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Background: As part of a large national survey of morbidity recording on general practice computers, morbidity and prescribing data were collected from three separate sources for more than 10,000 patients aged 45-64 years, randomly selected from 41 Scottish general practices., Aim: To amalgamate the three sources of data to provide estimates of prevalence rates for a range of common chronic diagnoses, and of medication rates for associated repeat prescription drugs., Method: Forty-one Scottish general practices were selected on a geographic basis in relation to the national population distribution. Within each practice, 250 patients aged 45-64 years were selected at random. Data relating to 19 diagnoses and 40 repeat prescription drugs were extracted from the computer records of these patients and compared with information held on patients' paper records and supplied by patients in response to a postal questionnaire. After assessing the completeness and accuracy of computer-held information, the three sources of data were amalgamated according to agreed protocols., Results: Lifetime prevalence rates are presented for each diagnosis, broken down by sex and age group. Differences in rates between the sexes, and with change in age, were in the expected direction for all diagnoses, and were matched by corresponding differences in entitlements to repeat prescription drugs. Comparison of these lifetime rates with published prevalence rates indicates a latent pool of morbidity within the community, which ranges from 1.0 to 10.0 times the annual prevalence rate for different conditions., Conclusion: The amalgamated data provide an estimate of lifetime prevalence rates for the range of conditions examined. They complement conventional morbidity statistics and have potential value in allowing the underlying management costs of specific chronic conditions to be evaluated.

That medicine is a science is the popular belief, and this has been reinforced by the advent of 'evidence-based medicine', which assumes that scientific proof is required to support medical practice. However, the view of science implied is a narrow one, foreign both to pure scientists and to artists, and the art of medicine is devalued by the approach. There are both important differences and important similarities between science and the arts. The arts should contribute to evidence-based practice and education along with science, and have a role in many aspects of medical practice.

Background: A high proportion of Scottish general practices use a standard computer software package (GPASS, general practice administration system for Scotland), and thus, Scotland is uniquely placed to amalgamate primary care data on a national scale. Practices, however, vary widely in the nature and extent of data entered on computer and a major limitation on the use of the collected data is the absence of information on the completeness and accuracy of the computer database., Aim: This study set out to assess the quality of morbidity and repeat prescribing records held on computer by general practices in Scotland., Method: Forty-one practices, with above average levels of morbidity data recorded on computer, were selected on a geographic basis in relation to the national population distribution. Within each practice, 250 patients aged 45-64 years were selected at random. Data relating to 19 diagnoses, six surgical procedures and 40 repeat prescription drugs were extracted from the computer records of these patients and compared with information held on patients' paper records and supplied by patients in response to a postal questionnaire. The completeness and accuracy of computer entries were assessed in terms of sensitivity and positive predictive value, respectively., Results: For the 5567 patients for whom all three sources of data (validated computer records, paper records and questionnaire responses) were available, sensitivity (completeness) of morbidity recording had median values of 0.67 for diagnoses, 0.93 for surgical procedures and 0.75 over all conditions examined. Practices varied both in the completeness of recording of each condition and in their overall performance. The predictive value (accuracy) of morbidity data was uniformly high for all conditions examined (median 1.00). For repeat prescription drugs, recording on GPASS was both complete and accurate., Conclusion: The recording of morbidity data on GPASS for 45-64-year-old patients in a selected group of 41 highly-computerized practices is about 75% complete and highly accurate. For national morbidity studies, it seems likely that amalgamated data from the best GPASS practices will be as complete and accurate as the morbidity statistics currently derived from hospital-based activities in Scotland.

Aim: This survey set out to determine the factors associated with outcome of unaided smoking cessation attempts and to compare the characteristics of smokers who had tried to stop with those who had never tried., Method: A postal questionnaire was sent to a random sample of 2000 adults in Aberdeen, Scotland. Those respondents who smoked or who were ex-smokers were sent a second questionnaire. The outcome measure for success in trying to stop smoking was abstinence for more than four months., Results: Light and heavy smokers were more successful at smoking cessation than moderate smokers. Those who succeeded perceived that they had more social support than failures, and were more likely to have 'simply just stopped'. They were less likely to have used nicotine gum or to believe that smoking was harmful. Those who failed experienced more withdrawal symptoms, and were more likely to be tempted by the presence of others smoking. Eleven per cent of smokers had never tried to stop. These smokers were older and more dependent than those who had tried to stop. They were less likely to acknowledge the health risks of smoking or to conform to social pressures, but were more likely to consider stopping for financial reasons alone., Conclusion: Heavily dependent smokers may fare better in unaided cessation than the results of clinic-based research suggest. For those who have tried to stop, increasing motivation and social support, and minimizing withdrawal symptoms, may be more productive than further emphasis on health risks. Motivating smokers who have not previously tried to stop may involve more emphasis on the health risks of smoking and the health benefits of stopping, as well as on other non-financial benefits of stopping such as social acceptability. Fiscal measures may be particularly effective in motivating this group of smokers to try to stop.

