Dissertations / Theses on the topic 'General practitioners'
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Egieyeh, Elizabeth Oyebola. "Inter-professional collaboration between general practitioners and community pharmacists: general practitioners’ perspectives." Thesis, University of Western Cape, 2012. http://hdl.handle.net/11394/3382.
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Magister Pharmaceuticae - MPharmThe global movement towards enhancing inter-professional collaboration in patient care is in light of the increasing potency of drugs and complexity of drug regimens, particularly in the chronically ill where poly-pharmacy is rife, collaborative patient management by general practitioners and community pharmacists, in particular, has the potential to enhance patient therapeutic outcomes in primary healthcare. Literature from other parts of the world has enumerated the advantages of collaboration. South Africa with its unusual quadruple burden of disease and human resource deficient public healthcare system would benefit from collaboration between general practitioners and community pharmacists through expanded roles for community pharmacists to enable them to make more meaningful contributions to primary healthcare regimens. Particularly with the introduction of the National Health Insurance (NHI) programme. This dissertation aims to assess from general practitioners‟ perspectives: the current level and stage of collaboration (using the collaborative working relationship (CWR) model proposed by McDonough and Doucette, 2001) between general practitioners and community pharmacists in patient care, if general practitioners‟ perceptions of the professional roles of community pharmacists in patients‟ care can influence desired collaboration (prospects of enhanced future collaboration) and how do general practitioners envision enhanced future collaboration between them and community pharmacists in patient care, possible barriers to the envisioned collaboration between the two practitioners, and how general practitioners‟ demographic characteristics influence inter-professional collaboration with community pharmacists. Sixty randomly selected consenting general practitioners in private practice participated in a cross-sectional, face- to-face questionnaire study. The questionnaire contained a range of statements with Likert scale response options. Data was initially entered into Epi Info (version 3.5.1., 2008) and then exported to IBM SPSS Statistical software for analysis (version19, 2010). Medians were used to summarize descriptive data and Spearman‟s correlation coefficient, Mann-Whitney U Test and Kruskal-Wallis Test was used for bivariate analysis. Ethical approval was granted by the Senate Research and International Relations Committee, University of the Western Cape (Ethical Clearance Number: 10/4/29). The results indicated low-levels of current collaboration at stage 0 of the CWR model between general practitioners and community pharmacists. A statistically significant correlation was observed between general practitioners‟ perceptions of the professional roles of community pharmacists and desired collaboration (prospects of enhanced future collaboration), [p=0.0005]. Good prospects of enhanced future collaboration between general practitioners and community pharmacists were observed. General practitioners identified barriers to collaboration to include: the lack of remuneration for collaboration, absence of a government mandate or policy supporting collaboration, inability of general practitioners to share patients‟ information with community pharmacists and questionable professional ethics exhibited by community pharmacists particularly over financial gains. Most general practitioners agreed that joint continuing professional education organized by pharmaceutical companies or other groups will increase interaction and enhance collaboration. Enhanced Inter-professional collaboration between general practitioners and community pharmacists‟ can be possible in the future but hindrances need to be eliminated for this to be achieved. Future research can be aimed at exploring the perspectives‟ of community pharmacists to inter-professional collaboration in South Africa and interventions that will enhance collaboration.
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Orton, Peter. "Burnout in general practitioners." Thesis, St George's, University of London, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.676094.
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Objectives: To examine the relationship between the level of burnout in general practitioners and doctors' interpersonal skills, the patient centeredness, the consultation length. The effect of GPs' gender, age, time since registered, and the likelihood to suffer from burnout was also investigated. Design: A cross-sectional study of NHS general practitioners. A postal survey used the Maslach Burnout Inventory to measure self-reported levels of burnout, in 564 doctors. A sample of 38 respondents, selected by high or low emotional exhaustion scores, was further assessed via practice visits. 822 consultations were audio recorded, and 1,900 patients completed the Doctor Interpersonal Skills Questionnaire. Setting: Two studies have been conducted. First, a pilot study was carried out in Tower Hamlets, Newham and Hackney areas of North London in 2000. Then, I set out to perform the main study in county of Essex in 2003. Main measures: Burnout of the doctors; patient-centeredness; the doctors' interpersonal skills, the consultation length, gender, age, time in practice since registration, workload characteristics of the doctors, and general characteristic of the patients. Results: I report high levels of emotional exhaustion and depersonalisation and correlate these levels to characteristics of the doctor. Male doctors reported significantly higher depersonalisation than female doctors, and doctors in group practice suffer more from depersonalisation than singlehanded practitioners. I also find no significant correlation with DISQ (patient assessment of the consultation) or patient centeredness (observer assessment of consultation). Finally, my results also demonstrate that patient-centeredness is significantly associated with consultation length and that "usual doctor" visits correlate with higher ratings of the doctors' interpersonal skills by patients (DISQ). Conclusions: Burnout is a significant issue in Essex general practitioners. Burnout, patient centeredness, doctors' interpersonal skills and consultation length are inter-related.
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Holt, Jackie. "Psychological distress amongst general practitioners /." [St. Lucia, Qld.], 2002. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17113.pdf.
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Crumbie, Alison. "A nurse practitioner's tale : an autoethnographic interpretive study of the values of nurse practitioners, general practitioners and district nurses." Thesis, Swansea University, 2005. https://cronfa.swan.ac.uk/Record/cronfa42455.
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Nurse practitioners began practising in the UK in the 1980s. Since then the numbers have grown and a body of research has developed relating to the role. The criticism of nurse practitioners has been that they work as "mini doctors" and that they no longer belong to the family of nursing. If nurse practitioners have more in common with medicine than they do with nursing one might expect to find that nurse practitioners have moved away from the values of nursing and have instead moved toward the values of medicine. To date we know relatively little about the role of the nurse practitioner. The aim of this study was to determine to what extent nurse practitioners share the values of nursing or medicine. In recognition of the author's own role as a nurse practitioner an autoethnographic approach was used. Unstructured interviews were carried out with general practitioners (GPs), nurse practitioners and district nurses and their values were revealed through descriptions of meaningful practice. Significant and important differences were found between the three groups of practitioners both in the form and the content of the narratives. The form of the narratives revealed the cultural connection of the nurse practitioners to nursing. The content of the narratives revealed the pioneering nature of the role and the nurse practitioners' concern with acceptance, recognition and respect. When analysed from a Maclntyrean perspective, the nurse practitioners lacked the purpose and goals that were evident in the descriptions of meaningful practice from the GPs and district nurses. Such a finding seems to be congruent with an emerging practice and challenges the nurse practitioner community to determine for itself the nature of its contribution to patient care.
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Dupuits, François Marie Hubert Marcel. "Diagnostic decision support for general practitioners." Maastricht : Maastricht : Universiteit van Maastricht ; University Library, Maastricht University [Host], 1997. http://arno.unimaas.nl/show.cgi?fid=5904.
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Gilboud, Elina. "Pricing Decisions by Australian General Practitioners." Thesis, Discipline of Economics, 2008. http://hdl.handle.net/2123/6439.
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In the Australian market for primary healthcare, some General Practitioners (GPs) bulk bill patients while others charge them a direct fee. The prevalence of these two fee structures means that patients are paying different prices for the same service. From a policy perspective, universal bulk billing is preferred since this leads to more equitable access to free primary healthcare. The empirical observation that bulk billing and fee charging GPs can exist in a single location has not been explained in the literature. This thesis seeks to explain the observation by differentiating GPs into those who provide long consultations and those who provide short consultations. Given the nature of policy in the market, these two types of GPs have different incentives when deciding whether to bulk bill or charge a fee. The hypothesis put forward in this thesis is that GPs who have long consultations will prefer to charge a fee while GPs who have short consultations will prefer to bulk bill.
