general CAMDEX-diagnoses of dementia were confirmed at 1-year follow-up, and thus the discrepancy between the two prevalence estimates must be attributed to the low sensitivity of the GPs. Sensitivity of the GP was related to help-seeking behaviour, with low sensitivity in patients with a low contact rate. It was also related to the use of less specific diagnostic labels by the GP (cognitive impairment), and to poor recognition of cognitive impairment in patients who visited their GP.
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Wright, Christine. "What general practitioner fundholders want to buy from a psychiatric service." Advances in Psychiatric Treatment 3, no. 4 (July 1997): 225–32. http://dx.doi.org/10.1192/apt.3.4.225.
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The Government White Paper ‘Working for Patients' (1989) incorporated the idea of general practitioners (GPs) managing funds in order to purchase health services for the patients under their care. The aim was for decisions about purchasing and providing health care to be taken as close to the patient as possible, by their own GP. It has meant that two forms of purchasing have grown side by side – health authority and GP fundholding. Subsequent policy changes have made fundholding accessible to more practices, and have extended the fundholders' areas of purchasing. More than 50% of the population in England are now covered by fundholding GPs. The proportion of GPs who are fundholders varies enormously geographically, with high levels in the West Midlands, Trent, South Thames, Oxford and Anglia regions, where the collective purchasing function of GP fundholders is now very considerable.
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Robinson, Suzanne, Helen Dickinson, Tim Freeman, and Iestyn Williams. "Disinvestment in health— the challenges facing general practitioner (GP) commissioners." Public Money & Management 31, no. 2 (March 2011): 145–48. http://dx.doi.org/10.1080/09540962.2011.560714.
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Han, Gil-Soo, Ben Wearne, Peter O'Meara, Matthew McGrail, and Janice Chesters. "Medical students' and GP registrars' accommodation needs in the rural community: insight from a Victorian study." Australian Health Review 26, no. 1 (2003): 92. http://dx.doi.org/10.1071/ah030092.
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Medical education in Australia is currently entering a new era, including support for the significant extension of medical students and general practitioner (GP)registrars' training programs in rural communities. This commitment to rural medical student and general practitioner recruitment and retention has made the provision of accommodation in rural communities a vital issue. This study has found that approximately half of all medical students on placement with rural GPs are currently accommodated with their GP supervisor or with other practice staff. This is a burden for many GPs and when the anticipated increase in the frequency and length of rural placements occurs what is currently a burden will become unsustainable. The changing gender and cultural demographics of medical students and rural general practitioners will also contribute to stresses on this accommodation system. It is important to have a systematic approach towards more appropriate and sustainable models of accommodation for both medical students and GP registrars.
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Peterson, Chris. "Health Service Restructuring: Changes in the Roles of General Practitioners." Australian Journal of Primary Health 2, no. 2 (1996): 12. http://dx.doi.org/10.1071/py96024.
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As part of the general restructuring of the health system in Australia, the role of the general practitioner (GP) is undergoing some changes. Experience in a number of countries has been to broaden the GP role and for some GP skills to be performed by other health professionals, and for GPs to subsume some specialist tasks. Some time ago the Federal government undertook initiatives to strengthen the position of GPs and to upgrade their status in the health system. This has had an impact in their role in co-ordinating care, as gatekeepers and case managers, and in potentially taking over some skills areas which specialists have performed for some time. Here it is proposed that the GP role needs to become more flexible to be able to account for changes in payment systems and moves towards fundholding arrangements. Some specialist skills can be subsumed into the GP role and maximum effort needs to be directed towards integrating the GP into the wider field of health service provision.
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Watt, Kelly, Penny Abbott, and Jenny Reath. "Cross-cultural training of general practitioner registrars: how does it happen?" Australian Journal of Primary Health 22, no. 4 (2016): 349. http://dx.doi.org/10.1071/py14165.
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An equitable multicultural society requires general practitioners (GPs) to be proficient in providing health care to patients from diverse backgrounds. GPs are required to have a certain attitudes, knowledge and skills known as cultural competence. Given its importance to registrar training, the aim of this study was to explore ways in which GP registrars are currently developing cultural competence. This study employed a survey design for GP registrars in Western Sydney. Training approaches to cultural competence that are relevant to the Australian General Practice setting include exposure to diversity, attitudes, knowledge and skills development. The 43 GP registrar respondents in Western Sydney are exposed to a culturally diverse patient load during training. Registrars report a variety of teachings related to cross-cultural training, but there is little consistency, with the most common approach entailing listening to patients’ personal stories. Exposure to cultural diversity appears to be an important way in which cultural competency is developed. However, guidance and facilitation of skills development throughout this exposure is required and currently may occur opportunistically rather than consistently.
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Cullinan, V., A. Veale, and A. Vitale. "Irish General Practitioner referrals to psychological therapies." Irish Journal of Psychological Medicine 33, no. 2 (April 23, 2015): 73–80. http://dx.doi.org/10.1017/ipm.2015.17.
