Comparison of anticoagulant control among patients attending general practice and a hospital anticoagulant clinic

Management of patients receiving oral anticoagulant therapy was assessed in general practice and a dedicated hospital anticoagulant clinic. The demographic characteristics of patients in both groups were similar, as were the indications for anticoagulation therapy and the duration of treatment. General practice patients were reviewed significantly more frequently, with a median interval of 16 days compared with 42 days for hospital patients (P < 0.001). Twenty four per cent of general practice visits and 26% of hospital attendances resulted in an alteration to the warfarin dosage. Overall, 52% of general practice thrombotest results lay within the ranges recommended by the British Society for Haematology, compared with 45% of hospital results (P < 0.001). There was no difference in the rate of complications in general practice and the hospital clinic. In this study, the anticoagulant control achieved in a general practice setting was superior to that in a dedicated hospital outpatient clinic, although control was far from ideal in either setting.     

Access to complementary medicine in general practice: survey in one UK health authority

Complementary therapy (CT) has become increasingly popular with the general public and interest from the health professions has been rising. There has been no study focusing on the pattern of availability of CT within urban and inner-city general practice. We aimed to describe the prevalence and pattern of access to complementary therapy in this setting, identifying the characteristics of practices offering CT and the perceived barriers to service provision. We sent a postal questionnaire to all 254 general practices on the Birmingham Family Health Services Authority list. Practices were asked whether they offered any access to CTs, how services were organized and which therapies were available and to identify any barriers to provision. 175 practices (68.9%) responded. Half of the practices offered access to CT. Of these, half offered an in-house service, usually provided by the doctor (81.8%). Of GPs practising therapies themselves, 58% began in or after 1990. Seventeen separate therapies were offered, most commonly acupuncture, osteopathy, chiropractic, hypnotherapy and homoeopathy. Practices significantly more likely to offer access to CT were of larger list size and training or teaching practices. They were equally likely to be fundholders or non-fundholders. Practices offering an in-house service tended to be fundholding, training and of larger list size. Finance was perceived as the major barrier. In the area studied, many patients now have some access to CT within primary care, often within their own practice. In the main, therapies offered are the 'medically acceptable face' of complementary medicine.     

The thoracic roentgen image: emergency and routine indications in the clinic and general practice

Even in the era of rapidly emerging cross-sectional imaging techniques (computed tomography, magnetic resonance imaging) the chest radiograph remains the most frequently performed diagnostic imaging procedure and has not lost any importance to other modalities. After technical considerations the value of chest radiography will be discussed based on the most widely applied indications in emergency and routine clinical settings and the link to subsequent imaging modalities will be outlined.     

The rapid access proctology clinic: an appraisal of one year's experience

A walk-in, once-a-week clinic was established in May 1993. In the first year, 1268 patients (954 new and 314 follow up) were seen with a reduction in waiting time, high patient and general practitioner satisfaction, and raised awareness of colorectal disease.     

Clinical epidemiology of childhood abdominal migraine in an urban general practice

The present study examined the epidemiology of abdominal migraine among 1104 children registered with a general practice. There was a similar prevalence of recurrent abdominal pain as in other studies (8.4 per cent). The prevalence of headache was higher among children with recurrent abdominal pain and significantly so among girls. Migrainous headache was not significantly more prevalent in children with recurrent abdominal pain. The prevalence of abdominal migraine with and without migrainous headache was 0.7 and 1.7 per cent, respectively. The peak prevalence of abdominal migraine without migrainous headache was between five and seven years for both sexes. When associated with migrainous headache, it peaked at five to seven years in girls and seven to nine years in boys. The syndrome was associated with travel sickness and was more common among girls and those with a maternal history of migraine. Many children were photo- and phonophobic during an attack.     

