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Acceptance of guideline recommendations and perceived implementation of coronary heart disease prevention among primary care physicians in five European countries: the Reassessing European Attitudes about Cardiovascular Treatment (REACT) survey.

https://arctichealth.org/en/permalink/ahliterature47472
Source
Fam Pract. 2002 Dec;19(6):596-604
Publication Type
Article
Date
Dec-2002
Author
F D Richard Hobbs
Leif Erhardt
Author Affiliation
Division of Primary Care, Public and Occupational Health, Department of Primary Care and General Practice, University of Birmingham, Edgbaston, UK. f.d.r.hobbs@bham.ac.uk
Source
Fam Pract. 2002 Dec;19(6):596-604
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Attitude of Health Personnel
Chi-Square Distribution
Coronary Disease - prevention & control
France
Germany
Great Britain
Guideline Adherence
Humans
Hypercholesterolemia - prevention & control
Interviews
Italy
Physician's Practice Patterns - statistics & numerical data
Physicians, Family - psychology
Primary Health Care
Risk assessment
Risk factors
Sweden
Abstract
BACKGROUND: Although primary care is the major target of coronary heart disease (CHD) clinical recommendations, little is known of how community physicians view guidelines and their implementation. The REACT survey was designed to assess the views, and perceived implementation, of CHD and lipid treatment guidelines among primary care physicians. METHODS: Semi-structured validated telephone interviews were conducted, in the relevant native tongue, with 754 randomly selected primary care physicians (GPs and family doctors) in five European countries (France, Germany, Italy, Sweden and the UK). RESULTS: Most physicians (89%) agreed with the content of current guidelines and reported use of them (81%). However, only 18% of physicians believed that guidelines were being implemented to a major extent. Key barriers to greater implementation of guidelines were seen as lack of time (38% of all physicians), prescription costs (30%), and patient compliance (17%). Suggestions for ways to improve implementation centred on more education, both for physicians themselves (29%) and patients (25%); promoting, publicizing or increasing guideline availability (23%); simplifying the guidelines (17%); and making them clearer (12%). Physicians perceived diabetes to be the most important risk factor for CHD, followed by hypertension and raised LDL-C. Most physicians (92%) believe their patients do associate high cholesterol levels with CHD. After establishing that a patient is 'at risk' of CHD, physicians reported spending an average of 16.5 minutes discussing risk factors and lifestyle changes or treatment that is required. Factors preventing this included insufficient time (42%), having too many other patients to see (27%) and feeling that patients did not listen or understand anyway (21%). CONCLUSIONS: Primary care physicians need more information and support on the implementation of CHD and cholesterol guideline recommendations. This need is recognized by clinicians.
Notes
Comment In: Fam Pract. 2003 Jun;20(3):35012738707
PubMed ID
12429661 View in PubMed
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Adoption of the Healthy Heart Kit by Alberta family physicians.

https://arctichealth.org/en/permalink/ahliterature147884
Source
Can J Public Health. 2009 Mar-Apr;100(2):140-4
Publication Type
Article
Author
Raphaël Bize
Ronald C Plotnikoff
Shannon D Scott
Nandini Karunamuni
Wendy Rodgers
Author Affiliation
Centre for Health Promotion Studies, School of Public Health, University of Alberta, Edmonton, AB, Canada.
Source
Can J Public Health. 2009 Mar-Apr;100(2):140-4
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alberta
Attitude of Health Personnel
Cross-Sectional Studies
Female
Health Care Surveys
Health promotion
Heart Diseases - prevention & control
Humans
Linear Models
Male
Middle Aged
Multivariate Analysis
Patient Education as Topic - methods
Physician's Practice Patterns
Physicians, Family - psychology - statistics & numerical data
Practice Guidelines as Topic
Public Health
Questionnaires
Social Marketing
Abstract
The Healthy Heart Kit (HHK) is a risk management and patient education kit for the prevention of cardiovascular disease (CVD) and the promotion of CV health. There are currently no published data examining predictors of HHK use by physicians. The main objective of this study was to examine the association between physicians' characteristics (socio-demographic, cognitive, and behavioural) and the use of the HHK.
All registered family physicians in Alberta (n=3068) were invited to participate in the "Healthy Heart Kit" Study. Consenting physicians (n=153) received the Kit and were requested to use it for two months. At the end of this period, a questionnaire collected data on the frequency of Kit use by physicians, as well as socio-demographic, cognitive, and behavioural variables pertaining to the physicians.
The questionnaire was returned by 115 physicians (follow-up rate = 75%). On a scale ranging from 0 to 100, the mean score of Kit use was 61 [SD=26]. A multiple linear regression showed that "agreement with the Kit" and the degree of "confidence in using the Kit" was strongly associated with Kit use, explaining 46% of the variability for Kit use. Time since graduation was inversely associated with Kit use, and a trend was observed for smaller practices to be associated with lower use.
Given these findings, future research and practice should explore innovative strategies to gain initial agreement among physicians to employ such clinical tools. Participation of older physicians and solo-practitioners in this process should be emphasized.
PubMed ID
19839292 View in PubMed
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[Analysis of the debate on the general practice list system on the Eyr]

