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Links between mental health care professionals and general practices in England and Wales: the impact of GP fundholding.

Corney, R H
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1996 EN
Relevância na Pesquisa
46.1%
BACKGROUND: Fundholding general practitioners are able to determine the type of contracts they place with providers of mental health care, and are able to employ some categories of mental health care professionals directly. The impact of this on the care of the mental health of patients in non-fundholding practices is not yet fully known. AIM: A survey was undertaken of 100 fundholding general practices and 100 similarly sized non-fundholding practices in order to investigate the changes in mental health provision made by general practitioners. METHODS: A sample of 100 fundholding general practices in England and Wales was randomly chosen from the list supplied by the Association of Fundholders and matched to a similarly randomly chosen sample of non-fundholding practices. Postal questionnaires were sent to the senior partner and to the practice manager in each practice. RESULTS: The number of mental health care professionals who are either employed by or attached to general practices, or who visit the general practice on a regular basis appears to have increased substantially since 1991. This increase was particularly marked in fundholding practices. The results suggest that general practitioners with specific links to particular mental health care providers were more satisfied with the service provided by the mental health care team...

Research general practices: what, who and why?

Smith, L F
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /02/1997 EN
Relevância na Pesquisa
46.06%
BACKGROUND: By the autumn of 1995, 14 research general practices had been funded. These are service NHS general medical practices that are supportive of primary care research and have a lead GP who has research experience as evidenced by publication in peer-reviewed journals. AIM: To ascertain the characteristics of those who have been successful in securing the first 14 grants, the effect the process has had on them, and the practical advice they would offer to future applicants and to future funding bodies. METHOD: A confidential postal survey of research general practices. RESULTS: They are atypical practices (high level of research and teaching involvement, mostly non-urban) with atypical lead GPs (male, research degrees, possess MRCGP, publications and grants obtained). Practices contemplating applying for future research practice grants should consider planning ahead, use of grant monies, protection of research time, involving the primary health care team, and sources of both internal and external support. Funding bodies need to make adequate funding available for capital expenditure and running costs as well as staff and lead GP time. CONCLUSION: Research general practices are ideal for integrating the core values of the medical profession...

Prevalence of breastfeeding at four months in general practices in south London.

Sikorski, J; Boyd, F; Dezateux, C; Wade, A; Rowe, J
Fonte: Royal College of General Practitioners Publicador: Royal College of General Practitioners
Tipo: Artigo de Revista Científica
Publicado em /06/2001 EN
Relevância na Pesquisa
56.04%
BACKGROUND: Successive quinquennial National Infant Feeding Surveys have provided a valuable picture of national and regional variations in infant feeding practices within the United Kingdom. Social variation in breastfeeding has been recognised to be an important source of health inequalities in childhood by the Independent Inquiry into Inequalities in Health Report. AIM: To determine the prevalence of breastfeeding at birth and at four months in a sample of women from urban general practices, its variation between practices, and relation to practice population deprivation scores. To report the timing of introduction of solid feeds. DESIGN OF STUDY: Cross-sectional questionnaire survey based on a random cluster sample. SETTING: Women with infants aged four months in general practices in South London. METHOD: Mode of infant feeding at birth and four months, and time of introduction of solids. Jarman score as a measure of practice population deprivation. Housing tenure, maternal ethnic group, and maternal age at leaving full-time education. RESULTS: Twenty-five general practices were sampled. Median practice Jarman score was 15.0 (interquartile range [IQR] = 12.6-21.9). Responses were received from 1053 out of 1532 mothers approached (69%). Of these...

A comparison of research general practices and their patients with other practices--a cross-sectional survey in Trent.

