The Journal of the Royal College of General Practitioners最新文献

A study of 67 women one month after miscarriage identified significant levels of dissatisfaction with their medical care. There are particular problems in managing miscarriage which is very distressing for many women but a common clinical presentation for doctors. The reasons for women's dissatisfaction with their management are explained. Greater understanding of the experience of miscarriage should lead to better management and suggestions are made for better care for this common distressing experience.

While a minority of general practices have been producing annual reports for a number of years one of the implications of the government's new contract is that this process will become much more widespread. To date the majority of reports have concentrated on looking back at past activity rather than on looking forward. In this article a mechanism is outlined for turning the annual report into a vehicle for improving participation; for enabling performance review; and for providing direction for the future. Central to this process is the incorporation of a number of objectives into the report. Objectives should relate to the resources of the practice, the activities of the practice and the results which the practice hopes to achieve. Methods for deriving appropriate objectives are described.

To investigate the feasibility of a standardized practice annual report, nine general medical practices in Grampian region collected data over a four month trial period. The definitions for core data used were arrived at after considerable consultation and discussion. They were found to be workable indicators of practice activity enabling comparisons to be made between practices. Three practices reported that they were completing forms more accurately and that this had led to increased item of service income. The results from this study show smaller variations than have been previously reported and there is a case to be made for the pooling and collation of such defined core data. Analysis of this practice activity would provide the stimulus for further research.

People with Down's syndrome form a heterogeneous group sharing a single constant feature--an extra chromosome. This paper reviews the many clinical problems associated with Down's syndrome and emphasizes the prevention of secondary handicapping conditions. Current policies on antenatal screening for Down's syndrome are discussed. The review draws attention to the need for general practitioners to see themselves as part of a network of community services providing support to people with Down's syndrome and their families.

Brighton community health council responded to the invitation of five local general practitioners to undertake a patient satisfaction survey of their practices. A total of 177 mothers of children under five years old were interviewed in their own homes. Satisfaction with the services provided by the general practitioners and members of the primary health care team to the respondents and to their young children was high overall, but critical comment reflected a dissatisfaction with professionals' unwillingness to take mothers' concerns at face value and to recognize the validity of mothers' own experiential knowledge. Some women were not satisfied with the extent to which they could ask questions or explain their problem. They resented attempts by receptionists to bar access to doctors and the apparent reluctance of doctors and health visitors to make home visits. It is suggested that various strategies such as telephone consultations, written guidelines on childhood ailments and parent support groups within the context of a more interactive partnership between patients and professionals could lead to a more effective service.

A system of diabetic review was introduced in two Southampton training practices in March 1985. Each partner, with the help of the practice nurse, retained responsibility for review of their own diabetic patients. During the study period (1984-86) 213 diabetics remained with the practices. In 1984 there were 94 non-insulin dependent patients who were not receiving hospital outpatient care. Over the study period there was an increase in the surveillance of blood glucose, blood pressure, weight, urine (for protein), fundi, visual acuity and feet for this group so that in 1986 between 79% and 89% of patients were having these parameters checked at least annually. More complications were found and more referrals for specialist evaluation were made. There was a trend towards transfer of care from the hospital to the general practitioner, and the proportion of non-insulin dependent diabetic patients receiving their care entirely from general practice increased from 22% to 60% over the period. There was a small increase in the workload of the general practitioners and a considerable contribution to care was made by the practice nurses. It is concluded that structured personal diabetic care based on a nurse coordinated service is a satisfactory alternative to the 'specialist' general practitioner mini-clinic model.