This study was conducted to describe the difficulties perceived by general practitioners concerning 24 common clinical problems and to compare their perceptions with those of faculty members in family medicine. A random sample of 467 general practitioners and all 182 faculty members in family medicine in Quebec were sent one of four open-ended questionnaires, each of which dealt with six clinical problems; 214 general practitioners and 114 faculty members participated. A total of 5111 difficulties were reported; the number reported by each subject varied from 0 to 13 (mean 2.6 [standard deviation 2.09]) per problem. The problems that generated the most difficulties were depression, confusion in the elderly, chronic back pain, loss of autonomy in the elderly and sexually transmitted disease. The most frequent difficulties were with the patient's noncompliance with treatment, clinical diagnosis, failure of a specific treatment, inadequate health care resources and the physician's own emotional reactions. The difficulties for each problem were the same in the two groups 70% of the time. Physician's perceptions of their difficulties can be useful in the planning of initial training and continuing medical education.
Cites: Biometrics. 1977 Mar;33(1):159-74843571
Cites: N Z Med J. 1983 May 25;96(732):395-76573610
Cites: Med Care. 1983 Jan;21(1):105-226403780
Cites: N Engl J Med. 1982 Mar 4;306(9):511-57057858
Cites: Can Med Assoc J. 1981 Mar 1;124(5):563-67471001
In a model incorporating uncertainty and state-dependent utility of health services, as well as information asymmetry between patients/buyers and physicians/sellers, two types of equilibria are compared: (1) when consumers have conventional third-party insurance and doctors are paid on the basis of fee-for-service; and (2) when insurance is through an HMO which provides health services through its own doctors. Conditions are found under which contractual or legal incentives can overcome the information asymmetry problem and bring about an efficient allocation of resources to health services provision.
A study was carried out in the county of Vestfold in the spring of 1989 to establish the quality and quantity of the medical services for patients nursed at home. The study showed that doctors in rural districts provide better service than doctors in the towns. This difference is particularly noticeable in the case of patients who are acutely ill. The study also showed that patient-doctor contacts are seldom for patients nursed at home, with an average frequency of one every eight weeks for consulting-room consultations and one every 15 weeks for visits to the home.
Among patients consulting general practitioners in northern Norway, 57% had a stable relationship with one doctor, according to answers to a questionnaire. Rather than having a free choice between several doctors, 85% preferred to have a personal doctor. About half the patients wanted the same doctor for the whole family. Even if they had to wait longer for the consultation, 63% would prefer to meet their own doctor. A personal doctor was much less common in northern Norway than in the rest of the country, which could be put down to lower stability in the practices.
In this article the author discusses some of the principles of evaluation of quality of care in general practice and connects this with some empiric results of a study which attempted to evaluate the quality of work of the general practitioners in a Finnish health centre. Data were obtained by 1) recording all the 8701 persons visiting during one year; 2) drawing a systematic sample of 2540 persons from all those who visited; and 3) abstracting the required information from patient documents to specially planned precoded and pretested forms. The objectives of the study included the investigation of the quality aspects of the health centre doctor services, among other things also the continuity and coordination of care. The results raise questions concerning the quality of work. No general conclusions on the quality of care are drawn, since the data may not be adequate for that. According to the author, the findings emphasise the importance of at least three things: The consideration of what is done in the context of the patients' prognosis, the communication skills of the general practitioners and the communication between the general practitioners who work in the same place. In the light of the described and other findings of the study it is strongly recommended that the study of the contents of the work should be an integral part of today's general practice.
Prostate cancer (PC) patients continue to have unmet information needs at the time of diagnosis and are often unable to communicate their preferences to physicians at the time of the treatment consultation.
The objective of the study was to determine the impact of health information-seeking behavior (HISB) and personal factors on patients' preferred role in treatment decision making (TDM).
Participants consisted of 150 men with newly diagnosed PC seen at 2 urology clinics in western Canada. A survey questionnaire was used to gather information on HISB, personal factors influencing treatment choice, and decision control.
More than 90% of the participants reported a preference to play either an active or collaborative role in TDM and having either an "intense" or "complementary" HISB. No significant association was found between HISB and preferred role in TDM. Impact of treatment on survival and urinary function and the urologist's recommendation were identified as the 3 main factors influencing the treatment decision.
At the time of diagnosis, the majority of men want to be involved in TDM and have access to information. Our findings suggest that the type and amount of information men want to access are dependent on HISB. Assessing factors having an impact on TDM may prove useful to guide patient-clinician treatment discussions.
This survey provides clinicians with a method to assess information and decision preferences of men with newly diagnosed PC and factors having an influence on treatment choice.