Hammersley, Vicky; Hippisley-Cox, Julia; Wilson, Andrew; Pringle, Mike
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/2002 EN
Relevância na Pesquisa
46.07%
BACKGROUND: When interpreting results of studies undertaken by research networks we need to know how representative volunteer practices and their registered patients are of the total population of practices and patients in their locality. AIM: To compare the following in research and non-research general practices in one region: practice and population demography, morbidity and mortality, selected performance indicators, and health outcomes. DESIGN OF STUDY: Cross-sectional survey. SETTING: Sixty-six Trent Focus Collaborative Research Network general practices and 749 other general practices in Trent, United Kingdom. METHOD: Practice characteristics and GP contract data were obtained from the NHS Executive, Quarry House, Leeds. The Trent Regional NHS Hospital Admission Database was searched to identify all relevant admissions to hospital from all practices between 1 April 1993 and 31 March 1997. Ward-linked data on cancer were obtained from the Trent Cancer Registry. RESULTS: Of the 815 general practices in Trent Region in the study period, 66 (8%) were in the Trent Focus network. They were more likely to be involved in training GPs and to have a female partner. They tended to be larger, with fewer single-handed doctors and younger GPs. Network practices prescribed a higher proportion of generics (median % prescribed/practice = 70%...

Distribution of mental health professionals working on site in English and Welsh general practices.

Kendrick, T; Sibbald, B; Addington-Hall, J; Brenneman, D; Freeling, P
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 28/08/1993 EN
Relevância na Pesquisa
46.08%
OBJECTIVE--To describe the nature and distribution of mental health professionals working on site in general practices. DESIGN--Postal questionnaire and telephone interview survey. SETTING--English and Welsh general practices. SUBJECTS--1880 general practitioners, of whom 1542 (82%) responded. MAIN OUTCOME MEASURES--Prevalence, types, and distribution of mental health professionals working on site among general practices. Factors predicting the presence of mental health professionals on site. RESULTS--The number of practices reporting the presence on site of each type of professional were 528 for community psychiatric nurses; 266 for practice counsellors; 177 for clinical psychologists; 132 for psychiatrists; 96 for psychiatric social workers; and 45 for psychotherapists. Mental health professionals tended to cluster together in practices more often than expected by chance alone. Practice characteristics which independently predicted the presence of a mental health professional on site were having four or more partners; being a training practice; and running stress, bereavement, or other mental health clinics. The proportions of practices with mental health professionals on site varied significantly among health regions. There was no association between the presence of mental health professionals on site and the location of practices...

A prescribing incentive scheme for non-fundholding general practices: an observational study.

Bateman, D. N.; Campbell, M.; Donaldson, L. J.; Roberts, S. J.; Smith, J. M.
Fonte: BMJ Group Publicador: BMJ Group
Tipo: Artigo de Revista Científica
Publicado em 31/08/1996 EN
Relevância na Pesquisa
46.06%
OBJECTIVE: To examine the effects of a financial incentive scheme on prescribing in non-fundholding general practices. DESIGN: Observational study. SETTING: Non-fundholding general practices in former Northern region in 1993-4. INTERVENTION: Target savings were set for each group of practices; those that achieved them were paid a portion of the savings. MAIN OUTCOME MEASURES: Financial performance; prescribing patterns in major therapeutic groups and some specific therapeutic areas; rates of generic prescribing; and performance against a measure of prescribing quality. SUBJECTS: 459 non-fundholding general practices, grouped into three bands according to the ratio of their indicative prescribing amount to the local average (band A > or = 10% above average, B between average and 10% above, C below average). RESULTS: 102 (23%) of 442 practices achieved their target savings (18%, 19%, and 27% of bands A, B, and C respectively). Band C practices that achieved their target had a lower per capita prescribing frequency for gastrointestinal drugs, inhaled steroids, antidepressants, and hormone replacement therapy. There were no other significant differences in prescribing frequency, and no reduction in the quality of prescribing in achieving practices. Total savings of pounds 1.54 m on indicative prescribing amounts were achieved. Payments from the incentive scheme and discretionary quality awards resulted in pounds 463...

