Increasing dietetic referrals: Perceptions of general practitioners,practice nurses and dietitians

Aim: To examine Australian private practice dietitians' relationships with general practitioners and practice nurses as a factor that influences dietetic referrals. Methods: Semistructured telephone interviews and an online survey were conducted with Australian private practice dietitians (n = 52 and n = 90, respectively) between April and May 2008. Semistructured questionnaires were conducted with general practitioners (n = 11) and practice nurses (n = 12) from the ‘GP Access’ Division of General Practice between March and July 2007. Results: General practitioners' relationships with dietitians were believed to be the primary influencing factor on referral, provided by 81% of survey dietitians and 25% of interview dietitians. The most common means of initially forming relationships with general practitioners were face‐to‐face introduction (48%) and introductory letters (37%). Patient feedback via letter, fax or email was the most popular method of maintaining relationships with general practitioners (77%). Meeting with general practitioners in person was believed to be the most effective activity in building relationships with general practitioners and increasing referral rates (42%). Referral was made easier for general practitioners by providing paper (37%) or electronic (19%) referral forms and contact details (19%). The majority of general practitioners and dietitians believed that the ‘Allied Health Services Under Medicare’ made it easier to refer to a dietitian. Conclusions: Dietetic referrals can be encouraged through good relationships between general practitioners, practice nurses and dietitians. Private practice dietitians would benefit from cultivating relationships with general practitioners and practice nurses through personal contact and providing good patient feedback.     

Having a baby in Victoria 1989-2000: women's views of public and private models of care

Objective : To assess and contrast women's views of antenatal, intrapartum and postnatal care based on data collected in three state-wide surveys of recent mothers conducted in 1989, 1994 and 2000.
Methods : Postal surveys were mailed to all women who gave birth in Victoria in one week in 1989, and in two weeks in 1993 and 1999, excluding those who had a stillbirth or neonatal death. Questionnaires were sent to women by hospitals and home birth practitioners 5–8 months after the birth.
Results : 58.6% of women participating in the 1989 survey rated their antenatal care as 'very good' compared with 62.4% in 1994 and 66.5% in 2000 (χ² for trend=15.01, p <0.001). In all three surveys, women enrolled in public models of care were significantly more likely to rate their antenatal care as less than 'very good' than women enrolled in private models of care. More than two-thirds of the women in each survey rated their intrapartum care as 'very good' (1989–67%, 1994–71 %, 2000–72%). Over the time period there was an improvement in the proportion of women rating their care as 'very good' among women in private care (χ² for trend=33.1, p <0.001), but no improvement was seen in public care. Only 52% (1994) and 51% (2000) of women rated their postnatal care as 'very good'.
Conclusions : The conduct of three population-based surveys of recent mothers in Victoria over the past 10 years has provided valuable information for charting the impact of organisational changes on women's views and experiences of maternity care.     

Nurses' attitudes to active voluntary euthanasia: a survey in the ACT

National public opinion polls show a large majority of Australians are in favour of active voluntary euthanasia (AVE). However, most members of the public have had only limited direct experience with dying people. For this reason, surveys of the opinions of medical practitioners and nurses on this issue are of great interest. The present study involved a postal survey in late 1996 of 2,000 randomly selected registered nurses from the Australian Capital Territory (ACT). The ACT has had extensive public debate about this issue. The questionnaire included some questions asked in earlier Australian surveys of the general public and health practitioners. Responses were received from 1218 nurses (61%). A majority of nurses who responded supported AVE as 'sometimes right', be it homicide by request (72%) or physician-assisted suicide (71%). A slightly smaller majority believed the law should be changed to allow homicide by request (69%) and physician-assisted suicide (67%). If AVE were legal, 66% of the nurses indicated they were willing to be involved in the procedure. Only 30% were willing to assist patients to give themselves the lethal dose, while 14% were willing to administer the lethal dose to the patient. Comparing these results with previous surveys, it appears that nurses are less in favour of AVE than the public, but more in favour than medical practitioners.     

Primer postcard improves postal survey response rates

OBJECTIVE: This study measures the effect of an intervention to improve mailed survey response rates. METHOD: A randomised controlled trial of a 'primer' postcard was performed as part of a large survey in Victoria in 1997. Prior to the survey mailout, half the sample of 800 general practitioners supplied by the Health Insurance Commission was sent, at random, a primer card to request prompt return of the survey. RESULTS: The intervention resulted in a more rapid return of the survey and improved overall response rates from 60% to 66%. The increased cost per returned survey (40 cents) was largely offset by fewer non-responders requiring follow-up. CONCLUSIONS: A primer postcard is a time and cost-efficient method to increase response rates in general practitioner surveys. IMPLICATIONS: Public health researchers should consider implementing this intervention to improve response rates to postal surveys. Reports of other response maximising strategies should report the cost per returned survey to allow better comparison.     

