Effect of feedback on test ordering behaviour of general practitioners.

Objective: To assess the effect of feedback on the test ordering behaviour of general practitioners.

Design: Comparison of requests at two diagnostic centres, and internal comparison between tests which were discussed in feedback and tests which were not.

Setting: A diagnostic centre in Maastricht giving feedback and another elsewhere in the Netherlands (laboratory A) not giving feedback.

Patient education in family practice: the consensus reached by patients, doctors and experts.

Patient education is a central aspect of the GP's work, but it is not clear what type of information and guidance should be given to patients during consultations. As the existing literature did not offer any clear solutions to this problem, a consensus study was carried out using a panel of GPs, patients and experts/policymakers in the field of health education. After three cycles of questioning involving written questionnaires and written feedback, the panel reached a consensus on 35 priorities and recommendations concerning patient education carried out by the GP.

National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards.

The Nederlands Huisartsen Genootschap (NHG), the college of general practitioners in the Netherlands, has begun a national programme of standard setting for the quality of care in general practice. When the standards have been drawn up and assessed they are disseminated via the journal Huisarts en Wetenschap. In a survey, carried out among a randomized sample of 10% of all general practitioners, attitudes towards national standard setting in general and to the first set of standards (diabetes care) were studied.

Disease-centred versus patient-centred attitudes: comparison of general practitioners in Belgium, Britain and The Netherlands.

The attitudes of general practitioners in Belgium, Britain and the Netherlands have been sought to determine if they are patient-centred or disease-centred (that is, doctor-centred). The results indicated that many of the doctors held disease-centred attitudes, which in previous studies in the Netherlands and Belgium had correlated with increased prescribing of symptomatic medication, shorter consultation time, inadequate patient records and poorer standards of care within the consultation. Doctors in Belgium had the highest level of disease-centred attitudes, Dutch doctors the lowest.

Attitudes to risk taking in medical decision making among British, Dutch and Belgian general practitioners.

The attitudes of groups of general practitioners in Belgium, the UK and the Netherlands to risk taking in medical decision making have been determined. The results indicate that many doctors seek to minimize the risks that they take when treating patients. Doctors in Belgium had the highest levels of 'no risk-taking' attitudes with 60% preferring not to take risks; Dutch doctors had the lowest levels with only 24% preferring not to take risks.

Peer review in primary care.

In a district of the town of Nijmegen in the Netherlands, 322 family physicians were approached to take part in an intensive peer review programme: 73% agreed to take part. The problems doctors experienced at the start of the programme were: a dislike of being criticized and doubts about such an investment of time. As the programme got going most of the problems shrank in size whilst the problem of changing their practice routines to meet certain guidelines for quality of care imposed by the programme grew.

General practitioners' opinions about their responsibility for medical tasks: comparison between England and The Netherlands.

A questionnaire survey compared a sample of 371 general practitioners in the Avon region of England with 74 general practitioners in the east of the Netherlands. A list of 14 medical tasks--six technical tasks and eight chronic disease management tasks--was presented and the doctors indicated whether each task was totally, often, sometimes, seldom or not at all the responsibility of the general practitioner. The results show that English general practitioners felt more responsibility for chronic problems than the Dutch doctors whereas Dutch general practitioners felt more responsibility for technical tasks than the English.

Effects of the vocational training of general practice consultation skills and medical performance.

The effects of the vocational training of general practitioners in the Netherlands on the consultation skills and medical performance of junior doctors were studied. Results obtained at a training institute providing systematic training in these skills (Nijmegen) were compared with those at an institute taking a problem-based learning approach (Groningen). Trainees (n = 63) audiotaped consultations and recorded their medical performance at the start and at completion of training.

The effects of peer review in general practice.

This paper describes the effects of an intensive, structured programme of peer review on the behaviour of general practitioners. Trained assessors evaluated 43 doctors before and after participating in the programme. Both the medical and non-medical performance of the general practitioners was assessed using a previously tested measuring instrument.

Audit: a project on peer review in general practice.

A project of group-based peer review by general practitioners is described. Attention is given to the motivation of general practitioners to participate in audits, to the threat posed by peer review and to the use of criteria. The recruitment and motivation were successful.

Attitude changes in the vocational training of general practitioners.

This investigation examined the extent to which attitudes of doctors who participated in a one-year training programme for general practice changed in intended directions by training. A large number of questionnaires, validated in earlier research, were administered to 84 trainee general practitioners (GPs) both at the start and at the end of the training year. There appeared to be a strong to very strong shift in the intended direction with regard to the demarcation of work between general practitioners and specialists, the feeling of competence at work, the fear of making mistakes, beliefs about taking risks when making medical decisions, confidence in specialist technical examinations and the way general practice work is experienced.

Work satisfaction of general practitioners and the quality of patient care.

The emotional reactions of 57 general practitioners to three aspects of work was assessed by means of questionnaires. The quality of patient care was assessed by means of observations of general practice consultations, assessment of audiotaped consulting hour contacts and an analysis of the referral and prescription figures. A distinction was made between the degree of positive and the degree of negative feelings general practitioners have about their work.