Frequency of patients' consulting in general practice and workload generated by frequent attenders: comparisons between practices

BACKGROUND: Patients who attend frequently may present a problem for general practitioners (GPs) in several ways. The frequency of patients' consulting, comparisons between practices, and the effect of frequent consulting on the clinical workload have not been quantified previously. AIMS: To examine the distribution of the number of consultations per patient in four general practices. To estimate the clinical workload generated by frequent attenders. To model the data to demonstrate the contribution of age, sex, and practice on the likelihood of attending frequently. METHOD: Analysis and modelling of a validated data set of date records of consultations collected routinely over a 41-month period from four practices in and around Leeds, representing 44,146 patients and 470,712 consultations. RESULTS: A minority of patients consulted with extreme frequency. All practices had similar distributions but varied with respect to the numbers of frequent attenders, and the frequencies of their consulting. The most frequent 1% of attenders accounted for 6% of all consultations, and the most frequent 3% for 15% of all consultations. Females and older people were more likely to be frequent attenders. CONCLUSION: Frequent attenders have an important effect on GPs clinical workload. Between one in six and one in seven consultations are with the top 3% of attenders. Further research is needed to explain the behaviour underpinning frequent attendance in order to identify appropriate management strategies; such strategies could have an important effect on clinical workload.     

Four years' experience of a senior house officer rotation in general medicine including general practice

A four-month post in general practice was included as an option available to doctors applying for a year-long medical senior house officer (SHO) rotation since August 1993. This study sought the views of SHOs before and after undertaking the general practice post. SHOs gained an understanding of modern general practice and changed their views about certain aspects of general practice. They reported gaining a range of generic skills, which included communication, consultation, and clinical skills. These perceived benefits suggest that such experience merits wider adoption and further evaluation.     

Patients' needs in hospital: nurses' and patients' views

This study set out to identify the most important needs of hospital patients on surgical and medical wards and to assess the ability of nurses to identify these needs. The population consisted of 92 Finnish patients and 69 Finnish nurses. The study was carried out using a questionnaire designed on the basis of the need theory presented by Yura and Walsh. The results of the statistical analyses were presented in the form of frequencies, cross-tabulations and chi-square tests. The patients' most common needs were related to vital functions (44%), followed by those related to functional health status (38%) and environmental needs (36%). The last item on the list of expressed needs concerned reactions to functional health status (31%). Over 70% of the surgical patients suffered from problems related to sleep and rest. Less than 60% of them suffered from acute pain. Medical patients, in turn, had more frequent needs related to vital functions than did surgical patients. Three out of four medical patients suffered from acute pain. Sleep and rest disturbances, stress, bad mood and listlessness were also common problems. The nurses underestimated all patient needs, apart from environmental needs, which they regarded as the main concern of patients. There was a statistically significant difference between patients' and nurses' assessments for 38% of all needs. Moreover, there were differences in assessments between the surgical and medical wards included in the study.     

Implementation of the national cervical cancer screening in general practice and feasibility of a general practice-based call system: the GP''s opinion

A male fetus is described with multiple congenital abnormalities including craniosynostosis and bilateral radial aplasia. There are many similarities to the case recently reported by Imaizumi and Kuroki (Am J Med Genet 41: 162-163). These cases may represent a new syndrome with overlapping features of the Baller-Gerold and Roberts syndromes.     

Increased general practice workload due to a primary care led National Health Service: the need for evidence to support rhetoric

Recent policy initiatives have focused on shifts in the balance of care from secondary care to primary care. A consequence of such shifts is increased workload in primary care. The aim of this paper is to appraise the literature critically to assess whether changes in the balance of care have led to additional work for general practices. In particular, the implications of this literature for the measurement of workload in general practice are highlighted. After an extensive, systematic literature search, only 12 studies that met the review criteria were identified. Although the studies pointed to negligible effects on the number of general practitioner (GP) visits, they failed to capture the many other attributes of a practice's work that are likely to be influenced by a shift in the balance of care. These include both qualitative (e.g. stress and mental effort) and quantitative (i.e. the use of resources in the practice, such as GPs, nurses and other staff's time and administration) measures of workload. The studies may therefore have under-estimated the effect on practice workload. To identify correctly the impact on workload of shifts in the balance of care, studies evaluating shifts need to improve their measurement of general practice workload. Furthermore, an extended definition of workload needs to be developed and tested, and workload monitored over time.     

