共查询到20条相似文献,搜索用时 15 毫秒
1.
2.
3.
4.
5.
Fiona M Walter Juliet A Usher-Smith Suresh Yadlapalli Eila Watson 《The British journal of general practice》2015,65(640):e761-e768
Background
Increasing numbers of people are living with, and beyond, cancer. They are at risk of long-term morbidity and premature mortality due to the consequences of their disease and its treatment. Primary care can contribute to providing ongoing care.Aim
To determine the current practice and views of GPs in England regarding cancer survivorship care.Design and setting
Online survey of a sample of 500 GPs, stratified by NHS region in England.Method
The survey included questions adapted from prior surveys assessing physician knowledge and attitudes regarding care of patients with cancer.Results
In total, 500 GPs responded; approximately half reported often providing care to people living beyond cancer for treatment-related side effects (51%), psychological symptoms (65%), and lifestyle advice (55%). Only 29% felt very confident managing treatment-related side effects compared with 46% and 65% for psychological symptoms and lifestyle advice respectively. Half reported usually receiving cancer treatment summaries and survivorship care plans but most of the sample felt these would improve their ability to provide care (76%). Only 53% were convinced of the usefulness of cancer care reviews. Although most felt that primary and specialist care should share responsibility for managing bone (81%) and cardiovascular (77%) health consequences, fewer than half reported often taking previous history of cancer or cancer treatment into consideration when assessing bone health; only one-fifth did this in relation to cardiovascular health. Most responders were interested in receiving education to improve their knowledge and expertise.Conclusion
GPs have a potentially important role to play in caring for people following cancer treatment. This study has highlighted areas where further support and education are needed to enable GPs to optimise their role in cancer survivorship care. 相似文献6.
Marie Blanquet Laurent Gerbaud Chantal Noirfalise Pierre Michel Llorca Claude Campagne Jacques Malaval 《The British journal of general practice》2011,61(582):e31-e41
Background
Prevention has become a legal obligation for French GPs, since a law was passed in March 2002.Aim
Measurement and analysis of preventive procedures performed by French GPs.Design of study
Observational survey.Setting
GP surgeries in Puy-de-Dôme, France.Method
Doctors completed a questionnaire about their socioprofessional characteristics, and a researcher completed another questionnaire about preventive procedures performed on the last 15 patients seen by each GP. Twenty preventive services were evaluated and, for each service, medical records, targets, and objectives were defined according to the national preventive care guidelines. The gap between guidelines and practice was explained by doctor characteristics. Statistical analyses were performed using χ2 and logistic regression.Results
Representative samples of 179 doctors and 2453 medical records were randomised. Four preventive services were performed in more than 75% of cases, and the gap was explained by the salaried job the doctors had. Ten preventive services were performed in 25% to 75% of cases and the gap was explained by the medical software used. The six remaining services were performed in less than 25% of cases and no explanatory variable was identified.Conclusion
Sixteen preventive procedures were insufficiently performed. The more a preventive service is performed the more the gap will be explained by GPs'' socioprofessional characteristics. The gap for a preventive procedure performed in 25% to 75% of cases was mainly explained by management of the medical records. A nationwide policy to improve prevention performance in general practice seems to be essential. 相似文献7.
A Joan P Boeke Marguerite E van Randwijck-Jacobze Elly MS de Lange-Klerk Sietske M Grol Mark HH Kramer Henriette E van der Horst 《The British journal of general practice》2010,60(579):e378-e384
Background
Many self-attending patients make inappropriate use of accident and emergency departments.Aim
To determine whether a new care method consisting of the involvement of a GP during the day with the staff of the accident and emergency department of an academic city hospital and application of the Nederlands Triage Systeem by a practice nurse is more effective than usual care.Design
Before and after intervention design.Setting
Accident and emergency department in the VU University Medical Center in Amsterdam.Method
Participants were patients (n = 1527) attending the accident and emergency department without a referral, on weekdays from 10.00–17.00 hours, from 1 November 2006 to 30 April 2007. The intervention consisted of a new care method that combined the involvement of a GP in the accident and emergency department and allocation of patients by triage to either the GP or the accident and emergency department physician. Main outcome measures were patient satisfaction, number and type of additional examinations, quality of diagnosis, process time, and treatment time.Results
Patient satisfaction with the treatment increased significantly. Compared to the usual care method, this new care method resulted in a 13% decrease in additional examinations. The percentage of incorrect diagnoses (1 %), as a measure of quality of care, was similar with the two methods. The mean process time decreased from 93 to 69 minutes (P<0.001). The mean treatment time decreased from 60 to 35 minutes (P<0.001).Conclusion
The new care method resulted in greater patient satisfaction and maintained the quality of care, with fewer additional examinations. It reduced both the process time and the treatment time. 相似文献8.