Disease management for hypertension: a pilot cluster randomized trial of 67 Australian general practices

Turnbull, D.; Beilby, J.; Ziaian, T.; Qureshi, F.; Nelson, M.; Tonkin, A.; Marley, J.
Fonte: Adis International Ltd Publicador: Adis International Ltd
Tipo: Artigo de Revista Científica
Publicado em //2006 EN
Relevância na Pesquisa
55.87%
OBJECTIVES: We aimed to assess the feasibility of implementing, within Australian general practice, an innovative disease management program for hypertension. The central platform of this program is an information communication technology package for risk assessment and management, access to a dietitian commissioned by the program and a tailored set of audiovisual and written material. METHODS: We carried out a pilot cluster randomized controlled trial (stratified for rurality) of 67 general practices (including 371 patients) across two Australian states. Our primary hypothesis was that a disease management program would improve the cardiovascular risk score in patients with mild to moderate hypertension, compared with that of patients being treated according to current clinical practice. Analysis was by intention to treat. RESULTS: There was a borderline significant favorable treatment effect of the disease management program on the cardiovascular risk score of 4.6 percentage points (95% CI –9.7, 0.6) (theoretical range: 0–100%) at 6 months. At 12 months there was a non-statistically significant effect of approximately 2 percentage points. The proportion of patients achieving the target blood pressure of ≤130/85mm Hg was modest at between 20% and 30%. There was no treatment effect of the disease management program on this outcome at 6 months and a treatment effect favoring the control group was seen at 12 months (difference = –11.6%; 95% CI –21.1...

Quality of routine spirometry tests in Dutch general practices

Schermer, T.; Crockett, A.; Poels, P.; van Dijke, J.; Akkermans, R.; Vlek, H.; Pieters, W.
Fonte: Royal Coll General Practitioners Publicador: Royal Coll General Practitioners
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
55.93%
Background: Spirometry is an indispensable tool for diagnosis and monitoring of chronic airways disease in primary care. Aim: To establish the quality of routine spirometry tests in general practice, and explore associations between test quality and patient characteristics. Design of study: Analysis of routine spirometry test records. Setting: Fifteen general practices which had a working agreement with a local hospital pulmonary function laboratory for spirometry assessment regarding test quality and interpretation. Method: Spirometry tests were judged by a pulmonary function technician and a chest physician. Proportions of test adequacy were analysed using markers for manoeuvre acceptability and test reproducibility derived from the 1994 American Thoracic Society spirometry guideline. Associations between quality markers and age, sex, and severity of obstruction were examined using logistic regression. Results: Practices performed a mean of four (standard deviation = 2) spirometry tests per week; 1271 tests from 1091 adult patients were analysed; 96.4% (95% confidence interval [CI] = 95.6 to 97.2) of all tests consisted of ≥3 blows. With 60.6% of tests, forced expiratory time was the marker with the lowest acceptability rate. An overall 38.8% (95% CI = 36.0 to 41.6) of the tests met the acceptability as well as reproducibility criteria. Age...

Amalgamation and collaboration in rural general practices: Early experience with the GP Links program in rural South Australia

Wilkinson, D.; Symon, B.
Fonte: Blackwell Science Asia Pty Ltd Publicador: Blackwell Science Asia Pty Ltd
Tipo: Artigo de Revista Científica
Publicado em //2001 EN
Relevância na Pesquisa
56.01%
The GP Links program aims to promote the amalgamation of smaller general practices into larger group practices and is one of several strategies being used to modernise Australian family practice. GP Links provides financial incentives to practices willing to amalgamate. The focus of the program has been on urban practices to date and indeed some of the requirements of the program mean that rural practices are less likely to access the scheme. We report our positive and negative experiences of practice amalgamation through the GP Links program in a regional setting of South Australia. From our experience we suggest that for rural practices, a staged approach of increasing collaboration that may lead to amalgamation, which focuses on rural practices developing a supportive network and alliances with others such as Divisions and University Departments of Rural Health might be a positive way ahead.; David Wilkinson and Brian Symon