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Brickley, Bryce. "Supporting Patient-Centred Care by General Practitioners." Thesis, Griffith University, 2021. http://hdl.handle.net/10072/410952.
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Patient-centred care (PCC) is an essential aspect of high-quality health care. Broadly, PCC is defined as care that is respectful and responsive to the needs and wishes of patients. The concept of PCC is embedded within primary health care policy throughout the world because of its potential to reduce the burden of disease and illness. The widespread policy-based advocacy towards PCC has resulted in many primary care organisations endorsing PCC and clinical teams enacting PCC. General practitioners (GPs), also referred to as family physicians, are positioned at the front-line of the primary health care system and are typically the first port of call for patients seeking health care services. There are several challenges for GPs to enact PCC holistically, such as lack of skills and knowledge regarding PCC, a lack of agreement in the literature of what constitutes GP-delivered PCC, and a lack of tools to support GPs with PCC. Supporting GPs to enact PCC is essential to achieve better patient outcomes from GP-delivered chronic disease management, preventative care and holistic care. The overarching aim of this PhD program was to build upon the understanding of GPdelivered PCC and research ways to support GPs to enact PCC. The sequential, multiphased design allowed the researcher to identify and subsequently address key gaps requiring further exploration. The aims within this doctoral research program were to synthesise literature relating to PCC delivered by GPs; explore patients’ and GPs’ perceptions and experiences of PCC; develop and evaluate a new model of PCC; develop and evaluate a tool kit to support GPs with PCC; and explore the perceptions and experiences of PCC within general practice teams during the COVID-19 pandemic. These aims were addressed in four phases of research. The research was within the pragmatic paradigm, qualitatively driven, and guided by assumptions from constructivist and interpretivist epistemological beliefs. In phase one, an integrative systematic literature review was conducted to identify studies that that related to GP-delivered PCC. Four main themes of GP-delivered PCC were identified, and these informed a new theoretical model with four components: 1) understanding the whole person, 2) finding common ground, 3) experiencing time, and 4) aiming for positive outcomes. The review identified several gaps in the literature, including a lack of qualitative studies involving both GPs and patients, which guided the subsequent research in conjunction with the updated theoretical model of GP-delivered PCC. In phase two, qualitative focus group interviews were conducted with patient advocates and GPs to explore perceptions and exp riences of PCC. Five themes emerged: 1) understanding of PCC is varied and personal, 2) valuing humanistic care, 3) considering the system and collaborating in care, 4) optimising the general practice environment and 5) needing support for PCC that is embedded into training. Findings suggested that more work was needed to create novel interventions with capacity to expose GPs to feedback from patients, promote GP self-reflection on PCC and support GPs to assess the patient-centeredness of the practice environment. Next, the model of GP-delivered PCC developed in phase one was qualitatively tested in the same focus groups. The data was synthesised to produce an updated model of PCC consisting of six inter-related elements, called Putting Patients First: A Map for Patient-Centred Care. Qualitative testing among GPs and patient advocates supported the credibility of the model and enhanced its applicability to ‘real world’ practice. In phase three, co-creation and action research informed the development of an innovative tool kit to support holistic PCC among general practice teams. This tool kit consolidates the new knowledge on PCC generated within this PhD and can be used in practice to support the understanding and delivery of PCC by general practice teams. The worldwide pandemic occurred during the research program and changed the anticipated direction of the final study to the delivery of PCC under pandemic conditions. One-on-one semi-structured interviews with practice representatives from five Australian general practice clinics who had been recognised for their pursuit of quality care. Key findings were that the pandemic altered the perceptions and experiences of PCC within general practice teams and created new barriers to enacting PCC. However, general practice teams who have previously been recognised for their ability to deliver high quality care, have maintained their focus on PCC. Strong leadership, patient-focused practice culture, new technology and infrastructure enabled PCC. This innovative PhD research contributes novel and important findings to support GPs with PCC. Collectively, the studies within the PhD informed a multifaceted understanding of GP-delivered PCC and described novel strategies to enact PCC. The concept of PCC has persevered despite the influence of the COVID-19 pandemic on the health system, and PCC should continue to be a focal point for research, policy, and practice. The understanding of PCC is varied among patients, GPs and between patients and GPs. Strategies to enhance PCC should emphasise the translation of complex PCC research, and harness the tools produced within this PhD to generate a uniform understanding of PCC between patients and general practice teams. The tools developed within the PhD can also provide a foundation for future research striving to enhance the levels of PCC in general practice; and inform policymakers and general practice organisations seeking to promote and sustain PCC. This work ensures that all patients and general practice teams have access to tools that can inform PCC.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Health Sci & Soc Wrk
Griffith Health
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Cassam, Carol L. "General practitioners have feelings too : the lived experience of antibiotic prescribing in a group of male general medical practitioners." Thesis, University of Surrey, 2015. http://epubs.surrey.ac.uk/807803/.
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Thousands of medical prescriptions are generated everyday by general practitioners (GPs) and one of the most frequently prescribed groups of medicines is antibiotic therapy (Duerden et al. 2011). Despite the many studies that have previously explored clinical decision making, there remains a lack of understanding about how GPs make clinical prescribing decisions. This study was undertaken because the lived experience in clinical decision making has not been widely studied and there is a gap in the literature. This study is the first of its kind to use a phenomenological approach to explore the lived experience and emotional side of antibiotic prescribing in the context of medical prescribing. The aim of this study was to explore, interpret, and understand the lived experience of antibiotic prescribing in general practice. To explore the lived experience of antibiotic prescribing, I used the methodological framework of hermeneutic interpretative phenomenology. Unstructured, face-to-face interviews were conducted with ten GP participants. I transcribed the interviews and based the analysis on Kvale’s six steps of data analysis. Medical prescribing is a complex process based on many factors that include intuitive feelings, clinical knowledge, and professional experience. There are many influences that evoke GPs’ emotions and these emotions then drive the prescribing decision. Influences are both internal, such as the knowledge and experience of the GP and external, such as patients, families, and national policy. Writing a prescription is one of the most frequent procedures undertaken in general practice, yet it often remains a challenging experience and causes many GPs to feel anxious, uneasy, and sometimes overwhelmed. Behind the confident and composed public face of GPs lies a professional group of clinicians who are caring and empathetic but often feel anxious and vulnerable. The findings of the study have implications for practice, education and research.
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Rosso, Stefano. "Preventive practices of general practitioners in Torino, Italy." Thesis, McGill University, 1989. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=59292.
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This thesis comprises a review of studies on the diffusion of recommended guidelines on preventive practices and three papers evaluating the preventive practice patterns of general practitioners in Torino, Italy.The first paper presents estimates of preventive practices and perceived effectiveness of preventive interventions. Patterns of practice were found to be consistently similar to those in other studies.
The second and third papers explore an array of determinants for ten primary and secondary preventive interventions.
An analysis of determinants indicates that complex patterns of behaviours are rather condition-specific, while the application of techniques is influenced to a varying extent by organizational and attitudinal factors.
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Weiss, Marjorie C. "Factors influencing the prescribing decisions of general practitioners." Thesis, University of Oxford, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.307966.
