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1.
AimThis article examines the way in which private general practitioners take into account the social position of their patients in their preventive work.MethodsAfter a review of the main normative constructs supposed to equip the general practitioners to grasp the social dimension of their practice, the article used two surveys on the provision of preventive care, one epidemiological (PrevQuanti) and the other sociological (PrevQuali).ResultsDeontology, training and recommendations make it difficult to shape the social dimensions of health that pratitioners have to deal with. The PrevQuanti survey, however, revealed that the provision of preventive care is subject to almost systematic but variable social gradients. The analysis, based on the PrevQuali interview study, makes the ways in which pratitioners mobilise the social position of their patients and whether or not they adapt to it.ConclusionThe positionings of general practitioners can be modelled in a typology of six postures between which some oscillate.  相似文献   

2.
This article looks at prevention in the context of recent policyinitiatives in the UK which have created new roles and new opportunitiesfor general practitioners (GPs) and primary care. One such opportunityis the potential to actively market preventive services in orderto retain and attract patients in a competitive market. We firstdescribe this context and then provide an example of how a patientsatisfaction survey can be an effective market-research toolThe results from a district-wide survey are evaluated in termsof socio-demographic differences which stratify the patientmarket into segments which are aware of, users of and are satisfiedwith preventive services and those who are not. This articleillustrates how GPs can use data of this kind when developinginvestment and marketing strategies.  相似文献   

3.
This article looks at prevention in the context of recent policyinitiatives in the UK which have created new roles and new opportunitiesfor general practitioners (GPs) and primary care. One such opportunityis the potential to actively market preventive services in orderto retain and attract patients in a competitive market. We firstdescribe this context and then provide an example of how a patientsatisfaction survey can be an effective market-research toolThe results from a district-wide survey are evaluated in termsof socio-demographic differences which stratify the patientmarket into segments which are aware of, users of and are satisfiedwith preventive services and those who are not. This articleillustrates how GPs can use data of this kind when developinginvestment and marketing strategies.  相似文献   

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AIM: A study was carried out to discover the views of Danish general practitioners on the possibility of intervening in their patients' lifestyles in general and on the obstacles to doing so, based on their experience of participating in a health promotion study. METHOD: A focus group interview was conducted with five general practitioners who had participated in "The Ebeltoft Health Promotion Study" to assess their views on their preventive role. RESULTS: The general practitioners have internalized the view advanced by society and the medical profession that they have an important role to play in preventing lifestyle-related illness. However, they are sceptical about the effectiveness of intervention and have ethical concerns about giving lifestyle advice. They are also somewhat irritated by the fact that patients are chiefly interested in having their health checked, rather than in following up by changing their behaviour. The general practitioners differ in their views as to when, and how actively, they should initiate discussions with individual patients to encourage them to change their lifestyles. CONCLUSIONS: If the medical profession and those responsible for overall health policy wish to make general practitioners change their behaviour towards their patients, it is important that they understand the aims, values, and working conditions of general practitioners that underlie their present attitudes and behaviour.  相似文献   

6.
Inner-city and suburban students' dental experiences, current practices, beliefs, and compliance with two school-based preventive programs were examined. Striking differences were found in the students' dental experiences, practices, and beliefs, but few in their compliance. These findings challenge the notion that inner-city students are poor compliers and suggest ways in which practitioners and public health officials might utilize the differing practices of these populations to plan preventive programs for adolescents.  相似文献   

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Abstract: Health promotion and prevention are critical elements of public health programs designed to improve health status and extend life chances. The pattern of mortality and morbidity in rural Australia suggests a particularly important role for health promotion and preventive measures in country areas. However, the importance of preventive health measures and how people access health-related information is not well understood. This study examines which sources of health-related information are most valued by rural residents and whether the importance attributed to different sources varies according to age, sex and geographic location. The results demonstrate the overwhelming importance of the general practitioner and pharmacist in provision of preventive health information for all rural people. There is a need to ensure that the work carried out by all those involved with health promotion is closely integrated with that of rural general practitioners.  相似文献   

