天津市全科医学人才培养的实践与探索

天津市自1994年开展全科医学教育和全科医学人才培养工作,建立了天津市全科医学教育培训中心,形成了较为完善的培训网络,提供了政策保障,完善了职称体系,建设了师资队伍,严格了建章立制,加强了规范管理,在全科医师岗位培训和规范化培训、社区卫生管理干部培训、全科医师继续教育等各类各层次人才培养方面进行了积极的实践与探索.     

天津市全科医学人才培养的实践与探索

天津市自1994年开展全科医学教育和全科医学人才培养工作,建立了天津市全科医学教育培训中心,形成了较为完善的培训网络,提供了政策保障,完善了职称体系,建设了师资队伍,严格了建章立制,加强了规范管理,在全科医师岗位培训和规范化培训、社区卫生管理干部培训、全科医师继续教育等各类各层次人才培养方面进行了积极的实践与探索。     

Patient morbidity and some patterns of family practice in southeastern Ontario.

Over a 7-month period the trial version of the International Classification of Health Problems in Primary Care (ICHPPC) was studied. Ten community physicians reported 28 399 encounters wtith 11 437 patients. The overall distribution of health problems was comparable to that found in other North American studies. Some differences between the morbidity distributions in urban and rural practices varies from those of previous Canadian studies. Other differences between practices appeared to be related to the interests and training of the individual physicians. The workload of the physicians varied considerably. Many of the encounters involved problems for which there may be minimal benefit from medical intervention, and there was a large discrepancy in the frequency of follow-up visits for specified stable chronic health problems. The implications of these interpractice variations in the altering field of health care are discussed.     

High-billing general practitioners and family physicians in Ontario: how do they do it? An analysis of practice patterns of GP/FPs with annual billings over $400,000.

BACKGROUND: To better understand the reasons why some fee-for-service physicians have high billing levels, the authors compared the practice and demographic characteristics of general practitioners and family physicians (GP/FPs) who submitted over $400,000 in annual Ontario Health Insurance Plan (OHIP) fee-for-service claims in 1994-95 with those of GP/FPs who billed between $35,000 and $400,000. METHODS: The authors describe the OHIP billing and physician characteristic data for fiscal year 1994-95. They used multivariate logistic regression to determine factors independently associated with high billing status. RESULTS: A total of 219 GP/FPs (2.5% of the GP/FPs in Ontario) billed over $400,000 in 1994-95. Of these, 14 had billing patterns similar to those of specialists, and 27 billed predominantly for diagnostic and therapeutic procedures (particularly physiotherapy). The remaining 178 (81.3%) billed for a mix of services similar to that of other GP/FPs but on average had 2.6 times the volume of patient assessments and a greater share of their total billings derived from diagnostic and therapeutic procedures (9.1% v. 5.6%). Multivariate analysis indicated that these high-volume GP/FPs were less likely than GP/FPs who billed between $35,000 and $400,000 to be 60 years of age or older (odds ratio [OR] 0.09, p < 0.05) and female (OR 0.21) and were more likely to be foreign graduates (OR 1.85) and practising in a region with low physician supply (OR 0.45 for each increase of 1 physician per 1000 population). Metropolitan Toronto was an outlier to the latter relation and was more likely to have high-volume GP/FPs (OR 16.89). INTERPRETATION: High-billing GP/FPs attained their high billing levels by maintaining large numbers of patient visits and by performing procedures. Further research is needed to determine the time spent per patient and the quality of care delivered by these physicians as well as the appropriateness of the procedures that they perform.     

浅议全科医生接受灾害医学教育的必要性

为了提高我国全科医生在灾害急救中的应急能力，进一步完善全科医学教育的科学体系，突出其科学性、系统性和实用性。应加强各个基层医院急诊科室医护人员全科医学教育的培训，尤其应系统地进行各种灾害医学教育的专业培训，这种创新的医学教育不仅是国际社会的共同需要，也是我国多发灾情的现实需要，更是世纪之交医学教育改革的历史需要。     

Interactions with the pharmaceutical industry: a survey of family medicine residents in Ontario.

OBJECTIVE: To determine the attitudes, knowledge and practices of family medicine residents relating to the pharmaceutical industry and to assess the effectiveness of existing guidelines on appropriate interactions with the pharmaceutical industry. DESIGN: Survey by mailed questionnaire. SETTING: Ontario. PARTICIPANTS: All 262 second-year family medicine residents in Ontario (seven centres); 226 (86.3%) responded. RESULTS: Fifty-two (23.0%) of the residents who responded stated that they had read the CMA policy statement on appropriate interactions between physicians and the pharmaceutical industry. A total of 124 (54.9%) stated that they would attend a private dinner paid for by a pharmaceutical representative; the proportion was not significantly reduced among those who had read the CMA guidelines, which prohibit the acceptance of personal gifts. In all, 186 (82.3%) reported that they would like the opportunity to interact with pharmaceutical representatives in an educational setting, even though several programs now discourage these interactions. Approximately three quarters (172/226 [76.1%]) of the residents indicated that they plan to see pharmaceutical representatives in their future practice. Residents at Centre 2 were significantly more critical of the pharmaceutical industry than those from the other centres. Overall, being aware of, and familiar with, departmental policy or CMA policy on interactions with the pharmaceutical industry did not affect the residents' attitudes or intended future practices. CONCLUSION: The presence of guidelines concerning physicians' interactions with the pharmaceutical industry does not appear to have a significant impact on family medicine residents in Ontario.     

Nosological Inaccuracies in death certification in Northern Ireland. A comparative study between hospital doctors and general practitioners.

We aimed to audit nosological inaccuracies in death certification in Northern Ireland and to compare performance of hospital doctors and general practitioners. Nosology is the branch of medicine which treats of the classification of disease. 1138 deaths were registered in Northern Ireland in a 4-week period commencing 3/10/94. 195 of these were either registered by HM Coroners (HMC) or required further investigation by their staff; these cases were excluded from the study. The remaining 943 were analysed for wording and formulation inaccuracies according to the revised notes (1974), Northern Ireland Medical Certificate of Cause of Death. These are issued in book form by the Registrar of Births and Deaths. The commonest inaccuracies in death certification occur in the areas of poor terminology, sequence errors and unqualified mode. One or more inaccuracies were found in 317 (33.6%) of cases. In 13 of these (4%) cases, the inaccuracies were serious enough to warrant referral by the Registrar of Deaths to HM Coroner. The numbers of general practitioners and hospital doctors were recorded, with general practitioners being responsible for 122 (38%) and hospital doctors being responsible for 195 (62%) of inaccuracies.     

Regional variations in test requiring patterns of general practitioners in Spain

Objective

To analyze the requesting patterns for a range of laboratory tests ordered in 2009 from eight laboratories providing services to eight health areas, using appropriate indicators.

Design

Indicators measured every test request per 1,000 inhabitants, and indicators that measured the number of tests per related test requested by general practitioners were calculated. The savings generated, if each Health Care Department achieved the appropriate indicator standard, were also calculated. Laboratory Information System registers were collected, and indicators were calculated automatically in each laboratory using a data warehouse application.

Results

There was a large difference in demand for tests by health areas. The ratio of related tests also showed a great variability. The savings generated if each Health Care Department had achieved the appropriate indicator standard were €172,116 for free thyroxine, €18,289 for aspartate aminotransferase, and €62,678 for urea.

Conclusions

Considerable variability exists in general practitioners'' demand for laboratory tests.