Statistical analysis of referrals by general practitioner at Health Insurance Organization clinics in Alexandria

Referral of patients generates significant economic costs for both physician fees and diagnostic tests. Variation in referral rates between general practices and between individual GPs has long been the focus of attention for policy makers. The present study aimed to analyze the referrals by General Practitioners (GP) at Health Insurance Organization (HIO) clinics in Alexandria. The study was conducted at 18 Health Insurance Organization (HIO) comprehensive clinics in Alexandria, distributed in the 6 districts of Alexandria HIO. Retrospective analysis of records and cross sectional interview to 180 GPs were carried out. Male GPs comprised 82.2% of the sample. On the average, GPs received 6.6 +/- 4.5 patients per working hour. Over the year 2002, 8.4% of consultations were referred to specialists, 5.4% referred to laboratory and only 0.09% were referred to hospital. The highest percent of referrals from GP to specialist were directed to internal medicine followed by orthopedics, general surgery, E.N.T, dermatology, neuropsychiatry, chest then urology clinics. Referral rate from GPs to specialists was found to have a 6.6-fold variation among clinics, and a 54.8-fold variation among individual GPs. Moreover, there was no homogeneity in variations in referral rates of clinics within 3 of the 6 districts. Using multiple regression analysis, the only significant factor was the indirect relation with workload. Comparison of referral rates of GPs with the limits set by HIO (8-17%) revealed that, 48.9% of GPs were within limits, 37.2% were lower and 13.9% were higher than limits. GPs who had diploma or master were average referrers in 51.5%, low referrers in 30.3% and high referrers in 18.2%, compared to 45.6%, 50.6% and only 3.8%, respectively for those with bachelor degree; the difference was statistically significant.     

Utilization of maternal health services offered by the Health Insurance Organization in Alexandria

This study examines the extent of utilization of maternal health services (MHS) currently offered by Health Insurance Organization (HIO) in Alexandria. A total of 1040 insured married females working in primary, preparatory and secondary schools in three educational regions in Alexandria were interviewed. Data was collected about socio-economic status of females, their knowledge about MHS offered by HIO, as well as sources of receiving MHS other than HIO. Barriers preventing utilization of such services and recommendations for improvement were explored from beneficiaries. The results revealed that for the last pregnancy, about half the sample utilized antenatal services and about one fourth utilized natal services, while a very small percentage (8%) utilized family planning services. The private sector was the main source for receiving MHS for non-utilizer. Lack of confidence and low quality of services were the main barriers preventing utilization. Complete physical examination, examination of fetal heart sound and improvement of physical environment of obstetrics and gynecology department were the main recommendations for improvement of MHS offered by HIO.     

An audit of general practitioner referrals for pelvic ultrasound

Pelvic ultrasound is a widely used diagnostic tool and accessto this investigation is not universally available to all generalpractitioners (GPs). The aim of this study was to assess ifGPs working in the United Arab Emirates (UAE) were using pelvicultrasound appropriately by determining the rates of diagnosticyield and referral after the investigation. It was then ascertainedif these results were affected by the post-graduate trainingor gender of the doctor. The subjects were adult females whohad had a pelvic ultrasound ordered by a GP over a 2-month period.A chart review determined the presenting complaint, the completenessof the request form, the result of the ultrasound and subsequentmanagement of the patient. Diagnostic yields and referral rateswere similar to those found in other studies and were unaffectedby the post graduate training or gender of the doctor or theamount of information contained in the request form. This studysupports the premise that GPs can use pelvic ultrasound appropriatelyand should be allowed free access to this investigation.     

A study of six general practitioner hospitals in Tunbridge Wells Health District

At the reorganization of the NHS in 1974 Tunbridge Wells Health District inherited an unusual distribution of beds: more than 25% of beds in general medicine, geriatrics and surgical specialties were in general practitioner hospitals. This article describes a study that attempted to obtain information about the work being done in the GP hospitals, assess their potential and plan their future. The ways in which the DMT is following up the study are outlined. A subsidiary study on transfer from general hospital to GP hospitals is also described.     

Health promotion clinics in general practice—new or old?

The objective of this paper is to assess the variety of specialized clinics available in practice before the implementation of the 1990 Contract. An audit was carried out using information provided in the log diaries from trainees in the West of Scotland sitting the mock Membership of the Royal College of General Practitioners (MRCGP) examinations. The different types of clinics being carried out were identified from the information given. Data were obtained from 147 practices. A wide variety of clinics were being carried out, many of which were included in the list of recommended health promotion clinics and many which did not attract a fee prior to the contractual changes. Only 57% of practices employed a practice nurse and 36% of trainees had no clinic experience in a typical week. The findings indicate that principals are aware of the benefits of clinics in practice and often undertake to carry them out themselves. It is important that trainees gain more experience in carrying out these clinics. Many more clinics have been set up since the contract changes but unless more funding is available to tackle the social problems which adversely affect health we will fail to improve the health of our community.     

Statistical process control tools for monitoring clinical performance.