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Stewart, Roy E. "A multilevel perspective of patients and general practitioners." [S.l. : [Groningen : s.n.] ; University Library Groningen] [Host], 2009. http://irs.ub.rug.nl/ppn/.
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Morris, Caroline Judith. "Patients' and general practitioners' perceptions of minor ailments." Thesis, University of Manchester, 2000. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.488404.
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Rees, Sharon. "The role of nurses in general practice: general practitioners' and practice nurses' perceptions." University of Southern Queensland, Faculty of Sciences, 2004. http://eprints.usq.edu.au/archive/00001489/.
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The role of nurses in general practice: General Practitioners' and Practice Nurses' perceptions is a study that identifies the beliefs of Practice Nurses (PNs) and General Practitioners (GPs) of the PN role and how those roles impact on the general practice. Ethnographic techniquess were used for this study, with data collected through interviews, observation and questionnaires. Interviews were conducted with four PNs and four GPs in practices that employed nurses in an increased role similar to that described in the Nursing in General Practice Fact Sheets (Royal College of Nursing Australia, 2002). Two practices were observed to identify work practices and the nurses' interaction within the practice. The main finding of the study was the importance placed on the general practice team. Both GPs and PNs believed that working as a team was vital. They indicated that working together provided holistic care and enabled the practice to provide quality care. The role of the PN in this study was consistent with other studies in Australia. However, the nurses in this study appeared to have more autonomy in regard to care of people with chronic illness and the aged. Continuing education was considered important for the further development of the PN role. However, participants believed that the PN also needed to have considerable and varied experience together with good people skills. To further develop the PN role innovative ways of providing education to PNs should be investigated to ensure nurses have the necessary skills to undertake their role. Payment issues in general practice should also be examined and addressed to ensure that PNs are able to be employed, and receive remuneration appropriate for their experience and job description.
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Young, Megan. "General practitioners' familiarity with and practices related to haemochromatosis /." [St. Lucia, Qld.], 2003. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17037.pdf.
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Backlund, Lars. "General practitioners' decision-making on drug treatment of hypercholesterolaemia /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-672-3/.
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Wong, Pik-wah Angela, and 黃碧華. "General practitioners' use of computers: a Hong Kong study." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B25101225.
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Ariss, Steven M. B. "Exploring interactions between general practitioners and frequently attending patients." Thesis, University of York, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.423745.
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Wong, Pik-wah Angela. "General practitioners' use of computers : a Hong Kong study /." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25101225.
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Bower, Peter John. "Attitudes, models and the detection of psychiatric disorder in general practice." Thesis, St George's, University of London, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.307454.
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Ellis, Elaine. "Transforming rehabilitation : probation practitioners negotiating change." Thesis, Cardiff University, 2017. http://orca.cf.ac.uk/111710/.
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The focus of this research is probation practitioner reaction and adaptation to change. Previous studies have shown probation core values to be resilient, practitioners managing to react and adapt to change whilst remaining committed to traditional humanistic values. However, predictions emerging as the latest programme of change, brought about by ‘Transforming Rehabilitation: A Strategy for Reform’ suggest these changes could result in the end of probation as it had come to be known. This research is a case study of Durham Tees Valley Community Rehabilitation Company the only not for profit Community Rehabilitation Company in England and Wales. The study follows a cohort of practitioners through the first 15 months of implementing a new operating model. The research argues that in some ways the flexibility afforded by Transforming Rehabilitation allowed practitioners to regain professional discretion and work in ways that reflected probation’s original purpose and values. However, it is also argued that this flexibility came at the cost of fragmentation of the service and a subsequent loss of trust within and between different parts of the service. The mixed methods case study design allowed for in-depth exploration and tracking of a cohort of practitioners as they negotiated the process of change. Analysis and interpretation of the data revealed significantly different practitioner reactions to the changes, dependent mainly on the length of time practitioners had worked in probation and to a lesser extent on their level of qualification. Practitioners appeared to move through the process of adaptation at different rates, with qualified probation officers, trained during the height of national standards appearing to find the process of change most difficult. The thesis concludes by critically evaluating earlier predictions for the future of probation in light of these findings and information emerging about other Community Rehabilitation Companies.
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Hindler, Charles Geoffrey. "Drug misusers and their general practitioners : a survey of the views of drug misusers : training of general practitioners in the management of drug misuse." Thesis, University College London (University of London), 2000. http://discovery.ucl.ac.uk/1348852/.
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Objectives 1. To determine drug misusers' views about their primary health care and their relationship with general practitioners. 2. To undertake a controlled evaluation of small group education of general practitioners in the management of drug misusers. Method 1. Drug misusers attending five treatment services in north east London - a general practice with a special interest in managing drug misuse; a private drug clinic; a community drug team; a drug dependence unit and a street agency - were interviewed using a semi-structured interview and the Social Functioning Questionnaire. 2. All general practitioners who practised within the former North East Thames Regional Health Authority were approached to take part in small group teaching about drug misuse. This was conducted over two consecutive afternoons in a general practice, with four follow-up seminars. The trained doctors were compared with two groups of untrained general practitioners. Outcome measures included: Drug Training Questionnaire responses at the outset and 9 months after training; evaluation of the training appraised on a ten point Likert scale; Home Office Addicts Index and North Thames Regional Drug Misuse Database figures for notification of newly presenting subjects, for each of the three groups of general practitioners, 8 months prior to training and 8 and 16 months after training. Results Ninety percent of the drug misusers were registered with a non-specialist general practitioner and 88% of these doctors were aware of their patients' drug use. Half of the non-specialist general practitioners aware of their patient's drug use were reported as prescribing substitute medication. Sixty percent of misusers attending the non-specialist doctors perceived their general practitioners to hold negative or neutral views about them. Doctors in the specialist general practice were more likely to prescribe, compared to the other four centres, and 97% of their patients believed these doctors had a positive view of drug misusers. The specialist general practice was more active in providing counselling and/or education about drug misuse. 2. Forty doctors attended the teaching programme. Twenty-eight doctors comprised comparison group one (interested but unable to attend the teaching) and 30 formed comparison group two(not interested in training but completed questionnaires). The about to be trained group were seeing and treating more drug misusers compared to the comparison groups. The overall ratings for the teaching programme were high (7.9 for usefulness and 8.0 for interest - maximum score 10). Doctors in the trained group were found to be notifying significantly more drug misusers to the Home Office and prescribing methadone more frequent1y 16 months after the teaching, than doctors in the comparison groups. Over 9 months, the Drug Training Questionnaires demonstrated no significant changes. The cost of the course per doctor was £127. Conclusions 1. The majority of drug misusers attending treatment centres are registered with general practitioners and regarded them as an important health resource in managing both their drug use and wider medical issues, despite the reluctance of non-specialist general practitioners to be involved in prescribing and a high prevalence of unfavourable attitudes towards drug misusers. 2. The participating doctors assessed the teaching programme positively and it was relatively cheap to run. The self-report questionnaires as a single determinant of outcome revealed no significant change in attitudes, knowledge or behaviour but when assessed by more objective means, demonstrated a rise in notification rates and methadone prescribing by the trained doctors.
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Colquhoun, D. (David James), and n/a. "What is Maori patient-centered medicine for Pakeha general practitioners?" University of Otago. Dunedin School of Medicine, 2003. http://adt.otago.ac.nz./public/adt-NZDU20070508.144541.