Accuracy and precision of desktop spirometers in general practices

Schermer, T.; Verweij, E.; Cretier, R.; Pellegrino, A.; Crockett, A.; Poels, P.
Fonte: Karger Publicador: Karger
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
56.05%
BACKGROUND: Spirometry has become an essential tool for general practices to diagnose and monitor chronic airways diseases, but very little is known about the performance of the spirometry equipment that is being used in general practice settings. The use of invalid spirometry equipment may have consequences on disease diagnosis and management of patients. OBJECTIVES: To establish the accuracy and precision of desktop spirometers that are routinely used in general practices. METHODS: We evaluated a random sample of 50 spirometers from Dutch general practices by testing them on a certified waveform generator using 8 standard American Thoracic Society waveforms to determine accuracy and precision. Details about the brand and type of spirometers, year of purchase, frequency of use, cleaning and calibration were inquired with a study-specific questionnaire. RESULTS: 39 devices (80%) were turbine spirometers, 8 (16%) were pneumotachographs, and 1 (2%) was a volume displacement spirometer. Mean age of the spirometers was 4.3 (SD 3.7) years. Average deviation from the waveform generator reference values (accuracy) was 25 ml (95% confidence interval 12-39 ml) for FEV(1) and 27 ml (10-45 ml) for FVC, but some devices showed substantial deviations. FEV(1) deviations were larger for pneumotachographs than for turbine spirometers (p < 0.0031)...

Untersuchung von Qualitätsmerkmalen der ambulanten Methadonsubstitution in allgemeinmedizinischen Praxen im Bereich Südwürttemberg vor dem Hintergrund der historischen Entwicklung; Inquiry of quality features in outstanding methadone maintenance therapy in general practices in the region of Southern Württemberg on the background of historical development

Haumann, Richard
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
Relevância na Pesquisa
46.08%
In den letzten Jahren wurden mehrere Studien zur Evaluierung der Substitutionsbehandlung vorgelegt, die in der Regel Modellprojekte oder Schwerpunktpraxen erfassten. Gleichzeitig wird diese Behandlungen aber immer mehr auch in den Praxen niedergelassener Ärztinnen und Ärzte, insbesondere von Allgemein- und Hausärzten, durchgeführt. Die Behandlungen sind durch zahlreiche Vorschriften reglementiert. Diese Regelwerke zeigen ein ausgeprägtes Misstrauen gegenüber der Qualität der durchgeführten Substitutionsbehandlungen, zumal der Focus bisher vor allem auf fatalen und missglückten Behandlungen lag. Anlässlich der neu eingeführten Meldung aller Behandlungen an das BfARM zum 1.7.2002 wurden in dieser Studie die an der Substitutionsbehandlung beteiligten Ärztinnen und Ärzte im Versorgungsgebiet der KV Südwürttemberg nach ihren eigenen Behandlungs- und Diagnoseregeln befragt. An 70 von 77 behandelnde Praxen wurde ein selbstentwickelter Fragebogen zugesandt. Die Rücksendung erfolgte anonym entsprechend dem Zweiumschlagverfahren. Zur Auswertung kamen 56 Bögen (Rücklaufquote 80 %). Etwa 2/3 der untersuchten Praxen strukturierten Abläufe im Sinne eines Qualitätsmanagementkonzepts analog den Richtlinien der Bundesärztekammer...

Team climate for innovation: what difference does it make in general practice?