9.
STUDY OBJECTIVE--The aim was to investigate the influence of ethnicity on the demand for preventive care by Mediterranean migrants in Belgium. DESIGN--This was a survey of patient contacts with general practitioners. SETTING AND PATIENTS--33 general practitioners working in Belgian localities with the highest migrant density collaborated in the study. During two months they recorded information on consultations with an estimated 72,600 clients. Participation was obtained from all subjects attending for preventive care or for a new episode of illness (n = 6256). MAIN RESULTS--An average of 30% of the patients sought preventive care, but multivariate analysis showed ethnicity to be a strong independent predictor of this type of demand. The higher primary preventive uptake by female Moroccans and Turks and the higher secondary preventive uptake by males from the same ethnic groups, as compared with the Belgian reference population, contrasted with a lower demand for tertiary prevention in migrants of either gender. The relative demand for preventive care by the more acculturated migrants was, however, quite similar to the demand of the Belgian population. CONCLUSIONS--The differential uptake of primary preventive care could be partly explained by the higher fertility rates of immigrant women, and the differential secondary uptake by a lower incidence of tuberculosis in the indigenous population. The meagre demand for tertiary prevention by Moroccan and Turkish migrants could be due to weaker compliance with treatments for chronic disorders, which is related to the perceptions of illness in these ethnic groups. The establishment of cross cultural mechanisms of dialogue should enhance compliance and improve the access of immigrants to the benefits of tertiary preventive care.  相似文献   

10.
The question of differences in health status and preventive behaviour in women in both parts of Germany will be examined by survey data from 1994. The data show, that in the field of subjective health very similar answers are given, greater differences occur in the prevalence of cardiovascular risk factors and morbidity, in the utilization of practitioners and in preventive behaviour. On the basis of these results consequences for a target-oriented preventive policy are discussed.  相似文献   

11.
目的:了解杭州萧山区企业食堂卫生状况,为萧山卫生行政部门决策提供依据。方法:采用随机抽样调查及现场调查的方法对98家企业食堂的基本状况及卫生设施进行了调查。结果:多数企业环境卫生状况良好,但是卫生许可证及从业人员健康证的持证率不高,从业人员卫生培训率不高,多数企业食堂布局流程不合理,图纸预审率较低。结论:卫生监督部门要做好预防性监督工作并加强施工中的卫生监督,同时强化从业人员卫生知识培训及食品卫生法的宣传工作。  相似文献   

12.
The article submits the results of the study of the organization and quality of care for diabetic patients, the dynamic observation of which at the out-patient establishments is provided by endocrinologists. The total structure of diabetic patients, the follow-up system, the dimensions of screening, the adequacy of treatment are analysed. It is demonstrated that the lack of continuity and interrelation between endocrinologists and district general practitioners in providing care to diabetic patients, the majority of whom have combined pathology, will result in inadequate provision of curative and preventive care to diabetic patients, according to the expert assessment.  相似文献   

13.
OBJECTIVE--To compare general practitioners' care of adult patients with learning disability with that of control patients in the same practice. DESIGN--Case-control study of patients and controls by a structured interview study of general practitioners. SETTING--Avon. PATIENTS--78 adult patients with learning disability and 78 age and sex matched controls--cared for by 62 general practitioners. MAIN MEASURES--Number and content of consultations and opinions of the general practitioners. RESULTS--There were more consultations for diseases of the central nervous system and of the skin among the patients than the controls (15 v 3 for central nervous system disease and 15 v 4 skin disease). There were also significantly fewer recordings of blood pressure and cervical cytology tests (34 v 51 for blood pressure and 2 v 18 for cytology). Although more patients were taking drugs affecting the central nervous system (33 v 6), more controls were taking drugs for musculoskeletal complaints (17 v 7). CONCLUSION: Although adult patients with learning disability consult with their general practitioners at equivalent rates to other patients, they get less preventive care and consult for different types of problems than do other patients. The reasons for these differences in preventive care are not clear. Carers and general practitioners should be informed of these differences to ensure that appropriate care is given.  相似文献   

