'Video, health education and the General Practitioner Contract'.

The 1990 General Practitioner Contract and the 1993 Contract Revision emphasised the role of health education/health promotion within primary care. In this paper, the authors suggest that a highly cost-effective approach is necessary given the premium on time available for general practitioners and members of the primary health care team to undertake such work. The views of general practitioners and the primary health care team in a random sample of general practices within all 15 Health Board areas in Scotland were sought between 1991 and 1993 regarding current experience and future potential in using video-based health education materials, with particular emphasis on the content, structure and parameters appropriate to running effective health education/health promotion programmes. This study has indicated the potential demand for high quality, appropriately targeted video-based materials for use by primary health care workers within a range of practice, community and home settings. Central to this is the need for a better system of information and dissemination of materials and a firmer evaluation framework for health education/health promotion programmes within primary care. The progress of several policy, management and research issues which arose from the findings of the study have been raised by the authors. These include implications for the NHS such as infrastructure resourcing and priority setting, programme development, information and dissemination, research and evaluation, and mechanism(s) whereby general practitioners can be better involved in this process.

Argyll and Clyde general practitioners' attitudes to standard setting in hypertension.

A questionnaire was sent to a one in five sample (68 GPs) of General Practitioners (GPs) in Argyll and Clyde Health Board to determine attitudes to standard setting in hypertension and the response rate was 80.7% (55 GPs). Thirty-six GPs (65.4%) stated that they would be interested in sharing care with a consultant who had an interest in the subject and 27 GPs (49.1%) stated that they would be interested in taking part in an educational audit of their hypertensive patients. The results of the study suggest that it would be possible to obtain broad agreement among GPs on standards for diagnosis, treatment and appropriate indications for hospital referral in the management of hypertension but in order to develop consensus further it would be necessary to carry out a more detailed study using a larger cohort of GPs.

Rheumatology at the general practitioner/hospital interface: a study of prevalence and access to specialist care.

Four general practices with a combined population of 23,300 in the west of Scotland participated in a record research and questionnaire assessment of 551 patients with rheumatic diseases. The study describes the prevalence, levels of disability found, and the types of service used. Even with this number of patients it was not possible to detect any significant differences in disability levels, use of second line drugs, or aids/appliances when comparing practices with adequate or inadequate access to rheumatological facilities (general practitioner perception). General practice is an appropriate setting in which to investigate the effect of service provision, but larger studies will be needed to reach more definite conclusions.

Questionnaire to measure perceived symptoms and disability in asthma.

A questionnaire was designed for completion by parents of asthmatic children aged from 5-14 years that provides scales of good content validity and internal reliability for the measurement of perceived disability, perceived nocturnal symptoms, and perceived daytime symptoms. We hope that this questionnaire will be included in future clinical studies of these patients.

Treatment of peptic ulcer in general practice and in hospital: a comparison of omeprazole and cimetidine.

The aim of this study was to compare duodenal ulcer healing and symptom relief after two and four weeks treatment with omeprazole or cimetidine in groups of patients treated in general practice and as hospital out-patients. It was a randomised, double-blind, parallel group study with stratification for trial centre (hospital or GP). Endoscopy was performed at entry, after two weeks and, if unhealed at two weeks, after four weeks. All endoscopies were carried out in hospitals. In all, 189 patients were randomised (98 omeprazole, 91 cimetidine), 79 (42 per cent) of which by GPs, to either omeprazole 20 mg om (n = 41) or cimetidine 800 mg nocte (n = 38) for two to four weeks. After two weeks, ulcer healing occurred in 56 per cent (omeprazole) and 29 per cent (cimetidine) (p less than 0.05) of patients treated by GPs, and 67 per cent (omeprazole) and 36 per cent (cimetidine) (p less than 0.005) of those treated as hospital out-patients. Similar differences in healing rates were seen after four weeks. Omeprazole produces faster duodenal ulcer healing than cimetidine whether patients are treated as hospital out-patients or by GPs.

Audit of process and outcome in a mini-clinic for children with asthma.

A mini-clinic for the management of children with asthma was started in a general practice, and 31 children aged between five and 14 years were invited to attend. Thirty-one age and sex matched asthmatics were recruited for comparison from a neighbouring practice. There was evidence of only slight improvement in outcome among the children attending the mini-clinic, although they required considerably more respiratory consultations than the children in the comparison practice. These observations, and the methodology, are discussed.

Use of laboratory services and communication of results to patients in an urban practice: an audit.

