scholarly journals Repeat prescribing policy in New Zealand general practice: making it better

2020 ◽  
Vol 12 (4) ◽  
pp. 373
Author(s):  
Steven Lillis ◽  
Liza Lack
Keyword(s):  
General Practice ◽  
New Zealand ◽  
General Practitioners ◽  
Local Development ◽  
Policy Research ◽  
Practice Research ◽  
Annual Conference ◽  
Protected Time ◽  
Repeat Prescribing ◽  
General Practices

ABSTRACT INTRODUCTIONRepeat prescribing is common in New Zealand general practice. Research also suggests that repeat prescribing is a process prone to error. All New Zealand general practices have to comply with requirements to have a repeat prescribing policy, with the details of the policy to be designed by the practice. AIMTo inform the development of practice policy, research was undertaken with experienced general practitioners to identify and mitigate risk in the process. METHODSAt the 2019 annual conference of the Royal New Zealand College of General Practitioners, a workshop was held with 58 experienced general practitioner participants. The group was divided into six small groups, each with the task of discussing one aspect of the repeat prescribing process. The results were then discussed with the whole group and key discussion points were transcribed and analysed. RESULTSIssues identified included: improving patient education on appropriateness of repeat prescribing; having protected time for medicine reconciliation and the task of repeat prescribing; reducing the number of personnel and steps in the process; and clarity over responsibility for repeat prescribing. DISCUSSIONThis research can inform the local development of a repeat prescribing policy at the practice level or be used to critique existing practice policies. Attention was also drawn to the increasing administrative burden that repeat prescribing contributes to in general practice.

scholarly journals Repeat prescribing safety survey

2019 ◽  
Vol 11 (3) ◽  
pp. 243
Author(s):  
Steven Lillis ◽  
Nicki Macklin ◽  
Michael Thorn ◽  
Emma Wicks ◽  
Kristin Good ◽  
...  
Keyword(s):  
General Practice ◽  
New Zealand ◽  
General Practitioners ◽  
Safety Profile ◽  
Response Rate ◽  
Developed Countries ◽  
Expert Group ◽  
Repeat Prescribing ◽  
Accepted Part ◽  
Zealand College

ABSTRACT INTRODUCTIONRepeat prescribing is an accepted part of general practice activities in New Zealand and in many developed countries. However, there has been little research on how this service is used in New Zealand, or on clinicians’ attitudes towards it. AIMTo discover the opinions of vocationally registered general practitioners (GPs) and general practice registrars regarding repeat prescribing, availability of practice policy and mechanisms for issuing such prescriptions. METHODSA survey was developed by an expert group and shared through the Royal New Zealand College of General Practitioners’ (the College) weekly newsletter, epulse, inviting members to participate in the survey. The survey was also emailed to registrars. RESULTSIn total, 144 vocationally registered GPs and 115 registrars responded (n=259), giving a response rate of 3.2% for GPs and 12.7% for registrars. Patient convenience and time efficiency for the practice were the most commonly cited reasons for repeat prescribing. Registrars had low awareness of practice policy on repeat prescribing and only one-quarter of practices had an orientation pack that contained advice on repeat prescribing. DISCUSSIONBetter practice systems are likely to improve the safety profile of repeat prescribing and should be addressed. There is substantial unwanted variability currently in these practice systems.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

scholarly journals Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers

2021 ◽  
Vol 10 (2) ◽  
pp. e001309
Author(s):  
Jennifer Gosling ◽  
Nicholas Mays ◽  
Bob Erens ◽  
David Reid ◽  
Josephine Exley
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
General Practitioners ◽  
Service Improvement ◽  
Protected Time ◽  
Routine Work ◽  
Professional Interest ◽  
Quality And Outcomes ◽  
Nationally Representative ◽  
The Uk

