In the opinion of the public, accessibility is probably one of the most important features of general practice. More than 3,500 patients in North Norway answered a questionnaire asking for their opinions on waiting time for consultation, the time spent in consultation and the possibility of the doctor visiting them at home. 80% thought that a waiting time of more than one week was too long. The actual waiting times differ considerably, but only a few practices serving less than 900 inhabitants per physician managed to satisfy their patients. On the other hand, about 80% found the time allocated for the consultation to be adequate. Almost half the patients who expressed an opinion thought it too difficult to get a doctor to visit them at home. Less than 10% considered a long distance to travel to a doctor to be an obstacle. Not surprisingly, young people were most demanding as regards quick service. Men were somewhat more satisfied than women, as were patients in rural areas compared with patients in the towns. In our opinion, some of the patients' causes of dissatisfaction can be removed by better routines. However, it seems that the resources available within general practice, are inadequate to meet all the patients' wishes, either now or in the future.
BACKGROUND: The most heavily discussed subject on Eyr, the Norwegian mailing list for general practitioners, has been the introduction of a general practice list system (GPLS). MATERIAL AND METHODS: All messages in the GPLS debate were recorded from its start in August 1996 up until the GPLS was introduced nationwide in June 2001. RESULTS: During this period, 243 different persons posted 2,153 messages about the GPLS, 232 of the participants were physicians, 203 of them GPs. Mean age was 46 years; males were strongly overrepresented (87%). 80% of the participants posted ten or fewer messages, 10% posted 11-20 messages, and 10% posted more than 20 messages. GPs sent most of their messages in the evenings, academics and public health officers sent most of their messages during work hours. Mean length of the messages was 179 words, 72% were responses to earlier messages. Most of the messages were neutral regarding the GPLS, 207 (9.6%) were negative, and 181 (8.4%) positive. Academics, public health officers, and participants in a GPLS trial were heavily overrepresented with positive messages. INTERPRETATION: It is concluded that this debate has been fairly balanced. Participation greatly exceeded what would have been possible in traditional media.
Initial efforts to increase the availability of training positions, standardise training, and obtain national recognition for family physicians who wished to practise anaesthesia had stalled.
To describe the work undertaken to create and sustain family medicine anaesthesiology capacity in Canada.
In our review, we examined the critical aspects of successful intersectoral work, namely, involvement by key stakeholders; the development of decision-making mechanisms; clearly defined objectives, roles and responsibilities; official support and legitimisation from participating organisations and adequate resources for partnership building.
Canadian rural family medicine anaesthesiology practice.
A small steering committee obtained funding for a national meeting of stakeholders and subsequent committee work over an 18-month period. The national meeting brought together the necessary stakeholders to review and discuss the issues and agree on a group-determined agenda, determine a work plan, identify priority areas and allow the College of Family Physicians of Canada to be the lead organisation in moving the work ahead. Within 18 months, the boards of the key organisations had accepted a common set of standards for training and a national curriculum. Work remains in the longer term to identify sustainable funding for training of family physician as well as the provision of continuing medical education for those trained.
Appropriate attention to the key components of successful intersectoral work may enable previously stalled and complex work to move ahead despite opposition.