Physician response rates to a mail survey by specialty and timing of incentive

BACKGROUND: Historically, achieving a high response rate on physician surveys has been a challenging task. Given such concerns, understanding research strategies that facilitate adequate response rates is important. Primary care physician responses to a mail survey on smoking cessation are summarized by physician specialty and timing of incentive. METHODS: A stratified random-sample design, stratified by patient populations-adults, adolescents, and pregnant women-was used. The sampling frame included New Jersey internists, general practitioners, family physicians, pediatricians, and obstetrician-gynecologists. A total of 2100 physicians, 700 physicians from each patient strata, were sampled and mailed a smoking-cessation survey in summer 2002. The sample was randomized by incentive timing: Half received the incentive (i.e., 25 dollars gift card) with the first survey mailing, and half received the incentive on receipt of their completed survey. RESULTS: The promised-incentive group achieved a significantly lower response rate (56%) compared with the up-front-incentive group (71.5%). Response rates by medical specialty varied overall and within incentive groups. The difference between the incentive groups was greatest among obstetrician-gynecologists (i.e., 20.2 percentage points) and was least among pediatricians (i.e., 5.8 percentage points). CONCLUSIONS: Physician response rates to mail surveys are greatly improved, especially among certain medical specialties, by using up-front incentives.     

A low response rate does not necessarily indicate non-response bias in gastroenterology survey research: a population-based study

Aim

To estimate the potential for response bias in standard mailed questionnaires used in surveys of GI symptoms in a community.

Subjects and methods

Validated self-report tools have been developed to measure functional gastrointestinal (GI) disorders but response rates in community surveys have been rapidly declining in many parts of the world. Whether a lower community response rate introduces significant response bias in GI survey research is unknown. A questionnaire was mailed to a total of 5,069 randomly selected subjects. The overall response rate was 52 %. A random sample of 723 of these subjects (428 responders and 295 non-responders, stratified by age and gender) was selected for medical record abstraction (including both inpatient and outpatient history).

Results

The odds for response increased in those with a higher body mass index (odds ratio (OR):1.02 [95 % CI: 1.01, 1.03]), more health care seeking behavior for non-GI problems (OR: 1.97 [95 % CI: 1.43, 2.72]), and for those who had responded to a previous survey (OR: 4.84 [95 % CI: 2.84, 8.26]). Responder status was not significantly associated with any GI symptoms or a diagnosis of GI or non-GI disease (with two exceptions, diverticulosis and skin disease).

Conclusions

Despite a response rate of only 52 %, the results of a community-based GI survey do not appear to be impacted by non-response bias in a major way. A low survey response rate does not necessarily indicate non-response bias.     

A comparison of general practitioner response rates to electronic and postal surveys in the setting of the National STI Prevention Program

Objective: To compare the response rates achieved for an online survey with a postal survey of general practitioners (GPs) as a method to evaluate the National STI Prevention Program. Methods: All GPs in Australia were asked to complete an online survey. A further sample of 509 GPs were asked to complete a postal survey. Response rates to both recruitment methods were compared. The demographic characteristics of responders were compared to the entire GP population of Australia. Results: Twenty GPs completed the online survey (response rate <0.1%). Sixty‐three GPs completed the postal survey (response rate 12.4%). The demographic characteristics of those responding to the postal survey showed no statistically significant difference compared to the general GP population. Conclusion: Our postal survey had a higher response rate than the online survey. Our response to the postal survey was lower than other similar studies and is likely to be due to a lack of incentives and follow‐up. Even with the low response rate it appears that postal surveys can provide a good representation of the overall population. Implications: Despite growing use of online surveys, postal surveys should still be the method of choice whenever possible. Postal surveys should include incentives and further follow‐up of the initial recruitment should be conducted.     

Differences in the contents of two randomized surveys of GPs' prescribing intentions affected response rates

OBJECTIVE: We investigated the differences in response rates and the presence of response bias in two randomized surveys of prescribing intentions for statins and asthma. STUDY DESIGN AND SETTING: We conducted the surveys of British general practitioners (GPs) in 2002. The two surveys had similar designs, formats, administration time, administration methods, and target populations. We compared the response rates to the two surveys while controlling for the characteristics of respondents with nonrespondents. We also compared early respondents with late respondents and assessed heterogeneity in the answers of early and late respondents to two key questions. RESULTS: The response rates to the two surveys were significantly different (statins: 27%; asthma: 19%; P=0.002). We found no interaction between the survey type and any of the GP and practice characteristics we examined. The GPs' answers to the key questions did not differ regardless of the timing of the responses. CONCLUSION: We demonstrated that the surveys' contents significantly influenced the response rates. We found no evidence that the nonrespondents would have answered the key questions differently. Future studies should investigate the mechanisms by which contents of surveys may influence response rate.     

