P-R-A-C-T-I-C-A-L: a step-by-step model for conducting the consultation in general practice.

Abstract:

BACKGROUND:It has been shown that when patients are unable to express all their major concerns, they are less likely to follow the physician's prescribed treatment plan and they are less satisfied. On the other hand, the GP has a limited amount of time to elicit all the appropriate information and must ask certain questions about the biological aspects of the illness in order to carry out her professional responsibilities. By acting in a patient-centred way, first enabling the patient to express himself, the GP can make maximum use of patients' ability for problem formulation and solution. METHODS:We describe a model, for which the mnemonic, P-R-A-C-T-I-C-A-L, will help the practitioner to remember its nine steps. The model uses a chronological succession of strategies during the consultation that balances the voices of medicine and the lifeworld. In overview, the GP takes the patient, step by step, first through an exploration and clarification of his views of the illness, then expands the problem by further examination (e.g. the physical examination), a negotiation about the final model of the illness that includes both diagnosis and management, a discussion of the treatment plan, and finally a moment of reflection to prepare for the next visit.

journal_name

Fam Pract

journal_title

Family practice

authors

Larsen JH,Risør O,Putnam S

doi

10.1093/fampra/14.4.295

subject

Has Abstract

pub_date

1997-08-01 00:00:00

pages

295-301

issue

4

eissn

0263-2136

issn

1460-2229

journal_volume

14

pub_type

杂志文章
  • Error and safety in primary care: no clear boundaries.

    abstract::This paper examines the notions of adverse events, error, critical incidents and safety from the specific viewpoint of primary care. We conclude that each term can be defined, but existing work which we reviewed uses many of the terms interchangeably. We recognise that trying to access medical error objectively within...

    journal_title:Family practice

    pub_type: 杂志文章,评审

    doi:10.1093/fampra/cmg302

    authors: Jacobson L,Elwyn G,Robling M,Jones RT

    更新日期:2003-06-01 00:00:00

  • The diagnostic accuracy of Danish GPs in the diagnosis of pigmented skin lesions.

    abstract:BACKGROUND:The GP often has a primary function in assessing pigmented skin lesions in Denmark. No data are available on the diagnostic accuracy of this process. OBJECTIVE:We aimed to study the sensitivity, specificity and positive prognostic value of the diagnosis made by 27 trained or trainee GPs. METHOD:We tested t...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/16.6.619

    authors: Jemec GB

    更新日期:1999-12-01 00:00:00

  • Shared decision making in hypertension: the impact of patient preferences on treatment choice.

    abstract:BACKGROUND:Recent guidelines for treatment of hypertension advocate a multifactorial approach based on absolute risk of a cardiovascular event. However, this does not take any account of individual patient values or preferences for health outcomes that result from having hypertension. OBJECTIVE:Our aim was to investig...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/18.3.309

    authors: Montgomery AA,Harding J,Fahey T

    更新日期:2001-06-01 00:00:00

  • Multimorbidity patterns in a primary care population aged 55 years and over.

    abstract:BACKGROUND:To support the management of multimorbid patients in primary care, evidence is needed on prevalent multimorbidity patterns. OBJECTIVE:To identify the common and distinctive multimorbidity patterns. METHODS:Clinical data of 120480 patients (≥55 years) were extracted from 158 general practices in 2002-11. Pr...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/cmv037

    authors: Sinnige J,Korevaar JC,Westert GP,Spreeuwenberg P,Schellevis FG,Braspenning JC

    更新日期:2015-10-01 00:00:00

  • Walk-in clinics in Quebec, Canada: patients and doctors do not agree on appropriateness of visits.

    abstract:INTRODUCTION:Walk-in clinics aim to be highly accessible facilities, in particular for urgent primary care cases. A perceived increase of walk-in clinic visits in Canada could put this accessibility at risk. We aimed to study the appropriateness of walk-in clinic visits in Québec, Canada. METHODS:We performed a cross-...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/cmt069

    authors: Broekhuis SM,van Dijk WD,Giesen P,Pavilanis A

    更新日期:2014-02-01 00:00:00

  • Barriers to general practitioners caring for patients with HIV/AIDS.

    abstract::This paper describes some of the barriers to caring for people with HIV and AIDS by general practitioners. It is based on a review of the literature and on interviews with individuals. The first section examines the reasons given by interviewees for their involvement in HIV and AIDS care. The next section discusses th...