The quality assurance of medical practice in most countriesis effected through a mixture of informal assessment and peerreview, and through more formal accreditation, credentialingor delineation of privilege. The process of assessment and reviewis often subjective and without explicit reference to pre-determinedstandards of practice. It has been argued that comparative treatmentoutcome data on an individual doctor’s performance isrequired to make quality assurance credible [1]. Equally, manywould add that objective and quantitative methods to monitorthe quality of a     

Aftercare in oncology--greater role for the general practitioner

Patients who undergo curative treatment for cancer continue to be medically monitored for a number of years. Scheduled aftercare, mainly aimed at early detection of locoregional cancer recurrences, distant metastases and secondary primary tumours, takes place chiefly in the second line, but is expected to shift to the first line. Figures from the Nijmegen Continuous Morbidity Registration show that an average (Dutch) general practitioner, caring for about 2500 patients, has in his practice 90 patients who have or have had cancer. This number will increase due to the increasing prevalence of cancer. In addition, extra consultations for each cancer patient will increase the demand for GP care.     

The efficacy of telemedicine for ophthalmology triage by a general practitioner

Although there are enough ophthalmologists for the Brazilian population, they are not evenly distributed throughout the country. Tele-ophthalmology may therefore be a useful tool. We have examined the feasibility of ophthalmology triage, performed by a general practitioner (GP) with remote support from an ophthalmologist. Forty patients with a variety of external and internal eye disorders were examined by the GP and also reassessed by an ophthalmologist, face to face, and then remotely by another ophthalmologist. There was agreement in 95% of the diagnoses between face-to-face and distant evaluation. The use of a digital camera and slit-lamp allowed greater accuracy of telediagnosis than the use of a digital camera alone. The GP would have referred 36 patients to an ophthalmologist, while both the local and the remote ophthalmologist saw the need for referral in 31 cases, i.e. assessment by tele-ophthalmology resulted in a 14% decrease in referrals. GP triage therefore appears to be feasible after appropriate training.     

当前农民健康保障路径分析

农民健康保障问题 ,是当前社会关注的重点、难点问题。为了进一步加强农村卫生保健工作 ,2 0 0 2年 10月国务院下发了《中共中央、国务院关于进一步加强农村卫生工作的决定》 ,为新时期我国农村卫生事业的发展指明了方向。农村和农民问题是关系全面建设小康社会的重大问题 ,稳定农村这个大头 ,就有了把握全局的主动权。鉴于《决定》精神 ,笔者认为 ,农民作为农村经济社会生活中最活跃、最有生命力的因素 ,应该得到更多的关注。为此 ,笔者就当前农民健康保障路径进行分析 ,提出新的观点 ,以期为促进农民健康提供理论参考。1　健康意识觉醒与…     

Improving fund allocation in Iran Health Insurance Organization by applying internal reference pricing: a policy brief

Journal of Public Health - Improving healthcare quality services is one of the governments’ major commitments, which often faces budget constraints. Addressing this challenge requires that...     

Health promotion at NHS breast cancer screening clinics in the UK

Suboptimal diets, sedentary lifestyles, overweight and obesity expose two-thirds of women in England aged over 50 to a heightened risk of lifestyle-related morbidities. The UK's NHS Breast Cancer Screening Programme now reaches 75% of all women aged 53-64 but provides only mammography screening. This cross-sectional survey of 413 women attending two NHS breast screening clinics in North Yorkshire found that the majority of women were interested in having diet and exercise advice at screening clinics and anticipated a neutral or positive effect on their future screening appointments. Interest was highest among older, less educated and overweight women suggesting that this may be a particularly effective medium for reaching higher risk subgroups. Women showed most interest in problem-solving advice, which provided short-term, life-enhancing benefits such as looking and feeling better, having more energy, losing weight and reducing menopausal symptoms, as well as potentially reducing their disease risk. Most appeared to find doing sufficient exercise more problematic than eating healthily and this might be exacerbated by low awareness of exercise guidelines. Given a choice, preferences were to access advice in leaflets or one to one from an expert; however, many younger, professional women were also interested in computer access. Findings indicate the need first for flexible, multi-level access, combining some broad-based information dissemination with pathways to more personalized support and secondly for the relevant 'consumer benefits' associated with better diet and exercise to be promoted as well as longer-term disease prevention. Overall, this study indicates that the UK's NHS Breast Cancer Screening Programme may be uniquely placed to provide health-enhancing advice as well as mammography screening to the majority of women in England, throughout the course of their mid-life.     

Statistical process control as a tool for research and healthcare improvement

Improvement of health care requires making changes in processes of care and service delivery. Although process performance is measured to determine if these changes are having the desired beneficial effects, this analysis is complicated by the existence of natural variation—that is, repeated measurements naturally yield different values and, even if nothing was done, a subsequent measurement might seem to indicate a better or worse performance. Traditional statistical analysis methods account for natural variation but require aggregation of measurements over time, which can delay decision making. Statistical process control (SPC) is a branch of statistics that combines rigorous time series analysis methods with graphical presentation of data, often yielding insights into the data more quickly and in a way more understandable to lay decision makers. SPC and its primary tool—the control chart—provide researchers and practitioners with a method of better understanding and communicating data from healthcare improvement efforts. This paper provides an overview of SPC and several practical examples of the healthcare applications of control charts.     

社区糖尿病患者的健康管理

糖尿病是由胰岛素抵抗和/或胰岛素分泌缺乏所致的一组以高血糖为特征的慢性疾病,随着病程延长可出现多系统损害,导致眼、肾、神经、心脏、血管等组织的慢性进行性病变,引起功能缺陷及衰竭,严重时可发生糖尿病急性并发症,甚至危及生命.临床上分为4型,其中2型糖尿病占糖尿病患者的95％以上,是社区预防与健康管理的重点.现就社区糖尿病的健康管理综述如下：