Survey of patient care in Barbadian family practice - abstract

A survey to establish the use of standard procedures in patient care was undertaken by 19 (31 percent) of the family physicians in Barbados. Seven physicians in the government service and 14 in private practice (2 physicians worked both in the government service and in private practice) recorded information on their management of each encounter over a 6-week period from November 11, 1982. There were 7,303 encounters, and in 5,525 (75.6 percent) of these a prescription was given. Drugs prescribed in order of frequency were anti-infective agents (39.7 percent), analgesics (34.7 percent), anti-hypertensive agents (17.7 percent), and cough preparations (15.4 percent). Of the total number 4,248 (77 percent) were short term management of less than two weeks, 595 (10.8 percent) were for 2 to 4 weeks' therapy and 670 *12.2 percent) were for long term therapy. Family practitioiner in the Government services wrote 2,008 prescriptions in 2,299 encounters, while those in private practice wrote 3,517 in 5,004 encounters. This difference was significant at the p<0.001 level. Physicians in practice for less than 5 years wrote fewer single drug prescriptions and more 2 to 5 drug prescriptions than their colleagues with 5 to 14 years' and 15+ years' experience. These differences were statistically significant (p<0.001). In 2,922 (40 percent) encounters, management entailed patient education or psychotherapeutic counselling. Minor operative procedures were carried out in 1,161 (16.2 percent) encounters, clinical observation in 686 (9.4 percent) and certification in 685 (9.4 percent). Drug prescribing was the most frequent method of patient care by family physicians and variations in this, according to the experience of the doctor and conditions of his employment, are important in further development of patient care. The relative infrequency of counselling and observation are surprising findings in a discipline where the emphasis is on health promotion, and where much of the morbidity is either self limiting or seen in the early stages of development (AU)

Progressive care: surgical wards at the University Hospital, Jamaica

A system of progressive care for surgical patients is examined. The points about the system are summarized below: (a) The care of the very ill patient in a special ward is improved once a stable core of trained nursing staff becomes available. (b) Achieving a stable core of trained nursing staff requires a good administrative head - this depends on the personality, interest and training in administrative work of the nurse in charge. (c) The system allows greater flexibility in the use of beds and has avoided the use of extra beds in spite of a bed occupancy rate averaging at 90 percent. (d) The flexibility requires the consistent movement of patients as determined by their nursing needs. (e) The responsibility for the movement of patients when left to the nursing staff has led to some problems, and it is suggested that it should be the responsiblity of the medical staff. (f) The supervision of the system by a single senior medical staff member is thought to be advantageous. (g) There can be recurring confusion over the type of case eligible for entry to an intermediate care ward. It is hoped that as well as frequent meetings to discuss problems, a large illustrative diagram of the system displayed on all wards involved in the system of progressive care, will solve this problem (AU)