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ObjectiveGeneral Medical Practitioners play a crucial role in the detection and referral of mental health problems in primary care. This study describes the referral patterns of Irish General Practitioners (GPs) to psychological therapies and profiles the range of psychological therapies available.MethodA 21-item study-specific questionnaire exploring referral processes to psychological therapies was sent to all GPs listed by the Irish College of General Practitioners in one county in Ireland. A 19-item questionnaire exploring details of psychological therapies offered and referral pathways was sent to members of psychological therapy accrediting bodies in the same county.ResultsOf 97 GP respondents (33% response rate), their estimation of the percentage of their patients who have presenting or underlying mental health issues averaged 22%. When asked to indicate which psychological therapies they consider for referrals, psychiatric referrals was the most frequent referral option (94%), followed by Counsellors (69%), Clinical psychologist (60%) and Psychotherapists (30%). GPs indicated they had some or very little knowledge of specific psychological therapies. Of 129 psychological therapists (45% response rate), self-referral and GP referral were their main referral pathways; 80% worked in private practice; highest qualification level was Undergraduate/Higher Diploma (66%), Master Level (39%) and Doctoral Level (5%).ConclusionGPs refer patients presenting with mental health problems to psychiatrists with significantly lower percentages referring to other types of psychological therapists. Findings demonstrate that there is a need for greater education and information-sharing between GPs and providers of accredited psychological therapies to increase knowledge on specific therapies and their evidence base.
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ATHERTON, W. G., A. A. FARAJ, A. C. P. RIDDICK, and T. R. C. DAVIS. "Follow-Up After Carpal Tunnel Decompression – General Practitioner Surgery Or Hand Clinic?" Journal of Hand Surgery 24, no. 3 (June 1999): 296–97. http://dx.doi.org/10.1054/jhsb.1999.0068.
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We prospectively randomized 100 patients following carpal tunnel decompression who were having a 2-week postoperative assessment and removal of stitches to either their local general practitioner (GP) or the hospital outpatient department. All patients were seen at hospital 6 weeks postoperatively for a final assessment. The waiting time for assessment and suture removal was shorter at the GP surgery than in the outpatient department (mean 13 min and 28 min respectively) but significantly more patients were diagnosed as having wound infections (14% and 0% respectively); most were given antibiotics, perhaps unnecessarily.
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Creed, Francis. "Course in Psychiatry for Family Doctors." Bulletin of the Royal College of Psychiatrists 11, no. 6 (June 1987): 193–94. http://dx.doi.org/10.1192/pb.11.6.193.
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This course was organised so that future general practitioners might learn those aspects of psychiatry which are relevant to their future work. It has been recognised that six months working in a mental hospital is only helpful to the future GP in terms of assessment and treatment of severe psychiatric illness of which the general practitioner sees relatively little. The vast majority of psychiatric illness seen by a general practitioner in his day-to-day work is not represented at all in an in-patient psychiatric unit.
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Perfors, Ietje A. A., Anne M. May, Josi A. Boeijen, Niek J. de Wit, Elsken van der Wall, and Charles W. Helsper. "Involving the general practitioner during curative cancer treatment: a systematic review of health care interventions." BMJ Open 9, no. 4 (April 2019): e026383. http://dx.doi.org/10.1136/bmjopen-2018-026383.
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ObjectiveThe role of primary care providers (PCP) in the cancer care continuum is expanding. In the post-treatment phase, this role is increasingly recognised by policy makers and healthcare professionals. During treatment, however, the role of PCP remains largely undefined. This systematic review aims to map the content and effect of interventions aiming to actively involve the general practitioner (GP) during cancer treatment with a curative intent.Study designSystematic review.ParticipantsPatients with cancer treated with curative intent.Data sourcesRandomised controlled trials (RCTs), controlled clinical trials (CCT), controlled before and after studies and interrupted time series focusing on interventions designed to involve the GP during curative cancer treatment were systematically identified from PubMed and EMBASE and were subsequently reviewed. Risk of bias was scored according to the Effective Practice and Organisation of Care Group risk of bias criteria.ResultsFive RCTs and one CCT were included. Interventions and effects were heterogeneous across studies. Four studies implemented interventions focussing on information transfer to the GP and two RCTs implemented patient-tailored GP interventions. The studies have a low–medium risk of bias. Three studies show a low uptake of the intervention. A positive effect on patient satisfaction with care was found in three studies. Subgroup analysis suggests a reduction of healthcare use in elderly patients and reduction of clinical anxiety in those with higher mental distress. No effects are reported on patients’ quality of life (QoL).ConclusionInterventions designed to actively involve the GP during curative cancer treatment are scarce and diverse. Even though uptake of interventions is low, results suggest a positive effect of GP involvement on patient satisfaction with care, but not on QoL. Additional effects for vulnerable subgroups were found. More robust evidence for tailored interventions is needed to enable the efficient and effective involvement of the GP during curative cancer treatment.PROSPERO registration numberCRD42018102253.
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Kant, A. C., B. T. H. M. Palm, E. Wentink, and C. van Weel. "General Practitioner Based Screening for Cervical Cancer: Higher Participation of Women with a Higher Risk?" Journal of Medical Screening 4, no. 1 (March 1997): 35–39. http://dx.doi.org/10.1177/096914139700400111.
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Objective— To test the hypothesis that a personal invitation for cervical screening by a woman's own general practitioner (GP) achieves a higher attendance of women with an increased risk for cervical cancer. Setting— Two general practices and the local health authority screening programme for cervical cancer, Nijmegen, The Netherlands. Methods— Attendance rates of women with an increased risk of cervical cancer were compared for two invitation strategies: (a) invitation by the woman's own GP, and ( b) invitation by a national call system through the local health authority. Data on risk profiles were gathered by questionnaire. Two hundred and thirty eight women eligible for screening were invited by their GPs (GP group), and 235 women by the local health authority (control group) in 1992. Results— The personal invitation by the GP resulted in an 18% higher overall attendance, and a 28% higher attendance of women with greater risk because of sexual behaviour and smoking. Conclusion— Greater involvement of the GP in inviting women for cervical cancer screening results in a higher attendance, particularly among women with increased risk, than a less personal health authority call system.