https://arctichealth.org/en/permalink/ahliterature71778
Source
Tidsskr Nor Laegeforen. 2001 Dec 10;121(30):3509-12
Publication Type
Article
Date
Dec-10-2001
Author
H. Sandvik
Author Affiliation
Institutt for samfunnsmedisinske fag Universitetet i Bergen Ulriksdal 8 c 5009 Bergen. hogne.sandvik@isf.uib.no
Source
Tidsskr Nor Laegeforen. 2001 Dec 10;121(30):3509-12
Date
Dec-10-2001
Language
Norwegian
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Attitude to Computers
Computer Communication Networks - utilization
English Abstract
Family Practice - organization & administration
Female
Humans
Internet
Male
Middle Aged
Norway
Physicians, Family - psychology
Physicians, Women - psychology
Abstract
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.
PubMed ID
11808009 View in PubMed
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[Are only general practitioners lost? Identity crisis of general practitioners--crisis of health care services?].

https://arctichealth.org/en/permalink/ahliterature194369
Source
Lakartidningen. 2001 May 2;98(18):2228-9
Publication Type
Article
Date
May-2-2001
Author
M. Magi
Author Affiliation
Ekensbergs vårdcentral, Nyköping. margus.magi@nln.dll.se
Source
Lakartidningen. 2001 May 2;98(18):2228-9
Date
May-2-2001
Language
Swedish
Publication Type
Article
Keywords
Burnout, Professional
Health services needs and demand
Humans
Identity Crisis
Interprofessional Relations
Physician's Role
Physician-Patient Relations
Physicians, Family - psychology
Sweden
PubMed ID
11402604 View in PubMed
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[Are out of hours contacts with physicians necessary? Assessment by physicians on call and by patients]

https://arctichealth.org/en/permalink/ahliterature32795
Source
Ugeskr Laeger. 2000 Apr 3;162(14):2032-6
Publication Type
Article
Date
Apr-3-2000
Author
H C Kjeldsen
L C Ovesen
M B Christensen
F. Olesen
Author Affiliation
Aarhus Universitet.
Source
Ugeskr Laeger. 2000 Apr 3;162(14):2032-6
Date
Apr-3-2000
Language
Danish
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Attitude of Health Personnel
Child
Denmark
Emergency Medical Services - manpower - statistics & numerical data - utilization
English Abstract
Evaluation Studies
Family Practice - statistics & numerical data
Health Services Misuse
Humans
Middle Aged
Patients - psychology
Physicians, Family - psychology
Questionnaires
Referral and Consultation - statistics & numerical data
Research Support, Non-U.S. Gov't
Abstract
Patients and GPs were asked about necessity and possible prevention of contacts to the out of hour service. 4187 (83.9%) of the GP questionnaires and 1493 (52.3%) of the patient questionnaires were returned. According to the GPs 25% of the contacts were not necessary and 5% were not necessary according to the patients. Patients and GPs agreed that contacts concerning old people were most necessary. GPs assessed contacts concerning children relatively more necessary. Patients assessed contacts concerning middle-aged relatively more necessary. Frequent users were assessed less necessary according to GPs but more necessary according to the users themselves. Many contacts could have been prevented according to both GPs and patients--especially within the first five hours of the service. Concordance between a patient's and a GPs answer was bad (kappa = 0.0-0.2). Concordance between the GPs answering the phone and the GPs examining the patient was only slightly better (kappa = 0.1-0.3).
PubMed ID
10815518 View in PubMed
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Assessing methods for measurement of clinical outcomes and quality of care in primary care practices.

