Computer use by general practitioners in Scotland.
BACKGROUND: Despite the widespread adoption by general practitioners (GPs) of desktop computers, there has been very little evaluation of the way in which the computer is actually used during consultations and the way in which it affects patient satisfaction. AIM: To ascertain the extent to which the computer is used in the consultation and to investigate the possible relationship between computer use and patient satisfaction. METHOD: Six GPs completed a short questionnaire about the extent to which they use the computer during surgeries. Eighty-four consultations from the surgeries of these GPs were video recorded. Patient satisfaction data on these 84 patients were collected at the time of the surgery using the previously validated Consultation Satisfaction Questionnaire. RESULTS: All six GPs stated that they usually used the computer during consultations. However, video observation revealed that the computer was used in just 51% of surgeries. The proportion of time that the computer was used for varied from 0.03 to 0.4, with a mean value of 0.12. The commonest function for which the computer was used was prescribing. The consultations in which the computer was used (CU) were on average 148 seconds longer than the non-computerized consultations (NCU). There was no difference in patient satisfaction between the two groups. CONCLUSION: Despite this group of GPs having a self-declared interest in the use of computers, the extent to which the computer was used was much lower than expected from the GPs' self-reported use. This may be partly explained by the fact that using the computer takes up valuable time within the consultation and does not appear to contribute to patient satisfaction. If desktop computers are to be used to their full potential in general practice, more work is required to evaluate their impact on the consultation process itself. (+info)
Relationship between practice counselling and referral to outpatient psychiatry and clinical psychology.
BACKGROUND: Although reduction in the use of secondary care mental health services is a suggested benefit of counselling in general practice, there has been little empirical investigation of this relationship. AIM: To investigate the relationship between the provision of counselling in general practice and the use of outpatient psychiatry and clinical psychology services across a geographical area. METHOD: Information on referrals to outpatient psychiatry and clinical psychology from all general practices in the London Borough of Islington over one year (October 1993 to September 1994) was collected from the routine information systems of the main hospital departments serving this area. Referral rates per 1000 practice population were compared for practices with and without a practice-based counsellor. RESULTS: Fifteen (35%) of the 43 practices had a counsellor based in the practice. The median referral rate to clinical psychology was higher in practices with a counsellor (4.1 per 1000) than in practices without a counsellor (0.8 per 1000). There was no relationship between the provision of practice counselling and median referral rates to outpatient psychiatry (1.8 per 1000 with a counsellor, 1.7 per 1000 without a counsellor). CONCLUSION: Provision of practice counselling in the study was associated with higher referral rates to clinical psychology and no difference in referral rates to outpatient psychiatry. This is in contrast to the hypothesis that counselling reduces the use of secondary care mental health services. (+info)
Late referral of end-stage renal failure.
We studied all new patients accepted for renal replacement therapy (RRT) in one unit from 1/1/96 to 31/12/97 (n = 198), to establish time from nephrology referral to RRT, evidence of renal disease prior to referral and the adequacy of renal management prior to referral. Sixty four (32.3%, late referral group) required RRT within 12 weeks of referral. Fifty-nine (29.8%) had recognizable signs of chronic renal failure > 26 weeks prior to referral. Patients starting RRT soon after referral were hospitalized for significantly longer on starting RRT (RRT within 12 weeks of referral, median hospitalization 25.0 days (n = 64); RRT > 12 weeks after referral, median 9.7 days (n = 126), (p < 0.001)). Observed survival at 1 year was 68.3% overall, with 1-year survival of the late referral and early referral groups being 60.5% and 72.5%, respectively (p = NS). Hypertension was found in 159 patients (80.3%): 46 (28.9%) were started on antihypertensive medication following referral, while a further 28 (17.6%) were started on additional antihypertensives. Of the diabetic population (n = 78), only 26 (33.3%) were on an angiotensin-converting-enzyme inhibitor (ACEI) at referral. Many patients are referred late for dialysis despite early signs of renal failure, and the pre-referral management of many of the patients, as evidenced by the treatment of hypertension and use of ACEI in diabetics, is less than optimal. (+info)
Assessment of swallowing and referral to speech and language therapists in acute stroke.
