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Onwuteaka-Philipsen, Bregje D; Kriegsman, Didi MW; van der Wal, Gerrit; Dillmann, Robert JM; van Eijk, Jacques ThM
doi: 10.3109/13814789909094286pmid: N/A
Objectives: Purpose of this study is to gain insight in the opinions of general practitioners (GPs) about different aspects of consultation, one of the ways in which euthanasia and physician-assisted suicide (EAS) can be safeguarded.Methods: Data from two studies were used. In the Amsterdam study, all GPs working in Amsterdam (n = 398) received a questionnaire in which they were asked to indicate to what extent they agreed with a list of 17 statements about different aspects of consultation. In the nationwide study, a stratified random sample of 405 Dutch GPs and other physicians was interviewed. In the interviews, two questions about consultation were asked.Results: Of Dutch GPs, 81% are of the opinion that consultation should take place in all cases of physician-assisted death. In general, GPs from Amsterdam consider the role of consultation in the decisionmaking in cases of EAS, the consultant's skills and activities, and consultation as method of review to be important. For instance, a large majority of the GPs agrees to a greater or lesser extent to the statements ‘I do not only consult because it is obligatory’ (84%) and ‘the consultant's judgement is important for my decision-making’ (73%).Conclusions: These results suggest that giving consultation a more important and formal role in the reviewing of cases of EAS, as is advocated by the Dutch government and the Royal Dutch Medical Association, will be feasible. GPs, at least those from Amsterdam, seem to consider consultation to be important enough.
Smyth, Bobby P; McMahon, Julie; O'Connor, John J; Ryan, Jim
doi: 10.3109/13814789909094287pmid: N/A
Objectives: Across Europe, GPs are increasingly being encouraged to become more involved in the treatment of those who misuse drugs, as ‘shared care’ is being advocated. Against this background, we assessed utilisation of primary care services by injecting drug users (injectors) recruited from a specialist drug treatment setting.Method: Interview using a structured questionnaire.Results: Of 105 injectors, 70% had seen their GP in the previous year and 29% had done so more than 20 times. Although 50% had attended A&E, only 7% had done so more than five times. Of the 77 (73%) who identified a principal GP, 91 % indicated that their GP was aware of their drug misuse and 37% reported that they were currently being prescribed benzodiazepines by their GP. The choice of benzodiazepine was a source of concern in nine cases. In exploring management of troublesome medical symptoms, 65% of those who would see a doctor would opt for a GP, 22% would see their doctor in the drug treatment centre and 12% would go to A&E. Those opting to see a GP were more likely to currently have a principal GP and also more likely to have seen their GP in the past month.Conclusion: Both GPs and specialist drug treatment services have substantial contact with injectors and at times provide overlapping roles. Policy should ensure increased communication between these two service providers, thereby facilitating integrated management.
Hill, Frank G; Bradley, Colin P
doi: 10.3109/13814789909094288pmid: N/A
Background: The recent development of reliable, economic, semiautomatic electronic blood pressure monitors provides an opportunity for GPs to monitor blood pressure outside the surgery environment. Because office measurements fail to define those patients with whitecoat hypertension and whitecoat effect, we are currently overdiagnosing hypertension.Objectives: To examine the comparability of the electronic sphygmomanometer (Omron HEM 705CP) with a standard mercury sphygmomanometer. To assess the prevalence of whitecoat hypertension and whitecoat effect in general practice and the effect of these diagnoses on the subsequent management of hypertension.Method: 87 consecutive patients with established or suspected hypertension were recruited over a six-month period. Average home readings were compared with average office readings to determine prevalence of whitecoat hypertension and whitecoat effect. Simultaneous electronic and mercury readings allowed evaluation of the electronic monitor throughout the study period. A patient questionnaire assessed the acceptability of the monitor and home blood pressure measurement. A GP questionnaire assessed the effect on blood pressure management.Results: Patients were generally quite happy with the monitor. The simultaneous electronic/mercury readings showed good comparability. Home blood pressure was significantly lower than office blood pressure. 24% (21 patients) had a significant element of whitecoat effect (>20/10 mmHg) and 6% (5 patients) had whitecoat hypertension. At the end of the study, 37% (32 patients) were on less medications than if they had been managed based on office blood pressure.Conclusions: This study indicates that home blood pressure monitoring can distinguish sustained hypertension from office hypertension and thus reduce overdiagnosis and overtreatment of hypertension.
Wood, David; De Backer, Guy; Faergeman, Ole; Graham, Ian; Mancia, Giuseppe; Pyörälä, Kalevi
doi: 10.3109/13814789909094289pmid: N/A
This summary is taken from the Second Joint Task Force of European and other Societies Recommendations on Prevention of Coronary Heart Disease in Clinical Practice. The second Task Force was convened by the European Society of Cardiology (ESC), the European Atherosclerosis Society (EAS) and the European Society of Hypertension (ESH), the societies responsible for the original 1994 Task Force recommendations on coronary prevention (Chairman Professor K Pyörälä) and consisted of a writing group, other invited members and specialists, together with representatives of other European societies and organisations as listed in the appendix. The full Task Force first met in November 1997 to review the original recommendations and agree on the principles for revision. The Writing Group then prepared a new draft of the recommendations and the specialist contributions of Professor Daan Kromhout (diet), Professor Kristina Orth-Gomér (socioeconomic, psychosocial factors and behavioural change), Professor Francois Cambien (genetics) and Dr Carlos Brotons (opportunities and barriers for coronary prevention) are gratefully acknowledged. This was submitted to a second Task Force meeting in April 1998 for approval. After this meeting the Writing Group prepared the final version of the recommendations and this was approved by the full Task Force in June. The expert advice of Professor Philip Home and Professor George Alberti on diabetes mellitus is gratefully acknowledged. The document was then approved by the ESC, EAS and ESH. The Task Force recommendations have been published in the European Heart Journal, Atherosclerosis and the Journal of Hypertension (summary only).
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