Evaluating prevention strategies used by general practitioners in Grahamstown in terms of recommended guidelines
Thesis (MMed)--Stellenbosch University, 2009.
Background: Increasing attention has been paid to preventative health over the past few decades. However because of constraints on consultation time and medical funds general practitioners (GPs) are often unsure which measures are appropriate and when to carry them out. They need to be well informed about the cost-effectiveness and evidence regarding each preventative measure to help their patients make informed choices about what needs to be done. Due to the large number of recommended screening measures general practitioners are often unsure which to prioritise and also forget to carry out all recommended measures. Recommendations for screening in South Africa and research into preventive strategies used by general practitioners are lacking. This research attempts to find out whether the prevention strategies used by general practitioners in private practice in Grahamstown follow recommended guidelines. Methods: To obtain a broad understanding of prevention strategies used by general practitioners in Grahamstown, the following tracer conditions were selected for the study: screening for smoking, breast cancer, cervical cancer, colorectal cancer, hyperlipidaemia, prostate cancer and human immunodeficiency virus (HIV) infection. Research on routine annual health checks was included as these are used by many GPs to screen for tracer conditions. The research was done in 2 parts: 1. Review of the literature to obtain evidence on the recommended prevention strategy for each of the selected tracer conditions and 2. Interviews with GPs to evaluate the prevention strategy they used for each tracer condition. The literature was reviewed for evidence on the following parameters for each tracer condition: burden of the disease prevented; cost-effectiveness of the screening measures; sensitivity and specificity of screening tests; whether the screening measure for and treatment of the tracer condition is acceptable to patients; appropriate duration between repeated screening tests and whether there is effective treatment for the tracer condition. Eleven general practitioners were interviewed on the prevention strategies they use for each of the selected tracer conditions. Transcriptions of the interviews were analysed qualitatively and qualitatively. The prevention strategies used by the general practitioners was then compared to recommended guidelines. Results: Evidence from the literature regarding the burden of and optimal prevention strategy for each tracer condition is reported. Using this evidence an appropriate prevention strategy for each tracer condition is outlined. The prevention strategies used by the GPs for each tracer condition and the routine annual health check is reported from the analysis of the interviews. The results show a wide range of differing strategies used by the GPs, often not following recommendations from research. Discussion: The prevention strategies used by general practitioners for each tracer condition is compared with the recommendations from the literature. Important differences between what are recommended and what general practitioners are doing is discussed. Some general practitioners are practicing largely curative medicine and are not adequately screening their patients. Others are over screening with too many unnecessary tests being done annually as a routine. The interviews reveal that generally GPs do not discuss the potential harms and limitations of screening tests with their patients; do not keep check lists for each patient and do not use registers or recall systems to ensure all screening is done. Conclusion: General practitioners need to ensure their prevention strategies follow recommended guidelines. To do so they can use the routine annual health check or opportunistic case finding and prevention. They need to ensure that routine health checks are targeted to the individual patients’ health risks and avoid doing unnecessary tests. Check lists can help to ensure all screening is done on every patient. While registers and recall systems improve screening rates they are not always possible in busy general practices. Recommended prevention strategies for each of the tracer conditions are made.