Paul, Tomlin.J; Mitchell, A; Nembhard, O.D
Author Affiliation, Ana.
The range of clinical procedures conducted by physicians in a group general practice setting
General Practice On-Line
Date of Publication
Background: General practitioners are often involved in carrying out a variety of procedures on patients in the office setting. The range of these procedures will depend on the level of skill of the physician and the types of problems being managed. Assessing the types of clinical procedures carried out in general practice can help trainers to gauge training needs and identify gaps in the provision of medical care. Inter-physician variations of various procedures can also be used to gain insights into different styles of practice. This study aims to determine the range of clinical procedures undertaken by physicians working in a group family practice and to assess inter physician variations in procedure rates. Methods: For the period January to June 2001, procedure listings for 3 general practitioners who were on regular service at a private group medical centre in Kingston, Jamaica were reviewed. A count and categorisation was made of all the procedures undertaken by each practitioner for the 6-month period. Only clinical procedures that had to do with the immediate care of the patient were counted. Rates of procedures were generated using patient-visits as the denominator and comparisons made among physicians. The practitioners were labeled physician 1, 2 and 3 for the purposes of this study. Results: The modal procedure for all physicians was injections reaching as high as 41% for physician 2. Dressings accounted for approximately 25% of all procedures for each physician. Injections featured as the procedure with the highest rate for all physicians (74 per 1,000 patient-visits for physician 2). Surgical procedures (e.g. suturing, incision and drainage and removal of nails) all had relatively very low rates (< 5 per 1,000 patient-visits). There was a statistically significant difference in the pattern of distribution of procedures with frequency greater than 5 per 1,000 patient-visits (p=0.002). Inter-physician variability in glucometer use was marked (range 6.8 to 28.2 per 1,000). Conclusion: Injections and dressings are the most frequent clinical procedures performed in this general practice setting. There is a very small load of surgical procedures. Variability in procedure rates among physicians may be related to differences in clientele profile and physician practice styles.....