National primary care research & development centre




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NEED AND DEMAND FOR CARE




Dowrick C, et al. General practitioners' views on reattribution for patients with medically unexplained symptoms: a questionnaire and qualitative study. BMC Family Practice 2008; 9(1):46.

http://dx.doi.org/10.1186/1471-2296-9-46

http://www.biomedcentral.com/1471-2296/9/46

http://pmid.us/18713473

Background: The successful introduction of new methods for managing medically unexplained symptoms in primary care is dependent to a large degree on the attitudes, experiences and expectations of practitioners. As part of an exploratory randomised controlled trial of reattribution training, we sought the views of participating practitioners on patients with medically unexplained symptoms, and on the value of and barriers to the implementation of reattribution in practice. Methods: A nested attitudinal survey and qualitative study in sixteen primary care teams in north-west England. All practitioners participating in the trial (n=74) were invited to complete a structured survey. Semi-structured interviews were undertaken with a purposive sub-sample of survey respondents, using a structured topic guide. Interview transcripts were used to identify key issues, concepts and themes, which were grouped to construct a conceptual framework: this framework was applied systematically to the data. Results: Seventy (95%) of study participants responded to the survey. Survey respondents often found it stressful to work with patients with medically unexplained symptoms, though those who had received reattribution training were more optimistic about their ability to help them. Interview participants trained in reattribution (n=12) reported that reattribution increased their confidence to practice in a difficult area, with heightened awareness, altered perceptions of these patients, improved opportunities for team-building and transferable skills. However general practitioners also reported potential barriers to the implementation of reattribution in routine clinical practice, at the level of the patient, the doctor, the consultation, diagnosis and the healthcare context. Conclusions: Reattribution training increases practitioners' sense of competence in managing patients with medically unexplained symptoms. However, barriers to its implementation are considerable, and frequently lie outside the control of a group of practitioners generally sympathetic to patients with medically unexplained symptoms and the purpose of reattribution. These findings add further to the evidence of the difficulty of implementing reattribution in routine general practice

Grytten J, Carlsen F, Skau I. Services production and patient satisfaction in primary care. Health Policy 23rd July 2008

http://dx.doi.org/10.1016/j.healthpol.2008.06.006

http://pmid.us/18656276

Context: The institutional setting for the study was the primary physician service in Norway, where there is a regular general practitioner scheme. Each inhabitant has a statutory right to be registered with a regular general practitioner. There are large differences between physicians in service production. ObjectivE: We studied whether difference in services production between physicians has an effect on how satisfied patients are with the services that are provided. Methodology: Data about patient satisfaction were obtained from a survey of a representative sample of the population. We obtained data about how satisfied the respondents were with: waiting time to get an appointment, amount of time the physician spent with them, and to what extent they perceived that the physician took their medical problems seriously. The survey data were merged with data on service production for the primary physician that the respondent was registered with. Service production was measured as the number of consultations per person on the list. Results: There was a positive and relatively strong association between the level of service production of the general practitioners and patient satisfaction with waiting time for a consultation. There was no association between the level of service production and the two other measures of patient satisfaction. Conclusion: The results provide evidence about one of several factors that should be taken into account when deciding on future health manpower policies with respect to primary physician services in Norway
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