https://arctichealth.org/en/permalink/ahliterature122368
Source
BMC Health Serv Res. 2012;12:214
Publication Type
Article
Date
2012
Author
Michael E Green
William Hogg
Colleen Savage
Sharon Johnston
Grant Russell
R Liisa Jaakkimainen
Richard H Glazier
Janet Barnsley
Richard Birtwhistle
Author Affiliation
Department of Family Medicine, Queen's University, Kingston, Ontario, Canada. michael.green@dfm.queensu.ca
Source
BMC Health Serv Res. 2012;12:214
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Chronic Disease - epidemiology - therapy
Cross-Sectional Studies
Diagnosis-Related Groups - statistics & numerical data
Female
Health Knowledge, Attitudes, Practice
Health Surveys
Humans
Male
Medical Audit - methods
Middle Aged
Ontario - epidemiology
Outcome Assessment (Health Care) - methods
Patient Acceptance of Health Care - psychology - statistics & numerical data
Patient Credit and Collection
Patients - psychology
Physicians, Family - psychology - standards
Preventive Health Services - economics - standards - statistics & numerical data
Primary Health Care - standards
Quality Indicators, Health Care
Social Class
Abstract
To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC) practices.
This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30) were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources.
Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening.
Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were willing to participate in and consent to, the collection and linkage of information from multiple sources that would be required for such assessments.
Notes
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PubMed ID
22824551 View in PubMed
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[Assessment of community mental health centres by general practitioners].

https://arctichealth.org/en/permalink/ahliterature166728
Source
Tidsskr Nor Laegeforen. 2006 Nov 2;126(21):2787-91
Publication Type
Article
Date
Nov-2-2006
Author
Øyvind Andresen Bjertnaes
Sigve Oltedal
Andrew Garratt
Jon Helgeland
John-Arne Røttingen
Author Affiliation
Nasjonalt kunnskapssenter for helsetjenesten, Postboks 7004 St. Olavs plass, 0130 Oslo. oyvind.andresen.bjertnes@kunnskapssenteret.no
Source
Tidsskr Nor Laegeforen. 2006 Nov 2;126(21):2787-91
Date
Nov-2-2006
Language
Norwegian
Publication Type
Article
Keywords
Attitude of Health Personnel
Clinical Competence
Community Mental Health Services - standards
Health Care Surveys
Humans
Interdisciplinary Communication
Interviews as Topic
Norway
Physicians, Family - psychology
Quality Assurance, Health Care - methods
Quality Indicators, Health Care
Questionnaires
Abstract
General practitioners' evaluation of Community Mental Health Centres (CMHC) has become a part of the Norwegian system of quality indicators. On the basis of a national survey, we present the way in which GPs have assessed the quality of 77 CMHCs.
A questionnaire was posted to every GP in Norway from November 2005 to March 2006. This was followed up with 2-3 reminders and telephone interviews. 2,415 out of 3,704 GPs (65%) responded.
GPs gave highest score for professional competence, the average being 55 on a scale of 0-100, where 100 is best. They gave lowest score for counselling (30) and staff situation (45). The average score given to the various CMHCs varied a lot for all dimensions, the largest difference being for counselling, with the highest average 58 and the lowest 8. There were many significant differences between various CMHCs' scores and the national average. When it came to counselling, the average score for 20 CMHCs was significantly different from that for the other CMHCs.
As GPs are important collaborators and users of the CMHCs, their views are valuable. The present findings need to be discussed. Many of the community mental health centres received all in all positive feedback from the GPs, suggesting that they may have useful experiences to share.
Notes
Comment In: Tidsskr Nor Laegeforen. 2007 Jan 4;127(1):64-5; author reply 6517205097
PubMed ID
17086217 View in PubMed
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Assessment of family physicians' performance using patient charts: interrater reliability and concordance with chart-stimulated recall interview.

https://arctichealth.org/en/permalink/ahliterature160442
Source
Eval Health Prof. 2007 Dec;30(4):376-92
Publication Type
Article
Date
Dec-2007
Author
François Goulet
André Jacques
Robert Gagnon
Pierre Racette
William Sieber
Author Affiliation
Collège des médecins du Québec, Montreal. goulet.cmq@sympatico.ca
Source
Eval Health Prof. 2007 Dec;30(4):376-92
Date
Dec-2007
Language
English
Publication Type
Article
Keywords
Clinical Competence
Humans
Interviews as Topic
Medical Audit - methods - standards
Medical Records
Mental Recall
Observation
Observer Variation
Peer Review, Health Care - standards
Physicians, Family - psychology - standards
Quality Assurance, Health Care - methods
Quebec
Reproducibility of Results
Abstract
Peer-assessment processes with chart review have been used for many years to assess the clinical performance of physicians. The Quebec medical licensing authority has been required by provincial law to assess the practicing Quebec physicians on a nonvoluntary basis. During the period from January 2001 to November 2004, 25 family physicians in active practice were randomly selected from a pool of about 300. For each physician, 25 to 40 patients' medical charts were randomly selected to evaluate the interrater reliability of peer-review assessment of medical charts and to compare ratings based on chart review with a chart-stimulated recall interview to those based on chart review alone. The concordance between chart review alone and that of chart review with chart-stimulated recall interview was 75% for chart keeping, 69% for clinical investigation, 81% for diagnostic accuracy, and 74% for treatment plan. Ratings based on chart review alone achieve moderate levels of reliability (Kappa = 0.44 to 0.56). It appears that some important information about quality of care is missed when only chart review is used.
PubMed ID
17986671 View in PubMed
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Assessment of psychosocial work environment in primary care--development of a questionnaire.

