Effect of NHS reforms on general practitioners' referral patterns.

Objective: To compare outpatient referral patterns in fundholding and non-fundholding practices before and after the implementation of the NHS reforms in April 1991.

Design: Prospective collection of data on general practitioners' referrals to specialist outpatient clinics between June 1990 and March 1992 and detailed comparison of two time periods: October 1990 to March 1991 (phase 1) and October 1991 to March 1992 (phase 2).

Setting: 10 fundholding practices and six non-fundholding practices in the Oxford region.

Diagnostic dilatation and curettage: is it used appropriately?

Objective: To determine patterns of use of dilatation and curettage in Britain as compared with those in the United States; to examine variations in utilisation rates within one regional health authority.

Design: Analysis of routinely collected hospital inpatient statistics.

Setting: Statistics for England, Scotland, and the United States; local statistics for Oxford region.

Lifestyle advice in general practice: rates recalled by patients.

Objective: To document how often patients with varying cardiovascular risk levels reported receiving lifestyle advice from general practice.

Design: Cross sectional descriptive survey by postal questionnaire.

Setting: 5 general practices in Bedfordshire.

The epidemiology of hysterectomy: findings in a large cohort study.

Objective: To examine patterns of hysterectomy in the Oxford-Family Planning Association (Oxford-FPA) study in relation to age, parity, social class and calendar period (-1974, 1975-79. 1980-84, 1985-89).

Design: The Oxford-FPA study is a large scale prospective study of 17,032 women recruited from 1968-74 and still under observation.

Outcome of general practitioner referrals to specialist outpatient clinics for back pain.

In 1983-84 general practitioners in the Oxford region kept records of their referrals to outpatient clinics over a period of six months. Five years later in 1988-89 the general practice notes of 182 patients referred for back pain were studied to determine the outcomes of their referral. The actions initiated in the outpatient clinics were compared with the general practitioners' main reason for referral recorded at the time of referral.

Outcomes of referrals to gynaecology outpatient clinics for menstrual problems: an audit of general practice records.

Objective: To determine referral rates and intermediate and long-term outcomes for patients consulting for menstrual disorders and referred by their general practitioner to gynaecology outpatient clinics.

Design: General practitioners' records of referrals to outpatient clinics and retrospective audit of general practice notes to determine outcomes.

Setting: General practices in the Oxford Regional Health Authority area referring to 19 gynaecology outpatient clinics.

Patient participation in general practice: who participates?

A postal survey of 4066 men and women aged between 16 and 64 years was carried out in a general practice in Oxfordshire which had a patient participation group, established in 1972. The aim of the survey was to ascertain the knowledge and use of the group among adults aged 16-64 years. The adjusted response rate was 73%.

Prevention in general practice: the views of doctors in the Oxford region.

A postal questionnaire was sent to all 1291 general practitioners in the Oxford region to determine the pattern of preventive care and their beliefs about its effectiveness. Replies were received from 1014 doctors (79%). Doctors' attitudes to their role in prevention and health promotion were very positive and a large majority claimed to discuss health related topics with their patients when indicated.

Relation between general practices' outpatient referral rates and rates of elective admission to hospital.

Objective: To examine the variation in rates of admission to hospital among general practices, to determine the relation between referral rates and admission rates, and to assess the extent to which variations in outpatient referral rates might account for the different patterns of admission.

Design: A comparison of outpatient referral rates standardised for age and sex and rates of elective admission to hospital for six specialties individually and for all specialties combined.

Setting: 19 General practices in three districts in Oxford Regional Health Authority with a combined practice population of 188 610.

A total audit of preventive procedures in 45 practices caring for 430,000 patients.

Objective: To develop and report the results of a system of audit of computer records in general practice.

Design: A retrospective audit of records in practices using the same computer system. Information about recorded preventive procedures was collected by sending the same audit program to each practice on floppy disk.

Childhood accidents: a practice survey using general practitioners' records and parental reports.

A survey of accidents in children under 16 years of age from one general practice (list size 6400) was carried out using a postal questionnaire to parents and an audit of medical records. Incidence rates were estimated by audit of medical records as 97% of accidents 'other than minor cuts and bruises' reported by parents had resulted in a medical consultation, and parental reporting was incomplete. For 1986, these rates were 254 per 1000 patients at the age of four years or less, 218 per 1000 at age five to nine years and 238 per 1000 at age 10 to 15 years.

Health checks in general practice: another example of inverse care?

Objective: To assess attendance at and the characteristics of patients attending health checks for cardiovascular disease offered in a general practice over a period of five years (1984-9).

Design: Medical record audit and postal questionnaire survey.

Setting: One general practice in Oxfordshire with a socially diverse population.