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Collaborative care in the United Kingdom

PRIMARY CARE 1999年第2期26卷 411-+页

作者： Jenkins, GC Counselling Primary Care Staines TW18 4DG England

It is estimated that in 1999, psychological counselors will work in over half of all general practices (primary care physician partnerships) in the United Kingdom. The history of the growth of counseling in general practice is, in many ways, typical of the British way of doing things. Ad hoc arrangements at a personal level, in which individual general practices let a counselor, of ten a social worker, colleague, or personal friend, see those patients who had a variety of problems the primary care physician felt unskilled to handle, characterized many of the early reports of General Practice Counseling.(2,3,26) From provisional data available from the first ever National Survey of general practice counselors,(29) it seems that most counselors are women (87%), with an average age of 48 years;all but a tiny handful have recognizable counselling or psychotherapy qualifications. Fifty percent usually possess a British Association for Counseling Recognized Certificate and Diploma, 25% possess additional counselling and psychotherapy qualifications, and 13% possess qualifications at a Masters level. The counselors surveyed come from many backgrounds, including social work, teaching, and nursing, and they work between 5 to 30 hours a week in general practice. As more research studies are published in the United Kingdom, their work, along with other members of the primary care teams (doctors, nurse practitioners, health visitors, psychotherapists, social workers, and others), is becoming increasingly valued by their fellow primary care team members, and by the patients they see who are referred to them by their primary care colleagues.(4,21,24)

关键词：合作行为咨询/组织和管理效率组织家庭医学/组织和管理大不列颠卫生保健费用/统计学和数值数据精神卫生服务/组织和管理初级卫生保健/组织和管理心理学临床/组织和管理人类

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Doctor-patient communication in different European health care systems: Relevance and performance from the patients' perspective

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PATIENT EDUCATION AND COUNSELING 2000年第1期39卷 115-127页

作者： van den Brink-Muinen, A Verhaak, PFM Bensing, JM Bahrs, O Deveugele, M Gask, L Leiva, F Mead, N Messerli, V Oppizzi, L Peltenburg, M Perez, A Netherlands Inst Primary Hlth Care NL-3500 BN Utrecht Netherlands

Our aim is to investigate differences between European health care systems in the importance attached by patients to different aspect of doctor-patient communication and the GPs' performance of these aspects, both being from the patients' perspective. 3658 patients of 190 GPs in six European countries (Netherlands, Spain, United Kingdom, Belgium, Germany, Switzerland) completed pre- and post-visit questionnaires about relevance and performance of doctor-patient communication. Data were analyzed by variance analysis and by multilevel analysis. In the non-gatekeeping countries, patients considered both biomedical and psychosocial communication aspects to be more important than the patients in the gatekeeping countries. Similarly, in the patients' perception, the non-gatekeeping GPs dealt with these aspects more often. Patient characteristics (gender, age, education, psychosocial problems, bad health, depressive feelings, GPs' assessment of psychosocial background) showed many relationships. Of the GP characteristics, only the GPs' psychosocial diagnosis was associated with patient-reported psychosocial relevance and performance. Talking about biomedical issues was more important for the patients than talking about psychosocial issues, unless the patients presented psychosocial problems to the GP. Discrepancies between relevance and performance were apparent, especially with respect to biomedical aspects. The implications for health policy and for general practitioners are discussed. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.

关键词：信息交流文化交叉比较横断面研究欧洲家庭医学/组织和管理健康知识态度实践病人满意度哲学医学医生病人关系青少年成年人老年人女(雌)性人类男(雄)性中年人

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Who is a generalist? An analysis of whether physicians trained as generalists practice as generalists

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EVALUATION & THE HEALTH PROFESSIONS 1999年第4期22卷 497-502页

作者： Rabinowitz, HK Hojat, M Veloski, JJ Rattner, SL Robeson, MR Xu, G Appel, MH Cochran, C Jones, RL Kanter, SL Thomas Jefferson Univ Jefferson Med Coll Ctr Med Educ Res & Policy Philadelphia PA 19107 USA Temple Univ Philadelphia PA 19122 USA Penn State Univ University Pk PA 16802 USA Univ Pittsburgh Pittsburgh PA 15260 USA

Accurate data on the number of generalist physicians are needed to monitor the physician workforce and to plan for future requirements in the changing health care system. This study assessed the relationship between two frequently used definitions of a generalist physician: completion of graduate medical education (GME) in only a generalist discipline and physician's self-report of practicing as a generalist. Data for 4,808 physician graduates from six Pennsylvania medical schools from 1986 to 1991 were analyzed using information from the GME tracking census of the Association of American Medical Colleges and the Physician Masterfile of the American Medical Association. Of 1,291 physicians trained in a generalist discipline, 1,205 (93%) reported practicing as generalists. Conversely, of the 3,517 not trained in a generalist discipline, 3,358 (95%) were not practicing as generalists. These results indicate GME training is a valid predictor of self-reported practice and provide baseline data to monitor future changes.