9.
Nicola Christie Kate Beckett Sarah Earthy Blerina Kellezi Jude Sleney Jo Barnes Trevor Jones Denise Kendrick 《The British journal of general practice》2016,66(642):e24-e31
Background
In the UK, studies suggest that the transition from hospital to home after an injury can be a difficult time and many patients report feeling inadequately prepared. Patients often use primary care services after hospital discharge. These consultations provide opportunities to consider problems that patients experience and to facilitate recovery. Little is known, however, about how patients and service providers view care after hospital discharge and the role played by primary care services, specifically GPs.Aim
To identify good practice and unmet needs in respect of post-discharge support for injured patients.Design and setting
Qualitative study using semi-structured interviews at four sites (Bristol, Leicester/Loughborough, Nottingham, and Surrey).Method
Qualitative interviews with 40 service providers and 45 hospitalised injured patients.Results
Although there were examples of well-managed hospital discharges, many patients felt they were not provided with the information they needed about their injury, what to expect in terms of recovery, pain control, return to work, psychological problems, and services to help meet their needs. They also described difficulty accessing services such as physiotherapy or counselling. Service providers identified problems with communication between secondary and primary care, lack of access to physiotherapy, poor communication about other services that may help patients, GP service and resource constraints, and difficulties in providing information to patients concerning likely prognosis.Conclusion
Discharge from hospital after an injury can be problematic for patients. Changes in both secondary and primary care are required to resolve this problem. 相似文献10.
Claessen SJ Echteld MA Francke AL Van den Block L Donker GA Deliens L 《The British journal of general practice》2012,62(595):e121-e126
Background
Little is known about treatment aims during the last 3 months of life.Aim
To investigate important treatment aims in the last 3 months of patients’ lives in cases of non-sudden death.Design and setting
Mortality follow-back study in the Netherlands.Method
Data were collected retrospectively in 2009 within the representative Sentinel Network of GPs in the Netherlands. GPs completed a standardised registration form.Results
Data for 279 patients were studied. Of these, 55% died of cancer and 45% of another disease. Treatment was aimed at palliation for 73% of the patients in months 2 and 3 before death, and for 95% of the patients in the last week of life. Seven per cent received treatment aimed at cure in the last week of life. In a minority of patients, cure/life prolongation and palliation were simultaneously important treatment aims. In the last week of life and in the 2–4 weeks before death, cure was more frequently reported as an important treatment aim in patients with a non-cancer disease than in patients with cancer. In the 2–4 weeks before death, palliation was an important treatment aim for a larger proportion of patients with cancer than patients with other diseases.Conclusion
Registration by GPs show that, in the last weeks and days of life, cure was more frequently reported as an important treatment aim in patients with a non-cancer disease than in patients with cancer. For a small number of patients, palliation and cure/life prolongation were simultaneously important treatment aims. 相似文献11.
12.
13.
Juan Gérvas Barbara Starfield Concepción Violán Sergio Minué 《The British journal of general practice》2007,57(544):912-917
The NHS Plan signalled the creation of GPs with special interests (GPwSIs) in the UK. The role of a GPwSI involves the acquisition of knowledge and skills that enable GPs to dedicate a portion of their time to performing the role of consultants to their colleagues within the ambit of general practice, and with respect to specific health problems encountered. The objectives behind the introduction of GPwSIs are to improve the patient's access to specialist care, to cut waiting-list times, and to save on referral costs, (and as a consequence to increase the prestige of the GPs involved). However, the reality may not meet these expectations. Before accepting the proposition for universal implementation of GPwSIs empirical evidence is required to demonstrate that overall health is improved (of patients as well as the population); patients, especially patients of doctors working alone or in small groups (specifically in rural areas) are not disadvantaged; referral is improved and made more appropriate to the requirements of patients and their health problems; real prestige is generated, not only among GPs and students, but also among patients; biological views typical of the specialist are not promoted; and a brake is not applied to other alternatives in, or the reorganisation of, primary care. 相似文献
14.