The pattern of investigations in an urban practice of 4200 patients was monitored over an eight-week period. An assessment was made of the characteristics of patients who sought the results of their investigations.During the study period there were 1522 consultations and 186 investigations were carried out on 155 patients. More females were investigated than males (3.4:1) with most tests among 31-40 year old women. At the end of the study period only 95 patients (61.3%) knew the results of their tests and of 34 abnormal results nine were not relayed to patients. The probability of a patient collecting a result was not influenced by the patient's age or sex, the reason for carrying out the test or the instructions given by the doctor for collection of the result. Abnormal test results were more likely to be collected than normal results.These findings suggest that many practice systems of relaying information to patients need modifying. Whose responsibility it should be to pass on the results of patients' investigations is discussed.

Assessment of disability caused by rheumatic diseases in general practice.

At present general practitioners lack a tool for defining the level of disability of individual patients and groups of patients with arthritis. An assessment technique (health assessment questionnaire) developed in the United States is described, and its use in general practice evaluated. Sixty two patients agreed to be visited at home to compare their observed abilities when performing the tasks of the health assessment questionnaire. The health assessment questionnaire (HAQ) is easily understood and takes patients only 10-15 minutes to complete. The numerical scores (range 0-3) for disability obtained on the postal questionnaire are close to the observed scores when patients are visited at home.

An ethical committee for general practice in the west for Scotland: proposals received in the first year.

The particular ethical problems of research in general practice and pressure from local general practitioners and hospital ethical committees led to the development of an ethical committee for general practice in the west of Scotland. The workload of this ethical committee in its first year of existence is described.Despite the fact that many of the studies considered by the committee were sponsored by pharmaceutical companies and were often sophisticated, the ethical issues of a general practice setting had not always been fully appreciated. Of the 21 study proposals submitted over the year 13 showed areas of ethical uncertainty. However, all the studies were eventually approved. Most of the problems encountered were easily overcome and might have been avoided if the general practitioners undertaking the research had been able to seek advice from those with experience of research in general practice and in particular of the ethical issues involved. Local ethical committees for general practice, made up largely of general practitioners but with at least one lay member, might provide one such source of advice.

Variation in peak expiratory flow in children with asthma.

Twice daily peak expiratory flow measurements were obtained at home from 65 asthmatic children and 34 non-asthmatic controls, and a measure of the daily variation in peak expiratory flow was calculated for each child (mean daily variation). Children aged less than 7.5 years appeared unable to provide reproducable peak expiratory flows, but above that age the mean of the mean daily variations was significantly higher for the asthmatics than the controls. This was true even on days when the asthmatics exhibited no wheeze or took no medication. The significance of the findings is discussed, and it is suggested that calculation of the mean daily variation might assist in the assessment of children presenting with atypical respiratory symptoms.

Wide variations in the night visiting rate.

The night visit record of an out-of-hours rota service of a large health centre which includes 10 group practices was examined. The mean annual night visiting rate for the health centre was 35.2 per 1000 patients, ranging from 25.8 to 43.5 between individual practices. The organization of medical care at night was the same for all the practices, and no major demographic differences between practices were identified. It is argued that the doctor-patient relationship may have an influence on differences in night visiting rates.

General practitioners' satisfaction with a primary care clinical psychology service.

A specialist Clinical Psychology Service in Primary Care was set up in one health district in 1979 on a three-year experimental basis. A survey conducted among the general practitioners who had used the service during this period found a high level of satisfaction. The views of the general practitioners are reported and also their ratings of the outcome of psychological treatment in each of 305 cases. The relationship between certain patient characteristics and treatment outcome is also presented. These results are discussed in relation to further research required in this area and the future of liaison between clinical psychologists and general practitioners.

Oxatomide in the management of hay fever--a placebo-controlled double-blind study in general practice.

Sixty-three patients completed a double-blind placebo-controlled study of oral oxatomide (30 mg t.d.s.) in the management of seasonal allergic rhinitis and/or conjunctivitis. Hay fever symptom scores were significantly lower for oxatomide-treated patients than for the placebo group on the majority of days during periods of high pollen counts. Moreover, on days when pollen counts were 10/m3 or more, a statistically significant positive correlation between symptom score and pollen count was demonstrated for the placebo group but not for the oxatomide group. Oxatomide also appeared to be superior to placebo in terms of patients' requirements for supplementary mepyramine (Anthisan) tablets, and the doctor's global assessment. Side-effects were reported by four patients in the oxatomide group and by three receiving placebo.