Proudfoot, J.; Jayasinghe, U.; Holton, C.; Grimm, J.; Bubner, T.; Amoroso, C.; Beilby, J.; Harris, M.
Fonte: Oxford Univ Press Publicador: Oxford Univ Press
Tipo: Artigo de Revista Científica
Publicado em //2007 EN
Relevância na Pesquisa
46.09%
Objective. Teamwork in primary healthcare is associated with patient care processes and staff outcomes. The ability of teams to be innovative is a hypothesized mechanism. We examined the characteristics of general practices with good team climate for innovation, and assessed the impact of climate on chronically ill patients' assessment of their care and on the job satisfaction of the staff. Design. Large cross-sectional study. Setting. Australian general practices. Participants. A total of 654 general practitioners and staff and 7505 chronically ill patients from 93 general practices in 6 Australian states and territories. Measures. The Team Climate Inventory and the Overall Job Satisfaction Scale, customized for use with general practices, were administered to general practitioners and practice staff, and the General Practice Assessment Survey was administered to patients. Practice characteristics were collected by survey from the principal doctor or practice manager. Results. Mean scores of team climate in Australian general practices were similar to those reported in the UK, except that in our study there was no association between the number of doctors in a practice and their team climate. Better team climate was found in practices with fewer non-clinical staff. Team climate predicted the job satisfaction of the general practitioners and staff...

Chronic Care Team Profile: a brief tool to measure the structure and function of chronic care teams in general practice

Proudfoot, J.; Bubner, T.; Amoroso, C.; Swan, E.; Holton, C.; Winstanley, J.; Beilby, J.; Harris, M.
Fonte: Blackwell Science Ltd Publicador: Blackwell Science Ltd
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
46.07%
Aim: At a time when workforce shortages in general practices are leading to greater role substitution and skill-mix diversification, and the demand on general practices for chronic disease care is increasing, the structure and function of the general practice team is taking on heightened importance. To assist general practices and the organizations supporting them to assess the effectiveness of their chronic care teamworking, we developed an interview tool, the Chronic Care Team Profile (CCTP), to measure the structure and function of teams in general practice. This paper describes its properties and potential use. Method: An initial pool of items was derived from guidelines of best-practice for chronic disease care and performance standards for general practices. The items covered staffing, skill-mix, job descriptions and roles, training, protocols and procedures within the practice. The 41-item pool was factor analysed, retained items were measured for internal consistency and the reduced instrument's face, content and construct validity were evaluated. Results: A three-factor solution corresponding to non-general practitioner staff roles in chronic care, administrative functions and management structures provided the best fit to the data and explained 45% of the variance in the CCTP. Further analyses suggested that the CCTP is reliable...

Microbiological contamination of spirometers: An exploratory study in general practice

Hancock, K.; Schermer, T.; Holton, C.; Crockett, A.
Fonte: Royal Australian College of General Practitioners Publicador: Royal Australian College of General Practitioners
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
56%
Background: Spirometry is an important tool when diagnosing chronic respiratory conditions in general practice. However, the equipment may harbour pathogenic micro-organisms and cross-transmission of aerolised pathogens could occur if hygiene measures are insufficient. Methods: We assessed microbiological contamination in 16 spirometers from a convenience sample of South Australian general practices. Results: We found potentially relevant microbiological contamination in three spirometers: two Pseudomonas spp.; one coagulase negative Staphylococcus sp. and one Alcaligenes sp. Although the three practices concerned all reported to have a written spirometer cleaning protocol in place, the frequency of spirometer disinfection did not match the manufacturers' recommendations. Discussion: Despite the small size of our study sample, we found potentially relevant microbiological contamination in 3 out of 16 spirometers from metropolitan general practices. The potential hazard of spirometers as reservoirs of microorganisms stresses the need for stricter attention to hygiene measures for spirometer maintenance in general practices.; Kerry L Hancock, Tjard R Schermer, Christine Holton, Alan J Crockett

Characteristics of general practices involved in undergraduate medical teaching.