Amy Waller Mariko Carey Danielle Mazza Serene Yoong Alice Grady Rob Sanson-Fisher 《The British journal of general practice》2015,65(634):e312-e318
Background
GPs are often a patient’s first point of contact with the health system. The increasing demands imposed on GPs may have an impact on the quality of care delivered. Patients are well placed to make judgements about aspects of care that need to be improved.Aim
To determine whether general practice patients perceive that the care they receive is ‘patient-centred’ across eight domains of care, and to determine the association between sociodemographic, GP and practice characteristics, detection of preventive health risks, and receipt of patient-centred care.Design and setting
Cross-sectional survey of patients attending Australian general practice clinics.Method
Patients completed a touchscreen survey in the waiting room to rate the care received from their GP across eight domains of patient-centred care. Patients also completed the Patient Health Questionnaire (PHQ-9) and self-reported health risk factors. GPs completed a checklist for each patient asking about the presence of health risk factors.Results
In total 1486 patients and 51 GPs participated. Overall, 83% of patients perceived that the care they received was patient-centred across all eight domains. Patients most frequently perceived the ‘access to health care when needed’ domain as requiring improvement (8.3%). Not having private health insurance and attending a practice located in a disadvantaged area were significantly associated with perceived need for improvements in care (P<0.05).Conclusion
Patients in general practice report that accessibility is an aspect of care that could be improved. Further investigation of how indicators of lower socioeconomic status interact with the provision of patient-centred care and health outcomes is required. 相似文献15.
Trevor W Lambert Fay Smith Michael J Goldacre 《The British journal of general practice》2016,66(652):e848-e857
BackgroundThere are more studies of current job satisfaction among GPs than of their views about their future career prospects, although both are relevant to commitment to careers in general practice.AimTo report on the views of GPs compared with clinicians in other specialties about their future career prospects.MethodQuestionnaires were sent to the doctors at different times after graduation, ranging from 3 to 24 years.ResultsBased on the latest survey of each graduation year of the 20 940 responders, 66.2% of GPs and 74.2% of hospital doctors were positive about their prospects and 9.7% and 8.3%, respectively, were negative. However, with increasing time since graduation and increasing levels of seniority, GPs became less positive about their prospects; by contrast, over time, surgeons became more positive. Three to 5 years after graduation, 86.3% of those training in general practice were positive about their prospects compared with 52.9% of surgical trainees: in surveys conducted 12–24 years after graduation, 60.2% of GPs and 76.6% of surgeons were positive about their prospects.ConclusionGPs held broadly positive views of their career prospects, as did other doctors. However, there was an increase in negativity with increasing time since graduation that was not seen in hospital doctors. Research into the causes of this negativity and policy measures to ameliorate it would contribute to the continued commitment of GPs and may help to reduce attrition. 相似文献
16.
BackgroundGeneral practice is becoming increasingly complex due to an ageing population with multiple morbidities and the shift of services from secondary to primary care, yet GP training remains largely the same. Extended training is now recommended, initially proposed as a fourth GP specialty trainee year, but more recently as a broad-based 4-year specialty training programme.AimTo explore the views of newly-qualified GPs about their training and preparedness for specific aspects of the GP’s role.MethodSemi-structured interviews with 18 GPs between November 2011 and April 2012.ResultsGaining experience in a variety of primary care environments widens insight into patient populations as well as helping GPs develop adaptability and confidence, although this is not routinely part of GP training. However, alongside variety, having continuity with patients in practice remains important. Opportunities to be involved in the management of a practice or to take on substantial leadership roles also vary widely and this may limit preparedness and development of generalist skills.ConclusionExtended training could help prepare GPs for the current challenges of general practice. It could ensure all trainees are exposed to a greater variety of primary care settings including those outside GP practice, as well as experience of business, finance, and leadership roles. Collectively, these changes have the potential to produce GPs with both generalist and enhanced skills, who are better prepared to work collaboratively across the organisational boundaries between primary, secondary, and community care. 相似文献
17.