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This research was designed to see whether the clinical method espoused by Moira Stewart et al in the book "Patient-Centered: Transforming The Clinical Method" is appropriate for Pakeha general practitioners to use in clinical consultations with Maori patients.
This thesis uses qualitative methodology. One of my supervisors and I selected from the kuia (old women) and kaumatua (old men) of Hauraki those whom I would approach to be involved. Nearly all responded in the affirmative.
The kuia and kaumatua talked about their tikanga, about the basis of tikanga, about the spirituality of their Maori worldview. They talked about the need to maintain their tikanga, about qualities that they respect. They described different roles within Maoridom, especially those of the kuia, whaea (mothers) and Tohunga (experts). They refer to a GP as a Tohunga because of the GP�s special expertise. The GP is able to use his or her special expertise to heal Maori patients, but needs to be able to get through barriers to do so. They are also clear that Maori and Pakeha live in two different worlds which can merge in some circumstances.
I came to two conclusions. The first is that the elements of Patient-Centered Medicine are relevant to the consultation of a Pakeha GP and Maori patient, and provides a framework that is productive. The second conclusion is that there is a better framework for working with Maori patients, within which Patient-Centered Medicine can be practiced more effectively. Maori already have a framework (tikanga) in which they function, and if in their settings, especially the marae, he or she is welcomed and has a place in their world; tikanga accommodates the GP as a Tohunga and Maori respond to him or her as such.
In summary, a Pakeha GP who has some knowledge of tikanga or Maori culture and who has a basic knowledge of the Maori language of tikanga of Maori culture and who has a basic knowledge of the Maori language can work very well for his or her Maori patients by working within the framework of Tikanga Maori and by being patient-centered in consultation.
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Braunack-Mayer, Annette. "General practitioners doing ethics : an empirical perspective on bioethical methods /." Title page, contents and abstract only, 1998. http://web4.library.adelaide.edu.au/theses/09PH/09phb8253.pdf.
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Peile, Edward Basil. "Evaluating process and outcome in the education of general practitioners." Thesis, Oxford Brookes University, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.289128.
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I set out to develop methodologies linking the educational processes adopted by General Practitioner trainers to outcomes, in terms of quality performance by their learners in later life as doctors. Evidence about educational process and about quality of practice must be collected and analysed in a format that takes full account of the judgements to be made for formative and summative assessment. This work iterates between considerations of evidence and judgements The first of three phases of research established a framework of categories and dimensions by which to describe educational behaviours of GP Trainers. This involved interviewing trained practitioners to find what had been of lasting value from training. The categories deriving from a Grounded Theoretical approach have proved useful in practice and have been incorporated into training assessments. Second Phase Research involved refining data collection methods for assessing prevalent educational behaviours in training practices. The process by which judgements are made about training was analysed and developed in the light of research findings, which support a trend towards self-assessment by trainers. The complexity of evidence collection is such that even experienced visiting teams struggled to construct meaningful aggregations across several categories in the course of a brief visit. Their limited data best serves to validate the self-assessments of trainers, carried out over an extended period of training, and involving potentially beneficial reflection-in-action and reflection-on-action. Finally, 31General Practitioners engaged in a pilot study of Insight 360® assessments of quality practice. Their self-assessments were compared against 331 patient assessments and 237 colleague perceptions. Literature review and preliminary experiments led to the conclusion that Multilevel Modelling (MLM) techniques are best suited to such data analysis. Even with small numbers, valid findings emerged around gender influences on self-perception, reinforcing the conclusion that MLM is needed if we are to relate complex data around quality of practice to the level of prior educational experience. .. Using the framework developed in this project, trainers can now be encouraged to examine their prevalent educational behaviours and record the evidence for formative and summative assessment. This work gives confidence that accumulated 3600 assessments of practitioners may in future be analysed using MLM techniques to shed light on different quality outcomes of varying educational processes
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Mildorf, Jarmila. "General practitioners' narrative discourse on domestic violence : a sociolinguistic study." Thesis, University of Aberdeen, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.395183.
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This doctoral thesis is founded on the sociolinguistic tradition of applying linguistic knowledge to social issues on the one hand, and the study of narrative on the other. The problem under investigation is general practitioners' narrative discourse on domestic violence. More precisely, this thesis: 1. analyses the discursive strategies GPs apply in interviews when they talk about their experiences with victims; 2. states what these strategies reveal about GPs' perceptions of and attitudes towards domestic violence; 3. demonstrates what this indicates with regard to the construction of medical knowledge about the issue; 4. identifies the problems the GPs' discursive practices might reveal and also engender for their daily work; 5. offers solutions from within the narrative framework as part of a larger endeavour to encourage cross-disciplinary collaboration. The data for this study were generated in twenty in-depth interviews with GPs in the City of Aberdeen in 2000. The linguistic features analysed include: evaluative devices, modalities, metaphors, thematic roles, passive constructions and spatio-temporal language. The analyses show that GPs often blur notions of agency and thus contribute to an indirect form of victim-blaming. A strategy of distancing is revealed which reconstructs patients as the 'deviant other'. At the same time, GPs express their anxieties about dealing with domestic violence. Furthermore, GPs locate and discuss the issue mainly within social rather than medical frameworks, and their discourse proves problematic as it is largely informed by common cultural myths which further stigmatise women who suffer abuse. GPs' "storied knowledge" is shown to be mainly constituted by extra-ordinary cases, which leads to a biased picture and may prove detrimental in GPs' daily practice work. Since the data identify a lack of adequate training on the issue currently offered to British GPs, the thesis finally proposes possible solutions in the form of a narrative teaching module on domestic violence.
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Wang, Qing. "Target payment and the UK NHS general practitioners service activity." Thesis, University of York, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.441059.
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Crabtree, Heather Jo. "Prescription Privileges for Psychologists: General Practitioners' Attitudes and Referral Behaviors." NSUWorks, 2011. http://nsuworks.nova.edu/cps_stuetd/22.
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The purpose of this study was to assess General Practitioners' (GPs') and medical students' attitudes towards psychologists seeking prescription privileges and their willingness to refer patients to these professionals, as well as factors relating to these variables. Three hundred and thirty-eight GPs from a national sample, and 48 medical students from a private medical school in the southeastern United States participated in this online study. Participants were divided into two experimental groups, with one group receiving additional information regarding the educational and training experiences of prescribing psychologists and one group receiving no additional information. Participants completed a survey, which assessed: demographic variables, attitudes, referral behaviors, and personality factors. It was predicted that participants receiving additional information prior to survey completion would have more favorable attitudes and referral behaviors than those who did not receive the information. This prediction was confirmed for participants' attitudes, but not referral behaviors. Results also indicated that the majority of participants held unfavorable attitudes towards prescribing psychologists and were generally unwilling to refer patients to these professionals. However, contrary to the research hypothesis, GPs were found to have more favorable attitudes and referral behaviors than medical students. Additionally, analyses were conducted in order to use multiple variables (e.g., information condition, participant type, gender, age, practice setting, location, openness score) to predict participants' attitudes and referral behaviors. However, these factors were only found to account for a very small percentage of participants' attitudes and referral behaviors. In light of this study's results, future research is needed in order to further explore factors related to attitudes and referral behaviors of GPs. Future research should also investigate ways to improve communication and collaboration between medical professionals and psychologists.
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Sager, D. "Exploring general practitioners' experiences of identifying and managing childhood obesity." Thesis, University of Salford, 2014. http://usir.salford.ac.uk/32048/.
