Information about patients'' deaths: general practitioners'' current practice and views on receiving a death register.

BACKGROUND. Although general practitioners are involved in the care of most dying patients, they do not routinely receive information about their deceased patients for whom they did not complete the death certificate, and often they rely upon informal communication channels. AIM. This study set out to assess how general practitioners obtained, recorded and used information about deceased patients and to determine their views on receiving a death register. METHOD. A questionnaire was sent to all 305 general practitioners in the Newcastle upon Tyne and Sunderland Family Health Services Authority areas. RESULTS. A total of 225 questionnaires were returned (response rate 74%). General practitioners usually first learnt about their patients' deaths from hospital discharge summaries (54%) and patients' relatives (46%) and less commonly from newspaper obituary columns (20%) and hospital telephone calls (9%). Two thirds of respondents recorded information about decreased patients, mainly listing personal details and the immediate cause of death. One third or fewer of those recording information listed contributory causes. The information was used mainly for following up bereaved relatives and notifying hospitals and other agencies. CONCLUSION. Current informal systems for handling information about patients' deaths are inadequate. General practitioners need and would welcome prompt, accurate and comprehensive information about all their deceased patients.     

Evaluation of death registers in general practice.

BACKGROUND: General practitioners (GPs) do not routinely receive information about the deaths of those patients whose death certificates they have not completed. We developed and evaluated a system for producing death registers for GPs. AIM: To evaluate GPs' and practice managers' views on, and uses of, the death register. METHOD: General practitioners in Newcastle (n = 161) and Sunderland Family Health Service Authority (n = 144) areas were sent a questionnaire on their sources and use of information about patients' deaths. Death registers were sent to Newcastle practices; Sunderland practices were the control group. A follow-up questionnaire was sent to Newcastle (n = 173) and Sunderland (n = 140) GPs after two years. Newcastle practice managers (n = 45) were interviewed after their practice had received death registers for one year. RESULTS: Ninety-two per cent of Newcastle responders had seen the death register. Seventy-three per cent saw it regularly. Of those who saw it, 92% found it useful for communication within the primary health care team, bereavement follow-up, and administration and medical audit. One fifth of GPs named the death register as their first source of information about their patients' deaths. Newcastle GPs reported greater levels of change in use of patient death information than the control group. Practice managers circulated, used, and recorded information from the death register. CONCLUSION: Death registers are valued and have demonstrable benefits with regard to administration, bereavement care, and medical audit.     

Asthma--still a challenge for general practice.

Asthma is probably the commonest chronic disease in the United Kingdom, and its attendant morbidity extends outside the possible scope of the hospital sector. Innovations to improve the care of asthma must therefore come from general practice. The need for such care initiatives is demonstrated by the rising mortality and morbidity from this condition, and by the evidence of less than optimum treatment at both the primary and secondary care levels. This paper reviews this evidence, and considers possible solutions to the problems raised. Pragmatic guidelines are offered for the promotion of good asthma care, while the need for proper evaluative research is stressed.     

The reliability and validity of the age-sex register as a population denominator in general practice

I report evidence which raises doubts about the reliability and validity of age-sex registers as true population denominators in general practice in the UK. These have potentially disturbing implications for the interpretation of data based on the presumed precision of age-sex registers. I am undertaking a prospective study to identify and quantify sources of inaccuracy to try to establish a method of estimating the true population at risk and its true age-sex characteristics. This would greatly enhance the utility of the age-sex register as the most valuable tool in general-practice research.     

Development of a thyroid function strategy for general practice.

A study was carried out to investigate a thyroid stimulating hormone (TSH) frontline strategy that could potentially result in a more straightforward interpretation of thyroid function tests, a reduction in the number of inappropriate referrals to medical outpatients, an improvement in the 'turnaround time' of results, and a reduction in the number of unnecessary tests carried out, thereby reducing costs.     

Domestic violence: a hidden problem for general practice.

Domestic violence is a common problem that may affect more than a quarter of women. It is a complex area in which to undertake research. Studies often focus on selected populations and exhibit a diversity of design, making comparison difficult. This review focuses on physical violence by men against women partners or ex-partners, and exemplifies important issues for general practitioners. Domestic violence frequently goes undetected. This may be the result of doctor's fears of exploring an area perceived as time-consuming, where knowledge is lacking and where they feel powerless to 'fix' the situation. Women may not reveal that they are experiencing violence, sometimes because doctors are unsympathetic or hostile. Nevertheless, women wish to be asked routinely about physical abuse and want to receive immediate advice and information about their options if necessary. Women experience a range of health and social problems in association with domestic violence, including depression, anxiety, substance abuse and pregnancy complications. However, none of these features is specific enough to be useful as an indicator of violence. Therefore, doctors should routinely ask all women direct questions about abuse. This recommendation can be incorporated into guidelines, which should be implemented widely in the UK, to improve the care of women experiencing domestic violence. In parallel with this, the educational needs of general practitioners should be addressed. Further research is needed to establish the prevalence of domestic violence in women presenting to general practice and to investigate how the problem is currently being addressed. If progress is to be made in tackling domestic violence, action within primary care is just one part of this: a fundamental change in the attitudes of men towards women is required.