    journal_title:Family practice

    pub_type: 杂志文章,评审

    doi:10.1093/fampra/10.1.8

    authors: Clarke AE

    更新日期:1993-03-01 00:00:00

  • What family physicians need in their doctor's bag.

    abstract::Our objective was to determine what family physicians need in their doctor's bag for urgent and non-urgent house calls. In a prospective survey, family physicians completed a structured report form after consecutive house calls, recording what equipment they needed for each. Thirteen doctors from two urban practices, ...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/12.4.430

    authors: Nakar S,Vinker S,Weingarten MA

    更新日期:1995-12-01 00:00:00

  • Non-steroids anti-inflammatory drugs and risk of peritonsillar abscess in pharyngitis: a French longitudinal study in primary care†.

    abstract:BACKGROUND:The safety of non-steroids anti-inflammatory drugs (NSAIDs) in the context of pharyngitis is doubtful with contradictory results in the literature. OBJECTIVE:To evaluate the risk of peritonsillar abscess (PTA) associated to NSAIDs consumption during a pharyngitis episode observed in primary care. METHOD:A ...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/cmy111

    authors: Piroulas C,Devillers L,Souty C,Sicsic J,Boisnault P,François M

    更新日期:2019-07-31 00:00:00

  • Consultations involving people with congenital disabilities: factors that help or hinder giving care.

    abstract:BACKGROUND:Previous studies have suggested that the attitudes of health professionals towards people with disability may be as negative as those of society. Further, even positive attitudes may not always be reflected in the health professional's behaviour. OBJECTIVE:The aim of this study was to examine GPs' (registra...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/18.4.419

    authors: Muir EH,Ogden J

    更新日期:2001-08-01 00:00:00

  • Different models to mobilize peer support to improve diabetes self-management and clinical outcomes: evidence, logistics, evaluation considerations and needs for future research.

    abstract::Much of diabetes care needs to be carried out by patients between office visits with their health care providers. Yet, many patients face difficulties carrying out these tasks. In addition, many adults with diabetes cannot count on effective support from their families and friends to help them with their self-manageme...

    journal_title:Family practice

    pub_type: 杂志文章,收录出版,评审

    doi:10.1093/fampra/cmp003

    authors: Heisler M

    更新日期:2010-06-01 00:00:00

  • The narrative approach as an effective single intervention in functional somatic symptoms in a multi-disciplinary referral clinic for primary care frequent attenders.

    abstract::Mental health problems are underdiagnosed in general practice, primarily because they are often somatized and the patient reports only physical symptoms. These somatized symptoms are responsible for a large percentage of the frequent attenders in general practice. Palpitations are among those somatized symptoms. Here ...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/cmh618

    authors: Matalon A,Nachmani T,Rabin S,Maoz B

    更新日期:2005-02-01 00:00:00

  • The effectiveness of waiting room notice-boards as a vehicle for health education.

    abstract::To determine whether patients read and remembered health promotion messages displayed in waiting rooms, 600 patients in a UK general practice were given a self-complete questionnaire. Two notice-boards carried between 1 to 4 topics over four study periods. Three-hundred and twenty-seven (55%) of subjects responded. Tw...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/11.3.292

    authors: Wicke DM,Lorge RE,Coppin RJ,Jones KP

    更新日期:1994-09-01 00:00:00

  • The assessment of genetic risk of breast cancer: a set of GP guidelines.

    abstract:BACKGROUND:Assessing a genetic risk for developing breast cancer is not an easy task for a GP. Current expert guidelines for referring and counselling women with a family history positive for breast cancer are complex and difficult to apply in general practice, and have only two strategies (to refer or not to refer for...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/16.1.71

    authors: de Bock GH,Vliet Vlieland TP,Hageman GC,Oosterwijk JC,Springer MP,Kievit J

    更新日期:1999-02-01 00:00:00

  • Influence of family on acceptance of influenza vaccination among Japanese patients.

    abstract:BACKGROUND:Influenza is a major cause of morbidity and mortality in Japan and worldwide, especially for people of >65 years old and those with high-risk medical conditions. Although the influenza vaccine is effective in reducing the morbidity and mortality, the vaccine coverage rate has not increased adequately in Japa...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/20.2.162

    authors: Takahashi O,Noguchi Y,Rahman M,Shimbo T,Goto M,Matsui K,Asai A,Onishi M,Koyama H,Sawada I,Yoshinaka T,Fukui T

    更新日期:2003-04-01 00:00:00

  • Confidentiality in general practice.