The role of the triage nurse practitioner in general medical practice: an analysis of the role

A 2-year pilot study was undertaken in a group general practice to evaluate the nurse practitioner triage role. The study was undertaken in several stages which included a patient satisfaction questionnaire survey, follow-up interviews with 30 patients from the questionnaire survey, and analysis of the nurse practitioner's work at different points over the 2-year study period. This paper describes the work of the nurse practitioner in comparison with that of seven general practitioners in a group general medical practice over a 5-day period in February 1996 and included patients' perceptions of their consultation. In this particular group medical practice, as in others throughout the country, many patients request same day appointments, often for self-limiting conditions, social advice and health education. This study demonstrates that the nurse practitioner can deal with such patients effectively and is undertaking an expanded and extended role in order to provide an holistic service to patients with which they are highly satisfied. It can be concluded that given the right kind of education and training and a supportive framework within the practice, the nurse practitioner undertaking a triage role can provide a highly effective service to patients and is a valuable member of the primary health care team.     

Domestic violence: a hidden problem for general practice

Domestic violence is a common problem that may affect more than a quarter of women. It is a complex area in which to undertake research. Studies often focus on selected populations and exhibit a diversity of design, making comparison difficult. This review focuses on physical violence by men against women partners or ex-partners, and exemplifies important issues for general practitioners. Domestic violence frequently goes undetected. This may be the result of doctor's fears of exploring an area perceived as time-consuming, where knowledge is lacking and where they feel powerless to 'fix' the situation. Women may not reveal that they are experiencing violence, sometimes because doctors are unsympathetic or hostile. Nevertheless, women wish to be asked routinely about physical abuse and want to receive immediate advice and information about their options if necessary. Women experience a range of health and social problems in association with domestic violence, including depression, anxiety, substance abuse and pregnancy complications. However, none of these features is specific enough to be useful as an indicator of violence. Therefore, doctors should routinely ask all women direct questions about abuse. This recommendation can be incorporated into guidelines, which should be implemented widely in the UK, to improve the care of women experiencing domestic violence. In parallel with this, the educational needs of general practitioners should be addressed. Further research is needed to establish the prevalence of domestic violence in women presenting to general practice and to investigate how the problem is currently being addressed. If progress is to be made in tackling domestic violence, action within primary care is just one part of this: a fundamental change in the attitudes of men towards women is required.     

Latex sensitization in general pediatric surgical patients: a call for increased screening of patients

BACKGROUND/PURPOSE: Latex sensitization is a well-documented occurrence in children with myelodysplastic and urologic anomalies. The incidence of latex allergy in general pediatric surgical patients, however, has not been previously addressed. The purpose of this study was to examine the risk of perioperative latex reactions in a general pediatric surgical practice over a 1-year period. METHODS: This study examined the occurrence of latex sensitization using two methods. First, the preoperative anesthesia records of patients that have undergone surgery from October 1995 through September 1996 at Mott Children's Hospital were reviewed retrospectively. Second, all patients who had intraoperative anaphylaxis attributable to latex sensitization, including those from three additional hospitals, were evaluated. RESULTS: During a 12-month period, 1,523 pediatric general surgical operations were performed at the C.S. Mott Children's Hospital. Of these, only 11 operations on five patients were performed under latex precautions. All of these patients had a preoperative diagnosis of latex sensitivity. During the same period, intraoperative anaphylactic reactions caused by latex allergy occurred in two of the general surgical patients (0.13%) at the C.S. Mott Hospital. Four additional cases are also reported from other study hospitals. None of these patients were suspected, based on current screening methods, of having a latex allergy before their surgery. CONCLUSIONS: Latex allergy is a potentially life-threatening condition in the pediatric general surgical population. Further study is needed to develop criteria to preoperatively identify patients at risk for latex sensitization.     