https://arctichealth.org/en/permalink/ahliterature198928
Source
J Med Syst. 1999 Dec;23(6):447-56
Publication Type
Article
Date
Dec-1999
Author
S. Wilhelmsson
I. Akerlind
T. Faresjö
A C Ek
Author Affiliation
Faculty of Health Sciences, Department of Medicine and Care, Linköping University, Sweden.
Source
J Med Syst. 1999 Dec;23(6):447-56
Date
Dec-1999
Language
English
Publication Type
Article
Keywords
Factor Analysis, Statistical
Humans
Physicians, Family - psychology - statistics & numerical data
Pilot Projects
Primary Health Care - manpower - statistics & numerical data
Psychology, Social
Public Health Nursing - manpower - statistics & numerical data
Questionnaires
Social Environment
Sweden
Work - psychology - statistics & numerical data
Workplace - psychology - statistics & numerical data
Abstract
Recent studies have indicated deteriorated working conditions of health care personnel. To have an efficient health care organization requires good working conditions and the well-being of the personnel. Today there are no "gold-standard" assessment tools measuring psychosocial working conditions. The aim of this study was to develop two valid and reliable questionnaires, one generic and one specific, measuring psychosocial working conditions for general practitioners (GPs) and district nurses (DNs) in Sweden, with a special emphasis on organizational changes. The construction of the questionnaires were made after a stepwise developing phase including literature review, interviews, and a pilot study. The pilot study included GPs n = 42 and DNs n = 39. The questionnaires were later on used in a main study (GPs n = 465, DNs n = 465). A factor analysis was carried out and showed that there were fewer items in the main study that had factor loading > or = 0.40 in more than one factor, compared to the pilot study. The factors from the main study were easier to label and had good correspondence with other studies. After this stepwise development phase good construct validity and internal consistency were established for the questionnaire.
PubMed ID
10763164 View in PubMed
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Associations between successful palliative trajectories, place of death and GP involvement.

https://arctichealth.org/en/permalink/ahliterature99272
Source
Scand J Prim Health Care. 2010 Sep;28(3):138-45
Publication Type
Article
Date
Sep-2010
Author
Mette Asbjoern Neergaard
Peter Vedsted
Frede Olesen
Ineta Sokolowski
Anders Bonde Jensen
Jens Sondergaard
Author Affiliation
The Palliative Team, Department of Oncology, Aarhus University Hospital, Denmark. man@alm.au.dk
Source
Scand J Prim Health Care. 2010 Sep;28(3):138-45
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Death
Cross-Sectional Studies
Denmark
Family Practice
Female
Home Care Services
House Calls
Humans
Male
Middle Aged
Neoplasms - nursing - psychology - therapy
Palliative Care - manpower - methods
Physician's Role
Physicians, Family - psychology
Professional-Family Relations
Questionnaires
Registries
Retrospective Studies
Terminal Care - manpower - methods
Abstract
OBJECTIVE: General practitioner (GP) involvement may be instrumental in obtaining successful palliative cancer trajectories. The aim of the study was to examine associations between bereaved relatives' evaluation of palliative cancer trajectories, place of death, and GP involvement. DESIGN: Population-based, cross-sectional combined register and questionnaire study. SETTING: The former Aarhus County, Denmark. SUBJECTS: Questionnaire data on GPs' palliative efforts and relatives' evaluations of the palliative trajectories were obtained for 153 cases of deceased cancer patients. MAIN OUTCOME MEASURES: A successful palliative trajectory as evaluated retrospectively by the relatives. RESULTS: Successful palliative trajectories were statistically significantly associated with home death (PR 1.48 (95% CI 1.04; 2.12)). No significant associations were identified between the evaluations of the palliative trajectory at home and GP involvement. "Relative living with patient" (PR 1.75 (95% CI: 0.87; 3.53)) and "GP having contact with relatives" (PR 1.69 (95% CI 0.55; 5.19)) were not significantly associated, but this may be due to the poor number of cases included in the final analysis. CONCLUSION: This study indicates that home death is positively associated with a higher likelihood that bereaved relatives will evaluate the palliative trajectory at home as successful. No specific GP services that were statistically significantly associated with higher satisfaction among relatives could be identified, but contact between GPs and relatives seems important and the impact needs further investigation.
PubMed ID
20698730 View in PubMed
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313 records – page 1 of 32.