Community pharmacy: a method of assessing quality of care.

Generalisability theory is presented as a research method for assessing the quality of health advice. The theory is applied to make a comprehensive assessment of primary health care advice given by community pharmacists. A random sample of pharmacies from all London postal districts were selected and visited for set periods throughout one year. During these visits all consultations on health or the use of drugs between pharmacists and clients were tape-recorded. Nine characteristics were derived by an external criterion panel on which the quality of advice in a random sample of consultations (50) was assessed using rating scales. Following the application of generalisability theory, operational conditions for the assessment were selected to obtain a generalisability coefficient of around 0.8. Nearly half the consultations achieved satisfactory scores on at least three-quarters of the criteria on which they were assessed. However almost a third were considered satisfactory on less than a quarter of the criteria, most of these being satisfactory on none of them. Performance regarding disease prevention/health promotion activity was poorest. Thus the quality of most consultations was found to be either very good or very poor, relatively few occupying the middle ground.

Current comment. (xxii) Traveller-Gypsies and general practitioners in East London: the role of the Traveller health visitor.

Traveller-Gypsy communities in the United Kingdom (UK) have higher morbidity and mortality levels than the national average and their members have only limited access to primary and preventative health care services in most areas. Results of a questionnaire survey of general practitioners (GPs) in East London support previous evidence that the appointment of specially trained health visitors could help improve levels of understanding between GPs and Traveller families and so help Travellers make more effective use of conventional local primary care networks. The relevance of this specific example for other minority populations is evident.

Teaching medical ethics symposium. A student-led approach to teaching.

It is increasingly agreed that ethics has a place in undergraduate medical education. There is, however, debate about how it should be taught, and by whom. We present our experience of teaching ethics in a general practice module over six years. During this period there has been a shift from a teacher-centred to a student-centred approach in which students choose ethical issues to explore within a framework provided. The issues raised are discussed with examples, and the future directions of our ethics teaching outlined.

Evaluation of a training scheme for receptionists in general practice.

Two training courses for receptionists in general practice were evaluated by questioning participants and doctors before and after the course took place. The results indicated that the training had been enjoyed and that participants had acquired a good deal of knowledge which they would be able to use effectively in their jobs. The courses and the evaluation exercise are described.

The clinical and psychometric evaluation of a new hypnotic drug, loprazolam, in general practice.

A double-blind crossover study was carried out in 16 patients with insomnia to assess the effectiveness and tolerance of a new hypnotic, loprazolam, with that of nitrazepam and placebo. Patients received 1 capsule each night for 7 days of either 1 mg loprazolam, 5 mg nitrazepam or placebo and then 7 days' treatment with each of the other medications in random order. The results of analogue rating scale assessment by the patients showed that 'ease of getting to sleep' and 'quality of sleep' were significantly better with loprazolam than with placebo. Loprazolam appeared to be at least as effective, if not more so, than nitrazepam. There were no significant differences between treatments on the morning muzziness assessment, which was low in each group, or in the psychometric tests carried out indicating that loprazolam is unlikely to produce hangover effects. There were no obvious differences between treatments in the incidence or frequency of side-effects spontaneously volunteered by the patients.

Doctors' attitudes to health centres.

In one Inner London health district many doctors seemed reluctant to work in health centres. To investigate the reasons, 44 general practitioners in two matched groups were interviewed. Those working in health centres appreciated the advantages of pleasant premises and the presence of a primary health care team. Other doctors believed health centres were disliked by patients, were bureaucratic in organization, and involved difficult interpersonal relationships. These were confirmed as real problems by health centre doctors. Thus, reluctance to join health centre practices is based on a realistic appraisal of the drawbacks. Recommendations are made.

Is anorexia nervosa a phobic disorder? A psychophysiological enquiry.

Skin conductance changes were measured in nine patients suffering from either frank anorexia nervosa or closely related feeding disorders after presentation of a series of food- and weight-related stimuli in imagination. The conductance changes observed were either absent or small. By contrast, in two of the patients who also had specific phobias, presentation in imagination of the specific feared object led to greater skin conductance changes.

Teaching about the primary care team: an experiment in vocational training.

As part of their regular half-day release course trainee general practitioners met with paramedical colleagues and ancillary practice staff for group discussions on aspects of teamwork. The series of meetings extended over two years. The organizer's aim, that the participants should obtain information about and insight into their colleagues' roles, was achieved. There was also evidence of significant professional maturation and interdisciplinary understanding.

Evaluation of the effects of clobazam, A 1,5 benzodiazepine, on mood and psychomotor performance in clinically anxious patients in general practice.

1 The methodology of clinical trails of anxiolytic drugs carried out in general practice conditions is discussed. Particular problems include: the selection of suitable patients; placebo effects; the influence of non-specific variables such as life-events; and patient compliance. 2 Clobazam, a novel 1,5 benzodiazepine, and diazepam were compared with placebo in a double-blind group comparative trial in general practice, which was designed to avoid as many confounding variables as possible. Anxiety-reducing effects were evaluated and at the same time the effects of the drugs on psychomotor performance were examined. 3 Both clobazam and diazepam produced significant improvements in anxiety ratings on the Hamilton Anxiety Scale and the Morbid Anxiety Inventory, whereas placebo did not. 4 The placebo group demonstrated a significant improvement in performance on a pursuit rotor and digit symbol substitution test (DSST), whereas the diazepam group's performance did not change. The clobazam group showed improvement in both tests, significantly so in the DSST. This suggests that diazepam produces impairment in performance, which had negated the practice effects seen in the placebo group, whereas clobazam did not seem to produce similar impairment.

A clinical and psychometric evaluation of flurazepam.

1 The efficacy of flurazepam (15 mg or 30 mg) as a hypnotic, and the residual effects of each dose were compared with placebo in a double-blind cross-over trial involving thirty patients in a general practice setting. Patients received each medication for one week. Daily self-ratings of onset, duration and quality of sleep, together with reports of any untoward effects were made. At the end of each period of medication psychomotor tests (reaction time, pursuit rotor, tapping speed) were administered at 09.00 hours. 2 Both doses of flurazepam were significantly more effective than placebo in inducing sleep, improving the quality of sleep and extending its duration. 3 'Hangover' effects were marked following 30 mg, but not after flurazepam (15 mg). Flurazepam (30 mg, but not 15 mg) significantly impaired performance on the pursuit rotor test and tapping speed. Flurazepam thus appears to be an effective hypnotic drug with the optimum dose for use in general practice being 15 mg at night.