Strategies to increase preventive care in general practice

OBJECTIVE: To develop strategies to overcome barriers to preventive care in general practice. METHOD: Participants invited to attend a one-day workshop ranked barriers to preventive care in a pre-workshop survey. During the workshop, small groups generated strategies to overcome the most influential barriers. After the workshop, participants nominated strategies for implementation in the ideal world and in the realities of resource constraints. PARTICIPANTS: Twenty-six participants representing general practice, medical academe, funding authorities, health policy planners, researchers, medicopolitical organisations and consumers. RESULTS: The surveys yielded preferred strategies for implementation in the ideal world and 10 preferred strategies for implementation given likely resource constraints. CONCLUSIONS: Authoritative guidelines are needed to guide clinical practice and to evaluate research. Other comprehensive strategies to overcome barriers to preventive care must be implemented and evaluated for effectiveness and acceptability in field experiments before wider implementation. The controlled implementation and evaluation of these strategies requires genuine collaboration amongst clinicians, health policy planners, researchers, funding authorities and general practice academe.     

Managing alcohol problems in general practice

A questionnaire on the management of alcohol problems was sent to 467 general practitioners. Of the 312 who replied, nine tenths thought that they had a legitimate role in working with patients with drinking problems, but less than a half thought that they were adequately equipped to perform this role. Only two fifths felt motivated to work with drinkers, less than a third were satisfied with the way in which they worked with drinkers, and fewer than one in 10 obtained work satisfaction from working with drinkers. Only 29% of doctors regularly gave advice to patients to reduce alcohol consumption, but 56% believed that their advice was effective. Doctors who had positive attitudes to working with drinkers undertook more work related to alcohol problems in their practice. There is a need to provide further education for general practitioners about alcohol related matters, and this education should include advice on intervention with heavy drinkers.     

Acceptance of a psychiatric screening questionnaire by general practice attenders

The general health questionnaire (GHQ) is a self-reporting psychiatric screening questionnaire which has been tested and validated in a number of languages and cultural settings. The translated and validated 30 item GHQ was given to a selected sample of women between 15 and 49 years attending a suburban general practice, as a part of a study on emotional disorder. The acceptance of the questionnaire was high with a compliance of 91.5% from those who were invited to participate. The majority of respondents showed much interest and willingness in filling in the questionnaire.     

Comparison of response rates to a postal questionnaire from a general practice and a research unit

A postal questionnaire study was carried out in an urban general practice to determine the effect of the introductory letter being sent by the participants' own general practitioner compared with that from a letter sent directly from a research unit. By sequential sampling 409 individuals aged between 40 and 59 were assigned to one of two groups. The people in one group were written to by their own general practitioner and those in the other by a doctor from a research unit. Husbands and wives were paired and were always sent the same letter. A second letter was sent to nonresponders after one month. The response rate to the general practitioner was significantly higher than that to the doctor in the research unit (85% compared with 75%) and differed by age and sex. The results have important implications for other research workers and suggest that general practitioners are in a key position in the conduct of medical and epidemiological research.     

饮酒对全麻患者术后早期认知功能的影响

目的 研究饮酒对全麻患者术后早期认知功能的影响.方法 采用神经心理学测试技术简易智力状态检查(MMSE)对40例长期大量饮酒者和40例匹配的正常对照者于术前1天及术后第3天评定认知功能,通过MMSE分值的变化来评价手术前后认知功能的改变及2组间的差异.结果 饮酒组术后早期MMSE值低于对照组(P＜0.05);饮酒组术后早期认知功能障碍(POCD)的发生率为37.5%,明显高于对照组的10.0%(P＜0.05).结论 长期大量饮酒对全麻患者术后早期认知功能损害起促进作用.     

Alcohol consumption in pregnancy: results from the general practice setting

Background

There is no established safe level of alcohol consumption in pregnancy. Studies from Ireland have consistently shown lower abstention and higher binge drinking rates in pregnancy than other countries, indicating a high potential for foetal alcohol-related disorders. There has been little research on alcohol in pregnancy in primary care.

Aims

To determine the prevalence of alcohol consumption amongst pregnant women attending their GP for antenatal care, and to compare this to use in the year prior to conception.

Methods

Prospective cross-sectional study was carried out in fifteen teaching practices in the greater Dublin area. Women were recruited at their antenatal visits. Data were gathered by self-completed questionnaire in the practice, or researcher-administered telephone questionnaire. The questionnaire was based on the AUDIT, a WHO-validated data collection instrument designed for use in primary care.

Results

Two hundred and forty valid questionnaires were returned (80 % recruitment rate). Alcohol intake and binge drinking levels were much lower during pregnancy compared to the year prior to pregnancy (p < 0.001). There was a marked reduction in the prevalence of alcohol use in pregnancy compared to previous research. Over 97 % drink no more than once a week, including almost two-thirds of women who abstain totally from alcohol in pregnancy. Non-pregnant Irish women drink alcohol more frequently, and with higher rates of binge drinking, than women of other nationalities.