深圳市宝安区社区全科医生精神卫生知识调查

目的调查深圳市宝安区社区全科医生对精神卫生知识的掌握情况。方法通过分层抽样,在宝安区的社区健康服务中心选取全科医生作为调查对象,以典型的焦虑症、抑郁症和精神分裂症个案作为案例描述,调查其对常见精神障碍的认识和相关知识的掌握情况。结果共回收有效问卷134份,深圳市宝安区社区全科医生对焦虑症、抑郁症、精神分裂症三种精神障碍的平均正确识别率为74.6%。对于非重性精神疾病中焦虑症和抑郁症,分别有85.1%和54.5%的全科医生建议咨询心理医生;而对于精神分裂症,79.1%全科医生建议看精神科医生。工作中遇到精神障碍患者,绝大多数(95.6%)会选择转诊转介专科机构,但其中只有71.4%人明确知道市级或区级精神卫生机构。结论有必要在社区全科医生中加大关于精神卫生知识的培训和宣传,提升其对常见精神障碍的识别、转诊、转介能力。     

SARS and biothreat preparedness--a survey of ACT general practitioners

In late 2003 and early 2004 the ACT Division of General Practice and ACT Health conducted two concurrent surveys designed to identify knowledge, attitudes and practices of Australian Capital Territory (ACT) general practitioners around severe acute respiratory syndrome (SARS) and biothreat preparedness. One survey asked individual general practitioners (GPs) about how they gathered information about SARS in 2003, how they preferred to receive information, current practices, and how they perceived the threat of SARS and other infectious agents. The second survey asked practice principals how they organised their practice to respond to the SARS threat in 2003, any difficulties they had with implementing this response, use of SARS infection control guidelines and current policies. The response rate for the individual GP survey was 48 per cent (184/381) and the response rate for the practice organisation survey was 54 per cent (74/136). GPS used many sources of information on SARS during the 2003 outbreak. Facsimiles from the ACT Division of General Practice were the primary source (17%) and facsimile was the preferred method of receiving information in future outbreaks. The majority of GP respondents felt adequately informed about SARS during the 2003 outbreak, but many general practices did not follow the national guidelines on telephone screening of patients, warning signs and having infection control kits available. The majority of practices reported that they had policies or procedures in place to isolate potentially infectious patients from others in the waiting room. GPs rated an influenza pandemic as a threat to themselves and their patients much more highly than SARS or bioterrorism. Suggestions and comments on how ACT GPs could be better prepared to respond to future outbreaks included the need for timeliness of information, information delivery mechanisms, communication issues, education, the availability of guidelines and protocols, planning, role delineation, the use of response teams, provision of equipment, and vaccination. Planning for future infectious disease outbreak events in the Australian Capital Territory should incorporate general practitioners so that the plans reflect what is a feasible response in the general practice setting.     

Use of research by the Australian health promotion workforce

This paper examines the attitudes and practices of Australian health promotion practitioners toward evidence-based practice (EBP). The study used a survey methodology and questionnaires were sent to 1114 members of the Australian Health Promotion Association. A response rate of 27% (n = 277) was achieved. The data showed that the vast majority of participant's attitudes toward EBP was very welcoming. However, in practice the impact of EBP was limited. Participants identified a range of significant barriers to implementing EBP including organizational culture, policy directives and lack of resources. A range of concerns was also identified regarding the applicability of the medically based EBP model within health promotion, which is based upon a social model of health. The findings highlight the importance of acknowledging the complexity of health promotion interventions and working toward developing an appropriate evidence base.     

Using the Internet to conduct surveys of health professionals: a valid alternative?

