Prevention in practice: results of a 2-year follow-up of routine health promotion interventions in general practice

BACKGROUND.: The effectiveness of health promotion activity in general practiceon risk factor reduction for coronary heart disease remainsthe subject of active debate. OBJECTIVE.: The study aimed to assess the impact of practice-based healthcheck-ups on health behaviours over a 2-year period. METHOD.: A general practice cohort of 7123 patients from 18 practiceswas surveyed. Eight hundred and forty (12%) patients had beenoffered a heafth check within a 12-month period from September1992 and 621 (9%) received one. Two hundred and fifty patients(40%) were asked back for follow-up after their health check. RESULTS.: Over a 2-year period there was no difference in smoking cessation,alcohol consumption, weight loss nor the amount of exercisetaken between those who attended for a health check and thosewho did not. The food score chosen to assess dietary change(Oxcheck) showed a statistically significant 1.16-point risefor the whole sample over the survey period. There was a significantdifference in mean food score change between heafth check attendersand non-attenders (Mann-Whitney U test: P << 0.002). Maintenanceof dietary improvement over a 2-year period was not affectedby health check attendance. CONCLUSIONS.: This study confirms the low impact of health checks on the selfreported modification of cardiovascular risk factors and showsthat maintenance of appropriate health behaviour change is nomore likely in those who have received a health check. Keywords. Health promotion, general practice.     

Time,risk and routine in general practice1

The paper is based on interviews with a sample of 50 general practitioners. It explores their concepts of time’ and ‘task’ in relation to their attempts to create satisfying work roles. There is a contrast between practitioners in urban and rural settings. For urban practitioners the economy of time as a scarce resource generates an element of risk from brief, ‘routine’ diagnosis. For rural practitioners time is not seen as a scarce resource, but they face the risk of working without additional specialist services. For most practitioners the problem is dealt with pragmatically by varying the mix of risky and routine work.     

Specialist and general practice views on routine follow-up of breast cancer patients in general practice

The practice of routinely following-up breast cancer in hospitalclinics is of widespread concern: studies have shown that itis not an effective way of detecting recurrent disease and itplaces great strain on cancer services which are already overstretched.A general practice centred system of routine follow-up may bea solution to this problem in those countries which have a strongprimary care base. Such a system would have other benefits suchas continuity of care for the patient. The objective of thisstudy was to determine the views of general practitioners andspecialists on follow-up of patients with breast cancer in remission,with special emphasis on their views on the transfer of routinefollow-up from the hospital to general practice. A postal questionnairesurvey of British breast cancer specialists (response rate 77.0%)and a personal interview survey of British general practitioners(response rate 81.8%) were conducted. The results show thatBritish general practitioners are willing to take on greaterresponsibility for the routine follow-up care of their patientswith breast cancer. However, there was frequently a mis-matchbetween specialists' and general practitioners' views on thissubject.     

Privacy in occupational health practice: promoting and impeding factors

AIM: This article describes the views of occupational health professionals, employees, and employers on factors that are thought to promote and impede privacy in occupational health practice. METHODS: The data were collected through theme interviews with 44 subjects and were analysed by content analysis. RESULTS: Both promoting and impeding factors organized around two content areas: "caregiving" (patient-caregiver relationship) and "tripartite cooperation" (cooperation between occupational health professionals, employees, and employer). The content areas illustrated the two different roles Finnish occupational health professionals have toward their two groups of clients: employees and employers. "Adequate behaviour" (respect, good communication, presence) and "Adequate knowledge base" (instinct, work experience, ethical thinking, knowledge of legislation) promoted privacy in caring relationship, whereas "Inadequate behaviour" (untrustworthy, busy, distant, "friend") impeded its realization. In tripartite cooperation, the promoting factors had to do with "Common good" (impartiality, regular contacts, community spirit, fair play) and "Individual good" (informed consent, advocacy). The main category, "Confusions in loyalties", emerged from three subcategories (confusions in confidentiality, confusions in duties, and confusions in roles) illustrating the impeding factors in tripartite cooperation. CONCLUSIONS: Questions of privacy are crystallized in occupational health professionals' diverse duties and roles towards employees and employers. In occupational health practice, privacy cannot be seen only as a privilege of employees, but must also be viewed as an instrumental value serving the interests of employers and whole work community. Confusions in loyalties need more discussion and research before privacy can be optimally realized. Lapses in confidentiality should never happen.     

Stop smoking advice by practice assistants after routine cervical screening in general practice: A qualitative exploration of potential barriers and enablers

BackgroundCervical screening could be an appropriate routine moment to provide female smokers with tailored stop smoking advice. In Dutch general practice, cervical smears are performed by practice assistants.ObjectivesThis study was performed in preparation for a randomised trial to identify potential barriers and enablers for a brief stop smoking strategy performed by trained practice assistants after routine cervical screening.MethodsBetween December 2016 and March 2017 three focus group meetings were held with ten practice assistants, three nurses, and six general practitioners to explore their views and expectations towards the proposed approach. We analysed data using thematic analysis. Identified factors are presented within the framework of the Social-Ecological Model.ResultsPotential barriers and enablers were identified at individual, interpersonal, and workplace levels. Practice assistants, nurses and GPs did not consider assistants to have a role in stop smoking care. They believed it is feasible to register smoking status but had reservations towards providing advice by assistants, for which knowledge and skills are needed. Practice assistants’ own beliefs about smokers and smokers’ response to stop smoking advice might influence how assistants and smokers interact. An explanation of why advice is given could help, provided assistants have enough time and experience with the smear. The nurses’ availability and general practitioners’ view on prevention might affect the delivery of the strategy by the assistant.ConclusionAt individual, interpersonal, and workplace levels, several factors could influence the provision of a stop smoking strategy by a practice assistant.     