BackgroundThis paper presents the results of the first UK-wide survey of National Health Service (NHS) general practitioners (GPs) and practice managers (PMs) designed to explore the service improvement activities being undertaken in practices, and the factors that facilitated or obstructed that work. The research was prompted by growing policy and professional interest in the quality of general practice and its improvement. The analysis compares GP and PM involvement in, and experience of, quality improvement activities.MethodsThis was a mixed-method study comprising 26 semistructured interviews, a focus group and two surveys. The qualitative data supported the design of the surveys, which were sent to all 46 238 GPs on the Royal College of General Practitioners (RCGP) database and the PM at every practice across the UK (n=9153) in July 2017.ResultsResponses from 2377 GPs and 1424 PMs were received and were broadly representative of each group. Ninety-nine per cent reported having planned or undertaken improvement activities in the previous 12 months. The most frequent related to prescribing and access. Key facilitators of improvement included ‘good clinical leadership’. The two main barriers were ‘too many demands from external stakeholders’ and a lack of protected time. Audit and significant event audit were the most common improvement tools used, but respondents were interested in training on other quality improvement tools.ConclusionGPs and PMs are interested in improving service quality. As such, the new quality improvement domain in the Quality and Outcomes Framework used in the payment of practices is likely to be relatively easily accepted by GPs in England. However, if improving quality is to become routine work for practices, it will be important for the NHS in the four UK countries to work with practices to mitigate some of the barriers that they face, in particular the lack of protected time.

scholarly journals Mental Illness in Primary Care Settings

1985 ◽  
Vol 9 (1) ◽  
pp. 12-13 ◽  
Author(s):  
Greg Wilkinson
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
General Practice ◽  
Social Security ◽  
General Practitioners ◽  
Research Unit ◽  
Practice Research ◽  
Policy Makers ◽  
Department Of Health ◽  
Primary Care Settings

A Conference on the above topic took place at the Institute of Psychiatry, London, on 17 and 18 July 1984. The Conference was sponsored by the Department of Health and Social Security and was organized by the General Practice Research Unit. Over 100 invited clinicians, research workers and policy-makers took part. The majority of the participants were either psychiatrists or general practitioners, but representatives of all relevant disciplines attended.

Mental Health Research in General Practice

2005 ◽  
Vol 13 (2) ◽  
pp. 181-184 ◽  
Author(s):  
Harry Minas ◽  
Steven Klimidis ◽  
Renata Kokanovic
Keyword(s):  
Mental Health ◽  
General Practice ◽  
General Practitioners ◽  
Health Research ◽  
Mental Health Research ◽  
Practice Research ◽  
Practice Setting ◽  
Key Issues ◽  
Practice Time ◽  
Time Limitations

Objective: To explore problems in carrying out a mental health research project in the general practice setting. Method: Open-ended interviews were conducted with general practice stakeholders, focusing on impediments to the conduct of mental health research in general practice and possible means for improving the participation of general practitioners in such research. Participants in the consultations were members of ?ve divisions of general practice, senior staff within an academic department of general practice, four general practitioners and a research group engaged with general practice research. The discussions were recorded in detailed interview notes, and key issues and themes emerging from consultations were derived by the researchers. Results: Three main themes summarized most of the issues reported through the consultations, including structural issues (e.g. disruption of practice, time limitations and lack of remuneration), process issues (e.g. researcher–general practice communication, researcher-imposed issues and need for partnerships) and content issues (e.g. study design, study procedures and methods). Conclusions: The consultations revealed similar ?ndings to previously published reports concerning general practice research, with an emphasis on the need for partnerships between researchers and general practice organizations in the conduct of such research.

Affective Disorders Among Elderly General Practice Patients

1994 ◽  
Vol 165 (4) ◽  
pp. 533-537 ◽  
Author(s):  
C. Turrina ◽  
R. Caruso ◽  
R. Este ◽  
F. Lucchi ◽  
G. Fazzari ◽  
...  
Keyword(s):  
General Practice ◽  
Major Depression ◽  
Elderly Patients ◽  
General Practitioners ◽  
Affective Disorders ◽  
Dysthymic Disorder ◽  
Not Otherwise Specified ◽  
Prevalence Of Depression ◽  
General Practices

BackgroundWe investigated the prevalence of depression among 255 elderly general practice patients and the practitioners' performance in identifying depression.MethodElderly patients attending 14 general practices entered a screening phase with GHQ-12 and MMSE. Those positive were then interviewed with GMS and HAS.ResultsDSM-III-R major depression affected 22.4%, dysthymic disorder 6.3%, not otherwise specified (n.o.s.) depression 7.1 %. General practitioners performed fairly well: identification index 88.4%, accuracy 0.49, bias 1.85.ConclusionsDepression was markedly high. A selective progression of depressed elderly from the community to general practitioners is implied.

scholarly journals A taboo topic? How General Practitioners talk about overweight and obesity in New Zealand