The best clinical assessment of swallowing following acute stroke, in order to decide whether to refer a patient to a speech and language therapist (SLT), is uncertain. Independently of the managing clinical team, we prospectively investigated 115 patients (51 male) with acute stroke, mean age 75 years (range 24-94) within 72 h of admission, using a questionnaire, structured examination and timed water swallowing test. Outcome variables included referral to and intervention by a speech and language therapist (SLT), dietary modification, respiratory complications and death. Of those patients in whom an SLT recommended intervention, 97% were detected by an abnormal quantitative water swallowing test; specificity was 69%. An SLT was very unlikely to recommend any intervention if the test was normal. Inability to perform a water test and/or abnormality of the test was associated with significantly increased relative risks of death, chest infection and dietary modification. A timed water swallowing test can be a useful test of swallowing and may be used to screen patients for referral to a speech and language therapist after acute stroke. (+info)
The identification of agreed criteria for referral following the dental inspection of children in the school setting.
AIM: To clarify the function of the school based dental inspection. OBJECTIVE: For representatives of the Community Dental Service, General Dental Service and Hospital Dental Service to identify an agreed set of criteria for the referral of children following school dental inspection. DESIGN: Qualitative research methodology used to establish a consensus for the inclusion of referral criteria following dental screening. SETTING: Ellesmere Port, Cheshire, England. MATERIALS: A Delphi technique was used to establish a consensus amongst the study participants on the inclusion of nine possible criteria for referral following dental screening. All participants scored each criterion in the range 1-9, with a score of 1 indicating that referral of individuals with the condition should definitely not take place, and a score of 9 indicating referral should definitely take place. Referral criteria were accepted only if they achieved a group median score of 7 or more, with an interquartile range of three scale points, with the lower value being no less than 7. RESULTS: Four of the nine possible criteria met the agreed group standard for inclusion: 'Sepsis', 'Caries in the secondary dentition', 'Overjet > 10 mm', and 'Registered & caries in the permanent dentition'. CONCLUSION: It is possible to agree clear criteria for the referral of children following the school dental inspection. (+info)
Descriptive study of cooperative language in primary care consultations by male and female doctors.
OBJECTIVE: To compare the use of some of the characteristics of male and female language by male and female primary care practitioners during consultations. DESIGN: Doctors' use of the language of dominance and support was explored by using concordancing software. Three areas were examined: mean number of words per consultation; relative frequency of question tags; and use of mitigated directives. The analysis of language associated with cooperative talk examines relevant words or phrases and their immediate context. SUBJECTS: 26 male and 14 female doctors in general practice, in a total of 373 consecutive consultations. SETTING: West Midlands. RESULTS: Doctors spoke significantly more words than patients, but the number of words spoken by male and female doctors did not differ significantly. Question tags were used far more frequently by doctors (P<0.001) than by patients or companions. Frequency of use was similar in male and female doctors, and the speech styles in consultation were similar. CONCLUSIONS: These data show that male and female doctors use a speech style which is not gender specific, contrary to findings elsewhere; doctors consulted in an overtly non-directive, negotiated style, which is realised through suggestions and affective comments. This mode of communication is the core teaching of communication skills courses. These results suggest that men have more to learn to achieve competence as professional communicators. (+info)
Special medical examination program reform proposal in Korea.
We are at a time when reform in the special medical examination program in keeping with the changing times is desperately needed because the common perception of workers, employers, and medical examination facilities is "special medical examination is merely ritualistic and unproductive." Therefore, we have tried to set forth the basic structure for reforming the special medical examination program by taking a close look at the management status of the current program and analyzing its problems. The specifics of the special medical examination program reform proposal consist of three parts such as the types, health evaluation based on occupational medicine, and the interval, subject selection, items and procedure. Pre-placement medical examination and non-periodic medical examinations-as-necessary are introduced newly. Health evaluation based on occupational medicine consists of classification of health status, evaluation of work suitability, and post-examination measure. Details regarding the medical examination interval, subject selection, items and procedure were changed. (+info)
Young women taking isotretinoin still conceive. Role of physicians in preventing disaster.
QUESTION: One of my adolescent patients was prescribed isotretinoin for severe acne by a dermatologist. I was shocked to discover she does not use any means of contraception. The dermatologist insists he told her about the need for contraception. How can we do better? ANSWER: Clearly this dermatologist, like many of his colleagues, does not comply with the Pregnancy Prevention Program. Until physicians become more aware of this program, babies will continue to be born with embryopathy due to isotretinoin. (+info)