Zoi Tsimtsiou Kalwant Sidhu Roger Jones 《The British journal of general practice》2010,60(580):e434-e439
Background
Master''s programmes can provide continuing professional development, equipping GPs to teach, research, and lead general practice. A previous evaluation of the MSc in primary health care found that graduates were contributing significantly to the discipline of general practice. Given the changes in general practice over the last 10 years, it was considered useful to investigate longer-term outcomes.Aim
To assess the benefits GPs have derived from the MSc in terms of the intended learning outcomes and their own plans for involvement in research and teaching.Design of study
A cross-sectional survey using a postal questionnaire.Setting
Department of Primary Care and Public Health Sciences, King''s College London.Method
A postal questionnaire was sent to the graduates of MSc in primary health care from 1997 until 2008.Results
A total of 50 completed questionnaires were returned (response rate 76%). After graduation, 22 GPs had completed another degree or diploma and 21 had work accepted for publication, resulting in 74 papers. Nine held academic posts at lecturer or senior lecturer level, 21 were GP trainers, and 21 undergraduate teachers. Twenty-five GPs held more than one teaching-related post. The majority of the graduates confirmed the attainment of the MSc''s intended outcomes. Positive influences of the MSc were identified, including career development, personal development, and job satisfaction.Conclusion
Graduates reported a number of benefits to themselves, their practices, and their patients. As the requirements for continuing professional development of GPs become more stringent, and with the advent of revalidation, the current ad hoc approach to career development in general practice is becoming unsustainable. To enhance its credibility as an academic discipline, general practice must continue to develop its capacity for research and scholarship. Master''s programmes are likely to have an important role in supporting professional development in general practice in the future. 相似文献18.
Dekker F Neven AK Andriesse B Kernick D Ferrari MD Assendelft WJ 《The British journal of general practice》2012,62(597):e268-e274
Background
Despite the considerable impact of migraine, the use of preventive medication in primary care is limited. Only about 5% of migraine patients who qualify for prophylaxis actually receive it, and adherence is far from optimal.Aim
To explore the opinions of GPs regarding preventive medication for migraine.Design and setting
A qualitative focus group study in Dutch general practice.Method
Four focus groups (six GPs each) were formed. GPs were purposively sampled to acquire a range of participants, reflecting the more general GP population.Results
GPs perceived patients'' concerns about the impact of migraine and the potential benefits of prophylaxis. However, some were hesitant to start prescribing prophylaxis due to doubts about effectiveness, potential side effects, and the risk of developing drug dependency. GPs'' decisions were often based on considerations other than those presented in national guidelines, for example, the patient''s need to control their own problem. Many GPs placed responsibility for initiating prophylaxis with the patient.Conclusion
Various considerations hamper GPs from managing migraine with preventive medication, and various patient-related concerns cause GPs to deviate from national headache guidelines. 相似文献19.
Emma C Richards Thomas E Cowling Elinor J Gunning Matthew J Harris Michael A Soljak Naomi Nowlan Kanika Dharmayat Nur Johari Azeem Majeed 《The British journal of general practice》2015,65(641):e806-e812
Background
The NHS Choices website (www.nhs.uk) provides data on the opening hours of general practices in England. If the data are accurate, they could be used to examine the benefits of extended hours.Aim
To determine whether online data on the opening times of general practices in England are accurate regarding the number of hours in which GPs provide face-to-face consultations.Design and setting
Cross-sectional comparison of data from NHS Choices and telephone survey data reported by general practice staff, for a nationally representative sample of 320 general practices (December 2013 to September 2014).Method
GP face-to-face consultation times were collected by telephone for each sampled practice for each day of the week. NHS Choices data on surgery times were available online. Analysis was based on differences in the number of surgery hours (accounting for breaks) and the times of the first and last consultations of the day only between the two data sources.Results
The NHS Choices data recorded 8.8 more hours per week than the survey data on average (40.1 versus 31.2; 95% confidence interval [CI] = 7.4 to 10.3). This was largely accounted for by differences in the recording of breaks between sessions. The data were more similar when only the first and last consultation times were considered (mean difference = 1.6 hours; 95% CI = 0.9 to 2.3).Conclusion
NHS Choices data do not accurately measure the number of hours in which GPs provide face-to-face consultations. They better record the hours between the first and last consultations of the day. 相似文献20.
Rachel Spencer Brian Bell Anthony J Avery Gill Gookey Stephen M Campbell 《The British journal of general practice》2014,64(621):e181-e190