Diabetes management in a Primary Care Network (PCN) of private general practitioners in Singapore: An observational study.
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ABSTRACT:
SUBMITTER: Luo M
PROVIDER: S-EPMC6221669 | biostudies-literature | 2018 Oct
REPOSITORIES: biostudies-literature
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Diabetes management in a Primary Care Network (PCN) of private general practitioners in Singapore: An observational study.
Luo Miyang M Poh Zhongxian Z Koh Gerald G Tham Tat Yean TY Lau Winifred W Toh Sue Anne SA Chong Chin Kwang CK Low Lian Leng LL Venkataraman Kavita K
Medicine 20181001 43
A Primary Care Network (PCN) is a virtual network of general practitioners (GPs), sharing common resources and common clinical governance framework for effective chronic disease management. In this study, we analyzed the frequency of assessment as well as control of HbA1c, blood pressure (BP), and low-density lipoprotein (LDL) over time among adult patients with diabetes managed by a group of private GPs under PCN.Data, including clinical measurements of HbA1c, BP, and LDL from 2012 to 2015, of ...[more]
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Project description:BackgroundGeneral practitioners (GPs) have a central place in the management of asthma, particularly in the context of acute exacerbations.AimTo evaluate the management of asthma exacerbations by GPs, and to investigate the ability of risk factors for near fatal asthma to predict the severity of asthma attacks in the community.Design of studyA 1-month multicentre cross-sectional survey.SettingOne thousand and ninety-four GPs of the French Sentinel Network were contacted; 365 responded.MethodAsthma exacerbations were classified according to severity at presentation. Univariate and multivariate analyses were performed by logistic regression to identify those factors associated with severe exacerbations.ResultsExacerbations were described in 219 patients with asthma. Over half (54%) of exacerbations were severe. Peak expiratory flow was recorded during the consultation in 55% of patients who were more than 5 years old. beta(2) agonists were prescribed to 93% of patients, systemic corticosteroids to 71%, and antibiotics to 64%. Only 42% of patients had a written action plan for self-management of exacerbations. Risk factors for near fatal asthma, identified in 26% of patients, were not significantly associated with severe asthma exacerbations. Short duration of exacerbation before consultation (<3 hours) was associated with an increase in relative risk of severe exacerbation of 3.38, 95% confidence intervals (CIs) = 1.19 to 9.61, compared with duration of >3 hours.ConclusionRisk factors for near fatal asthma identified in previous studies were not predictive of a severe exacerbation in general practice, with the exception of short duration of exacerbation before consultation. This suggests that new methods to predict risk in the outpatient settings should be developed.
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Project description:BACKGROUND:Research on individual general practitioner (GP) workload, e.g. in terms of consultation counts, is scarce. Accurate measures are desirable because GPs' consultation counts might be related to their work satisfaction and arguably, there is a limit to the number of consultations a GP can hold per day without jeopardizing quality of care. Moreover, understanding the association of consultation counts with GP characteristics is crucial given current trends in general practice, such as the increasing proportion of female GPs, part-time work and group practices. AIM:The aim of this study was to describe GPs' consultation counts and efficiency and to assess associations with GP and practice variables. METHODS:In this retrospective observational study we used routine data in electronic medical records obtained from 245 Swiss GPs in 2018. We described GPs' daily consultation counts as well as their efficiencies (i.e. total consultation counts adjusted for part-time work) and used hierarchical linear models to find associations of the GPs' total consultation counts in 2018 with GP- and practice-level variables. RESULTS:The median daily consultation count was 28 over all GPs and 33 for full-time working GPs. Total consultation counts increased non-linearly with part-time status, with high part-time working GPs (60%-90% of full-time) being equally or more efficient than full-time workers. Excluding part-time status in the regression resulted in higher consultation counts for male GPs working in single practices and with older patients, whereas part-time adjusted consultation counts were unaffected by GP gender and practice type. CONCLUSION:Female gender, part-time work in the range of 60%-90% of full-time, and working in group practices do not decrease GP efficiency. However, the challenge of recruiting sufficient numbers of GPs remains.
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Project description:Background Repeated studies of working hours among Norwegian regular general practitioners (RGPs) have shown that the average total number of weekly working hours has remained unchanged since 1994 and up until 2014. For both male and female RGPs, the mean total weekly working hours amounted to almost 50?h in 2014. In recent years, Norwegian RGPs have become increasingly dissatisfied. They experience significantly increased workload without compensation in the form of more doctors or better payment. A study from the Norwegian Directorate of Health in 2018 (the RGP study) showed that Norwegian RGPs worked 55.6?h weekly (median 52.5). 25% of the respondents worked more than 62.2?h weekly. Based on data from the RGP study we investigated Norwegian RGP’s out-of-hours (OOH) work, how the working time was distributed, and to what extent the OOH work affected the regular working hours. Methods In early 2018, an electronic survey was sent to all 4640 RGPs in Norway. Each RGP reported how many minutes that were spent that particular day on various tasks during seven consecutive days. Working time also included additional tasks in the municipality, other professional medical work and OOH primary health care. Differences were analysed by independent t-tests, and regression analyses. Results One thousand eighty hundred seventy-six RGPs (40.4%) responded, 640 (34.1%) had registered OOH work. Male RGPs worked on average 1.5?h more doing regular work than did females (p =?0.001) and on average 2.3?h more OOH work than females (p =?0.079). RGPs with no OOH work registered a mean of 1.0?h more clinical work than RGPs working OOH (p =?0.043). There was a large variation in OOH working hours. A linear regression analysis showed that male RGPs and RGPs in rural areas had the heaviest OOH workload. Conclusions One in three Norwegian RGPs undertook OOH work during the registration week in the RGP study. OOH work was done in addition to a sizeable regular workload as an RGP. We found small gender differences. OOH work was not compensated with reduced regular RGP work.
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Project description:ObjectivesTo ascertain how frequently general practitioners (GPs) in Australia encounter sexually transmitted infections (STIs), how STIs are managed in general practice, and the characteristics of GPs who manage STIs.MethodsData were derived from the Bettering the Evaluation and Care of Health (BEACH) database. BEACH is a cross sectional survey of national GP activity. Approximately 1000 GPs per year each record details of 100 consecutive patient encounters. Details from April 1998 to March 2001 about frequency and pattern of STIs managed and the characteristics of GP managing them were analysed using SAS.Results3030 GPs provided data on 303000 encounters. Only 521 problems managed were STIs. Viral STIs were most frequently managed including genital herpes (0.08 per 100 encounters), genital warts (0.07 per 100 encounters). Gonorrhoea, syphilis, chlamydia, and trichomoniasis were rarely managed. Medication was prescribed at a rate of 56.1 per 100 STI contacts (95% CI 50.4 to 61.7). Antivirals were the most common followed by topical chemotherapeutics. GPs managing STIs were significantly younger and more likely to be female, urban, have fewer years in practice, work fewer sessions a week, work in a larger practice, have graduated in Australia, and hold the FRACGP (all p<0.005) than those who did not.ConclusionManagement of diagnosed STIs forms only a small part of a GP's workload in Australia. Genital herpes and warts are the most commonly managed conditions. GPs managing STIs are different from those who do not. Strategies to improve diagnosis, management, and screening should be evaluated.
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