2018 ◽  
Vol 10 (2) ◽  
pp. 150 ◽  
Author(s):  
Lesley Gray ◽  
Maria Stubbe ◽  
Lindsay Macdonald ◽  
Rachel Tester ◽  
Jo Hilder ◽  
...  
Keyword(s):  
New Zealand ◽  
Weight Management ◽  
General Practitioners ◽  
Health Professionals ◽  
Secondary Analysis ◽  
Overweight And Obesity ◽  
Full Potential ◽  
Naturally Occurring ◽  
Interactional Analysis ◽  
General Practices

ABSTRACT INTRODUCTION Obesity is overtaking tobacco smoking in New Zealand as the leading potentially modifiable risk to health. International obesity guidelines recommend that health professionals opportunistically encourage weight management with their patients. However, research shows consistently low rates of weight management discussion, suggesting that health professionals may not be realising their full potential to address obesity. AIM To identify communication strategies used by General Practitioners (GPs) to open the topic of weight and weight management in routine consultations. METHODS A secondary analysis was conducted of 36 video-recorded consultations in general practices, selected for relevance from a database of 205 consultations. Content and interactional analysis was conducted in the context of the entire consultation. RESULTS The topic of weight was initiated more often by GPs than patients and was raised mostly once or twice in a consultation and occasionally as many as six times. GPs employed opportunistic strategies twice as often as they used structured strategies. DISCUSSION This study of naturally occurring consultations confirmed GPs do engage in opportunistic discussions about weight. However, such discussions are challenging and interactionally delicate. Highlighting the clinical relevance of weight appears to be effective. The high frequency of patient contact with GPs provides opportunity to reach and work with people at risk of chronic conditions associated with excess weight. Further research is required to identify suitable training and brief intervention tools for use in routine consultations that may be beneficial for both GPs and patients.

Adoption of ICT in Rural Medical General Practices in Australia

2012 ◽  
pp. 40-51 ◽  
Author(s):  
Patricia Deering ◽  
Arthur Tatnall ◽  
Stephen Burgess
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Network Theory ◽  
Medical Records ◽  
Actor Network Theory ◽  
Actor Network ◽  
Its Analysis ◽  
General Practices ◽  
Suitable Framework

ICT has been used in medical General Practice throughout Australia now for some years, but although most General Practices make use of ICT for administrative purposes such as billing, prescribing and medical records, many individual General Practitioners themselves do not make full use of these ICT systems for clinical purposes. The decisions taken in the adoption of ICT in general practice are very complex, and involve many actors, both human and non-human. This means that actor-network theory offers a most suitable framework for its analysis. This article investigates how GPs in a rural Division of General Practice not far from Melbourne considered the adoption and use of ICT. The study reported in the article shows that, rather than characteristics of the technology itself, it is often seemingly unimportant human issues that determine if and how ICT is used in General Practice.

Problems with Recruitment in a Randomized Controlled Trial of Counselling in General Practice: Causes and Implications

1996 ◽  
Vol 1 (2) ◽  
pp. 77-80 ◽  
Author(s):  
Karen Fairhurst ◽  
Christopher Dowrick
Keyword(s):  
General Practice ◽  
Randomized Controlled Trial ◽  
General Practitioners ◽  
Controlled Trial ◽  
Psychiatric Morbidity ◽  
Family Health ◽  
Telephone Interviews ◽  
Randomized Controlled ◽  
Authority Area ◽  
General Practices

Objectives: To evaluate the effectiveness of counselling in the management of minor psychiatric morbidity in general practice, and to explore the reasons for difficulties in recruiting patients to such an evaluation. Methods: We attempted to conduct a randomized controlled trial of counselling in eight general practices in one NHS family health services authority area in England. Having experienced significant problems recruiting patients, we conducted semi-structured telephone interviews ( n = 8) with participating GPs to explore the reasons for these difficulties. Results: Five months after the start of the study only one patient had been recruited. The main reasons identified as contributing to the recruitment problems were: General practitioners' motivation for involvement in the study; their ethical doubts about the randomization process; the perceived lack of a viable non-counselling intervention; and their existing practical commitment to counselling. Conclusion: Although methodological modification might enhance the potential for success in future studies of this sort, more fundamental difficulties concerning general practitioners' attitudes to research and their professional responsibilities lie at the heart of our recruitment problems.

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