The Role of the General Practitioner in the Last Developmental Task of the Elder People About Death, Identity, Narratives and Dignity

2022 ◽  
pp. 395-406
Author(s):  
Ines Testoni
Keyword(s):  
General Practitioner ◽  
Developmental Task ◽  
Identity Narratives ◽  
Elder People

THE ROLE OF THE GENERAL PRACTITIONER IN AN OBSTETRICS TEACHING HOSPITAL

1975 ◽  
Vol 2 (15) ◽  
pp. 605-607
Author(s):  
James E. Breheny ◽  
Lawrence Hatherley
Keyword(s):  
General Practitioner ◽  
Teaching Hospital

scholarly journals General practitioner use of D-dimer in suspected venous thromboembolism: historical cohort study in one geographical region in the Netherlands

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026846 ◽  
Author(s):  
Angel M R Schols ◽  
Eline Meijs ◽  
Geert-Jan Dinant ◽  
Henri E J H Stoffers ◽  
Mariëlle M E Krekels ◽  
...  
Keyword(s):  
Cohort Study ◽  
General Practitioner ◽  
Clinical Assessment ◽  
Geographical Region ◽  
Historical Cohort ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
D Dimer

ObjectivesTo investigate how many general practitioner (GP)-referred venous thromboembolic events (VTEs) are diagnosed during 1 year in one geographical region and to investigate the (urgent) referral pathway of VTE diagnoses, including the role of laboratory D-dimer testing.DesignHistorical cohort study.SettingGP patients of 47 general practices in a demarcated geographical region of 161 503 inhabitants in the Netherlands.ParticipantsWe analysed all 895 primary care patients in whom either the GP determined a D-dimer value or who had a diagnostic work-up for suspected VTE in a non-academic hospital during 2015.Primary and secondary outcome measuresThe primary outcomes of this study were the total number of VTEs per year and the diagnostic pathways—including the role of GP determined D-dimer testing—of patients urgently referred to secondary care for suspected VTE. Additionally, we explored the use of an age-adjusted D-dimer cut-off.ResultsThe annual VTE incidence was 0.9 per 1000 inhabitants. GPs annually ordered 5.1 D-dimer tests per 1000 inhabitants. Of 470 urgently GP-referred patients, 31.3% had a VTE. Of those urgently referred based on clinical assessment only (without D-dimer testing), 73.8% (96/130) had a VTE; based on clinical assessment and laboratory D-dimer testing yielded 15.0% (51/340) VTE. Applying age-adjusted D-dimer cut-offs to all patients aged 50 years or older resulted in a reduction of positive D-dimer results from 97.9% to 79.4%, without missing any VTE.ConclusionsAlthough D-dimer testing contributes to the diagnostic work-up of VTE, GPs have a high detection rate for VTE in patients who they urgently refer to secondary care based on clinical assessment only.

scholarly journals Impact of regional socioeconomic variation on coordination and cost of ambulatory care: investigation of claims data from Bavaria, Germany

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016218 ◽  
Author(s):  
Michael Mehring ◽  
Ewan Donnachie ◽  
Antonius Schneider ◽  
Martin Tauscher ◽  
Roman Gerlach ◽  
...  
Keyword(s):  
General Practitioner ◽  
Rural Areas ◽  
Hierarchical Models ◽  
Claims Data ◽  
Medical Condition ◽  
District Level ◽  
Considerable Proportion ◽  
Specialist Care ◽  
Physician Density

ObjectivesA considerable proportion of regional variation in healthcare use and health expenditures is to date still unexplained. The aim was to investigate regional differences in the gatekeeping role of general practitioners and to identify relevant explanatory variables at patient and district level in Bavaria, Germany.DesignRetrospective routine data analysis using claims data held by the Bavarian Association of Statutory Health Insurance Physicians.ParticipantsAll patients who consulted a specialist in ambulatory practice within the first quarter of 2011 (n=3 616 510).Outcomes measuresOf primary interest is the effect of district-level measures of rurality, physician density and multiple deprivation on (1) the proportion of patients with general practitioner (GP) coordination of specialist care and (2) the mean amount in Euros claimed by specialist physicians.ResultsThe proportion of patients whose use of specialist services was coordinated by a GP was significantly higher in rural areas and in highly deprived regions, as compared with urban and less deprived regions. The hierarchical models revealed that increasing age and the presence of chronic diseases are the strongest predictive factors for coordination by a GP. In contrast, the presence of mental illness, an increasing number of medical condition categories and living in a city are predictors for specialist use without GP coordination. The amount claimed per patient was €10 to €20 higher in urban districts and in regions with lower deprivation. Hierarchical models indicate that this amount is on average higher for patients living in towns and lower for patients in regions with high deprivation.ConclusionThe present study shows that regional deprivation is closely associated with the way in which patients access primary and specialist care. This has clear consequences, both with respect to the role of the general practitioner and the financial costs of care.

scholarly journals Commissioning mental health services: role of the consultant psychiatrist

2000 ◽  
Vol 6 (1) ◽  
pp. 73-80 ◽  
Author(s):  
Chris Simpson
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
General Practitioner ◽  
National Health Service ◽  
Health Service ◽  
Health Services ◽  
Consultant Psychiatrist ◽  
Health Authorities ◽  
Care Groups

The current National Health Service (NHS) approach to commissioning health services is in flux. The purchasing of care from providers by general practitioner fundholders (GPFHs) and health authorities has changed with the new White Papers. GPFHs no longer exist and the commissioning role is being handed over from health authorities to primary care groups (PCGs). An understanding of the reasons for change and current arrangements will aid the consultant psychiatrist in influencing this process.

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