关键词：医务工作者的态度职业选择家庭医学/教育家庭医学/组织和管理职务说明宾夕法尼亚医师诊疗模式/组织和管理医师家庭/教育医师家庭/组织和管理医师家庭/心理学问卷调查人类

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Sustaining complementary therapy provision in primary care: lessons from existing services

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COMPLEMENTARY THERAPIES IN MEDICINE 2000年第3期8卷 173-179页

作者： Luff, D Thomas, KJ Univ Sheffield Sch Hlth & Related Res Med Care Res Unit Sheffield S1 4DA S Yorkshire England

Objective:To examine factors which sustain complementary therapy services in primary care in order to inform policy making in a context of rapid change. Design: In-depth qualitative case studies, including semi-structured interviews with key informants. Setting: 10 existing schemes of complementary therapy provision in primary care across England. Results: GPs and complementary practitioners reported wide-ranging benefits from complementary therapy provision in primary care. However, they felt that their ability to sustain complementary therapy provision was mediated by a) funding, b) the need For research, and c) appropriate service delivery mechanisms. a) Many schemes were the result of and sustained by personal vision. As such they had negotiated a variety of funding sources over a considerable period, against a background perception that continued funding was uncertain, b) Most informants believed that more research was needed to provide a solid evidence base for service continuation and development, in particular clinical and cost-effectiveness work. c) The manner of service delivery, notably whether a service was located within a general practice or in a referral centre, was seen as having implications for the integration of practitioners and for patient access to services. Conclusions: Current complementary therapy provision in primary care has developed on an 'ad hoc' basis. In particular, the existence of GP fundholding in the 1990s, in which primary care physicians were able to purchase health services on a practice basis, facilitated the development of services in this way. Within the current Primary Care Group context, where purchasing decisions are made collectively by a group of general practices within a region, consideration needs to be given to both the continuity of schemes already in existence and to whether a more standardized approach to service development will be required to facilitate sustainable provision. (C) 2000 Harcourt Publishers Ltd.

关键词：补充疗法/经济学英格兰循证医学家庭医学/组织和管理筹资组织模型组织管理医师诊疗模式人类

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Model of family medicine and obstetrics-gynecology collaboration in obstetric care at the University of Michigan

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OBSTETRICS AND GYNECOLOGY 2000年第2期96卷 308-313页

作者： Berman, DR Johnson, TRB Apgar, BS Schwenk, TL Univ Michigan Hlth Syst Dept Obstet & Gynecol Ann Arbor MI 48109 USA Univ Michigan Hlth Syst Dept Family Med Ann Arbor MI 48109 USA

Objective: To assess concordance between family physician obstetric privilege delineation and actual care delivered, and describe associated clinical and educational collaborations between family medicine and obstetrics and gynecology. Methods: We conducted a descriptive retrospective review of the care and complications of 962 consecutive patients admitted to a family medicine obstetric service in a research-intensive academic medical center, and compared the results with a structured obstetric privilege delineation. Results: Of 962 women admitted by family medicine faculty members, 741 (77.9%) were managed exclusively by family physicians, 63 (6.6%) were comanaged by family physicians and obstetricians, and 147 (15.5%) were transferred to obstetricians (data missing for 11 patients). Spontaneous vaginal deliveries were performed in 772 patients (81%), cesarean delivery in 116 patients (12.2%), and assisted delivery by forceps or vacuum in 19 (2%) and 44 (4.6%) patients, respectively. Of 926 intrapartum obstetric complications identified in 604 obstetric deliveries, 615 complications (66.4%) in 418 deliveries were managed exclusively by family physicians consistent with privilege delineation, comanagement occurred in 56 patients with 92 complications (9.9%), and care was transferred in 130 patients with 219 complications (23.7%). Conclusion: A structured method of obstetric privilege delineation for family medicine faculty members and associated guidelines for family physician-obstetrician interactions has Led to a successful family medicine obstetric service at a research-intensive, tertiary-care medical center, with a high concordance between privilege delineation and actual care delivered. This success has resulted in incremental clinical and educational collaborations that have improved the quality of women's health care and education. ((C) 2000 by The American College of Obstetricians and Gynecologists.).

关键词：家庭医学/组织和管理医院大学职业间关系病案医务人员权利密执安模型组织管理产科学/组织和管理结果评价(卫生保健) 诊疗准则(主题) 产前保健/组织和管理产前保健/标准转诊和会诊/标准回顾性研究女(雌)性人类妊娠

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Occupational and environmental medicine and primary care

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PRIMARY CARE 2000年第4期27卷 813-+页

作者： Frumkin, H Emory Univ Rollins Sch Publ Hlth Dept Environm & Occupat Hlth Atlanta GA 30322 USA

This article introduces occupational and environmental medicine (OEM) to physicians in other specialties, and especially to primary care physicians, by highlighting the common foundations of OEM practice and primary care practice. These common foundations include careful diagnosis and treatment, appropriate use of consultants, collaboration with non-medical professionals, attention to psychosocial issues, care of the entire family, respect for confidentiality, patient education, preventing disability and maximizing function, diligent patient follow-up, epidemiological thinking, and continuing medical education.