Exploring spatial patterns in general practice expenditure

The determinants for per capita general practitioner (GP) public expenditure across Danish municipalities are analysed using data from the period 1997–2004. Heterogeneity and dependency across years are controlled for. Spatial spillover effects across municipalities are investigated in order to disclose the spatial dynamics of public GP expenditure. The results reveal substantial heterogeneity and dependency across time, as well as the presence of a significant spatial spillover effect. The effects of determinants are seriously over-estimated if such features are ignored. The spatial coefficient is strongly significant and suggests that there is an indirect effect on expenditure of non-observable variables that are geographically concentrated.      

Utilization patterns of oral contraceptives in UK general practice

The aim of this article was to analyze and compare recent oral contraceptive utilization patterns in UK general practice.The database comprised at least 12 months of medical records during 1990–1991 from 693, 705 women aged 14–45 years registered with 398 practices. The database was searched for OC utilization patterns with emphasis on differences between combined OCs containing levonorgestrel (LNG), desogestrel (DSG), or gestodene (GSD).Women using OCs with LNG were older, more likely to be long-term users, and less likely to be starters or switchers than women using OCs with DSG or GSD. Use patterns of triphasic LNG did not differ markedly from that of monophasic LNG-containing OCs. Use of Schering PC4 a postcoital preparation peaked among women <20 years, whereas progestogen-only pills were prescribed mainly to women >30 years.The different utilization patterns between women using LNG-containing OCs and those using OCs containing DSG or GSD should be taken into account when making comparisons of the incidences of side effects.     

Variations in activity and practice patterns: a French study for GPs

OBJECTIVES: To identify the different practice profiles of general practitioners (GPs) in order to test the hypothesis of heterogeneity in physician behaviour. DATA: For the year 2000, 4,660 GPs from two regions in France. Variables: volume and structure of the physicians' medical activity, income level, personal characteristics, socioeconomic and geographical environment, characteristics of their patients. METHODS: A cluster analysis to identify different practice profiles and a regression analysis to display the determinants of the physicians' activity. RESULTS: Four different homogeneous groups can be identified, each one associating a physician's level of activity to his socioeconomic status. The level and the intensity of medical activity depend on individual factors, patients' characteristics as well as the socioeconomic context. CONCLUSIONS: There is no uniformity in the way GPs practice medicine. An immediate consequence is that any cost-containment measure that is applied uniformly to all GPs inevitably results in different outcomes according to the physicians' category type.     

Prevention and health promotion in clinical practice: the views of general practitioners in Europe

BACKGROUND: Disease prevention and health promotion are important tasks in the daily practice of all general practitioners (GPs). The objective of this study was to explore the knowledge and attitudes of European GPs in implementing evidence-based health promotion and disease prevention recommendations in primary care, to describe GPs' perceived barriers to implementing these recommendations and to assess how GPs' own health behaviors affect their work with their patients. METHODS: A postal multinational survey was carried out from June to December 2000 in a random sample of GPs listed from national colleges of each country. RESULTS: Eleven European countries participated in the study, giving a total of 2082 GPs. Although GPs believe they should advise preventive and health promotion activities, in practice, they are less likely to do so. About 56.02% of the GPs answered that carrying-out prevention and health promotion activities are difficult. The two most important barriers reported were heavy workload/lack of time and no reimbursement. Associations between personal health behaviour and attitudes to health promotion or activities in prevention were found. GPs who smoked felt less effective in helping patients to reduce tobacco consumption than non-smoking GPs (39.34% versus 48.18%, P < 0.01). GPs who exercised felt that they were more effective in helping patients to practice regular physical exercise than sedentary GPs (59.14% versus 49.70%, P < 0.01). CONCLUSIONS: Significant gaps between GP's knowledge and practices persist in the use of evidence-based recommendations for health promotion and disease prevention in primary care.     

Dyspepsia in general practice: incidence, risk factors, comorbidity and mortality

BACKGROUND: Many individuals consulting their GP with upper abdominal symptoms are initially classified as having dyspepsia. Few studies have described the incidence of dyspepsia or the comorbidities, risk factors or prognosis associated with this diagnosis. METHODS: We used the UK General Practice Research Database to find patients with a new diagnosis of dyspepsia in 1996 (n = 6,913) and a control cohort (n = 11,036). We determined the incidence of dyspepsia, potential risk factors and comorbidity, and the risk of new onset morbidity in the year following the index date. RESULTS: The incidence of dyspepsia was 15.3 per 1,000 person-years. An increased probability of a dyspepsia diagnosis was associated with chest pain [odds ratio (OR): 2.4], general pain (OR: 1.8), sleep disorders (OR: 1.5), angina (OR: 1.5), osteoarthritis/rheumatoid arthritis (OR: 1.4) and smoking (OR: 1.2). There was only a borderline association with obesity (OR: 1.1). Patients with dyspepsia had an increased likelihood of a diagnosis of irritable bowel syndrome (IBS) (OR: 264), gastroesophageal reflux disease (GERD) (OR: 62.8) or peptic ulcer disease (PUD) (OR: 27.2) during the following year. CONCLUSIONS: The commonest diagnosis to emerge after an initial consultation for dyspepsia was IBS, followed by GERD and PUD.