Conclusions

Primary care is a suitable setting to research alcohol use in pregnancy. Alcohol use in pregnancy in Ireland has decreased markedly compared to previous research from this jurisdiction.     

饮酒态度问卷的初步编制及其在基诺族中的适用研究

目的 为对基诺族饮酒相关精神卫生问题的病因学能进行较深入的定量研究,编制饮酒态度调查问卷并研究其在基诺族中的适用性.方法 分析收集可能反应饮酒态度的日常话语42条形成问卷条目库,在调查基诺族饮酒相关精神卫生问题流行病学资料的同时用该条目库对被分层随机抽样得到的625名被试进行评定,对评定结果进行结构效度、重测信度、同质信度、效标效度分析.结果 经过对591(94.6%)份有效回答问卷的因子分析,编制出26个条目5个维度的饮酒态度调查问卷,该问卷在基诺族中应用的重测信度和同质信度良好,效标效度也较好,结构效度则一般.结论 此饮酒态度调查问卷已经基本具备了在基诺族当中使用的条件,值得进行更深入系统的研究以获得更好的效果并扩大使用范围.     

饮酒态度问卷的初步编制及其在基诺族中的适用研究

目的为对基诺族饮酒相关精神卫生问题的病因学能进行较深入的定量研究，编制饮酒态度调查问卷并研究其在基诺族中的适用性。方法分析收集可能反应饮酒态度的日常话语42条形成问卷条目库，在调查基诺族饮酒相关精神卫生问题流行病学资料的同时用该条目库对被分层随机抽样得到的625名被试进行评定，对评定结果进行结构效度、重测信度、同质信度、效标效度分析。结果经过对591（94．6％）份有效回答问卷的因子分析，编制出26个条目5个维度的饮酒态度调查问卷，该问卷在基诺族中应用的重测信度和同质信度良好，效标效度也较好，结构效度则一般。结论此饮酒态度调查问卷已经基本具备了在基诺族当中使用的条件，值得进行更深入系统的研究以获得更好的效果并扩大使用范围。     

Influence of an increase in excise duty on alcohol consumption and its adverse effects

The excise duty on alcoholic beverages was increased in March 1981, causing the cost of alcohol to rise faster than other prices for the first time in 30 years. For this reason 463 "regular drinkers" in the Lothian region whose drinking habits had been established in 1978-9 were reinterviewed in 1981-2. Overall, their alcohol consumption had fallen by 18% and associated adverse effects by 16%. Heavy drinkers and suspected dependent drinkers both reduced their consumption at least as much as light or moderate drinkers and suffered considerably fewer adverse effects as a result. Increasing the excise duty on alcoholic beverages can therefore be an effective public health measure. Factors related to rising unemployment were responsible for about 20% of the overall reduction in consumption.     

Reactions of patients to video recording of consultations in general practice

The potential value of video recording for examining medical consultations depends on the extent to which recordings are representative of unfilmed consultations. This paper examines the views of 295 patients in two general practices whose consultations were filmed and compares them with the views of a control group of 185 patients. Most of those who were filmed reported that the consultation was not directly affected, and no overall effect of filming was discovered when patients rated their stress after the consultations, their rapport with the doctor, or other aspects of the consultation. At one practice, however, filming was significantly associated with lower ratings of rapport between doctor and patient among those patients who reported some direct effect of filming. Patient refusal rates from other studies are also examined and shown to vary systematically--the more opportunity patients are given to decline the more likely they are to take it. Consideration of doctors' responses to being filmed would usefully complement the emphasis on the views of patients.     

The otolaryngology, head and neck training appraisal questionnaire: a national general practice perspective

Background

Diseases of the Ear, Nose and Throat (ENT) make up a considerable proportion of the everyday workload of general practitioners (GPs). It is recognized that ENT makes up a very small part of the undergraduate curriculum, but some post-graduate training schemes are now offering placements in Otolaryngology.

Aim

The aim of the study was to examine a perceived knowledge ‘gap’ of GPs in the area of Otolaryngology.

Method

A postal questionnaire was sent to 1,000 GPs distributed evenly throughout the country.

Results

There was a 47.3 % response rate; 72 % of GPs felt that they would see at least three or more children with a relevant ENT problem each day. Almost 70 % of GPs had less than a month exposure to ENT in medical school and 84 % of GPs felt that further emphasis was required at the undergraduate level. Twenty-one per cent of GPs surveyed had spent some time in Postgraduate ENT training. Ninety-one per cent of GPs agreed that further emphasis on ENT training was required at the Postgraduate level.

Conclusion

General Practitioners feel that increased importance should be placed on the study of Otolaryngology at both undergraduate and Postgraduate level.