Teenagers' views on the general practice consultation and provision of contraception. The Adolescent Working Group

BACKGROUND: The rate of unwanted pregnancies in adolescents in the United Kingdom (UK) is one of the highest in Europe and is a major reason for the RCGP's concern at the under-use of general practitioners' (GPs') contraceptive services by young people. AIM: To discover the attitudes of 15- to 16-year-olds to the GP consultation and contraceptive services. METHOD: Questionnaires were completed as part of an evaluation of a novel sex education programme in 30 schools in 1994, and provided the data for this study. A total of 4481 teenagers (51.6% male and 48.4% female completed the questionnaires in their classrooms under conditions of complete confidentiality. RESULTS: The median consulting rate per year was two for males and three for females. Over 60% of adolescents attended the consultation with a parent. Of the males, 27.5% 'felt that the discussion with their GP could be relayed to their parents against their wishes', as did 25.1% of the females. Other difficulties with GP appointments were identified as embarrassment (63% of females and 46% of males), difficulty getting a quick appointment (44% of both males and females), and an unsympathetic GP (32% of females and 20.5% of males). CONCLUSIONS: Adolescents identify significant factors blocking them from easy access to consultation with their GP. These included lack of trust in confidentiality, lack of staff friendliness, and delay in appointment. Consideration of how these blocks can be removed will assist in providing improved contraceptive services in primary care. General practices need to consider the above factors when providing contraceptive and other services to their teenage patients.     

Nurse managed occupational health services: a primary care model in practice

1. Managed care focus on delivering health care which values prevention, early intervention, continuity of care, commitment to quality care, and outcomes, as well as client satisfaction. Occupational health nurses routinely integrate these values into their practice. 2. An on-site model of primary health care delivery, incorporating the fundamentals of occupational health nursing, can bring significant savings to the organization in health related costs. 3. Case management may provide the greatest potential for growth in occupational health nursing. It is a method that can be used together with managed care to maximize quality health care services. 4. Viewing health related costs as an investment as opposed to part of a benefit plan, influences employees to make positive choices. It also impacts the delivery of health care services on a systematic, global level, which affects total health care costs.     

Nurse practitioners, practice nurses and nurse specialists: what''s in a name?

Nitric oxide (NO) readily makes corresponding complexes not only with ferrous iron but also with ferric iron. However, NO-ferric complexes of many heme proteins were unstable, while horseradish peroxidase formed the very stable NO-ferric porphyrin complex with a shift of the Soret band of the absorption wavelength from 396.5 nm to 420.0 nm. The concentration of NO in aqueous media could be monitored by measuring the absorption changes, and the detection limit was 10 nM. The simple procedure is convenient for concentration determination of NO solution.     

Entrepreneurship research and practice: A call to action for psychology.

Entrepreneurship is a major source of employment, economic growth, and innovation, promoting product and service quality, competition, and economic flexibility. It is also a mechanism by which many people enter the society's economic and social mainstream, aiding culture formation, population integration, and social mobility. This article aims to illuminate research opportunities for psychologists by exposing gaps in the entrepreneurship literature and describing how these gaps can be filled. A "call to action" is issued to psychologists to develop theory and undertake empirical research focusing on five key topic areas: the personality characteristics of entrepreneurs, the psychopathology of entrepreneurs, entrepreneurial cognition, entrepreneurship education, and international entrepreneurship. Methodological issues are discussed and recommendations provided. It is shown that psychologists can help identify the factors that influence new venture creation and success and inform the construction of public policy to facilitate entrepreneurship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dialogue medicine: a health-liberating attitude in general practice

The threespine stickleback Gasterosteus aculeatus is an important model in evolutionary and ethologic studies. Its utility would greatly be increased by the availability of molecular markers distinguishing individuals and populations. Such markers can be provided by the major histocompatibility complex (Mhc) genes, which are well known for their extensive polymorphism. In the present study, both class I and class II B Mhc genes have been identified and sequenced. Fifteen distinct class I exon 2 and exon 3 sequences were obtained and assigned to 12 loci on the basis of intron 2 length differences. Some of the loci appear to be related to class I loci identified previously in cichlid fish. The intron 2 sequences and insertions/deletions in exon 2 group the loci into three families (with one family divided further into two subfamilies) derived from different ancestral genes. The ancestors presumably diverged from one another before the divergence of Gasterosteiformes from Perciformes. The 12 distinct class II B sequences may be derived from six loci, which are, however, closely related to one another in both exonic and intronic parts and may have diverged from a single common ancestor after the divergence of Gasterosteiformes from Perciformes. The intron 2 of some of the class I genes contains two microsatellites that can be used as markers, in addition to the polymorphism of the Mhc genes in their exonic regions.