Organization of anticoagulation therapy in general practice is described on the basis of data from 56 general practitioners interviewed by questionnaire. The average number of patients controlled by each practitioner was 12.0, and 52% of the general practitioners performed the analyses themselves. In municipalities with a local hospital only 13% of the general practitioners performed the analyses themselves, compared with 75% in municipalities without a hospital. The average weekly number of Thrombotests performed by each practitioner was 12.2. When an external laboratory was used 88% were contacted earlier in the case of International Normalized Ratio (INR) > 4.8 while this was uncommon (12%) in the case of International Normalized Ratio
OBJECTIVES: The aim of this study was to identify clinical characteristics of depression in elderly people that could be useful for case finding in general practice. DESIGN: A cross-sectional study of clinical characteristics through review of medical records. SETTING: Herrhagen health centre, Karlstad, Sweden. SUBJECTS: Seventy-one persons with a high depressive score in a screening of depressive symptoms and an age-matched and sex-matched control group of 138 persons with a low depressive score. RESULTS: The high depressive score group had an increased relative risk for "mental health problems" (RR 3.4; CI 95% 1.7-7.2), "many contacts with the health care centre" (> or = 14/3 years) (RR 2.9; CI 95% 1.4-6.1), and prescriptions of benzodiazepines (RR 1.7; CI 95% 1.0-2.9). Two-thirds of those in the high depressive score group had at least one of these characteristics. However, three-quarters of those with any of these characteristics had a low depressive score. In our population of elderly people with an estimated prevalence of 10.2% the positive predictive value would be 21% and the negative predictive value 95%. CONCLUSION: General practitioners should suspect a possible depressive disorder in elderly patients with mental health problems, with frequent contacts with the health centre or with prescriptions of benzodiazepines. Despite the high occurrences of these prominent clinical characteristics in the high-score group, they did not unfortunately have sufficient discriminatory power to be useful for case finding.
Patient priorities and patient evaluations indicate that accessibility should receive more attention to increase quality in general practice. The definition of family medicine emphasizes the patient-centred approach, communication skills, continuity, and clinical skills. We aimed to explore the associations between the 23 items in the Europep questionnaire measuring patient evaluation of general practice and the patients' recommendation of their general practitioner (GP) to friends and to study the relationship of these items with the core competences of family medicine.
Cross-sectional study where patients aged 18 years and over attending the practice were included. Patients completed the Danish version of the 23 item Europep questionnaire and an additional item about the degree to which they could recommend their GP to friends.
Danish general practice (the DanPEP study).
A total of 50 191 patients and 690 GPs were included in the analyses.
For each item, associations were calculated between a positive answer and the degree to which the patient could recommend the GP. Analyses were made at patient and GP levels.
We found 12 items that covered the 10 most strongly associated items from both analyses: four of six items from the "doctor-patient relationship", two of five items from "medical care", and all items from "information and support" and "organization of services". No items from "accessibility" were among the 12 items.
Recommending the GP to others was most strongly associated with the "emphatic", "patient-oriented", "informative and coordinating", and "competent/skilled" GP and to a lesser degree with accessibility to general practice.
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BACKGROUND: Most cancer patients die at institutions despite their wish for home death. GP-related factors may be crucial in attaining home death. AIM: To describe cancer patients in palliative care at home and examine associations between home death and GP involvement in the palliative pathway. DESIGN OF STUDY: Population-based, combined register and questionnaire study. SETTING: Aarhus County, Denmark. METHOD: Patient-specific questionnaires were sent to GPs of 599 cancer patients who died during a 9-month period in 2006. The 333 cases that were included comprised information on sociodemography and GP-related issues; for example knowledge of the patient, unplanned home visits, GPs providing their private phone number, and contact with relatives. Register data were collected on patients' age, sex, cancer diagnosis, place of death, and number of GP home visits. Associations with home death were analysed in a multivariable regression model with prevalence ratios (PR) as a measure of association. RESULTS: There was a strong association between facilitating home death and GPs making home visits (PR = 4.3, 95% confidence interval [CI] = 1.2 to 14.9) and involvement of community nurses (PR = 1.4, 95% CI = 1.0 to 1.9). No other GP-related variables were statistically significantly associated with home death. CONCLUSION: Active involvement of GPs providing home visits and the use of home nurses were independently associated with a higher likelihood of facilitating home death for cancer patients. The primary care team may facilitate home death, accommodating patients' wishes. Future research should examine the precise mechanisms of their involvement.
3,739 patients in North-Norway were asked about the preferred time of day for an appointment with the doctor. One in five indicated a time outside current opening hours. The oldest patients, and those living in rural areas, were the groups who preferred current opening hours. More than half the patients aged 21-64 indicated that the time they preferred was during their own free time. The study shows that an adjustment in the opening hours of doctors' practices is necessary if the patients' wishes are to be accommodated.