Illness behaviour in mothers with young children.

113 families with young children were studied over a 12-month period, when all contacts with the general practitioner and hospital emergency services were recorded. Socioeconomic data was obtained at interview, together with responses to a vignette instrument describing common childhood problems. Health diaries were completed by 70% of mothers, providing further information about illness and mothers anxiety about it. Analyses showed that significant disease in any child was the strongest predictor of frequency of new consultations, with measures of mothers anxiety, number of children in the family, mothers education level and her response to the vignettes also contributing significantly. Socioeconomic deprivation was associated with increased utilisation, even when the effects of prevalence of chronic diseases, size of family and mothers' anxiety were taken into account. From the spontaneous comments made during the vignette responses further information was obtained about how mothers reach the decision to consult the family doctor about children's illness. Thus in a Primary Care setting some systematic differences have been demonstrated between high and low consulting families, which may partly explain the wide variation in spontaneous consultation rates observed.

Exploration of doctor and patient agendas in general practice consultations.

A method for the interactional analysis of doctor/patient consultations is described and applied to six naturally occurring general practice interviews by three raters. The method is reliable given sufficient training and satisfies the stringent criteria for any method of analysis for medical interviews proposed by Wasserman and Inui [1: Wasserman R.C. and Inui R.S. Med. Care 21, 279, 1983].

The outpatient experience: results of a patient feedback survey.

Patient surveys can be used to enable hospital management to evaluate the services they provide. This study shows high levels of patient satisfaction with the quality of their consultations and the attitude shown to them by medical staff. Patient feedback shows that despite the introduction of the Patients' Charter, waiting times from referral to appointment and delays in clinics are still identified as the main areas for improvement. Findings show that patients are, however, remarkably tolerant and understanding of the pressures and demands placed upon outpatient staff.

Psoriasis and cancer.

A possible association between psoriasis and cancer was investigated by a study of general practice records in 25 practices.No difference was found in the prevalence of malignant disease between a group of 738 psoriasis cases and a group of matched controls.This result accords with the recent finding that tissue from psoriasis patients does not differ from normal in its response to potentially carcinogenic substances.

Epiglottitis.

A case of acute epiglottitis due to Haemophilus influenzae is described. The problems of making this diagnosis as early as possible are discussed, with a review of the literature.

Child consultation patterns in general practice comparing "high" and "low" consulting families.

All children's consultations with their general practitioner over a 12 month period in a small urban practice were analysed. Overall consultation rates ranged from 2.2 per child a year for 8 to 11 year olds, to 6.8 for those under 2. Families were grouped according to their average rate of new consultation for children, standardised for age. Families with higher consulting rates scored higher on an index of economic disadvantage, with mothers who scored higher on a test of "tendency to consult" and who were less educated than those in lower consulting families. The presence of any doctor-defined "significant disease" in any child was highly correlated with the family's consultation rate.

Principle agendas of doctors and patients in general practice consultations.

Seventy-three general practice interviews were analysed according to the method described by Butler et al. Results for the three principal agenda types (physical, emotional and social) are presented in terms of the control exerted by either doctor or patient in determining the content of the interview. Both doctor and patient address physical agendas to a similar high degree. In contrast, patients present emotional agendas to a far greater extent than doctors address these concerns. The findings for social agendas are intermediate between those for physical and those for emotional agendas. It is argued that doctors can facilitate the expression of emotional and social agendas by giving explicit or implicit permission for their presence in the interview.

Evaluation of a controlled drinking minimal intervention for problem drinkers in general practice (the DRAMS scheme).

Sixteen general practitioners participated in a controlled trial of the Scottish Health Education Group's DRAMS (drinking reasonably and moderately with self-control) scheme. The scheme was evaluated by randomly assigning 104 heavy or problem drinkers to three groups - a group participating in the DRAMS scheme (n = 34), a group given simple advice only (n = 32) and a non-intervention control group (n = 38). Six month follow-up information was obtained for 91 subjects (87.5% of initial sample). There were no significant differences between the groups in reduction in alcohol consumption, but patients in the DRAMS group showed a significantly greater reduction in a logarithmic measure of serum gamma-glutamyl-transpeptidase than patients in the group receiving advice only. Only 14 patients in the DRAMS group completed the full DRAMS procedure. For the sample as a whole, there was a significant reduction in alcohol consumption, a significant improvement on a measure of physical health and well-being, and significant reductions in the logarithmic measure of serum gamma-glutamyl transpeptidase and in mean corpuscular volume. The implications of these findings for future research into controlled drinking minimal interventions in general practice are discussed.