    abstract::Attitudes among general practitioners to confidentiality were studied in Denmark in 1980 and in 1984 and in France in 1980 using mailed questionnaires. A number of typical situations in general practice were described. The doctors were asked whether they would disclose information about the patient in the situations d...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/2.4.199

    authors: Mabeck CE

    更新日期:1985-12-01 00:00:00

  • Cardiovascular health check in the elderly in one general practice: does it offer new information and lead to interventions?

    abstract:BACKGROUND:Prevention of cardiovascular disease in the elderly is becoming increasingly important. GPs are in a unique position to initiate preventive interventions in this age group. However, it is not clear which strategy a GP should follow to identify patients at increased cardiovascular risk-case finding or screeni...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/16.4.389

    authors: van den Berg PJ,van Dalsen CL,de Rooij RA,Prins A,Hoes AW

    更新日期:1999-08-01 00:00:00

  • Health problems in people with intellectual disability in general practice: a comparative study.

    abstract::In a GP database, 318 people with intellectual disability (ID) appeared to have 2.5 times more health problems than people without ID. This short report deals with the nature of the health problems. Consequences for health care policy are discussed. ...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/17.5.405

    authors: van Schrojenstein Lantman-De Valk HM,Metsemakers JF,Haveman MJ,Crebolder HF

    更新日期:2000-10-01 00:00:00

  • Will shared decision making between patients with chronic musculoskeletal pain and physiotherapists, osteopaths and chiropractors improve patient care?

    abstract:BACKGROUND:Chronic musculoskeletal pain (CMP) is treated in primary care by a wide range of health professionals including chiropractors, osteopaths and physiotherapists. AIMS:To explore patients and chiropractors, osteopaths and physiotherapists' beliefs about CMP and its treatment and how these beliefs influenced ca...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/cmr083

    authors: Parsons S,Harding G,Breen A,Foster N,Pincus T,Vogel S,Underwood M

    更新日期:2012-04-01 00:00:00

  • Late-life depression and the association with multimorbidity and polypharmacy: a cross-sectional study.

    abstract:Background:Late-life depression often coincides with chronic somatic diseases and, consequently, with polypharmacy, which may complicate medical treatment. Objective:To determine the associations between patients diagnosed with late-life depression in primary care and multimorbidity and polypharmacy. Methods:This cro...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/cmx018

    authors: Holvast F,van Hattem BA,Sinnige J,Schellevis F,Taxis K,Burger H,Verhaak PFM

    更新日期:2017-09-01 00:00:00

  • Knowledge, opinions and attitudes of primary care physicians about generic drugs: a cross-sectional study.

    abstract:BACKGROUND:Generic drug (GD) use is affected by many factors, including physicians' approach. OBJECTIVE:This study aimed to investigate the knowledge, opinions and attitudes of primary care physicians (PCPs) about GDs and potentially associated factors. METHODS:An adequately representative sample (n = 354) of PCPs wa...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/cmaa138

    authors: Oncu S,Bayram D,Aydin V,Isli F,Aksoy M,Akici A,Ucku R,Gelal A

    更新日期:2020-12-19 00:00:00

  • The BeweegKuur programme: a qualitative study of promoting and impeding factors for successful implementation of a primary health care lifestyle intervention for overweight and obese people.

    abstract:BACKGROUND:The aim of the study was to identify promoting and impeding factors for successful implementation of a Dutch primary health care-based lifestyle programme called 'BeweegKuur'. BeweegKuur aims to increase the physical activity and change the diet of people at increased health risk due to overweight or obesity...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/cmr056

    authors: Helmink JH,Kremers SP,Van Boekel LC,Van Brussel-Visser FN,Preller L,De Vries NK

    更新日期:2012-04-01 00:00:00

  • Assessing family history of heart disease in primary care consultations: a qualitative study.

    abstract:BACKGROUND:Current primary prevention guidelines recommend the assessment of family history of coronary heart disease (CHD) to identify at-risk individuals. OBJECTIVE:To examine how clinicians and patients understand and communicate family history in the context of CHD risk assessment in primary care. METHODS:A quali...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/cmm037

    authors: Hall R,Saukko PM,Evans PH,Qureshi N,Humphries SE

    更新日期:2007-10-01 00:00:00

  • A new method for describing smokers' consulting behaviours which indicate their motivation to stop smoking: an exploration of validity and reliability.