Nephrology in general practice

Hints for the practitioner concerning the management of patients with renal disease are presented. Important facts relating to history, physical, laboratory and radiological findings are stressed and diagnostic assessment is briefly described. Although the general practitioner will refer such patients in most instances to a nephrologist, he should know what kind of further examinations and studies are necessary for correct diagnosis and adequate treatment. The present therapeutic possibilities have greatly improved, but one still disappointing aspect is the treatment of certain forms of glomerulonephritis. The cumulative survival rates in patients undergoing hemodialysis and renal transplantation are assessed and compared with the survival rates in patients suffering from myocardial infarct and carcinoma of the breast, colon and the lung. Essential preventive measures are avoidance of toxic substances like analgesics and consistent antihypertensive therapy even in patients with a renal ailment. The dosage of drugs which are mainly eliminated by the kidneys must be adapted to renal function (serum creatinine or clearance of endogenous creatinine).     

Somatization in general practice

Patients with unexplained physical symptoms are very common in primary care. Some patients attribute these symptoms to physical disease (somatizing patients). Somatization can be a symptom of psychiatric disorder, which is found in 1/4 to 1/3 of the patients in a primary care setting. This form of somatization makes diagnosing difficult and is the main reason why psychiatric disorders are underdiagnosed. Simple techniques for diagnosing and treating somatizing patients are available to general practitioners. However, to improve diagnostic sensitivity and treatment, further teaching and development in primary care settings are necessary.     

Psoriasis in general practice

This report, based on a resource pack for primary care nurses, describes the features of psoriasis and reviews current prevention and treatments. The pack emphasises the important role of nurses in helping people to maintain their confidence and independence in the face of this chronic disease.     

Contraceptive practice after clinic discontinuation

A follow-up study was conducted of clients who stopped attending 4 family planning clinics in Washington County, Oregon, a predominantly white, middle-class suburban community. Clients had enrolled in the program between 1971-74, and dropped out by April 1975. 29% of the women (746) who were overdue for a return visit by more than 3 months (i.e. inactive clients) were contacted by phone and mail. No significant social or demographic differences were found between active and inactive clients or between dropouts who were contacted and those who were not. 71% of all program enrollees dropped out by the end of 3 years. However, 90% of the sample were either using contraception or not at risk of an unwanted pregnancy for a variety of reasons. The remaining 10% were either unprotected or already pregnant with an unplanned pregnancy (2%). The women at risk and not using contraception were more likely to be young, poorly educated, single, and recent enrollees in the family planning program. No other social or economic differences affected the comparison of the 2 groups. Most users continued to use the same method of contraception they had used before. However, a significantly smaller proportion of women were using the pill, a slightly larger proportion were using IUD and 6% more clients were sterilized. The most common reasons for leaving the program were the decision to use a private physician and relocation. Among women at risk, the most common reason was worry about the contraceptive method, especially the pill. New sources of care included private physicians (71%, but 1/3 of these women were disatisfied with their doctors' care or fees), public health clinic not part of the family planning program (21%) and drugstores. A very few women reported no alternate source of care.     

Impact of a collaborative immunisation programme in an inner city practice

OBJECTIVES: To describe the impact of a collaborative immunisation programme, between an inner city practice and the Eastern Health Board (EHB). DESIGN: An observational study using a computer database formed from practice and EHB records. SETTING: One Dublin inner city practice with three partners located in an area with a deprived socio-economic profile. SUBJECTS: All patients in the practice aged more than six months and less than five years identified both from practice registers and opportunistically during study period. RESULTS: 342 children, older than six months and less than five years were identified at start and 464 (a 36% increase) by end of the programme. Uptake changed for DPT from 30% before, to 57% after the programme (p < 0.0005), for DT from 15% to 13%, for Hib from 7% to 50% (p < 0.0005) and for MMR (over 15 months) from 53% to 75% (p < 0.0005). Uptake of the DPT, Hib and MMR was 35% among GMS eligible, 51% among GMS ineligible (p < 0.005). CONCLUSION: A collaborative immunisation programme significantly improved practice uptake rates. These improved rates still do not attain declared national targets. To achieve these targets, radical overhaul of the immunisation service is required.