General practitioner's care of the elderly: studies of aspects of workload.

This paper reports trends in the volume and nature of general practitioners' contacts with the elderly patients on their NHS lists in Dundee during the 1970s. It forms part of a larger project involving 32 general practitioners collaborating in a continuing study concerning the introduction of the first health centre in Dundee.During the decade contacts with the elderly increased as a proportion of the general practitioners' total work, broadly commensurate with the increase in Dundee's elderly population. Indirect contacts, mainly reissue of prescriptions for longterm medication, showed a greater proportional increase than direct consultations. Home visiting of the elderly remained relatively constant, while house calls to other age groups declined. Hospital referrals remained a small proportion of the general practitioners' work. Entry into a health centre was not associated with obvious changes in patterns of workload.If more might be done in planning and implementing changes in care of the elderly at general practice level, such changes should be the result of consensus among the professionals concerned, and should take account of the views of recipients of care.

Comparison of response rates to a postal questionnaire from a general practice and a research unit.

A postal questionnaire study was carried out in an urban general practice to determine the effect of the introductory letter being sent by the participants' own general practitioner compared with that from a letter sent directly from a research unit. By sequential sampling 409 individuals aged between 40 and 59 were assigned to one of two groups. The people in one group were written to by their own general practitioner and those in the other by a doctor from a research unit. Husbands and wives were paired and were always sent the same letter. A second letter was sent to nonresponders after one month. The response rate to the general practitioner was significantly higher than that to the doctor in the research unit (85% compared with 75%) and differed by age and sex. The results have important implications for other research workers and suggest that general practitioners are in a key position in the conduct of medical and epidemiological research.

Evaluation of the effectiveness of UK community pharmacists' interventions in community palliative care.

INTRODUCTION: In 1997, the Royal Pharmaceutical Society of Great Britain Working Party reported that UK community pharmacists had a crucial role in effective medicines management and effective symptom control for those receiving palliative care in the community. However, prior to the integration of community pharmacists into the community palliative team, it is necessary to evaluate the effectiveness of their pharmaceutical interventions. AIM: To assess the effectiveness of community pharmacists' clinical interventions in supporting palliative care patients in primary care using an independent multidisciplinary panel review. METHODS: Patients with a life expectancy of less than 12 months were each registered with a single pharmacy and their consent was obtained for the community pharmacists to access their general practitioner (GP) case records. The community pharmacists received training in palliative pharmaceutical care and documenting interventions. The trained community pharmacists provided palliative pharmaceutical care to the recruited patients. At the end of a 10-month period, the clinical interventions were reviewed by an independent multidisciplinary expert panel consisting of a palliative care consultant, a Macmillan nurse (community palliative care nurse) and a hospital pharmacist with special interest in palliative care. RESULTS: Fourteen community palliative care teams (including community pharmacists, GPs and community nurses) took part in the study and 25 patients were recruited over the 10-month recording period. All but one patient had a diagnosis of cancer; the other patient had chronic obstructive pulmonary disease. By the end of the project, 14 patients had died. Community pharmacists recorded a total of 130 clinical interventions. Thirty interventions were excluded as insufficient information had been documented to allow review by the panel. Eighty-one per cent of the interventions were judged by the expert panel likely to be beneficial. However, 3% were judged likely to be detrimental to the patients' well-being. CONCLUSIONS: Most of the clinical interventions made by the community pharmacists for palliative pharmaceutical care were judged by the expert panel as being likely to be beneficial. The result supports the view that when community pharmacists are appropriately trained and included as integrated members of the team, they can intervene effectively to improve pharmaceutical care for palliative care patients.