A multinational study of the factorial structure and other characteristics of the Dartmouth COOP Functional Health Assessment Charts/WONCA.

BACKGROUND: The 'Dartmouth COOP Functional Health Assessment Charts/WONCA' constitute a relatively new derived instrument for assessing health status that is specifically intended for use in primary care on a world-wide basis. It needs further validation in its special area of use. OBJECTIVES: Over a range of countries, social backgrounds and case mixes, our aim was (i) to examine the factorial structure of the instrument; (ii) to explore how well it was understood; (iii) to check its acceptability; and (iv) to assess the value of the pictures on the charts. METHODS: The charts themselves, accompanied by a short questionnaire about the charts, were administered to 1719 patients at eight varied types of treatment centre in Canada, Japan, Nepal and Spain. The responses to the instrument were subjected to standard factor analysis and a special Q-type principal components analysis. The responses to direct questions about the charts were compared with the answers to open-ended questions. RESULTS: Factor analysis suggested a shared factorial pattern for all sites, with the first two factors accounting for 88.5% of the variability in correlations between the charts across the sites. The individual questions were understood by most patients, but a substantial minority did not appear to grasp the underlying purpose of the instrument. The instrument was well accepted. The pictures were considered to be helpful by most respondents, especially those at the Nepal sites. The variability in the scores for the individual charts across sites was less than expected and not always in the expected direction. CONCLUSIONS: The COOP/WONCA system continues to show promise, but needs more validation.

Why do patients continue to see the same physician?

In this study we examined the meaning that patients attach to continuity of care, an important construct of family practice and primary care. Structured oral interviews were conducted with 60 patients who were 35 years of age or older and who had sought health care from a single family physician for at least 15 years. The data included 10 domains that characterize patients' perceptions regarding long-term continuous care. The interview data were analyzed using ethnographic techniques. The main factors contributing to the maintenance of a continuous care relationship seemed to be patient familiarity with the physician, physician knowledge of the patient, patient satisfaction with care received, and patient confidence in the physician. Other factors were personal attributes of the physician, friendship with the physician, ease of communication with the physician, and professional growth of the physician. The availability of the physician and the location of the practice appeared to be reasons to start consulting a physician rather than to continue the relationship with a physician.

The epidemiology of mumps in southern Alberta 1980-1982.

The full spectrum of mumps in Southern Alberta was studied over the years 1980-1982. In the community, a random sample of 3,497 children was tested for prevalence of immunity to mumps. The 1,816 who were not immune were retested after one year. The incidence of new immunity was 16.5%. Most seroconverters had no illness suggestive of mumps. History of previous mumps or immunization were found to be unreliable predictors of serologic immune status. In the family study, information was obtained on 342 cases diagnosed as mumps by family physician recorders. The overall complication rate was 10.8% and the secondary attack rate within families was 11.7%. Hospital records of all 25 patients admitted in Calgary with mumps during the same period were analyzed. Estimated costs of unopposed mumps over 20 years compared with the estimated costs of vaccination showed that a vaccination program could give a benefit-cost ratio between 6.4 and 247. These studies show that mumps is a mild disease with relatively few serious complications or sequelae. Even so, there would be definite medical and economic benefit with immunization. A low-cost addition of mumps vaccine to the immunization program would be justified.

Family doctors and their records: a survey in southern alberta.

A questionnaire about their approach to keeping office records was completed by 82 randomly selected family physicians in southern Alberta. The results suggest that although there were few manifestly inadequate recordkeepers, there were many areas for legitimate concern, especially the following:1. Extremely brief notes2. Limited attention to psychosocial data3. Underutilization of the more efficient filing techniques4. Poorly organized charts5. Failure to exploit fully innovations which had been introduced into the records system6. Inadequate protection of the records.There is reason to believe that the standard of record-keeping in family practice is improving. A few small, simple changes in our record-keeping habits could effect a considerable acceleration of this process.

The analysis of family practice workloads by seriousness.

There is a need for a measure of the overall seriousness of a given family practice workload. In the past, such measurements have been attempted in various ways. In this work, the rubrics of the Canuck Book Classification (a classification of health problems in family practice) were rated for seriousness. There was sufficient agreement on 96 rubrics for them to be used as indicators of the seriousness of workloads in general. Some examples of the uses of the system are shown. Several difficulties were encountered; these are not insuperable, and the method deserves to be developed further.

The electric speaking practice: a telephone workload study.

The telephone workload in a family practice was studied for two recording periods separated by a 12 month interval. A record was kept of the number of calls, their length, the day of the week on which they were made, to whom they were made, and for what purpose.The telephone practice accounts for about 20 percent of the total practice workload. Calls to the patients and to their representatives were about equally common and account for most of the workload, but a large amount of telephone work is devoted to 'backing up' these direct contacts. The use of the telephone for medical purposes saves much time for the patients and much money for the paying agency. A plea is made for intensive study of this aspect of family medicine.

Classification of disease in general practice: a comparative study.

A comparison is made between the International Classification of Diseases (Eighth Revision) and the classification of the British College of General Practitioners (1963 Revision), with particular reference to their application to the diagnostic data from a family practice in Canada over a period of one year. The International Classification proves superior but would require modification to be ideal for use in recording morbidity from general practice. A plan for such a modification is outlined.