Gray, R W; Carter, Y H; Hull, S A; Sheldon, M G; Ball, C
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /05/2001 EN
Relevância na Pesquisa
46.08%
BACKGROUND: The movement of medical education into the community has accelerated the development of a new model of general practice in which core clinical services are complemented by educational and research activities involving the whole primary care team. AIM: To compare quality indicators, workload characteristics, and health authority income of general practices involved in undergraduate medical education in east London with those of other practices in the area and national figures where available. DESIGN OF STUDY: A comprehensive survey of undergraduate and postgraduate clinical placements and practice-based research activity within general practice. SETTING: One-hundred and sixty-one practices based in East London and the City Health Authority (ELCHA). METHOD: Cross-sectional survey comparing routinely-collected information on practice resources, workload, income, and performance between teaching and non-teaching practices. RESULTS: In east London, teaching practices are larger partnerships with smaller list sizes, higher staff costs, and better quality premises than non-teaching practices. Teaching practices demonstrate significantly better performance on quality indicators, such as cervical cytology coverage and prescribing indicators. Patient-related health authority income per whole time equivalent (WTE) general practitioner (GP) is significantly lower among teaching practices. A multiple regression analysis was used to explore the association between teaching status and income. Eighty-eight per cent of the variation in patient-related income could be explained by the combination of list size...

Annual night visiting rates in 129 general practices in one family health services authority: association with patient and general practice characteristics.

Majeed, F A; Cook, D G; Hilton, S; Poloniecki, J; Hagen, A
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/1995 EN
Relevância na Pesquisa
46.07%
BACKGROUND. Rates of night visiting by general practitioners have increased steadily over the last 30 years and vary widely between general practices. AIM. An ecological study was carried out to examine night visiting rates by general practices in one family health services authority, and to determine the extent to which differences in night visiting rates between practices could be explained by patient and practice characteristics. METHOD. The study examined the variation in annual night visiting rates, based on night visit fees claimed between April 1993 and March 1994, among 129 general practices in Merton, Sutton and Wandsworth Family Health Services Authority, London. RESULTS. Practices' annual night visiting rates varied from three per 1000 to 75 per 1000 patients. The percentages of the practice population aged under five years and aged five to 14 years were both positively correlated with night visiting rates (r = 0.38 and r = 0.35, respectively), as were variables associated with social deprivation such as the estimated percentage of the practice population living in one-parent households (r = 0.24) and in households where the head of household was classified as unskilled (r = 0.20). The percentage of the practice population reporting chronic illness was also positively associated with night visiting rates (r = 0.26). The percentages of the practice population aged 35 to 44 years and 45 to 54 years were both negatively associated with night visiting rates (r = -0.34 and r = -0.31...

Influences on the variation in prevalence of type 2 diabetes between general practices: practice, patient or socioeconomic factors?

Whitford, David L; Griffin, Simon J; Prevost, A Toby
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /01/2003 EN
Relevância na Pesquisa
46.11%
BACKGROUND: The prevalence of type 2 diabetes is known to vary between countries, districts and general practices. The influence of early detection and screening on the variation of prevalence between general practices has not previously been investigated. AIM: To test the hypothesis that the prevalence of type 2 diabetes is associated with awareness of and screening for diabetes within general practices and to explore other factors that may explain the variation in prevalence between practices. DESIGN OF STUDY: Cross-sectional study of general practices. SETTING: Forty-two general practices in Newcastle and North Tyneside; 20% random sample of patients with type 2 diabetes (n = 1056). METHOD: Factors thought to be associated with the variation of type 2 diabetes prevalence were collected from general practices through practice managers, medical records, and patient questionnaire. Pearson's correlation coefficient was used to quantify the association, and variables significant at the 5% level were entered into a multiple linear regression model. RESULTS: There was a wide inter-practice variation in age/sex standardised type 2 diabetes prevalence (range = 0.69% to 2.73%; P < 0.001). There was no significant association between the prevalence of type 2 diabetes and the proportion of patients detected outside primary care or the proportion of patients detected through screening...

Influences on prescribing in non-fundholding general practices.

