Hormone replacement therapy: the views of general practitioners and practice nurses.

The knowledge and attitudes of primary healthcare professionals have been cited as barriers to appropriate uptake of hormone replacement therapy (HRT). This questionnaire survey of general practitioners and practice nurses revealed positive attitudes to HRT but uncovered a lack of pharmacological knowledge.     

Paediatric developmental screening: a survey of general practitioners

A questionnaire survey of 293 general practitioner trainers in England to investigate paediatric screening yielded a response rate of 86%. Paediatric screening sessions were being held by a practice member in the practices of 54% of respondents. In one-third of these practices the practice member was acting in the capacity of clinical medical officer. Of responding trainers 28% held sessions personally and these doctors did not differ significantly from the remainder in terms of sex, seniority, hospital paediatric experience or membership of the Royal College of General Practitioners. About one-third of the doctors holding sessions had spent six months or more working in hospital paediatric departments. First-hand experience of paediatric screening was gained by 60% of the current trainees.

Sixty-one per cent of trainers agreed with the view that developmental screening is an appropriate task for all general practitioners, while 71% saw it as an appropriate task for themselves. Eight-six per cent of trainers agreed that doctors should be paid for this service if trained for it, and 56% that they should be paid regardless of training.

Comparative figures were determined from a parallel survey of 333 non-training general practitioners of whom 225 (68%) replied. Paediatric screening sessions were held in the practices of 34% of respondents and personally by 21%.

It is concluded that there is a high level of interest in paediatric screening among general practitioners, but that there is a need for further expansion in postgraduate paediatric training.

     

Domiciliary hospice care: a survey of general practitioners

A survey of general practitioners in two London health districts was undertaken to gauge their reaction to a domiciliary hospice team which had been available in those districts for two years. Seventy-two per cent of the 226 respondents had used the service, 23% more than four times, and 94% indicated satisfaction at having such a service available, with only 1% expressing dissatisfaction. Although the overall response to the questionnaire was positive, much constructive criticism was also received. Conducting the survey has encouraged more doctors to use the service.     

Psychiatry and general practice: results of a survey of Avon general practitioners

A survey of general practitioners' views on psychiatry and the psychiatric services within an area has shown that considerable problems exist between general practitioners and psychiatrists over the care of patients with mental illness.     

Hormone replacement therapy in a risk-benefit perspective

The relative cost-effectiveness of different treatment strategies for hormone replacement therapy (HRT) was assessed within the framework of a computer model. Where data were lacking, it was necessary to make assumptions about the effects of HRT, particularly in relation to combined oestrogen-progestogen therapy and cardiovascular disease; however, sensitivity analyses were performed to assess the impact of changing these assumptions on the cost-effectiveness equation. It appears that net expenditure by the NHS will depend critically on the direct costs of treatment, rather than on any indirect costs incurred or saved as a result of side-effects. In terms of mortality, a reduction in cardiovascular disease risk would have greatest impact and would overshadow any small increase in breast cancer risk which may be associated with long-term use. If the cardioprotective effect of oestrogen is real, our results suggest that long-term prophylactic treatment of hysterectomised women would be relatively cost-effective. Treatment of symptomatic menopausal women for any period of time appears to offer very good value for money. The lack of data relating to combined oestrogen-progestogen therapy and cardioprotection, and the major importance of the latter in the equation of benefits and risks, make it more difficult to draw conclusions about the cost-effectiveness of treating non-hysterectomised asymptomatic women for prophylactic reasons.     

Chronic debilitating fatigue in Irish general practice: a survey of general practitioners' experience.

BACKGROUND: Doctors are called upon to treat chronic debilitating fatigue without the help of a protocol of care. AIMS: To estimate the incidence of chronic debilitating fatigue in Irish general practice, to obtain information on management strategy and outcome, to explore the attitudes of practitioners (GPs) towards the concept of a chronic fatigue syndrome (CFS), and to recruit practitioners to a prospective study of chronic fatigue in primary care. METHOD: A total of 200 names were selected from the database of the Irish College of General Practitioners (ICGP); 164 of these were eligible for the study. RESULTS: Altogether, 118 questionnaires were returned (72%). Ninety-two (78%) responders identified cases of chronic fatigue, giving an estimated 2.1 cases per practice and an incidence of 1 per 1000 population. All social classes were represented, with a male to female ratio of 1:2. Eleven disparate approaches to treatment were advocated. Many (38%) were dissatisfied with the quality of care delivered, and 45% seldom or hardly ever referred cases for specialist opinion. The majority (58%) accepted CFS as a distinct entity, 34% were undecided, and 8% rejected it. Forty-two (35%) GPs volunteered for a prospective study. CONCLUSION: Chronic fatigue is found in Irish general practice among patients of both sexes and all social classes. Doctors differ considerably in their management of patients and are dissatisfied with the quality of care they deliver. Many cases are not referred for specialist opinion. A prospective database is required to accurately assess the scale of this public health problem and to develop a protocol of care.     

Management of angina pectoris in general practice: a questionnaire survey of general practitioners.