14.
OBJECTIVE: To investigate the relationship between elements of practice organization related to stroke prevention in general practice, and suboptimal preventive care preceding the occurrence of stroke. DESIGN: This study was conducted among 69 Dutch general practitioners in the Rotterdam region. Information on the implementation of elements of practice organization related to stroke prevention was collected by postal questionnaire. Data on the process of patient care were collected by means of chart review and interviews with general practitioners. Cases of stroke (n = 186) were retrospectively audited by an expert panel with guideline-based review criteria. Using logistic regression analysis we investigated the relationship between the probability of suboptimal care delivery and the presence of specific elements of practice organization related to stroke prevention (tailored information systems, formal delegation of preventive tasks, standardization of care). RESULTS: For some elements of practice organization significant relationships with the quality of stroke prevention were found. Suboptimal care was less common among general practitioners with a higher level of noting high risk patients in the patient records (odds ratio 0.30; 95% CI 0.13-0.69, P = 0.01), delegating follow-up visits to support staff (odds ratio 0.42; 95% CI 0.22-0.82, P = 0.01) and compliance with the hypertension guideline (odds ratio 0.57; 95% CI 0.41-0.78, P = <0.001). Except for practice type (general practitioners in health centres less often provided suboptimal care, P = 0.02), no significant relationships with general practitioner and practice characteristics were found. CONCLUSION: This study shows that general practitioners with a higher level of integrated organizational structures for stroke prevention (record keeping, formal delegation of preventive tasks, guideline compliance) are less likely to deliver suboptimal care.  相似文献   

15.
The practice guideline 'Smoking cessation' from the Dutch College of General Practitioners has been published. If general practitioners are going to use the standard, this can have a great impact on smoking in the Dutch population. A decrease in smokers among the population will also have an impact on several smoking-related chronic diseases from a preventive point of view. The guideline emphasizes that smoking cessation is not a one-stop shop but that it requires a long-term effort.  相似文献   

16.
Problem drinking among medical practitioners is an importanthealth hazard and has been much ignored in the past. There isconsiderable evidence to suggest that doctors constitute a highrisk group in respect of drinking problems. Follow-up studiesof alcoholic doctors have given variable results but on thewhole there is room for a reasonable degree of optimism. Scottish and Irish practitioners would appear to be particularlyvulnerable and the writer's study in Glasgow suggests the possibilityof a higher degree of risk among general practitioners. The general issue of the sick doctor is now receiving attentionfrom the newly constituted General Medical Council and the newprocedures should be observed with interest. The causal factors of problem drinking among doctors are multiple. Early recognition of the problem among doctors can lead to worthwhiletreatment. There is, however, a need for preventive and healtheducation measures among the medical profession.  相似文献   

17.
Health and social service professionals generally view respite services as a preventive health care measure for both caregiver and recipient. However, many families with dependent elders are reluctant to use formal respite care services. Factors associated with family member perceptions of hospital-based respite care as a viable personal option are examined. The findings suggest that families often fail to recognize the preventive health care functions that respite care may offer and that practitioners should propose respite care as part of overall treatment plans.  相似文献   

18.
There is unequivocal evidence from across Australia of entrenched patterns of socio‐economic related health inequality. These patterns are seen in mortality, morbidity, health risk factors and access to preventive health services. Discussing the potential role of health promotion in addressing these health inequalities needs to be based on an agreed definition of health inequality and an understanding of the differences between health inequity and health inequality. This involves making value judgements on whether opportunities for health are fairly distributed. Health promotion practitioners need to be able to argue why they think health inequalities are important, have a clear understanding of what they think are the causes of health inequality and be informed on action that can be taken to reduce health inequality. The ever‐increasing level of information on patterns of health inequality within Australian society are likely to place increased pressure on health promotion policymakers and practitioners to ensure that their actions reduce health inequality – or at least not contribute to widening health inequality. The way in which these issues are approached will be strongly influenced by our values, the values of the organisations in which we work and the wider community. This requires each of us to be proactive in articulating our values and beliefs and being open to them being challenged.  相似文献   

19.
Nearly three-fourth of the indigenous medical practitioners (74.37%) in the rural area of Agra were treating 15 patients in a day. Maximum number of patients was attended by trained practitioners. Only 21.82 percent of the practitioners were providing preventive services apart from curative services. Inspite of wide variations in level of training with consequent difference in knowledge, skills and practice, these practitioners still make a significant contribution to health care of the community provided they get some training of modern health system and state patronage. To start with, at least they should be given orientation towards vaccination as they are still giving tetanus toxoid only at the time of injury. In the same way training should be given regarding distribution of vitamin 'A' for prevention of night blindness and iron folic acid tablets for control of anaemia in vulnerable groups.  相似文献   

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