OBJECTIVE: The purpose of this study was to examine whether Internet-based surveys of health professionals can provide a valid alternative to traditional survey methods. METHODS: (i) Systematic review of published Internet-based surveys of health professionals focusing on criteria of external validity, specifically sample representativeness and response bias. (ii) Internet-based survey of GPs, exploring attitudes about using an Internet-based decision support system for the management of familial cancer. RESULTS: The systematic review identified 17 Internet-based surveys of health professionals. Whilst most studies sampled from professional e-directories, some studies drew on unknown denominator populations by placing survey questionnaires on open web sites or electronic discussion groups. Twelve studies reported response rates, which ranged from nine to 94%. Sending follow-up reminders resulted in a substantial increase in response rates. In our own survey of GPs, a total of 268 GPs participated (adjusted response rate = 52.4%) after five e-mail reminders. A further 72 GPs responded to a brief telephone survey of non-respondents. Respondents to the Internet survey were more likely to be male and had significantly greater intentions to use Internet-based decision support than non-respondents. CONCLUSIONS: Internet-based surveys provide an attractive alternative to postal and telephone surveys of health professionals, but they raise important technical and methodological issues which should be carefully considered before widespread implementation. The major obstacle is external validity, and specifically how to obtain a representative sample and adequate response rate. Controlled access to a national list of NHSnet e-mail addresses of health professionals could provide a solution.     

Antenatal care: a case of the inverse care law?

Abstract: As part of a review of maternity services this study assessed satisfaction with antenatal care among 1193 women who gave birth in Victoria during two weeks of 1989, except for those who had a stillbirth or whose infant died between the birth and the survey. The survey questionnaire was mailed to women eight to nine months after the birth. The response rate, excluding duplicates, women who gave birth outside the survey period and those whose questionnaires were returned because of a change of address was 71.5 per cent. Women attending public hospital clinics were the least satisfied with antenatal care and those attending private obstetricians were the most satisfied, with general practitioners intermediate. These differences by provider accounted for almost all the differences by sociodemographic factors (age, marital status, family income, being of non-English-speaking background and health insurance status). While the majority of women were happy with their antenatal care, an inverse care law still applied: women whose economic and social circumstances meant they were most likely to need ‘care’ from caregivers were more likely to be limited in their choice of caregiver and to be dissatisfied with the care they received.     

Recommendations by Queensland GPs to be more physically active: which patients were recommended which activities and what action they took

Objective: To ascertain the extent to which general practitioners in Queensland recommend physical activity to their patients, the types of patients they target, types of activities they suggest and how patients respond to the recommendations. Methods: Questions designed to answer the research objectives were included in the Queensland Social Survey. Univariate, bivariate and logistic regression analyses were employed linking relevant variables with demographic data from the survey. Results: The survey was completed by 1,261 (35.2%) people. In the previous year, 225 (18%) of them were recommended by a general practitioner to do more physical activity. These people were more likely to have a higher body mass index and rate their general health as fair or poor. Walking was the most common activity recommended (75%). Only 18% of people were not pleased to be recommended to take more exercise and most (67%) reported following the advice. Blue‐collar workers and older people were less likely to follow the recommendations. Conclusions: General practitioners in Queensland are recommending increased physical activity to patients with weight problems and with medical problems. Patients are usually pleased to receive the advice and act upon it. Implications: General practitioners should be aware that physical activity recommendations are received favourably by most patients and there is potential to improve public health by giving physical activity advice to sedentary and/or overweight patients when appropriate.     

Patterns of computer usage among medical practitioners in rural and remote Queensland

ABSTRACT: As part of a more detailed needs analysis, patterns of computer usage among medical practitioners in rural and remote Queensland were investigated. Utilising a questionnaire approach, a response rate of 23.82% (n = 131) was obtained. Results suggest that medical practitioners in rural and remote Queensland are relatively sophisticated in their use of computer and information technologies and have embraced computerisation to a substantially higher extent compared with their urban counterparts and previously published estimates. Findings also indicate that a substantial number of rural and remote practitioners are utilising computer and information technologies for clinical purposes such as pathology, patient information sheets, prescribing, education, patient records and patient recalls. Despite barriers such as bandwidth limitations, cost and the sometimes unreliable quality of Internet service providers, a majority of rural and remote respondents rated an Internet site with continuing medical education information and services as being important or very important. Suggestions that 'rural doctors are slow to adapt to new technologies' are questioned, with findings indicating that rural and remote medical practitioners in Queensland have adapted to, and utilise, information technology to a far higher extent than has been previously documented.     

