Showing papers by "Mark Ashworth published in 2003"

Perceptions of psychological content in the GP consultation: the role of practice, personal and prescribing attributes

Abstract: Objective: The aim of the present study was to determine the relationship between the characteristics of general practices and the perceptions of the psychological content of consultations by GPs in those practices. Methods: A cross-sectional survey was conducted of all GPs (22 GPs based in nine practices) serving a discrete inner city community of 41 000 residents. GPs were asked to complete a log-diary over a period of five working days, rating their perception of the psychological content of each consultation on a 4-point Likert scale, ranging from 0 (no psychological content) to 3 (entirely psychological in content). The influence of GP and practice characteristics on psychological content scores was examined. Results: Data were available for every surgery-based consultation (n = 2206) conducted by all 22 participating GPs over the study period. The mean psychological content score was 0.58 (SD 0.33). Sixty-four percent of consultations were recorded as being without any psychological content; 6% were entirely psychological in content. Higher psychological content scores were significantly associated with younger GPs, training practices (n = 3), group practices (n = 4), the presence of on-site mental health workers (n = 5), higher antidepressant prescribing volumes and the achievement of vaccine and smear targets. Training status had the greatest predictive power, explaining 51% of the variation in psychological content. Neither practice consultation rates, GP list size, annual psychiatric referral rates nor volumes of benzodiazepine prescribing were related to psychological content scores. Conclusion: Increased awareness by GPs of the psychological dimension within a consultation may be a feature of the educational environment of training practices.

The development of prescribing incentive schemes in primary care: a longitudinal survey.

Abstract: Primary Care Groups and Trusts in England (Primary Care Organisations, or PCOs) are required to operate a prescribing incentive scheme. Little is known about their development since their inception in 1999. We surveyed incentive schemes in London and the South-East NHS Regions in the two consecutive years since 1999. Most of the changes to the incentives and prescribing indicators favoured improvements in prescribing quality, rather than cost control. Quality improvements may be hampered in those PCOs offering financial rewards to underspent general practices that fail to achieve any prescribing quality targets.

Partnership effects in general practice: identification of clustering using intra-class correlation coefficients.

Abstract: Although most United Kingdom general practitioners (GPs) work together in a shared professional arrangement termed 'partnership', little is known about the nature of such partnerships. We report the results of a survey of 61 general practice partners in 15 group practices and their attitudes to prescribing and managerial issues related to participation in a commissioning group. Intra-class correlation coefficients (ICCs) were used to explore how these individually held attitudes clustered within groups. The low ICCs found for attitudes relating to prescribing issues suggested that GPs acted individually in this respect, while, in contrast, responses to managerial questions clustered strongly in partnerships, implying that managerial attitudes were more likely to be shared within partnerships. The ICC statistic is a useful tool for exploring homogeneity and heterogeneity within general practice partnerships.