Læknablaðið - 15.05.1987, Blaðsíða 4

146
1987; 73: 146 LÆKNABLAÐIÐ
LAUK MASTERSPRÓFI í HEIMILISLÆKNINGUM
Gísli G. Auðunsson lauk nýverið mastersprófi í
heimilislækningum í Kanada. Stundaði hann nám
við The University of Western Ontario i London,
Ontario. Heiti ritgerðar hans er: Preventice
Infrastructure in Family Practice og fer útdráttur
hér á eftir:
Health promotion and prevention of disease was
for centuries a central theme of medicine. With
new developments in science and technology in
the beginning of the 20th century the preventive
approach lost ground as curative medicine
became endowed with ever more powerful tools.
With escalating costs curative medicine has
reached a point of an ever diminishing return,
forcing health care authorities to look for other
means of health care. This has revived the interest
in preventive medicine and today the preventive
approach has been identified as one of the basic
elements of family medicine.
In order to explore one aspect of prevention in
family practice, a study was undertaken to
examine the systems used to enhance the
preventive approach in family physicians’
everyday patient care. And simultaneously to test
the hypothesis that residency trained family
physicians would be found to have significantly
more extensive preventive systems in their offices
(called preventive infrastructure) than their peers,
who had not pursued any specific training in
family medicine.
The study design was a mail survey by a
self-administered questionnaire. The
questionnaire was a new instrument developed
specifically for the study. Two groups of doctors
were included in the study; the family medicine
trained group (family physicians with residency
training in family medicine), and; the comparison
group (family physicians who had not pursued
any specific training in family medicine). The
response rate was 82.7%. For the trained group it
was 85.2% and 80.2% for the comparison group.
The most commonly used prevention items in
relations to the medical record, were, in order of
frequency:
Antenatal record form (90%), growth percentile
chart for infants (81%), long term drug list
(73%), SOAP-format of patients’ notes (68%),
long term problem list (62%), growth percentile
chart for children (47%).
Gísli Auðunsson
Other common prevention strategies were:
Educational material on display (96%),
educational material for distribution (74%),
checklist for adult patients (37%), checklist for
well baby care (35%).
The most commonly hired personnel in or
adjacent to the office, were:
Receptionist (91%), secretary (71%), public
health nurse (use of service) (67%), registered
nurse (60%).
Responses to the questions on the questionnaire
were weighted to create »the prevention score«.
The range on the score was from 0-79 points. The
mean score for each of the groups was calculated
and the t-test used to test the significance of the
difference between the groups. The result showed
the mean prevention score for the trained group
to be 34.7 points and 30.0 points for the
comparison group. The t-test showed this to be a
highly significant difference with a probability
level of 0.011, thus confirming our hypothesis
that residency trained family physicians have a
more extensive preventive infrastructure than
their colleagues who have not pursued training in
family medicine.
The results, it is concluded, are encouraging for
family medicine teaching programs. Finally, the
implications this study has for family practice, for
teaching in family medicine, and for further
research, are discussed.