AN INTRODUCTION TO INDIGENOUS HEALTH AND CULTURE: THE FIRST TIER OF THE THREE TIERED PLAN

ABSTRACT: The objective of the present study was to prepare new doctors with an awareness of cultural and health issues to facilitate positive experiences with indigenous patients. The study incorporated the 1998 intern orientation programs in Queensland public hospitals. The study method included tier one of the Three Tiered Plan, which was implemented and audited. Indigenous liaison officers, directors of clinical training and medical education officers were surveyed prior to this implementation to determine whether any or similar initiatives had been carried out in previous years and /or were planned. Post-implementation feedback from interns was obtained by using questionnaires. Follow-up telephone interviews with the directors of clinical training, medical education officers and indigenous hospital liaison officers detailed the format and content of tier one at each hospital. The results indicate that this active intervention improved the implementation rate of tier one from nine of 19 (47%) Queensland public hospitals in 1997 to 17 (90%) in 1998. The 14 indigenous hospital liaison officers (100%) involved in the intervention perceived it as beneficial. Forty-three (67%) of interns who responded to the survey indicated they had encountered an indigenous patient within the last 2–4 months. The level of knowledge of indigenous health and culture self-reported by interns was between the categories 'enough to get by' and 'inadequate'. In conclusion, it appears that tier one has been successful and is to be a formal component of intern orientations in Queensland public hospitals. Further initiatives in indigenous health and culture targeting medical staff (i.e. tier two and tier three), are needed.     

How Can We Attract More Doctors to the Country?

ABSTRACT: Drawing on findings from an extensive survey of rural general practitioners in Victoria, this article explores proposals for improving the recruitment, training and retention of rural doctors. The study which included metropolitan comparison groups achieved a 75 per cent response rate, providing information representative of most GPs in Victoria. Main barriers to entering rural practice identified by rural doctors were spouse problems; lack of skills; city background and training; ignorance of country practice; lack of self confidence; and inadequate remuneration. Negative attitudes towards the country and general practice plus 'learned helplessness' picked up in medical school were rated by rural doctors as being of significant importance. Of 14 suggestions for improving recruitment, training and retention of rural GPs the following were rated as top priority; substantial clinical experience in rural hospitals and practices; reciprocal links between the country and medical schools; extra financial reward for isolated rural practice; establishment of Rural Medical Education Centres; and a program to meet the needs of the rural practitioner's spouse.     

疫情应激对医护人员睡眠及情绪的影响调查

目的了解医务人员在重大公共卫生事件中的应激程度以及对发生创伤后应激障碍的预防提供数据支持和干预方向。方法采用网络随机抽样的原则,在疫情发生的两周内,收集258份医务人员和63份普通大众的有效问卷。调查内容包含一般人口学资料、IES-R(事件冲击量表)、PSQI(匹兹堡睡眠质量指数量表)、PHQ-9(9条目健康问卷)、GAD-7(7条目健康问卷)。结果医务人员在重大公共卫生事件中的IES-R量表得分显著高于普通大众(P<0.01),但一线医务人员和二线医务人员在得分上没有显著差异,管理岗位的医务人员得分最高,不同岗位间差异显著(F=3.931);且IES-R量表及其三个不同维度分别与睡眠情况、抑郁、焦虑显著相关(P<0.01);同时,医务人员的睡眠质量指数得分显著高于疫情期间的普通大众,也显著高于平时的医务人员群体(P<0.01)。结论医务人员在重大公共卫生事件时具有高应激性,由此带来睡眠问题突出,要注意调节情绪,预防创伤后应激障碍的发生。     

Future directions for clinical practice guidelines: needs, lead agencies and potential dissemination strategies identified by Australian general practitioners

Abstract: There has been an increasing interest in developing clinical practice guidelines for general practitioners as a means of improving health outcomes. We conducted a survey of a national random sample of Australian general practitioners in May 1995 to determine their needs, preferred formats and dissemination strategies and to identify potential lead agencies for guidelines development. Of 373 eligible general practitioners, 286 (77 per cent) returned completed questionnaires. At least 50 per cent of respondents considered guidelines in angina, psychotic illness, skin cancer and attention deficit disorder as 'extremely' or 'very' useful. However, three other topics identified as areas for future guidelines development in Better health outcomes for Australians were so rated by less than half of the general practitioners surveyed. The Australian Cancer Society and the Australian Medical Association outranked nine other organisations in terms of credibility in guidelines development. Innovative formats, including computerised medical records or text, were not highly rated, consistent with our finding that only 27 respondents (9 per cent) had Internet access. Strategies nominated as likely to increase the adoption of a guideline included a personal visit by a trained nurse, a lecture about its content or a Medicare rebate being available when a patient was managed in accordance with the guideline. Public health practitioners and nominated lead agencies are encouraged to respond to these findings and recognise potential strategies to enhance the effective dissemination of guidelines. Interventional studies are required to demonstrate and allow understanding of changes in clinical practice attributable to guidelines. ( Aust N Z J Public Health 1997; 21: 495–9)