R J Taylor

Stages of Change training for opportunistic smoking intervention by the primary health care team. Part I : randomised controlled trial of the effect of training on patient smoking outcomes and health professional behaviour as recalled by patients

The Stages of Change approach to smoking cessation intervention is increasingly advocated in primary care, and training in the approach is readily available. However, there has been little formal evaluation of the effectiveness of such training. A one-day Stages of Change training for primary health care teams was evaluated using both quantitative analysis of patient outcomes in a randomised controlled trial, and qualitative analysis of interviews with workshop partici pants. This paper reports the quantitative findings. Patients in the intervention group were more likely than controls to recall smoking having been mentioned in a consultation, but there were no significant effects of the intervention on patient smoking outcomes fourteen months after the workshops.

DO PHYSICIANS' PERCEPTIONS OF DRUG COSTS INFLUENCE THEIR PRESCRIBING?

SummaryThis study examines general practitioner (GP) attitudes towards and knowledge of prescribing costs, and the influence of these 2 factors in the doctor’s demand for drugs. The main emphasis of the study is on the influence of perceived cost of drugs on prescribing habits.A postal questionnaire was sent to all 273 GPprincipals in the Grampian region of Scotland. This questionnaire assessed GPs’ attitudes and knowledge with respect to prescribing costs. Information was also collected on the prescribing habits of 176 of these GPs. This information was linked to look at the influence GPs’ knowledge of drug costs has on their actual prescribing behaviour. Three drug groups were studied: ulcer—healing drugs, pain—killers and penicillins.The results showed that although most GPs agreed that costs should be borne in mind when prescribing medicines, their actual knowledge of drug costs was often inaccurate. Furthermore, for certain therapeutic groups, prescribing habits are influenced by GPs’ perceptions of drug costs. This implies that GPs are not as averse to considering costs as is often assumed, and that giving GPs better information about drug costs might promote more rational prescribing.

The cost of medicines in the United Kingdom. A survey of general practitioners' opinions and knowledge.

SummaryPrescribing costs in general practice continue to grow. Their importance is underlined by the amount of information concerned with costs that general practitioners (GPs) receive, and by the existence of target budgets. In 1986 and 1991, surveys showed that GPs agreed that cost should be borne in mind when choosing medicines, but that their knowledge of drug prices was often inaccurate. This study assessed the current knowledge and attitudes of GPs in the UK in respect of prescribing costs, and examined the influence of various developments in general practice since 1986 on the accuracy of drug price estimation.1000 randomly selected GP principals (500 in Scotland and 125 in each of 4 English health regions) were sent a postal questionnaire. The GPs’level of agreement with 5 statements concerned with prescribing costs, and the accuracy of their estimates of the basic price of 31 drugs, were analysed.Most GPs (71 %) agreed that prescribing costs should be taken into account when deciding on the best treatment for patients. Fundholders were more likely than non-fundholders: (i) to agree that prescribing costs could be reduced without affecting patient care; (ii) to agree that providing more information on costs would lower the cost of prescribing; and (iii) to comment that cost guidelines had changed their prescribing habits. Fundholders were less likely than nonfundholders to reject the principle of fixed limits on prescribing costs.Overall, one-third of the price estimates given were accurate (within 25% of the actual cost). For the most expensive drugs in the survey [those priced over 10 pounds sterling ( £ ) per pack], half of the price estimates were accurate. There were significant differences between non-fundholders’ and fundholders’ estimates of the price ofless expensive drugs (those priced at less than £ 10 per pack). Use of a formulary or computer-displayed drug price information did not affect the accuracy of price estimates.It may be that GPs who were more knowledgeable and concerned about costs were more likely to become fundholders. It is also possible that the expansion of fundholding, or other mechanisms that give GPs responsibility for resource allocation, might improve accurate cost awareness in prescribing. Clinical and economic review of repeat prescribing is recommended.

Pharmacists: A resource for general practice?

A postal questionnaire seeking the views of all Grampian general practitioners (n=314) to a proposed wider role for pharmacists obtained an 85 per cent response rate. The questionnaire consisted of prescribing related and general tasks compiled from the recommendations of the joint working partys report “Pharmaceutical care: the future for community pharmacy” and those identified by a local GP and pharmacist while working on a joint study.

Epidemiology teaching: student and tutor perceptions

There is concern that undergraduate medical students are not exposed to appropriate opportunities to learn and understand the fundamental principles of epidemiology. In this study the aim was to explore students’ and tutors’ perceptions of the epidemiology teaching in the first three years of the Aberdeen, UK, medical undergraduate curriculum, with particular reference to the teaching in the Community Course. The study adopted a qualitative approach: six individual interviews and two focus-group meetings with quota samples of medical students in the fourth year, and one focus-group meeting with a purposive sample of Community Course tutors. It was found that most students acknowledged difficulty in learning epidemiology because they perceive the topic to be dry, boring and difficult to understand. However, there is a dawning awareness that it is important and its relevance becomes more obvious to students as they progress through the medical course, especially if they have undertaken an intercalated BSc Medical Sciences degree. Students want practical and clinically relevant teaching. Most students are exam driven and will only make efforts to learn topics that are assessed. Tutors also find epidemiology to be difficult and want their teaching to be clinically relevant.

Do general practitioner attitudes and characteristics of their practices explain patterns of specialist referral

Objectives: To describe attitudes of general practitioners to their work, and to relate these to characteristics of their practices and to rates of specialist referral.Methods: Data were collected from 109 Scottish general practitioners. Questionnaires were used to measure doctors perceptions of their responsibilities, their tolerance of uncertainty, their perception of benefits resulting from specialist referral, and perception of the incidence of a range of conditions which might require specialist referral. Rates of specialist referral were measured prospectively over a one-year period.Results: There was wide variation in the responses to all questionnaires. More developed practices (e.g. computerised, with access to hospital beds) reported a greater sense of responsibility for the care of their own patients, and perceived less benefit from specialist referral. Doctors who perceived serious disease as relatively uncommon and those who saw themselves as responsible for a wide range of conditions referre...

Review of undergraduate small group teaching with television in general practice

To help new part‐time lecturers to develop skill in undergraduate small group teaching, videorecorded seminars conducted by each lecturer were reviewed at a series of staff meetings using analyses produced by experienced full‐time staff. One year later a second series of comparable seminars was recorded and, using a simple method of communication analysis, the lecturers were found to be less opinionated and more non‐directive towards students.