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Skarshaug, Lena Janita, Silje Lill Kaspersen, Johan Håkon Bjørngaard, and Kristine Pape. "How does general practitioner discontinuity affect healthcare utilisation? An observational cohort study of 2.4 million Norwegians 2007–2017." BMJ Open 11, no. 2 (February 2021): e042391. http://dx.doi.org/10.1136/bmjopen-2020-042391.
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ObjectivesPatients may benefit from continuity of care by a personal physician general practitioner (GP), but there are few studies on consequences of a break in continuity of GP. Investigate how a sudden discontinuity of GP care affects their list patients’ regular GP consultations, out-of-hours consultations and acute hospital admissions, including admissions for ambulatory care sensitive conditions (ACSC).DesignCohort study linking person-level national register data on use of health services and GP affiliation with data on GP activity and GP characteristics.SettingPrimary care.Participants2 409 409 Norwegians assigned to the patient lists of 2560 regular GPs who, after 12 months of stable practice, had a sudden discontinuity of practice lasting two or more months between 2007 and 2017.Primary and secondary outcome measuresMonthly GP consultations, out-of-hours consultations, acute hospital admissions and ACSC admissions in periods during and 12 months after the discontinuity, compared with the 12-month period before the discontinuity using logistic regression models.ResultsAll patient age groups had a 3%–5% decreased odds of monthly regular GP consultations during the discontinuity. Odds of monthly out-of-hours consultations increased 2%–6% during the discontinuity for all adult age groups. A 7%–9% increase in odds of ACSC admissions during the period 1–6 months after discontinuity was indicated in patients over the age of 65, but in general little or no change in acute hospital admissions was observed during or after the period of discontinuity.ConclusionsModest changes in health service use were observed during and after a sudden discontinuity in practice among patients with a previously stable regular GP. Older patients seem sensitive to increased acute hospital admissions in the absence of their personal GP.
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Hensher, M. "Improving General Practitioner Access to Physiotherapy: A Review of the Economic Evidence." Health Services Management Research 10, no. 4 (November 1997): 225–30. http://dx.doi.org/10.1177/095148489701000403.
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The provision of physiotherapy via general practitioner (GP) ‘direct access’ arrangements or in primary care itself has become increasingly common in the UK. Evidence on the economics and the cost-effectiveness of alternative methods of organizing access to physiotherapy services is reviewed, and the likely impacts of different organizational models are discussed. GP direct access physiotherapy and primary care provision appear to have a lower average cost than consultant access physiotherapy models, while GP direct access appears to minimize health care resource use per patient. Primary care physiotherapy provision appears to minimize the costs to patients of seeking care, and appears to generate a greater demand for service than other models. The extent to which physiotherapy provision in primary care can substitute for physiotherapy and other resources in the hospital sector is discussed, as is the extent to which patients may benefit from receiving physiotherapy in primary care. It is argued that continued expansion of access to physiotherapy should be critically appraised, and its ability to improve health status compared with that achievable in alternative patient groups who might benefit from physiotherapy in hospital or rehabilitation settings.
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Su, Yuliu, Shrutivandana Sharma, Semra Ozdemir, Wai Leng Chow, Hong-Choon Oh, and Ling Tiah. "Nonurgent Patients’ Preferences for Emergency Department Versus General Practitioner and Effects of Incentives: A Discrete Choice Experiment." MDM Policy & Practice 6, no. 2 (July 2021): 238146832110275. http://dx.doi.org/10.1177/23814683211027552.
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Objective. This study investigates potential of a new financial incentive policy, the GP-referral discount scheme introduced in Singapore, in reducing nonurgent emergency department (ED) visits, and compares it with alternative interventions. Methods. A discrete choice experiment (DCE) was designed to elicit patients’ preferences for ED and general practitioner (GP) under hypothetical nonurgent medical conditions. Through latent class multinomial logistic regression, choice models were estimated to quantify how patients’ choices are influenced by GP-referral discount, other ED/GP attributes (waiting time, test facilities, and payment), patient demographics, and their perception of severity. The choice models were used to predict uptake of the GP-referral discount scheme and other countermeasures suggested by these models. Results. Survey responses from 849 respondents recruited from a public hospital in Singapore were included in the study. The choice model identified two prominent classes of patients, one of which was highly sensitive to GP-referral discount and the other to test-facility-availability. Patients’ perceptions of severity (“critical” v. “not critical” enough to go to ED directly) were highly significant in influencing preference heterogeneity. Predictive analysis based on the choice model showed that GP-referral discount is more effective when patients visit ED expecting “shorter” waits, as opposed to test-facility provision at GPs and perception-correction measures that showed stronger effects under “longer” expected waits. Conclusions. The new GP-referral financial incentive introduced in Singapore can be effective in reducing nonurgent ED visits, if it reasonably covers the (extra) cost of visiting a GP. It may serve as a complement to test-facility provision at GPs or perception-correction measures, as the financial incentive and the latter two measures appear to influence distinct classes (discount-sensitive and facility-sensitive) of patients.
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Hemphill, Elizabeth, and Carol T. Kulik. "Defining a Process for Segmenting the General Practitioner Market for Rural Practice Recruitment." Social Marketing Quarterly 15, no. 2 (May 22, 2009): 74–91. http://dx.doi.org/10.1080/15245000902878852.
