Dickinson Ja

Delay in consulting a medical practitioner about rectal bleeding.

STUDY OBJECTIVE--The aims were to estimate the incidence of rectal bleeding in the community, and to determine the proportion of individuals who delay or fail to seek medical advice after a first episode of rectal bleeding. DESIGN--The data were collected as part of a large scale general population survey of the health practices and attitudes of individuals in a randomly selected sample of 2121 households. SETTING--The survey was conducted in the Newcastle and Lake Macquarie areas of New South Wales, Australia, during 1987-88. PARTICIPANTS--Information about rectal bleeding was collected from 1213 individuals aged 40 years and over. MEASUREMENTS AND MAIN RESULTS--Of the 1213 people aged 40 years and over, 239 (20%) reported noticing rectal bleeding at some time in their life. However, since an estimated 4.5% had noticed rectal bleeding for the first time in the past year the true lifetime incidence of rectal bleeding is likely to be much higher. Of the 77 individuals who had noticed a first occurrence of rectal bleeding more than three months but less than five years prior to the interview, 23 (30%) had either not sought medical advice or had only done so after a period of delay. The most commonly reported reason for delay or failure to consult was thinking that the bleeding was not serious and would clear up by itself. CONCLUSIONS--The data suggest that prompt investigation of rectal bleeding is not occurring in a relatively large proportion of cases. However, in the absence of firm evidence that early detection improves prognosis, and considering the costs of screening, it would be premature to initiate programmes which encourage people to seek care promptly for this symptom.

Effectiveness of three community based strategies to promote screening for cervical cancer

Objective– Evaluation of three potential methods for increasing Pap smear use: television media, television media combined with letter based recruitment, and television media combined with general practitioner based (GP based) recruitment. Setting - A trial of each intervention was carried out in three postal regions in New South Wales, Australia — a rural locality (containing about 1000 women), a country town (about 3000 women), and a major rural centre (about 10000 women). Three control regions were selected to be demographically similar to the corresponding intervention regions. Methods– Outcome data on regional Pap smear rates were obtained from government health insurance claims for cervical screening, and from pathology service records. Expected Pap smear rates for the three months after the intervention were predicted from 45 pre-intervention months and were compared with observed rates for this period. Results– Television media alone was associated with a significant increase in attendances for screening in one of the three regions where a trial was carried out: 13.3% in the rural centre. The media/ letter based campaign was associated with a significant increase in attendances in two out of three regions: 52.7% in the rural locality, 43.2% in the rural centre. The media/GP based campaign was associated with significant increases in attendances in all three regions: 50.2% in the rural locality, 80.8% in the country town, 15.7% in the rural centre. All three interventions were associated with significant increases in the number of women attending for cervical screening above those observed in the control regions. Furthermore, these increases were not restricted to women at low risk. They were also found for older women (aged 50–69 years) and women who had not had a Pap smear within the past three years.

The assessment of reactivity in direct observation studies of doctor-patient interactions

Abstract A number of recent studies have used the direct observation technique to explore the nature of the medical consultation and its impact on outcomes such as diagnosis, adequacy of care, patient compliance and satisfaction. However, none of these included adequate assessments of the reactive effects of the observation procedure. The present research aimed at extending the current understanding of reactive effects in observation studies of doctor-patient interactions, and was part of a larger study involving the videotaping of over 2000 consultations in the primary care setting. Habituation to the observation procedure was assessed by examining changes over time in the doctors rates of identifying smoking and psychiatrically disturbed patients. Data from 20 doctors and 619 consultations were assessed for smoking detection and 22 doctors and 564 consultations for psychiatric disturbance. When differences between sessions in case mix and the differential ability of individual doctors to detect were co...