BACKGROUND. Little is known about the current management of angina pectoris in general practice. AIM. This survey set out to assess general practitioners' perceptions of current investigation and treatment for angina pectoris. METHOD. A postal questionnaire was sent to all 217 general practitioners listed with the Hampshire Family Health Services Authority who have access to a regional cardiac centre in Southampton. RESULTS. The response rate was 79% (171 of 217). The majority (80%) of general practitioners reported referring 10% or fewer of their patients with angina to a cardiologist at the regional centre, and 72% reported referring a quarter or fewer of their patients to a hospital physician. Most (77%) considered an exercise test useful for diagnosis of angina, but almost half (47%) were uncertain about its prognostic value. Most respondents (79%) were not confident of interpreting the results of an exercise test. The majority (79%) believed that there was scientific evidence to show that coronary angioplasty relieves symptoms and 21% were of the opinion that it prolongs survival. Ninety six per cent believed coronary artery bypass grafting relieves symptoms and 62% that it prolongs survival. CONCLUSION. General practitioners do not appear to refer the majority of patients with angina pectoris for hospital investigation, and express divergent and contradictory opinions about exercise testing and the scientific evidence for the benefits of coronary angioplasty and coronary artery bypass surgery. Easier access to cardiological investigation and population based data about the value of exercise testing and survival benefits from coronary intervention are required to optimize selection of patients in the community who are most likely to benefit from coronary revascularization.     

The work commitments of British general practitioners: a national survey.

Many qualified general practitioners (GPs) are choosing not to become principals. With the current problems in recruitment and retention of GPs, workforce planning for the future of general practice is contingent upon the work commitments of both GP principals and non-principals. A questionnaire survey of 5966 vocationally trained doctors in the UK suggests that shortfalls in the GP workforce will not be alleviated by relying on the non-principal pool increasing their time commitment to general practice work.     

Doctors' attitudes to information systems: a survey of Derbyshire general practitioners

This paper describes the results of a survey of all 365 general practitioners in Derbyshire. It deals in particular with their attitudes to information systems and the factors which affect them. The results show that there is much more interest in continuous data collection from primary care than is often supposed. This is particularly so among younger general practitioners. The survey thus describes the possible interest in information recording amongst a typical population of general practitioners.     

Hormone replacement therapy: determinants of women's decisions

Hormone replacement therapy: determinants of women's decisions The purpose of this qualitative study was to explore the decision-making process used by menopausal women initiating or remaining on hormone replacement therapy (HRT), stopping HRT, or never starting HRT. Eight focus groups, composed of women reflecting these categories, were conducted. Four major themes or spheres of influence emerged as important in the women's decision-making process: the woman's internal influence – the interface between her perceptions and feelings including the symptoms of menopause, the benefits realized by HRT usage, and the experiences of negative side effects; interpersonal relationships, including the patient–physician relationship, family, friends and information networks; external influences, such as ageism and sexism; and consequences resulting from whichever treatment decision was chosen. A new concept was elucidated called “weighted influence” to underscore the dynamic interplay among the spheres. As information about HRT continues to grow and change, an understanding and application of these spheres of influence can assist physicians in engaging in a dialogue with their patients that allows individual evaluation and application of this new information.     

Hormone replacement therapy and hemostasis: principles of a complex interaction

Postmenopausal women on hormone replacement therapy (HRT) have been shown to be at reduced risk of arterial thrombotic disease. The risk of venous thrombosis appears not to be increased in HRT users in the absence of specific risk factors. However, while these data refer predominantly to women using conjugated equine estrogens, it is less clear whether the favourable impact on cardiovascular diseases may also be achieved by other preparations. Dose, as well as route of application and, particularly, the combination of steroids have been shown to affect both the clinical and the metabolic profile. With regard to cardiovascular diseases, differential effects on the hemostatic system are of particular interest. The principles of the interaction of steroids with the hemostatic system are reviewed. Also, the principal limitations of the assessment of the hemostatic system, as well as its interpretation, with regard to cardiovascular diseases are discussed. It is proposed to view the hemostatic system predominantly as a monitor of endothelial function rather than as a mediator of potential harmful effects on the cardiovascular system.     

Hormone replacement therapy and hemostasis: principles of a complex interaction

Postmenopausal women on hormone replacement therapy (HRT) have been shown to be at reduced risk of arterial thrombotic disease. The risk of venous thrombosis appears not to be increased in HRT users in the absence of specific risk factors. However, while these data refer predominantly to women using conjugated equine estrogens, it is less clear whether the favourable impact on cardiovascular diseases may also be achieved by other preparations. Dose, as well as route of application and, particularly, the combination of steroids have been shown to affect both the clinical and the metabolic profile. With regard to cardiovascular diseases, differential effects on the hemostatic system are of particular interest. The principles of the interaction of steroids with the hemostatic system are reviewed. Also, the principal limitations of the assessment of the hemostatic system, as well as its interpretation, with regard to cardiovascular diseases are discussed. It is proposed to view the hemostatic system predominantly as a monitor of endothelial function rather than as a mediator of potential harmful effects on the cardiovascular system.