Background: Acute infective diarrhoea is one of the commonest reasons for admission to hospital with an infectious disease., Aim: This study set out to describe the clinical features of infective diarrhoea at the time of presentation in adults managed in the community or admitted to hospital in 1990-91, in order to try to understand the decision-making process which led to referral to hospital., Method: Data were collected from general practitioners by computer assisted telephone interview for 114 patients with presumed infective diarrhoea referred to the infection unit at the City Hospital, Aberdeen from all practices in the Grampian region and for 121 non-referred patients managed within seven practices., Results: General practitioners appeared to use examination, investigation and referral selectively in patients presenting with diarrhoeal illness. A comparison of referred and non-referred patients identified differences in patients' reasons for consultation and the general practitioners' clinical findings, suggesting these were important in the decision to refer the patient for hospital admission. General practitioners were more likely to refer adult patients with infective diarrhoea if the patients were older, were seen at home and were more acutely unwell with fever, dehydration and abdominal tenderness., Conclusion: The identification of these criteria may help general practitioners to decide when to refer a patient with infective diarrhoea to hospital.

Hormone replacement therapy can successfully treat menopausal symptoms. A postal questionnaire was used to investigate the knowledge of and attitudes to hormone replacement therapy of an age-stratified, computer-generated, representative sample of 1500 women living in the Grampian region of Scotland. A response rate of 78% was achieved. Comparisons were made between women of differing age, educational background and their current or past experience of hormone replacement therapy. The questionnaire also assessed their knowledge of osteoporosis, including the possible beneficial role of hormone replacement therapy. The results showed that women had a poor knowledge of the potential risks and benefits of oestrogen, lack of knowledge being greatest in the less educated and older women. The majority of women agreed with the view that because the menopause is brought on by diminished hormone levels, it should be viewed as a medical condition and treated as such, and also that a woman who experiences distressing menopausal symptoms should take hormone replacement therapy. Despite this, relatively few postmenopausal women were currently taking hormone replacement therapy (9%) or had taken the treatment in the past (7%), although many had experienced menopausal symptoms for over six months. The most common reason for postmenopausal women never having taken hormone replacement therapy was that they had never considered the treatment (70%) and had not discussed it with a doctor (79%).(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of this study was to describe the types of drugs prescribed by general practitioners in a sample of initial (rather than repeat) prescriptions, the additions and deletions made to a doctor's repertory and the factors influencing these changes. The method used here enabled repeat prescriptions to be excluded as these are an inaccurate reflection of the current habits of the prescriber. A total of 201 (74%) of the principal general practitioners in the Grampian region participated. Data were obtained by substituting special prescription pads containing duplicate forms which allowed additional data to be recorded at the time of prescribing, including perceived influences that had resulted in changes from established choices of drug therapy. A sample of 100 forms were collected on seven occasions from each doctor over a one year sample period. Prescribers on average selected a preparation that they had only started to use within the last 12 months (that is newly adopted to their repertory) in 5.4% of initial prescriptions. These changes mostly involved antibiotics and analgesics and were occasioned mainly by the influence of the 'limited list' regulations, pharmaceutical company representatives and hospital specialists. We conclude that general practitioners were not unduly influenced by commercial sources of information, and that their prescribing habits were stable and conservative. The paper presents a case for the separate analysis of initial and repeat prescriptions as an essential step in producing more informative data on prescribing.

The level of recording of risk factors for cardiovascular disease by general practitioners in north east Scotland has been audited. The effect of the audit on recording levels has also been determined by means of a second audit one year later. Twenty four practices in Grampian took part in the study, each auditing a random selection of 100 records of male patients aged 35-64 years. The risk factors chosen were blood pressure, smoking habit, alcohol consumption, weight and height. Blood pressure was recorded in the majority of the records (68.0%) and the mean level of recording of all of the risk factors increased between the two audits. The increase in the recording of smoking habit, alcohol consumption and weight was statistically significant. Practices with organized systems of data collection had higher levels of risk factor recording than those without. The levels of recording achieved were thus dependent on factors that existed in the practices prior to the study. This suggests that to increase recording levels, future educational intervention should be aimed at changes of motivation.

A large representative sample of women of child bearing age in five urban practices were asked to complete two measures to record premenstrual changes in their health. The first method was a daily health record which sought to disguise the fact that the focus of the study was premenstrual changes while the second method was a conventional, retrospective checklist. In addition, the women completed a personality inventory which allowed them to be allocated to one of two personality subtypes according to level of neuroticism--neurotic or stable. The results suggest that women in the neurotic subgroup are, in general, more likely to report premenstrual changes than stable women and particularly so on the retrospective checklist rather than the daily record of health changes. It was also shown that women in the stable subgroup were less likely to be inconsistent reporters of symptoms on the two questionnaires than neurotic women. Better understanding of the variable nature of the premenstrual syndrome may demand that more attention is paid to the method of collection of data and to how this interacts with the woman's basic personality. In particular, for research purposes, the traditional method of a retrospective checklist introduces an unacceptable level of response bias in favour of the identification of women with high neuroticism scores, and underrepresents more stable women who suffer from premenstrual complaints. Previous treatment trials which have used this method may therefore be invalid and their conclusions should be reappraised.