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National policies (DoH, 2008; 2011) propose a clear role for GPs in responding to the increase in childhood obesity, despite a limited evidence base which would secure such an emphasis. Previous research has indicated multiple barriers to the engagement of GPs in this clinical activity due to the sensitivities of the subject, low levels of role competence and confidence and limited access to specialist services. Using interpretive phenomenological analysis, this study explored how GPs made sense of their experiences of identifying and managing childhood obesity in order to provide a unique insight into these professional behaviours. Retrospective semi-structured interviews were carried out with ten GPs,who had been in practice for over 25 years. Four themes emerged. The first ‘understanding the family’ demonstrated how the GPs utilised their knowledge of the family’s health beliefs, motivations, skills, and wider socio economic factors to compile a unique understanding of the family which framed their responses to the obese child. The second ‘flexibility and responsiveness’ explored how this complex knowledge of the family was used to negotiate and address the different physical and emotional needs of the child. The third theme ‘professional and individual dilemmas’ explored areas of professional uncertainty, the identification of perceived legitimate role boundaries and the personal belief systems of the GPs regarding childhood obesity. The final theme ‘organisational challenges’ highlighted how time pressures, competing priorities, and structural constraints challenged their abilities to provide effective responses. An extended explanatory insight is provided by exploring the GPs’ dominant epistemological framework which resulted in the identification of 4 role types, using Laws et al., (2009) theoretical framework. The role types are considered in relation to the GPs’ professional identities and their contextual responses to the child and family. The research concludes with practical recommendations for service improvement at the practitioner, commissioner and national policy level.
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Hartley, Nicholas Terry. "General practitioners' beliefs about obesity and their decision to treat." Thesis, University of Leeds, 2013. http://etheses.whiterose.ac.uk/4964/.
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The current study explored the relationships between GPs' beliefs about the cause of obesity and treatment choices. Participants (n = 81) responded to two sets of materials; vignettes featuring obese patients in which the grade and cause of obesity were manipulated, and a survey of beliefs about the causes of obesity. Participants were asked to rate how likely it would be for the patient to receive each of six treatments. Group comparisons, correlational analyses and logistic regression methods were employed. The results revealed that, as obesity increased, participants were more likely to refer patients on for all of the interventions rather than to 'watch and wait' and provide advice directly. The grade of obesity explained the most variance in ratings of treatment choice, suggesting that GPs' decisions are in line with current guidelines (NICE, 2006). Participants were more likely to agree with statements supporting an internal locus of control in the cause of obesity (LoCI) than an external locus of control (LoCE). Participants' beliefs that obesity is caused by LoCE factors were associated with them being more likely to refer for both medical interventions (pharmacological/surgical) and behavioural-based treatments (nurse/dietician/clinical psychology). Participants' beliefs that obesity is caused by LoCI factors were associated with GPs being more likely to 'watch and wait'. Previous research suggests that patients are more likely to believe obesity is out of their control (Ogden et al, 2001). The current study therefore suggests that GPs are more likely to work directly with patients who have different beliefs about the cause of obesity to their own. The implications of this finding for future research and practice are discussed.
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Smith, Liz. "How do clinicians use guidelines in decision making?" Thesis, University of Aberdeen, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.252143.
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This thesis presents a series of studies about general medical practitioners’ patient management decisions in depression and the role of the clinical guideline within these. The goal of the research was to identify the factors that influence their prescribing and to investigate how guideline use could be increased so as to promote clinical effectiveness. A lens model study found that GPs tend to over prescribe compared with the guidelines and place much more emphasis on patients’ reports of thoughts of suicide and sleep disturbance than the guideline. Although GPs’ judgement data were well described by regression models, a simple fast and frugal model of decision-making explained the judgement data equally well. A cluster analysis was carried out on the resulting GPs’ decision policies and 3 clusters emerged which could be differentiated by the size of practice they worked in. GPs in the larger practices had decision policies, which were more like those of guideline recommendations. GPs were found to have good self-insight in to their decision-making when a policy recognition task was used. A further analysis found that GPs in one area in England prescribed at a greater rate than those in the Grampian region of Scotland and decision policies showed that patient treatment preference had less influence on the English GPs’ decisions. The results from these quantitative studies were explored further by using in-depth interviews with GPs. A number of factors which help to explain why the GPs are sometimes prevented from following guideline recommendations and fulfilling patient treatment wishes and why changing behaviour in order for it to be more compliant with guideline recommendations it so difficult.
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Evans-Jones, Josephine Helen. "How does a GP decide to refer to a mental health specialist?" Thesis, Open University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250489.
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Dyer, Mary A. "What does it mean to be an early years practitioner? : an investigation into the professional identity of graduate early years practitioners." Thesis, University of Huddersfield, 2018. http://eprints.hud.ac.uk/id/eprint/34584/.
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This study explores the impact of government-driven change (DfEE, 198; DfES, 2006, DCSF, 2008; DfE, 2017b), within a sector largely comprising privately owned and managed organisations, on how individual practitioners understand their role and their professional identity. Workforce reform strategies included the introduction of sector-endorsed degrees to promote the use of critical reflection to raise the quality of practice, a skill understood to develop confidence, autonomy and agency in practitioners (Moss, 2006; Osgood, 2010), for which a personal vision of practice (Dyer and Taylor, 2012) is required. This raises a potential tension between the empowering nature of reflection, and expectations of compliance with government-led standards and practice guidance. This study explores how this shapes graduate practitioners’ understanding and articulation of professional identity, and their understanding of their professional status and agency. 23 semi-structured interviews were conducted, within which participants shared narratives of their practice experience, discussing what they considered to be strong and weak practice, and how they prioritised the different aspects of their role. These were analysed using the Listening Guide (Doucet and Mauthner, 2008), an approach selected for its effectiveness in drawing attention to the voice and the stories of narrators, to understand how they perceive their world and themselves within it. The data analysis draws on literature exploring the nature of early years practice, power relations within the sector, and the formation of professions. This study shows that these participants understand professionalism and their role in terms of the relationships they form within their own organisations, privileging interpersonal skills over abstract, high level knowledge, and presenting these as personal values rather than professional ethics. By using Bronfenbrenner’s ecological model of development (Bronfenbrenner, 1979; 1986), this study identifies that these participants engage with their sector largely within the micro-and meso-systems of early years practice, limiting their agency as a professional workforce. It is isolation, rather than lack of knowledge, that restricts their agency, from other practitioners within the workforce, from the politics that drive change within the sector, and also from the research community that produces the knowledge they use to underpin their practice. This study concludes with curricular and pedagogic implications for professional educators within the sector, and also identifies how the workforce itself might more closely engage with the wider systems that impact on their sector.
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Jabareen, Hussein Mohammad. "Skill mix development in general practice : a mixed method study of practice nurses and general practitioners." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/632/.