关键词：出院后医疗机密合作行为环境卫生家庭/心理学家庭医学/组织和管理职业病/诊断职业病/病因学职业病/心理学职业病/治疗职业医学/教育职业医学/组织和管理病人医疗小组医师的作用初级卫生保健/组织和管理公共卫生工作转诊和会诊成年人女(雌)性人类男(雄)性中年人

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Family support in general practice

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JOURNAL OF THE ROYAL SOCIETY OF MEDICINE 1999年第10期92卷 525-528页

作者： Goodhart, C Layzell, S Cook, A Graffy, J Statham Grove Surg London N16 9DP England Univ London Queen Mary & Westfield Coll Dept Gen Practice & Primary Care London E1 4NS England

At a time when social services are overburdened in Britain, family support in general practice offers one way to fill the gap. In the WellFamily Project, a 'family support coordinator' worked within a general practice in Hackney, London. In the first eighteen months she saw 113 clients. Evaluation was by semistructured interviews with a sample of these clients and with professional workers. Comments from those interviewed indicate that the family support was valued. The general practice base was convenient and non-stigmatizing. By adopting a proactive approach, the project was able to work with clients who had previously 'slipped through the net'. Some of the professionals interviewed would have liked to provide the same help, but were unable to do so because of time and other constraints. Family support provided through general practice was well received by vulnerable families. Although there was overlap with the remit of health visitors and social workers, the protected time and the independence of the coordinator enabled clients to obtain the help they wanted. The replicability of this strategy now needs to be assessed.

关键词：家庭卫生家庭医学/组织和管理病人接受卫生保健的程度方案评价社会支持社会福利成年人人类

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Models of collaboration

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PRIMARY CARE 1999年第2期26卷 401-+页

作者： Lorenz, AD Mauksch, LB Gawinski, BA Univ Rochester Sch Nursing Dept Family Med Rochester NY USA

In order for primary care clinicians to address the complex needs of their patient population they must be able to collaborate with mental health professionals. The peculiar need for this collaboration arises from the mind-body split embedded in our cultural heritage and the resulting professional separatism. A brief review of that history is followed by sections on the spirit of collaboration, the spectrum of collaboration, key ingredients for effective collaboration, and some thoughts about the future of collaboration.

关键词：信息交流病人医护连续性合作行为家庭医学/组织和管理整体保健职业间关系精神卫生服务/组织和管理模型组织管理病人医疗小组初级卫生保健/组织和管理专业场所心理生理学人类

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The struck-off mystery

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JOURNAL OF THE ROYAL SOCIETY OF MEDICINE 1999年第11期92卷 608-608页

作者： McKinley, RK Dixon-Woods, M Univ Leicester Leicester Gen Hosp Dept Gen Practice & Primary Hlth Care Leicester LE5 4PW Leics England Univ Leicester Dept Epidemiol & Publ Hlth Leicester LE1 6TP Leics England

Observations on ward rounds suggested that psychiatric patients might be at special risk of removal from their general practitioner's list. Little has been published on why patients are struck off and our first attempt at investigation was by direct appeals for patients. This drew a small and unsatisfactory sample. We then asked two family health services authorities to distribute questionnaires to struck-off patients. One agreed, but later withdrew cooperation. There is a danger that struck-off patients will become an underclass excluded from primary care. We propose anonymous collection of information by health authorities, so that policy can be reviewed if necessary.

关键词：社区精神病学/组织和管理数据收集/方法英格兰家庭医学/组织和管理卫生服务易得程度/统计学和数值数据医生病人关系诊疗准则(主题) 医生拒绝医治/统计学和数值数据人类

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Enrolment procedures and self-selection by patients: evidence from a Polish family practice

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HEALTH POLICY AND PLANNING 1999年第3期14卷 285-290页

作者： Chawla, M Tomasik, T Kulis, M Windak, A Rogers, DA Harvard Univ Sch Publ Hlth Dept Populat & Int Hlth Int Hlth Syst Grp Boston MA 02115 USA Hlth Serv Krakow Poland Jagiellonian Univ Dept Family Med Collegium Medicum Krakow Poland Harvard Jagiellonian Consortium Hlth Krakow Poland

This paper examines the consequences of patient enrolment procedures in a capitation-based family practice in Krakow (Poland), where the local city government used two different methods for preparation of patient lists. In the first, the city gave the individuals living within the practice area the option of withdrawing from being enrolled in the practice;in the second, individuals were given the option of enrolling in the practice. These two enrolment procedures, identified as 'active-negative' and 'active-positive' respectively, provide a natural experiment for investigating the effects of an enrolment methodology on the economics of a physician's practice. An examination of the data indicates that self-selecting enrolees utilize significantly greater quantities of health care compared to others, and university educated individuals and individuals more likely to fall ill are more likely to self-select into a practice. The study suggests that in order to reduce demand-side adverse selection, either the system of active-positive enrolment should be modified, or capitation rates should be risk-adjusted by health status rather than by demographic variables only. The policy implications of this study become even more significant as more and more physicians leave their salaried jobs to start state-financed independent practice.

关键词：按人收费/组织和管理发展中国家家庭医学/经济学家庭医学/组织和管理卫生服务需求卫生服务研究病人接受卫生保健的程度病人满意度波兰利用情况审核人类

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