ABSTRACT
BACKGROUND: The increased application of evidence based medicine (EBM) to health care practice has been endorsed in national health policy. This paper focuses on what EBM means for GPs. OBJECTIVES: To present the outcomes of engaging practising GPs in applying EBM principles to a general practice scenario. DISCUSSION: Caution about the potential for misuse of EBM has been voiced by GPs based on the biopsychosocial model of general practice and concerns about the limited utility of largely biomedical evidence in general practice. The EBM process begins with converting information needs into questions, but this first step presupposes that the doctor has obtained a good history including eliciting any hidden agenda. It is important to recognise the context in which people's health issues and problems arise, the paucity of evidence that is derived within the biopsychosocial model of general practice, and the difficulties that GPs face in accessing evidence.
Subject(s)
Evidence-Based Medicine , Family Practice , Adult , Female , Humans , Male , Medical History Taking , Middle Aged , Physician-Patient RelationsABSTRACT
OBJECTIVE: To identify individual and social characteristics of patients making sequential visits to a different rather than the same general practitioner (GP). METHOD: Data for this study were extracted from the "Record Linkage Pilot Study" of the National Centre for Epidemiology and Population Health, which linked information from personal interviews with Health Insurance Commission and National Heart Foundation Risk Factor Survey data. Each sequence of visits (any two consecutive visits) made by each participant to the same or a different GP from January 1991 to December 1992 was treated as an event. PARTICIPANTS: 521 subjects aged between 23 and 72 years who gave consent to release of Health Insurance Commission data. MAIN OUTCOME MEASURE: A visit to the same GP or a different GP from the one seen at the last visit. RESULTS: Logistic regression analysis showed that younger age, good physical functioning, good self-rated health, normal body mass index, shiftwork and a longer time interval between visits were significantly associated with less continuity of care. CONCLUSIONS: Our study raises questions about the relationship between chronological continuity and quality of care. For example, if infrequent visits (associated with less continuity) are for distinct illnesses, is quality of care affected by information or treatment from a previous visit? Our results also suggest that some GPs, because of the demography of their practices (more young people, a higher proportion of shift workers), may be disadvantaged by continuity-based reward systems. Moreover, because of lack of continuity young people may miss out on GPs' health promotional activities.
Subject(s)
Continuity of Patient Care , Family Practice , Patients , Adult , Age Factors , Aged , Australia , Female , Humans , Logistic Models , Male , Medical Record Linkage , Middle Aged , Physician-Patient Relations , Quality of Health CareABSTRACT
The aim of this Australian study was to explore the reasons for peoples' choice of general practitioner (GP) in an environment where they have freedom of choice of doctor on every occasion of attendance. A questionnaire was administered by trained research assistants to 555 people during an hour-long interview. Utilization of more than one general practitioner was examined in terms of sociodemographic factors, health status and satisfaction with the last general practice visit. Respondents were more likely to see more than one general practitioner if they had more visits; were dissatisfied with their last consultation with a general practitioner; were younger; were female; and were highly qualified. Further, respondents who described good communication as the rationale for their satisfaction rating for their last general practitioner visit were less likely to have seen more than one general practitioner.