Eccles, M P; Soutter, J; Bateman, D N; Campbell, M; Smith, J M
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /05/1996 EN
Relevância na Pesquisa
46.07%
BACKGROUND: The experience from general practice fundholding suggests that financial incentives may influence prescribing; guidelines and hospital prescribing are two other suggested influences. AIM: A study was undertaken to establish general practitioners' attitudes to a financial prescribing incentive scheme, the presence and use of guidelines, and the influence of prescribing initiated within secondary care. METHOD: A postal questionnaire survey of non-fundholding general practices in the former Northern Region was conducted. RESULTS: Practices' thinking and subsequent decisions about the incentive prescribing scheme were most often influenced by discussions within the practice (45%). Those practices that achieved their savings under the incentive scheme were less likely than those not achieving savings to feel that the target was not achievable, the time scale was unacceptable, and that the philosophy behind the scheme was unacceptable. Forty-five per cent of practices received advice from neither a medical nor a pharmaceutical adviser; 27% of practices received advice from both, 12% from a medical adviser only and 16% from a pharmaceutical adviser only. Of the practices that tried to make their target savings, 91% intended to increase generic prescribing; fewer than one-third of practices mentioned any other measure. Prescribing guidelines were reported by a minority of practices...

Hospital admissions for asthma in east London: associations with characteristics of local general practices, prescribing, and population.

Griffiths, C.; Sturdy, P.; Naish, J.; Omar, R.; Dolan, S.; Feder, G.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 15/02/1997 EN
Relevância na Pesquisa
46.08%
OBJECTIVE: To determine the relative importance of appropriate prescribing for asthma in explaining high rates of hospital admission for asthma among east London general practices. DESIGN: Poisson regression analysis describing relation of each general practice's admission rates for asthma with prescribing for asthma and characteristics of general practitioners, practices, and practice populations. SETTING: East London, a deprived inner city area with high admission rates for asthma. SUBJECTS: All 163 general practices in East London and the City Health Authority (complete data available for 124 practices). MAIN OUTCOME MEASURES: Admission rates for asthma, excluding readmissions, for ages 5-64 years; ratio of asthma prophylaxis to bronchodilator prescribing; selected characteristics of general practitioners, practices, and practice populations. RESULTS: Median admission rate for asthma was 0.9 (range 0-3.6) per 1000 patients per year. Higher admission rates were most strongly associated with small size of practice partnership: admission rates of singlehanded and two partner practices were higher than those of practices with three or more principals by 1.7 times (95% confidence interval 1.4 to 2.0, P < 0.001) and 1.3 times (1.1 to 1.6...

Understanding high and low patient experience scores in primary care: analysis of patients? survey data for general practices and individual doctors

Roberts, Martin J.; Campbell, John L.; Abel, Gary A.; Davey, Antoinette F.; Elmore, Natasha L.; Maramba, Inocencio; Carter, Mary; Elliott, Marc N.; Roland, Martin O.; Burt, Jenni A.
Fonte: BMJ Group Publicador: BMJ Group
Tipo: Article; published version
EN
Relevância na Pesquisa
46.09%
This is the final published article. It first appeared at http://www.bmj.com/content/349/bmj.g6034.; Objectives To determine the extent to which practice level scores mask variation in individual performance between doctors within a practice. Design Analysis of postal survey of patients? experience of face-to-face consultations with individual general practitioners in a stratified quota sample of primary care practices. Setting Twenty five English general practices, selected to include a range of practice scores on doctor-patient communication items in the English national GP Patient Survey. Participants 7721 of 15?172 patients (response rate 50.9%) who consulted with 105 general practitioners in 25 practices between October 2011 and June 2013. Main outcome measure Score on doctor-patient communication items from post-consultation surveys of patients for each participating general practitioner. The amount of variance in each of six outcomes that was attributable to the practices, to the doctors, and to the patients and other residual sources of variation was calculated using hierarchical linear models. Results After control for differences in patients? age, sex, ethnicity, and health status, the proportion of variance in communication scores that was due to differences between doctors (6.4%) was considerably more than that due to practices (1.8%). The findings also suggest that higher performing practices usually contain only higher performing doctors. However...