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General practitioner (GP) to patient ratios fall below benchmarks, particularly in rural areas. A marketing solution to this significant social problem might be to develop recruitment strategies differentiating medical practices (brands) and targeting different segments of the GP market. This article uses data gathered in Australia from practice managers, GPs, and recruitment advertisements to develop a taxonomy of family, job, and practice attributes that could be used to recruit GPs. Current recruiting strategies emphasize a mix of family, job and practice attributes, but better recruitment outcomes might be achieved by the implementation of branding principles that more clearly differentiate general practices with targeted recruitment advertisements. This research prescribes a path for future research on GP recruitment. The first step is to gather data on the relative and absolute value of different attributes within the taxonomy. These data can then be used to develop targeted marketing strategies for recruiting GPs to rural practices.
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Plat, Fredrik M., Yvonne A. S. Peters, Paul Giesen, and Marleen Smits. "Availability of Dutch General Practitioners for After-Hours Palliative Care." Journal of Palliative Care 33, no. 3 (April 2, 2018): 182–86. http://dx.doi.org/10.1177/0825859718766947.
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Background: Continuity of care is important for palliative patients in their end of life. In the Netherlands, after-hours primary care for palliative patients is either provided by large-scale general practitioner (GP) cooperatives or GPs choose to give palliative care by themselves while they are not on duty. Aim: To examine the availability of, perceived problems by, and attitude of Dutch GPs regarding providing palliative care for their own patients outside office hours. Design and Setting: Cross-sectional observational study among 1772 GPs from 10 Dutch regions. Method: Online questionnaire among GPs affiliated with 10 GP cooperatives. Results: Five hundred twenty-four (29.6%) eligible questionnaires were returned. Of the GPs, 60.8% were personally available outside office hours for their own palliative patients on their own private cell phone and performed home visits if needed. In 33.0%, GPs were willing to make home visits in private time instigated by the GP cooperative and 26.8% were only accessible for telephone consultation by the GP cooperative. In 12.2%, the GP delegated after-hours palliative care completely to the GP cooperative. The GPs predominantly reported “time pressure” problems (17.3%) as a barrier and 61.7% stated that after-hours palliative care is the responsibility of the own GP. Conclusion: The large majority of Dutch GPs is personally available for telephone consultation and/or willing to provide palliative care for their own patients outside office hours. For the future, it is important to maintain the willingness of GPs to remain personally available for their palliative patients.
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Leusink, Peter, Renee Steinmann, Merel Makker, Peter L. Lucassen, Doreth Teunissen, Antoine L. Lagro-Janssen, and Ellen T. Laan. "Women’s appraisal of the management of vulvodynia by their general practitioner: a qualitative study." Family Practice 36, no. 6 (May 10, 2019): 791–96. http://dx.doi.org/10.1093/fampra/cmz021.
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Abstract Background Provoked Vulvodynia (PVD) is the most common cause of vulvar pain. General practitioners (GPs) are insufficiently familiar with it, causing a delay in many women receiving correct diagnosis and treatment. Besides patients factors, this delay can partly be explained by the reluctance of GPs to explore the sexual context of PVD and by their negative emotional reactions such as helplessness and frustration when consulted by patients with medically unexplained symptoms like PVD. Objective To gain insight into how women with PVD perceive and evaluate condition management by their GP, in order to support GPs in the consultation of women with PVD. Methods We performed face-to-face in-depth interviews with women diagnosed with PVD. The interviews were recorded, transcribed verbatim and thematically analysed. The Consolidated Criteria for reporting Qualitative Research (COREQ-criteria) were applied. Results Analysis of the interviews generated four interrelated themes: Doctor-patient relationship, Lack of knowledge, Referral process and Addressing sexual issues. Empathy of the GP, involvement in decision-making and referral were important factors in the appreciation of the consultation for women with PVD who were referred to a specialist. Because women were reluctant to start a discussion about sexuality, they expected a proactive attitude from their GP. The communication with and the competence of the GP ultimately proved more important in the contact than the gender of the GP. Conclusion Women with PVD prefer a patient-centred approach and want GPs to acknowledge their autonomy and to address sexuality proactively.
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O'Donoughue Jenkins, Lily, Peter Butterworth, and Kaarin J. Anstey. "A Longitudinal Analysis of General Practitioner Service Use by Patients with Mild Cognitive Disorders in Australia." Dementia and Geriatric Cognitive Disorders 41, no. 5-6 (2016): 324–33. http://dx.doi.org/10.1159/000447123.
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Background: The aim of this study was to ascertain if participants diagnosed with any mild cognitive disorder (MCD) visited a general practitioner (GP) more than those without MCD and the effect of either depression or arthritis on GP use longitudinally. Methods: 2,551 participants aged 60-64 years at baseline completed the Personality and Total Health Through Life (PATH) study in Canberra. Follow-up data were collected after 4 and 8 years. A cognitive screening battery was used to screen participants into a substudy of MCD. Results: Participants with any MCD had greater GP use than cognitively healthy participants across all three waves (wave 1, M = 7.35 vs. 5.59; wave 2, M = 7.77 vs. 5.86; wave 3, M = 9.01 vs. 6.81). After adjusting for demographic and health factors, MCD was a significant predictor of GP use at all three waves (p < 0.05, CI 0.84-0.99). Conclusion: This study has shown that MCD is associated with a higher use of GP visits, especially if the patient has a comorbid condition.
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Neilson, Sue, Faith Gibson, Stephen Jeffares, and Sheila M. Greenfield. "GPs and paediatric oncology palliative care: a Q methodological study." BMJ Supportive & Palliative Care 10, no. 2 (April 21, 2017): e11-e11. http://dx.doi.org/10.1136/bmjspcare-2015-000852.