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General practice has undergone considerable change in the last two decades. New roles for nurses working in general practice have extended to include tasks that were previously delivered by general practitioners, in particular chronic disease management, and the development of new, advanced roles such as independent nurse prescribing. There have been few research studies investigating the impact of these changes, especially after the introduction of the new General Medical Services contract in April 2004. The overall aim of the work presented in this thesis was to examine the emerging roles of practice nurses, the forces influencing that development, and the effects of these changes on doctor-nurse skill mix in general practice within NHS Scotland. The work employed a mixed methods approach, with three inter-linked studies. The first study was a quantitative, desk-based analysis of workload and clinical activities of doctors and nurses working in 37 practices across Scotland for the year 2002. The second study was a postal questionnaire to all practice nurses working within NHS Greater Glasgow (n=329), conducted in autumn 2005 and achieving a 61% response rate. The third study was a qualitative study, consisting of eighteen interviews with a doctor and nurse inform each of nine general practices. The interviews were conducted between January and July 2006 and practices were selected according to the number of partners and the deprivation status of the practice population. Analysis of workload data showed that practice nurses and general practitioners dealt with 27.5% and 72.5% of total face-to-face encounters, respectively. Many of the encounters with nurses involved chronic disease management, with 20% of such encounters appearing similar in content to the work of GPs. The postal survey found that one third of practice nurses were aged over 50, and will be approaching retirement within 10 years. The majority worked in small teams of nurses, although 31% worked alone. This may have contributed to the finding that 52% (n=103) reported feeling isolated in their workplace. Many had attended CPD training on chronic conditions, but identified minor illness treatment as an area for future training. The qualitative study showed that the Quality and Outcomes Framework of the 2004 contract had been a key driver of changes in general practice service delivery. This has led to an increasing shift in routine care from doctors to nurses. As new roles for practice nurses have evolved, GPs have been able to focus on treating complex morbidities that need medical diagnosis and intervention. The incentivised targets of the new contract have made chronic disease management a predominant activity for practice nurses, with treatment room and non-incentivised activities featuring less and increasingly being provided by new, lower grade nurses or nurse replacements such as Health Care Support Workers (HCSW). There was no consensus between interview participants in terms of the most appropriate use of doctor-nurse skill mix in general practice. Nor did they agree on the merit of advanced roles for practice nurses. However, respondents did emphasise that nurses who wanted to have an independent/advanced role in the practice would need to combine three competencies (independent nurse prescribing, triaging, and minor illness treatment). Most practice nurses interviewed were concerned with obtaining a fair financial return to match their increasing responsibilities, especially after the introduction of the nGMS contract. GPs, however, tended to believe that nurses were appropriately remunerated for the level of responsibility they had within the practice. The continuing role of the GP as the employer of practice nurses was problematic for some nurses and many felt there would be advantages to being employed on Agenda for Change terms and conditions. However, the majority of nurses interviewed preferred being employed by a GP rather than the Health Board. There was little support amongst either nurses or GPs for the notion of nurse partners within practices. Overall, these studies provide lessons which will be of value in planning the future training and development of practice nurses. It suggests that practice nurses should obtain proper training and support in order to meet their individual needs and to carry out new responsibilities and roles. In addition, the impending shortage of practice nurses due to retirement, lack of retention and potential recruitment difficulties needs to be addressed urgently at the level of primary care policy and manpower planning.
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Durey, Angela. "The changing face of rural general practice: an ethnographic study of general practitioners and their spouses." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2005. https://ro.ecu.edu.au/theses/61.
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Rural general practice is general practice at its best: a comment by one GP interviewed for this study was echoed by colleagues who viewed their work in a rural setting as challenging, diverse, rewarding and satisfying. Despite reported difficulties associated with rural general practice, many GPs argued that the benefits outweigh the disadvantages. Few wanted to leave. Nonetheless, too few Australian trained GPs are willing to move from cities to work in the country. Consequently, overseas trained doctors have been recruited to fill vacancies or nurses provide health services in communities unable to attract a GP.
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Buhler, Patricia Lynn. "Prenatal care : a comparative evaluation of nurse-midwives and general practitioners." Thesis, University of British Columbia, 1985. http://hdl.handle.net/2429/24489.
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The practice of midwifery by those other than physicians is illegal in Canada and despite recommendations of nursing, medical and consumer groups, no trials evaluating the effectiveness of the nurse-midwife as a member of the modern obstetrical team have occurred here. To demonstrate a nurse-midwifery model, four nurse-midwives provided primary care to forty-seven childbearing women and their families over a twenty-two month period in a maternity teaching hospital. This clinic presented a unique opportunity for comparing the prenatal care provided by nurse-midwives with that of general practitioners who attended deliveries in the same setting. Utilizing a retrospective chart audit, case control study design, the nurse-midwife cases (NM cases) were each matched to two general practitioner controls (GP controls) through the use of the hospital's prenatal data base. The matching characteristics included low risk status, date of delivery, age, parity, gravidity, previous pregnancy losses and census tract income. Prenatal criteria that had been developed and tested in "The Burlington Randomized Clinical Trial of the Nurse Practitioner" for assessing the quality of care were reviewed and updated for this study. With these criteria two blinded abstractors audited the prenatal record forms of all the subjects and scored them as either "superior", "adequate" or "inadequate".
Seventy-seven percent of the records of the NM cases received a
"superior" score, where as 60% of the GP controls' records received an
"inadequate" score [mathematical formula omitted] Overall, the general
practitioners' records indicated more erratic care than those of the nurse-midwives. Although the physicians met most of the initial assessment criteria, they failed to meet the criteria that evaluated the ongoing routine assessment process by recording an inadequate number of prenatal visits (36%), or by omitting urine test results (38$) and blood pressure readings (21%). No differences were found in variables relating to labour and delivery with the exception of the incidence of episiotomies. The results indicate that nurse-midwives as part of an obstetrical team are able to provide safe prenatal care to a low risk population in a Canadian urban context, and that their records are thorough and more consistent than those of general practitioners.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Simmons, Tanya Ann. "The effect of general practitioners' participatory helpgiving practices on patient empowerment /." Title page, table of contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09ARPS/09arpss5921.pdf.
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Harries, Clare. "Judgement analysis of patient management : General Practitioners' policies and self-insight." Thesis, University of Plymouth, 1995. http://hdl.handle.net/10026.1/1630.
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In this thesis judgement analysis (multiple linear regression techniques) was used to look at both GPs' decisions to prescribe certain types of drug for patients and their judgements of patients' risk of coronary heart disease. All of these were idiographic analyses in that decision making by each GP was modelled separately. Judgement analysis (paramorphically) describes a subject's judgement or decision making policy in terms of the relative influence of different pieces of information. The amount of information subjects could take into account was limited. For all types of judgement or decision doctors were influenced on average by only four of the thirteen or twelve cues available. The decision to prescribe one of the types of drug was modelled not only in terms of the individual effects of cues (judgement analysis) but also in terms of the influence of the doctor's assessment of the patient's risk. Doctors agreed more about judgements of risk and the factors influencing this than about prescription. Doctors only prescribed to patients they rated as at high risk but factors such as for example smoking behaviour led some doctors not to prescribe to individuals in this group. Judgement and decision making policies (explicit policies) were also elicited verbally from doctors. These showed greater agreement than the policies captured using judgement analysis (tacit policies) did. When these explicit policies were compared to tacit policies a moderate amount of correspondence was found. However, doctors tended to over-rate the importance of certain cues. A number of explanations for this pattern of self-insight were investigated including the possibilities that doctors have self-insight but are unable to state it and that the pattern was an artefact of linear modelling. Both of these hypotheses were rejected. Subjects' explicit policies were found to resemble the pattern of selection of information more than the pattern of its use. Both the hypotheses that subjects' explicit policies were based on phenomenal knowledge and that they are based on some ideal model (influencing which cues are selected) were supported.
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Irfan, Muhammad. "Knowledge and practices of general practitioners of district Peshawar about schizophrenia." Master's thesis, Faculdade de Ciências Médicas. UNL, 2012. http://hdl.handle.net/10362/9425.