    abstract:BACKGROUND:Smokers vary in their readiness to try stopping smoking, but there currently are no objective tools for identifying smokers' consulting behaviours which indicate their level of motivation to try stopping smoking. OBJECTIVE:The aim of this study was to investigate the construct validity and inter-observer re...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/19.2.154

    authors: Coleman T,Stevenson K,Wilson A

    更新日期:2002-04-01 00:00:00

  • Patient experience of primary care and advance care planning: a multicentre cross-sectional study in Japan.

    abstract:Background:Advance care planning (ACP) is becoming increasingly important in the primary care setting because of its positive impact on the end-of-life care. Objective:We aimed to investigate the relationship between patient experience of primary care and ACP. Methods:This cross-sectional study was conducted in 28 pr...

    journal_title:Family practice

    pub_type: 杂志文章,多中心研究

    doi:10.1093/fampra/cmw126

    authors: Aoki T,Miyashita J,Yamamoto Y,Ikenoue T,Kise M,Fujinuma Y,Fukuma S,Kimachi M,Shimizu S,Fukuhara S

    更新日期:2017-04-01 00:00:00

  • Disability and quality of life in heart failure patients: a cross-sectional study.

    abstract:BACKGROUND:Although both hospitalization and mortality due to heart failure (HF) have been widely studied, less is known about the impact of HF on disability and quality of life. AIM:To assess the degree of disability and quality of life in HF patients attended at family medicine centres. DESIGN AND SETTING:Cross-sec...

    journal_title:Family practice

    pub_type: 杂志文章,多中心研究

    doi:10.1093/fampra/cmz017

    authors: García-Olmos L,Batlle M,Aguilar R,Porro C,Carmona M,Alberquilla A,Sánchez-Gómez LM,Monge E,López-Rodríguez AB,Benito L,Baños N,Simón A,Martínez-Álvarez MA,Luque EM,García-Benito C

    更新日期:2019-11-18 00:00:00

  • Palpitation referrals from primary care to a secondary care cardiology outpatient clinic: assessing adherence to guidelines.

    abstract:BACKGROUND AND AIMS:Palpitations are a common presentation in primary care. Guidelines have been developed to identify patients with palpitations who require further assessment by a cardiologist in secondary care. However, patients that do not meet guideline thresholds for referrals are still referred to secondary care...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/cmaa094

    authors: Pallikadavath S,Patel R,Sarania R,Ahmad T,Vali Z,Kandala NI,Sandilands A

    更新日期:2020-09-12 00:00:00

  • The effectiveness of local adaptation of nationally produced clinical practice guidelines.

    abstract:BACKGROUND:Local adaptation is often reported in the literature to be an important strategy in achieving local ownership and relevance of guidelines in order to increase the likelihood of their uptake and implementation. However, the process is also potentially time-consuming and costly. OBJECTIVE:The aim of this stud...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/19.3.223

    authors: Silagy CA,Weller DP,Lapsley H,Middleton P,Shelby-James T,Fazekas B

    更新日期:2002-06-01 00:00:00

  • Achieving involvement: process outcomes from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice.

    abstract:BACKGROUND:A consulting method known as 'shared decision making' (SDM) has been described and operationalized in terms of several 'competences'. One of these competences concerns the discussion of the risks and benefits of treatment or care options-'risk communication'. Few data exist on clinicians' ability to acquire ...

    journal_title:Family practice

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1093/fampra/cmh401

    authors: Elwyn G,Edwards A,Hood K,Robling M,Atwell C,Russell I,Wensing M,Grol R,Study Steering Group.

    更新日期:2004-08-01 00:00:00

  • What do patients expect from consultations for upper respiratory tract infections?

    abstract:BACKGROUND AND OBJECTIVE:A cross-sectional survey was conducted amongst patients who consulted for upper respiratory tract infections (URTI) at 22 private practitioners' offices. METHOD:A total of 505 adult patients and 504 guardians (parents or grandparents of child patients) completed a self-administered questionnai...

    journal_title:Family practice

    pub_type: 杂志文章

    doi:10.1093/fampra/13.3.229

    authors: Chan CS

    更新日期:1996-06-01 00:00:00

  • Doing randomized controlled trials in a developing country: some practical realities.

    abstract:BACKGROUND:Formal randomized controlled trial results are often reported. The difficulties of doing such trial are not. Developing countries represent a new field in which trials can be undertaken. In this context even less is known about the practicalities involved. METHOD AND RESULTS:A randomized, double-blind, para...

    journal_title:Family practice

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1093/fampra/13.1.98

    authors: Glasgow NJ,Murdoch JC,Baynouna L,al Sabosy MM,al Jabiri ON,Harron DW

    更新日期:1996-02-01 00:00:00