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ObjectiveThis mixed-methods study set in the West Midlands region of the UK demonstrates the effectiveness of Q methodology in examining general practitioners' (GPs') perception of their role in children's oncology palliative care.MethodsUsing data obtained from the analysis of semistructured interviews with GPs who had cared for a child receiving palliative care at home and bereaved parents, 50 statements were identified as representative of the analysis findings. 32 GPs with a non-palliative child with cancer on their caseload were asked to rank the statements according to their level of agreement/disagreement on a grid. They were then asked to reflect and comment on the statements they most and least agreed with. The data were analysed using a dedicated statistical software package for Q analysis PQMethod V.2.20 (Schmolck 2012). A centroid factor analysis was undertaken initially with 7 factors then repeated for factors 1–6. Varimax and manual flagging was then completed.Results4 shared viewpoints were identified denoting different GP roles: the GP, the compassionate practitioner, the team player practitioner and the pragmatic practitioner. In addition consensus (time pressures, knowledge deficits, emotional toll) and disagreement (psychological support, role, experiential learning, prior relationships) between the viewpoints were identified and examined.ConclusionsQ methodology, used for the first time in this arena, identified 4 novel and distinct viewpoints reflecting a diverse range of GP perspectives. Appropriately timed and targeted GP education, training, support, in conjunction with collaborative multiprofessional working, have the potential to inform their role and practice across specialities.
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Donnelly, M. J., M. S. Quraishi, and D. P. McShane. "Indications for paediatric tonsillectomy GP versus Consultant perspective." Journal of Laryngology & Otology 108, no. 2 (February 1994): 131–34. http://dx.doi.org/10.1017/s0022215100126088.
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AbstractTonsillectomy is a commonly performed operation in children. Although the justification for this procedure has been debatable in the past, more rigorous criteria in defining the need for tonsillectomies are becoming established. The role of the primary care physician in the management of tonsillar disease in children is important as the decision to refer a child for tonsillectomy is made by the general practitioner. A questionnaire survey of 400 general practitioners (GPs) and 31 consultant ENT surgeons was carried out to establish the important criteria used in deciding the need for paediatric tonsillectomy. We found that in general there was a good correlation between GP and Consultant indications for tonsillectomy. However there were two important areas of difference, while most of the GPs felt that recurrent ear infections and ‘glue ear’ were important indications for tonsillectomy, Consultants did not. Therefore we must be aware of the current recommendations for tonsillectomy and inform present and future GPs.
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Bushnell, John. "Mental Disorders Among Maori Attending Their General Practitioner." Australian & New Zealand Journal of Psychiatry 39, no. 5 (May 2005): 401–6. http://dx.doi.org/10.1080/j.1440-1614.2005.01588.x.
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Objective: This paper identifies rates of common mental disorders among Maori and non-Maori consulting a general practitioner (GP), and explores the association between ethnicity and social and material deprivation. Method: Survey of GPs and their patients. Participants were randomly selected GPs (n = 70), and their patients (n = 3414, of whom a subset of 786 form the basis of this paper). The main comparison is between self-identified ethnicity, mental disorder assessed by the Composite International Diagnostic Interview, and social and material deprivation measured by NZDep2001 (an area based measure), and an individualized index of deprivation. Results: Rates of mental disorder among Maori general practice attenders were higher than among non-Maori. Overall, Maori women attenders were twice as likely as non-Maori women attenders to have a diagnosable mental disorder. The rates of anxiety, depressive and substance use disorders were all higher for Maori than for others attending GPs. Treatment for psychological problems was offered by the GP at similar rates to both Maori and non-Maori. Although there were differences between Maori and non-Maori in terms of social and material deprivation, higher rates of mental disorder among Maori attending GPs compared to non-Maori cannot be accounted for by these differences alone. Conclusions: These findings support the view that whilst social and material deprivation may play a role in the high rates of mental disorders among Maori general practice attenders, there are additional ethnicity-specific factors involved. Interventions to address Maori mental health (whether by reducing risk factors for mental disorder, by promoting disclosure, early recognition and intervention, or by ensuring access to acceptable and effective treatments) may need to explicitly take those factors into account.
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Keogh, Peter, Peter Weatherburn, and David Reid. "Learning from the experiences of people with HIV using general practitioner services in London: a qualitative study." Primary Health Care Research & Development 17, no. 04 (January 15, 2016): 351–60. http://dx.doi.org/10.1017/s1463423615000481.
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AimTo explore the experiences of people with HIV (PWHIV) using general practitioner (GP) services in order to identify barriers to use.BackgroundTraditionally, GPs have little involvement in the care of PWHIV. However, as HIV becomes a chronic condition and the population of PWHIV ages, there is a need to increase this involvement. Despite high levels of GP registration, the majority of PWHIV in London report that their GP is not involved in their HIV care.MethodsThis paper presents qualitative findings from a mixed method study of PWHIV’s experiences of clinical services. Survey respondents were purposively sampled to recruit 51 PWHIV who took part in eight focus groups. Participants were asked about their experience of using GP services.FindingsThree factors emerged which mediated experiences of GP care.Competence: respondents were concerned about the potential for misdiagnosis of symptoms, lack of awareness of the health needs of PWHIV and experiences of prescribing, which could lead to drug interactions.Continuity: not being able to get appointments quickly enough, not being able to see the same doctor twice and not being able to keep the same GP when one changed address were experienced as impediments to use.Communication: lack of communication between GPs and HIV specialists led to what participants called ‘patient ping-pong’ where they found themselves acting as a go-between for different clinical specialists trying to make sense of their care.ConclusionMeaningful contact between HIV specialists and GPs is likely to allay concerns about competency as treatment and care decisions can be taken collaboratively between the GP, HIV specialist and patient. A key component of acceptable GP care for PWHIV is likely to be the application of long-term condition management approaches, which includes empowered patient self-management.