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ABSTRACT: Schizophrenia with its disabling features has been placed in the top ten of global burden of disease and is associated with long-term decline in functional ability. General Practitioners not only have an important role in treating patients with an established diagnosis of schizophrenia but they can also contribute significantly by identifying people in early stages of psychosis as they are the first hand medical help available and the duration of untreated psychosis is a good indicator of patient’s prognosis.
This cross sectional survey, conducted at the clinics of General Practitioners, was designed to assess the knowledge and practices of general practitioners in Peshawar on diagnosis and treatment of schizophrenia. A semi structured questionnaire was used to assess their knowledge and practices regarding schizophrenia. The Knowledge/Practice was then categorized as good or poor based on their responses to the questions of the administered questionnaire.
Overall, the results showed that the knowledge and practices of general practitioners of district Peshawar were poor regarding schizophrenia and may be responsible for delayed diagnosis, inadequate treatment and poor prognosis.
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Liountris, Demitri. "Exploring rape myth acceptance among general medical practitioners in South Africa." Master's thesis, Faculty of Law, 2021. http://hdl.handle.net/11427/32782.
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Rape myths have several negative effects on society, and can affect those who come into contact with victims of sexual assault on a professional level. One group of professionals that assist victims are general medical practitioners and in a country like South Africa, that has a high rate of rape, it is not uncommon for general medical practitioners to find themselves assisting victims. Previous research has suggested that professionals who assist victims such as police officers and lawyers are susceptible to rape myth acceptance. In South Africa, research suggests that medical health professionals can have negative views of victims, depending on a number of factors such as the victim's behaviour and alcohol consumption. Presenting data collected using the Illinois Rape Myth Acceptance Scale (IRMAS) from a sample of 44 general medical practitioners in South Africa, it was found that the participants had low levels of rape myth acceptance. The findings indicated that not only were rape myths not strong influences within the sample, myths that related to the concept of ‘real rape' were the least likely to be supported. Furthermore, additional questions in the survey revealed that general medical practitioners are not well-equipped to provide care to victims of sexual assault and more effort is needed with regards to service provision.
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Cuevas, Marianela. "Perceptions of elder abuse among Australian elderly individuals and general practitioners." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1998. https://ro.ecu.edu.au/theses/994.
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Research available on elder abuse is limited. There continues to be a lack of uniformity in how to define and identify the problem, as well as how to intervene. One group which continues to be excluded from the process of gaining knowledge on the issue of elder abuse is the elderly themselves. As general practitioners are the primary source of health care for older people, their perspectives on elder mistreatment should be explored as well. The first objective of this study was to examine whether differences existed in the perceived severity of potentially abusive situations between three groups of older people and general practitioners. The second objective was to determine if gender differences existed in perceptions of severity of abuse. The sample consisted of 48 general practitioners, 40 independent elderly, 38 elderly caregivers and 36 elderly care-receivers. The participants' perceptions of elder abuse were assessed using a modified version of a questionnaire developed by Moon and Williams (1993). The questionnaire described 10 potential elder abuse scenarios which covered five categories of abuse: physical, psychological, sexual, financial and neglect. Participants were asked to indicate whether or not they perceived each situation to represent an example of elder abuse and, if they answered affirmatively, to rate the severity of the abusive behaviour and identify which aspect of the scenario they considered abusive. Data were analysed using split-plot analysis of variance, as well as contingency tables. The results suggested that significant differences existed in the perceptions of severity of elder abuse scenarios across groups and gender. General practitioners tended to view the scenarios as less severe examples of elder abuse than the older-aged groups. There were similarities within the elderly groups in that all groups perceived the sexual abuse scenarios as examples of more severe forms of abuse than the financial abuse scenarios. Within the elderly groups, caregivers generally perceived the scenarios as less abusive. With regard to gender differences, females generally perceived the sexual abuse scenarios as more severe than males. This was particularly so for female independent elders and female care-receivers. Both the symbolic interaction theory and social exchange theory were adopted to explain why there were differences in the perceived severity of the scenarios. It was argued that how the participants viewed the interactions between the characters in the scenarios, and whether they perceived the interactions as being rewarding or unrewarding for particular characters, would affect participants' perceptions of severity. To conclude, with such differences in views found, the development of effective assessment and intervention strategies will be difficult. However, both the public and professionals alike need to increase their understanding on the topic of elder abuse, lest the abuse continues.
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Hannis, Dorothy. "An ethnography of general practice in the north east of England." Thesis, Durham University, 2000. http://etheses.dur.ac.uk/4085/.
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This thesis is based on an eighteen-month period of fieldwork with a group of general practitioners in the North East of England. Changing patterns in the practice of primary health care are examined alongside a detailed discussion of the role of the practice nurse in order to set general practice in its cultural and historical context. The thesis takes issue with the positioning of primary health care practitioners squarely within Kleinman's 'professional' sector. Within this context, three major themes relating to the primary health care setting are identified as being of major relevance to the enquiry 1. the use of narratives by patients and practitioners, both clinical and therapeutic 2. The role of the general practitioner and practice nurse in mediation between the patient and the secondary health care sector and the role of the practice nurse in mediation between the general practitioner and the patient3. the similarities in practice between healers in primary health care settings and ethnomedicine in traditional and developed societies These themes are illustrated by the use of fieldwork material and are discussed with reference to current anthropological theory concerning narrative, mediation, dialogics, the placebo effect and the practice of shamanism, as an example of ethnomedicine. On the basis of an examination of the similarities between primary care practitioners and ethnomedical practitioners, namely: quality of practitioner-patient relationship based on narrative understanding, shared cultural explanatory models, and shared mediatory role, this thesis concludes that a shared philosophy underlines the two, and that general practice is in itself a system of ethnomedicine practised within the Western context.
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Jovicic, Ana. "General Practitioners' views and experiences of loneliness in their older adult patients." Thesis, University of Essex, 2018. http://repository.essex.ac.uk/23260/.
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Background: Loneliness is associated with numerous detrimental effects on physical health, mental health, cognition, and lifestyle. Older adults are one of the groups at highest risk of loneliness, and indeed about 46% of older adults in England are lonely. Those experiencing loneliness visit their General Practitioner (GP) more frequently than those who are not, which has the capacity to put a strain on GPs and primary care waiting lists and costs. There is some literature on GPs’ experiences of other social problems, but it is yet unknown how GPs in the UK perceive and work with loneliness in older adult patients. Aims: To explore GPs’ views and experiences of loneliness within their older adult patients. Method: A qualitative approach was taken for this research and followed a social constructivist perspective. 19 GPs were recruited using researcher contacts, snowballing, and purposive sampling. Individual semi-structured interviews were conducted either in person or over the telephone. Data were transcribed and analysed using thematic analysis Findings: Five over-arching themes and 14 corresponding sub-themes were presented. GPs’ definitions of loneliness and its prevalence in our society is discussed. GPs held a medicalised and individualistic view regarding loneliness. They discussed their barriers to raising the topic, as well as the social stigma surrounding loneliness for both GP and patient. GPs felt powerless in their ability to fix the problem, and tended to use self-protection strategies. Further need for GP support and system improvements were discussed. Conclusions: Study findings are discussed in the context of relevant theories and literature. Implications include greater emphasis on social problems like loneliness in GP training, more practical and emotional support for qualified GPs, and a clearer more streamlined approach to managing loneliness presentations in primary care. Strengths and limitations of the study are discussed, and avenues for future research suggested.
