Disability as identified from general practice records

Thirty eight doctors who attended a postgraduate educational course provided information about disabled patients identified in a search of 7000 records. Disablement was defined as a major disruption to the normal lifestyle of patients in appropriate age and sex groups. Altogether 242 people were identified as disabled, equivalent to 32 per 1000 population, which is closely similar to that published by Harris, who identified patients by postal questionnaire. Among adults aged 15 to 64 more men were identified than women, and we suggest that a higher rate of disablement might be expected in men. Disablement among women may be underestimated because of underrecognition by doctors of disability in housewives. Fifty two per cent of all disabled people were able to attend the doctor's surgery, and 72% were receiving regular medication; 79% were dependent on relatives, but only 30% were dependent on statutory services. In the opinion of the recording doctors medical and nursing needs were well met, though not the social needs, where the importance of living alone is noteworthy.     

Evaluation of quality of contents of general practice records

The quality of contents of general practice records was assessed by retrieving clinical information pertaining to hypertension in 171 consecutive records, and the quality of communication storage was assessed by seeking evidence of tuberculin skin tests or BCG vaccination, or both, in 298 consecutive records. There was no mention of urine analysis and blood test results in 43.3% and no record of fundal examination in 61.4% of the records of patients with hypertension. Electrocardiography was performed in 67.8% and chest x ray examination was done in 65.5% of these patients. These observations have importance for patient care, education, and research. The information regarding tuberculin skin test or BCG immunization, or both, was not available in 78% of the records. Reassessment of the individuals, however, showed that 89% of the studied population had had the test or vaccination, or both. There was thus a deficiency in communication and storage.     

Shuttle case records: link between general practice and the specialist unit

General practitioners have participated in the long term follow up of 367 patients who have undergone treatment with potent antirheumatic drugs at this hospital. Over the past two and a half years we have used the "shuttle case record" system, whereby patients' records are mailed back and forth between our department and general practitioners. This seems to work well. It is safe for the patients, and they save time and money in travel. The general practitioners like it, it improves communication between them and the specialist unit, and it enables the specialist unit to use its resources and manpower more effectively. The system may also be used to monitor patients with other chronic disorders, and it may be a valuable tool for doing research in general practice.     

Giving patients their own records in general practice: experience of patients and staff

Patients have reacted positively to seeing their medical records in a general practice which has a predominantly working class population in south east London. Most patients were familiar with the information in their records. Older people tended to avoid reading their notes. There have been few inaccuracies and unpleasant reactions reported, and few problems have arisen.     

Death certification in cancer of the breast

The cause of death entered on the death certificates of 193 patients originally diagnosed as having cancer of the breast was compared with information obtained from clinical records, cancer registry records, and necropsy findings to determine the accuracy of death certification and the proportion of patients who, though dying from another cause, still had overt signs of cancer of the breast. It was found that the overall error in certifying cause of death as breast cancer was small, being an underestimate of about 4%. About a third of patients with breast cancer dying from other causes had overt signs of breast cancer at the time of death.     

Towards vertical integration in general practice education: literature review and discussion paper

Background

Medical education policy in Ireland has enabled an increase in undergraduate and postgraduate education activity in general practice. Internationally, ‘vertical integration in general practice education’ is suggested as a key strategy to support the implementation of this policy development.

Aims

To review the emerging literature on vertical integration in GP education, specifically to define the concept of ‘vertical integration’ with regard to education in general practice and to describe its benefits and challenges.

Methods

We searched ‘Pubmed’, ‘Academic Search Complete’, ‘Google’, and ‘MEDLINE’ databases using multiple terms related to ‘vertical integration’ and ‘general practice education’ for relevant articles published since 2001. Discussion papers, reports, policy documents and position statements were identified from reference lists and retrieved through internet searches.

Results

The key components of ‘vertical integration’ in GP education include continuous educational pathway, all stages in GP education, supporting the continuing educational/professional development needs of learners at each stage and effective curriculum planning and delivery. Many benefits (for GPs, learners and the community) and many challenges (for GPs/practices, learners and GPs in training) have been described. Characteristics of successful implementation include role sharing and collaborative organisational structures.

Conclusions

Recent developments in medical education in Ireland, such as the increase in medical school clinical placements in general practice and postgraduate GP training and the introduction of new competence assurance requirements offer an important opportunity to further inform how vertical integration can support increased educational activity in general practice. Describing this model, recognising its benefits and challenges and supporting its implementation in practice are priorities for medical education in Ireland.     

Can the prevalence of disease risk factors be assessed from general practice records?

The result of an audit of the recording of smoking habit, alcohol consumption, blood pressure level, diet, exercise, height, weight, and occupation in patients in five general practices is reported. This audit was the first phase of a study to assess the feasibility of the exchange of information between general practice and a district health authority. The frequency with which each item was recorded varied from 3% (exercise) to 65% (blood pressure) in a five year period. The sample of patients upon whom a recording had been made was shown to be unrepresentative of the practice population: this presents a difficulty in using general practice records to estimate the prevalence of risk factors for disease in the community.     

Immediate coronary care in general practice — a three-year review

The general practitioners in a rural practice in a three-year period were called to 101 patients (25% female) who suffered a myocardial infarction. The average response time was 15 minutes. Seventeen patients collapsed and died and the 84 who survived the initial period were given immediate coronary care and either cared for at home, admitted by cardiac ambulance to a coronary care unit, or admitted to a general medical ward with monitor facilities. The four-week mortality rates were 21.0%, 21.5% and 57.7% respectively. Thirty-six patients required treatment for arrhythmias in the initial care period, of whom nine required defibrillation. This survey supports the view that patients over the age of 60 years with uncomplicated myocardial infarction may be cared for successfully at home.     

Personal health records: a scoping review

Electronic personal health record systems (PHRs) support patient centered healthcare by making medical records and other relevant information accessible to patients, thus assisting patients in health self-management. We reviewed the literature on PHRs including design, functionality, implementation, applications, outcomes, and benefits. We found that, because primary care physicians play a key role in patient health, PHRs are likely to be linked to physician electronic medical record systems, so PHR adoption is dependent on growth in electronic medical record adoption. Many PHR systems are physician-oriented, and do not include patient-oriented functionalities. These must be provided to support self-management and disease prevention if improvements in health outcomes are to be expected. Differences in patient motivation to use PHRs exist, but an overall low adoption rate is to be expected, except for the disabled, chronically ill, or caregivers for the elderly. Finally, trials of PHR effectiveness and sustainability for patient self-management are needed.