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Chadborn, N. H., A. L. Gordon, R. Devi, C. Williams, C. Goodman, and K. Sartain. "21 Realist Review of General Practitioners’ Role in Advancing Practice in Care Homes (Grape Study)." Age and Ageing 50, Supplement_1 (March 2021): i1—i6. http://dx.doi.org/10.1093/ageing/afab028.21.
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Abstract Introduction Many care home residents have high levels of complex needs and their medical care is the responsibility of the general practitioner (GP) in UK. GPs have multiple roles, including gatekeeper for access to other healthcare services and often play a leadership role in the healthcare team. Our aim is to develop realist programme theories for how GPs interact with care homes to facilitate improvements in care of residents. Method Using realist review we aimed to describe “what works” for GPs to be involved in improvements in care of residents. Firstly we carried out a scoping review of UK literature and interviewed GP leaders in order to build programme theory. Secondly iterative literature searches were performed in Medline, Embase, CINAHL, PsycInfo, ASSIA, Scopus and many grey literature databases. This international literature is being used to test and refine programme theories and to explore the range of contexts. Results A scoping search identified a small number (n = 5) of recent UK articles (2010–19) that described GP input into quality improvement. To gain insight into context, observational studies (n = 4 in UK and Ireland) were identified which described concerns about workload and resource constraints. To develop initial programme theories, we conducted interviews with 6 GP leaders, where themes of risk and specialism were identified. We are developing the following mechanisms within programme theory: where GP profession have an ownership of the agenda, this encourages GP involvement. In other initiatives, the mechanism may be a trusting relationship between GP and another practitioner, eg pharmacist. Conclusion Many reported projects which aim to improve care quality in care homes do not describe how the initiative relates to GP practice. We have identified mechanisms which, when present, may cause GPs to contribute leadership and medical expertise, and thus lead to successful outcomes for residents.
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Gavino, Alex, Vivian Isaac, and Craig McLachlan. "Hypertension Status and Associations with Self-Rated Health and General Practitioner Health Seeking in a Rural Australian Cohort." Journal of Cardiovascular Development and Disease 5, no. 4 (November 6, 2018): 53. http://dx.doi.org/10.3390/jcdd5040053.
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Hypertension is the most frequently managed condition by Australian general practitioners (GP). Knowledge of hypertension and blood pressure (BP) values may motivate individuals to seek GP management. Our study aims to determine the associations of knowledge of BP values, BP perception, GP health seeking, and self-rated health (SRH) in a rural population. Two-hundred and seventy-eight (278) residents responded to the health survey on socio-demographic profile, medical history, BP knowledge and perception, SRH, and GP visit frequency. Associations were evaluated using Chi-squared test and multivariate logistic regression. Cohort mean age was 63.6 (12.4) years with 63.3% females. Hypertension (37.8%) was the most common condition. GP visits were made at least once every month (19.1%), every 2–6 months (35.6%), >6 months (11.5%), or only when needed (29.5%). Univariate analyses showed age, education, alcohol consumption, comorbidities, hypertension status, and SRH were significantly associated with visit frequency. After adjustments, hypertension status (OR = 3.6, 95% CI [1.7, 7.9]) and poor SRH (OR = 3.1, 95% CI [1.4, 7.0]) were significantly associated with frequent monthly visits. Our cohort demonstrated that having hypertension and poor self-rated health were associated with frequent monthly GP visits. The perception of high blood pressure does not drive seeking additional GP input.
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Kludacz-Alessandri, Magdalena, Liliana Hawrysz, Piotr Korneta, Grażyna Gierszewska, Wioletta Pomaranik, and Renata Walczak. "The impact of medical teleconsultations on general practitioner-patient communication during COVID- 19: A case study from Poland." PLOS ONE 16, no. 7 (July 16, 2021): e0254960. http://dx.doi.org/10.1371/journal.pone.0254960.
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According to the outbreak of the Covid-19 pandemic, medical teleconsultations using various technologies have become an important tool to mediate communication between general practitioners (GP) and the patients in primary health care in many countries. The quality of the GP-patient communication is an essential factor, which improves the results of treatment and patient satisfaction. The objective of this paper is to study patients’ satisfaction from teleconsultation in primary care and the impact of teleconsultations on GP-patient communication through the Covid-19 pandemic in Poland. We analyse whether the teleconsultations performed without physical examinations have a positive impact on GP-patient communication. The quality of teleconsultation and GP-patient communication have been measured using a questionnaire regarding the quality of medical care in a remote care conditions. Among 36 items, nine questions have been related to the dimension of GP-patient communication and ten to system experience. Our results suggest that the quality of teleconsultations is not inferior to the quality of consultation during a face-to-face visit. The patients indicated a high level of satisfaction regarding communication with their GP during teleconsultation. We have also identified that the technical quality and the sense of comfort during teleconsultation positively impact the communication quality.
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G. Bolton, Patrick, Sharon M. Parker, Kylie J. Fergusson, and Jannifer D. Orman. "The Impact of a Clinical Audit on GP Detection of Depression." Australian Journal of Primary Health 9, no. 1 (2003): 88. http://dx.doi.org/10.1071/py03011.