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Nascimento, R. W. F. D. "An exploration of contemporary working life and professionalism of general practitioners (GPs)." Thesis, Exeter and Plymouth Peninsula Medical School, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.713938.
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This thesis contributes to the scholarship of medical professionalism by construing an anthropological study with general practitioners (GPs) in the United Kingdom (UK). Whilst enquiring into GPs’ working lives, the study attempts to move along interdisciplinary approaches of professionalism by following it in everyday life. It is based on anthropological fieldwork carried out in Devon and Cornwall from November 2011 to February 2013 with mid-career GPs in the National Health Service (NHS). I engaged in participant observation by shadowing four GPs for over eight weeks each and conducted in-depth interviews with two GPs in addition to those I shadowed. Partaking in exploratory enquiries into their working life, the study has three major outcomes. Firstly, I craft a narrative and descriptive account of the ‘correspondence’ process between the GPs and I, attending to what GPs showed or told me and the personal experiences they enabled me to undergo in their presence. I argue that GPs exposed me to ways of carrying on a life informed by a specific “professional culture” but also by a wider “culture of professionalism”. Secondly, I discern motional, spatial and temporal references that provide a sense of orientation in everyday work, such as the moods alternating between work motions, the boundaries delimiting the workplace, and the tasks distinguishing moments at work. I argue that such norms and values, by ordering everyday life, inform GPs’ ‘moral experience’ of professionalism. Thirdly, I examine the premises by which medical generalism presumes ‘jurisdiction’ over place, time and action, and explore GPs’ self-investment in such professionalism claims when negotiating with oneself between one’s expectations and the actualities of working life. I argue that professionalism, as economic morality, affords a personhood animated by an evolving occupational ethos enmeshed with other moral logics along which GPs, as wayfarers, are making a way of life. The thesis proposes an analytical distinction between therapeutic and professional dimensions of medical work. By focusing on the latter, I consider how professionalism engages at micro and macro levels, local and global scales, and in particulars and universals. Finally, by interweaving this ‘practice of education’, the study brings to life a moral economy of professionalism.
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Heywood-Everett, Suzanne Mary. "General practitioners' diagnosis, management and referral of patients with an eating disorder." Thesis, University of Leeds, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.438489.
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Cottrell, Elizabeth. "General practitioners' attitudes, beliefs and behaviours regarding exercise for chronic knee pain." Thesis, Keele University, 2016. http://eprints.keele.ac.uk/2389/.
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Patients with chronic knee pain (CKP) frequently present to general practitioners (GPs). Exercise, a core management approach for CKP, reduces pain and improves functioning. To maximise patient outcomes, GPs should practise in line with best evidence recommendations. Using an underpinning model (developed using behavioural theory), this thesis describes the attitudes, beliefs and behaviours of GPs regarding the use of exercise for patients with CKP. A systematic review revealed a paucity of published studies specifically examining this topic. Available data suggested that GPs’ attitudes and beliefs about exercise for CKP varied widely, exercise appeared to be underused and its implementation by GPs was unclear. The need to concurrently and specifically investigate the attitudes, beliefs and behaviours of GPs regarding exercise for CKP was identified. A vignette-based pilot questionnaire survey of 800 UK GPs was undertaken to refine the survey tool and methods and to inform the required sample size for the main survey. The subsequent main survey of 5000 UK GPs revealed that exercise was used by most GPs for CKP. However, methods employed to initiate exercise within an individual patient’s management plan were variable and imperfectly aligned with evidence-based recommendations. Attitudes and beliefs about exercise for CKP were generally positive; however GPs expressed some uncertainty about safety and efficacy, particularly regarding local exercise (e.g. strengthening, range-of-movement, stretching). Although some elements of the underpinning model (e.g. role and identity) predicted GPs’ behaviour, others (e.g. beliefs about capabilities) performed less well. To maximise the clinical outcomes of patients with CKP, recommendations from this research include: development of educational, organisational change and/or behaviour change strategies to improve initiation of individualised exercise, and clarification of GPs’ role, in this context. Approaches to better understand the key influences on GPs’ behaviour are required; a greater focus on decision-making theory may be valuable.
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Ram, Paul. "Comprehensive assessment of general practitioners a study on validity reliability and feasibility /." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 1998. http://arno.unimaas.nl/show.cgi?fid=8535.
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Köberlein, Juliane, Mandy Gottschall, Kathrin Czarnecki, Alexander Thomas, Antje Bergmann, and Karen Voigt. "General practitioners' views on polypharmacy and its consequences for patient health care." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-127598.
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Background: Multimorbidity is defined as suffering from coexistent chronic conditions. Multimorbid patients demand highly complex patient-centered care which often includes polypharmacy, taking an average of six different drugs per day. Adverse drug reactions, adverse drug events and medication errors are all potential consequences of polypharmacy. Our study aims to detect the status quo of the health care situation in Saxony’s general practices for multimorbid patients receiving multiple medications. We will identify the most common clinical profiles as well as documented adverse drug events and reactions that occur during the treatment of patients receiving multiple medications. We will focus on exploring the motives of general practitioners for the prescription of selected drugs in individual cases where there is evidence of potential drug-drug-interactions and potentially inappropriate medications in elderly patients. Furthermore, the study will explore general practitioners’ opinions on delegation of skills to other health professions to support medical care and monitoring of patients receiving multiple medications.
Methods/design: This is a retrospective cross sectional study using mixed methods. Socio-demographic data as well as diagnoses, medication regimens and clinically important events will be analyzed retrospectively using general practitioners documentation in patients’ records. Based on these data, short vignettes will be generated and discussed by general practitioners in qualitative telephone interviews.
Discussion: To be able to improve outpatient health care management for patients receiving multiple medications, the current status quo of care, risk factors for deficient treatment and characteristics of concerned patients must be investigated. Furthermore, it is necessary to understand the physicians’ decision making process regarding treatment.
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Vanagas, Giedrius. "Work characteristics and work-related psychosocial stress among general practitioners in Lithuania." Thesis, Nordic School of Public Health NHV, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3278.
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Background. There are a number of studies showing that general practice is oneof the most stressful workplaces for health care workers. Since the Baltic States regained independence in 1990, a reform of the health care systems took place in which a new role and more responsibilities were allocated to general practitioners. This study aimed to explore the psychosocial stress level among Lithuanian general practitioners (GPs) and examine the relationship between their psychosocial stress and work characteristics. Methods. A cross-sectional study was madeof 300 Lithuanian general practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the Karasek scale. The analyses included descriptive statistics, interrelationship analysis between the different characteristics, and multivariate logistic regression to estimate odd ratios for each of the independent variables in the model. Results. The study shows that 48% of the respondents could be classified as suffering from work related psychosocial stress by the Reeder scale. The highest job strain prevalence was among widowed, single and female GPs. The lowest job strain prevalence was among males and GPs of older age. Job strain occurs when job demands are high and jobdecision latitude is low. Conclusions. The greatest risk tophysical and mental health from stress occurs to general practitioners facing high psychological workload demands combined with low decision latitude in meeting those demands. High job demands, patient load more than 18 patients per day and young age of general practitioners can predict a statistically significant effect on job strain.ISBN 91-7997-095-8
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McGlade, Kieran John. "A study of general practitioners awareness of psychological morbidity among surgery attenders." Thesis, Queen's University Belfast, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335971.
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Linden, Gerard James. "The management of periodontal disease by general dental practitioners in Northern Ireland." Thesis, Queen's University Belfast, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387893.
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