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Objective: To determine if a clinical audit and linked educational workshop would improve the ability of general practitioners to accurately detect depression. Design: Pre- and post-data collection over a six-month period (two eight-week collection periods), associated educational workshop, and comprehensive treatment guidelines. Setting: General Practice in the Central Sydney Area. Study participants: A total of 1106 patients (592 pre-, 514 post-collection) from six general practices. Patients were required to be 18-65yrs and willing and able to complete a self-administered depression rating scale. Main Outcome Measures: General practitioner rating of consecutive patients using a tick box scale matched to patients' self-report on the Hospital Anxiety and Depression Scale. Comparison of patients' scores on the two sub-scales of the Scale (depression and anxiety) and the reason for presentation rated by the general practitioner. Results: The mean age of participants was 35 years for audit one and 33 years for audit two with substantially more females participating (73.6% and 68.1%) as opposed to males (26.4% and 31.9%). The presence of psychological problems as identified by the HADS was higher than that reported in the literature and actually decreased from 65.9% in audit one to 59.7% in audit two. There were non-significant increases in the rate at which participating general practitioners detected depression with the proportion of "true negatives" increasing between the audits and the proportion of "false negatives" decreasing. No change occurred in either the true or false positive rates. Conclusions: Within this study, the audit, feedback and educational workshop in combination achieved poor results. This, and the prevalence of depression in the population, suggests further research is warranted to determine an effective method of educating general practitioners to detect depression.
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Barnett, Stephen, Sandra C. Jones, Sue Bennett, Don Iverson, and Andrew Bonney. "Usefulness of a virtual community of practice and Web 2.0 tools for general practice training: experiences and expectations of general practitioner registrars and supervisors." Australian Journal of Primary Health 19, no. 4 (2013): 292. http://dx.doi.org/10.1071/py13024.
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General practice training is a community of practice in which novices and experts share knowledge. However, there are barriers to knowledge sharing for general practioner (GP) registrars, including geographic and workplace isolation. Virtual communities of practice (VCoP) can be effective in overcoming these barriers using social media tools. The present study examined the perceived usefulness, features and barriers to implementing a VCoP for GP training. Following a survey study of GP registrars and supervisors on VCoP feasibility, a qualitative telephone interview study was undertaken within a regional training provider. Participants with the highest Internet usage in the survey study were selected. Two researchers worked independently conducting thematic analysis using manual coding of transcriptions, later discussing themes until agreement was reached. Seven GP registrars and three GP supervisors participated in the study (average age 38.2 years). Themes emerged regarding professional isolation, potential of social media tools to provide peer support and improve knowledge sharing, and barriers to usage, including time, access and skills. Frequent Internet-using GP registrars and supervisors perceive a VCoP for GP training as a useful tool to overcome professional isolation through improved knowledge sharing. Given that professional isolation can lead to decreased rural work and reduced hours, a successful VCoP may have a positive outcome on the rural medical workforce.
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Duru, Gérard, Jean Vetel, and Karine Danno. "Management of Anxiety and Depressive Disorders in Patients ≥ 65 Years of Age by Homeopath General Practitioners versus Conventional General Practitioners, with Overview of the EPI3-LASER Study Results." Homeopathy 107, no. 02 (March 20, 2018): 081–89. http://dx.doi.org/10.1055/s-0038-1636536.
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Background The increasing use of psychotropic drugs to treat anxiety and depressive disorders (ADDs) is concerning. According to the study, ‘Etude Pharmacoépidémiologique de l'Impact de Santé Publique des modes de prise en charge pour 3 groupes de pathologies’ (EPI3)-LASER, adult ADD patients who consult a general practitioner prescribing homeopathic medicines (GP-Ho) report less psychotropic drug use and are marginally more likely to experience clinical improvement than those receiving conventional care. We determined whether these observations also apply to patients ≥ 65 years old in the EPI3 cohort. Methods The EPI3-LASER study, conducted in France between March 2007 and July 2008, was a nationwide, observational survey of the three most common reasons for primary care consultation, including ADD, and the impact of the GPs' prescribing preferences: homeopathy (GP-Ho), conventional medicines (GP-CM) or mixed prescriptions (GP-Mx). This sub-analysis included 110 patients ≥ 65 years old with ADD from the EPI3 cohort who consulted either a GP-CM or GP-Ho. Socio-demographic and medical data and details of any medications prescribed were collected at inclusion. Information regarding the patients' functional status (Hospital Anxiety and Depression Scale [HADS)]) was obtained via a telephone interview 72 hours after inclusion, and at 1, 3 and 12 months post-inclusion. Medication use and outcome were determined over the 12-month period. Differences between the GP-CM and GP-Ho groups were assessed by multivariate logistic regression analysis. Results One hundred and ten patients were recruited and 87 (79.1%) with ADD (HADS ≥ 9) at the 72-hour interview were evaluated (age range: 65–93 years, 82.8% female). Patients who consulted a GP-Ho were more likely (odds ratio [OR] = 10.38, 95% confidence interval [CI]: 1.33–81.07) to have clinical improvement (HADS < 9) after 12 months than those in the GP-CM group. Patients who consulted a GP-Ho reported less psychotropic drug use (OR = 22.31 [95% CI: 2.20–226.31]) and benzodiazepine use (OR = 60.63 [95% CI: 5.75–639.5]) than GP-CM patients. Conclusions Management of ADD patients aged ≥ 65 years by GP-Ho appears to have a real public health interest in terms of effectiveness and lower psychotropic drug use.
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Bryant, Linda, Gregor Coster, and Ross McCormick. "General practitioner perceptions of clinical medication reviews undertaken by community pharmacists." Journal of Primary Health Care 2, no. 3 (2010): 225. http://dx.doi.org/10.1071/hc10225.
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INTRODUCTION: 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. METHODS: Thirty-eight GPs who participated in the General PractitionerPharmacists 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. FINDINGS: 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. CONCLUSION: GPs attributed different values to community pharmacists undertaking clinical medication reviews, but this value usually balanced the quality and usefulness of the pharmacists recommendations with the efficiency of the system in terms of workload and funding. KEYWORDS: Family physicians; community pharmacy services; drug utilization review; primary healthcare; health plan implementation; qualitative research; interprofessional relations
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Fraser, Sally, Michael Leveritt, and Lauren Ball. "Patients perceptions of their general practitioners health and weight influences their perceptions of nutrition and exercise advice received." Journal of Primary Health Care 5, no. 4 (2013): 301. http://dx.doi.org/10.1071/hc13301.
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INTRODUCTION: General practitioners (GPs) play an important role in the management of patients who are overweight or obese. Previous research suggests that GPs physical characteristics may influence patients perceptions of health care received during consultations, mediating the likelihood of patients following health advice provided by GPs. This study aimed to explore patients perceptions of their GPs health status and its influence on patients perceptions of healthy eating and exercise advice. METHODS: An interpretive approach to phenomenology underpinned the qualitative inquiry and study design. Twenty-one participants (aged 55.9 ± 6.5 years; 14 females, 7 males) who had previously received healthy eating and/or exercise advice from a GP participated in an individual semi-structured interview. A constant comparison approach to thematic analysis was conducted. FINDINGS: Participants identified three key indicators of perceived health of their GP. These included the GPs physical appearance, particularly weight status; perceived absence of ill health; and disclosure of a GPs health behaviours. Participants expressed favourable perceptions of the weight status of their GP. Participants expected their GP to be a healthy role model and often, but not always, felt more confident receiving advice from a GP that they perceived as healthy. CONCLUSION: The findings highlight that a GPs perceived health status influences patients perceptions of the health advice received during consultations. These findings provide a foundation for future research that may allow GPs to modify patients perceptions of their health status in order to facilitate behaviour change in overweight or obese patients. KEYWORDS: Body weight; general practitioners; obesity; overweight; physicians; primary health care
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Huang, Luke Y. I., Samuel J. Fogarty, Arnold C. T. Ng, and William Y. S. Wang. "Rates and predictors of general practitioner (GP) follow-up postdischarge from a tertiary hospital cardiology unit: a retrospective cohort study." BMJ Open 9, no. 10 (October 2019): e031627. http://dx.doi.org/10.1136/bmjopen-2019-031627.
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ObjectivePrevious studies in cardiac patients noted that early patient follow-up with general practitioners (GPs) after hospital discharge was associated with reduced rates of hospital readmissions. We aimed to identify patient, clinical and hospital factors that may influence GP follow-up of patients discharged from a tertiary cardiology unit.DesignSingle centre retrospective cohort study.SettingAustralian metropolitan tertiary hospital cardiology unit.Participants1079 patients discharged from the hospital cardiology unit within 3 months from May to July 2016.Outcome measuresGP follow-up rates (assessed by telephone communication with patients’ nominated GP practices), demographic, clinical and hospital factors predicting GP follow-up.ResultsWe obtained GP follow-up data on 983 out of 1079 (91.1%) discharges in the study period. Overall, 7, 14 and 30-day GP follow rates were 50.3%, 66.5% and 79.1%, respectively. A number of patient, clinical and hospital factors were associated with early GP follow-up, including pacemaker and defibrillator implantation, older age and having never smoked. Documented recommendation for follow-up in discharge summary was the strongest predictor for 7-day follow-up (p<0.001).ConclusionAfter discharge from a cardiology admission, half of the patients followed up with their GP within 7 days and most patients followed up within 30 days. Patient and hospital factors were associated with GP follow-up rates. Identification of these factors may facilitate prospective interventions to improve early GP follow-up rates.
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Verhaak, P. F. M., and M. A. R. Tijhuis. "The Somatizing Patient in General Practice." International Journal of Psychiatry in Medicine 24, no. 2 (June 1994): 157–77. http://dx.doi.org/10.2190/45h7-h8xf-t636-ub0x.
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Objective: The exploratory study described in this article followed two groups of patients over a twelve-month period. Subjects were drawn from a pool of patients who had consulted their general practitioner during the three-month selection period. One group consisted of patients who had consulted their general practitioner at least once about a physical complaint that the GP regarded as predominantly psychosocial; these patients did not articulate complaints of an explicitly mental or social nature. The second group was characterized by the fact that its members voiced precisely such mental or social complaints. Method: The study investigated the extent to which the two groups (which were comparable in the severity of their complaints) differ with respect to patient characteristics such as the severity of their possible psychological problems, the frequency with which they visited their GPs, and the types of complaints—e.g. mental, psychosomatic and purely physical—they presented. Results: It was found that patients in the first group, whose somatic complaints were seen to have a psychosocial basis, are not the dependent types generally mentioned in theories about somatization. In fact, they adopt a more independent attitude to the GP than do patients voicing mental complaints. There are indications that for “somatizing” patients, underlying mental problems are less important than for “psychologizing” patients. Conclusions: Both the somatizing patients and the psychologizing patients continued very frequent visits to their GP during the 12-month research period, although chiefly to address physical complaints that the GP also assessed as such.