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Background: Curricula in most western medical universities include teaching in the primary care setting as core elements. This affects GP-teachers, their patients and their interaction. Therefore, it was the aim of this study to assess the influence of the presence of medical students in the teaching practice on the attitudes of both GPs and patients., Methods: Seventy-four GP-preceptors were invited to answer an online survey. Patients attending consultations with a medical student present completed questionnaires either before the consultation (WR group) or immediately after consultation (AC group)., Results: Fifty- nine preceptors completed the online survey. Physicians showed positive attitudes towards their activities as preceptors: 95% expressed a positive attitude predominantly towards being a role model and to represent the discipline and for 64% remuneration was not important. In 28 practices 508 questionnaires were completed by patients in the WR-group and 346 by the AC-group. Only 12% (WR) and 7.2% (AC) of patients expressed a preference for being seen by the doctor alone. While 16% of doctors rated that confidentiality of the doctor-patient relationship is compromised, only 4.1% (WR) and 1.7% (AC) of patients felt so., Conclusion: The motivation to be a preceptor is primarily driven by personal and professional values and not by economic incentives. Further, patients have even more positive attitudes than the preceptors towards the presence of students during their consultation. Reservations to teaching students in GP-practices are, therefore, unwarranted.

Background: We investigated drug substitution patients' biographical data for counselling, to recognize social and other risk factors and additionally consumed drugs., Methods: We decided on a retrospective, descriptive investigation in one practice. A preformed pattern of questions was applied to the charts of drug-substituted patients., Results: We found data on 332 men and 114 women. Statistical connections were counted by SPSS 11.5 and Chi-square-tests. Two-thirds had completed compulsory school, one third had some kind of vocational training, and current occupation was frequently different to training. 72% of the patients claimed to have "a supportive family relationship with their families". 25% were in touch with their children. Drug abuse started early, below the age of 14 for nearly 25% of our group.179 patients had withdrawal treatment.138 patients (31%) confirmed hepatitis C infection, 23 out of 441 had tested HIV positive (5.2%)., Conclusions: Inconstant relationships to family, education and profession combine to early drug use.

Background: To increase the rate of prescriptions for generic drugs in Vienna an information campaign was started in 2004 and quality circles for prescribing doctors were organized. Since the result of this initiative is not yet known publicly this report aims to present a preliminary analysis., Methods: The prescription statements kindly provided by the health insurance fund of Vienna could be analysed. Data from the Chamber of Viennese Physicians were used for compiling a report about the quality circles., Results: A total of 17 quality circles with an average of 15 participants were formed; they met four times yearly. Participants were paid for their attendance. The rate of prescribed generic drugs in Vienna has continuously improved, with the major increase in the first year of the activities. In the year 2006 a rate of over 40% generic prescriptions was reached by 80% of general practitioners., Conclusions: This cooperation between the health insurance fund and doctors apparently resulted in both an increase in the rate of generic drugs prescribed and in a good acceptance among physicians.

Introduction: Two strategies have been proposed to increase the rather low recognition rate of common mental disorders in primary care: (1) the use of screening instruments and (2) extensive psychiatric training for general practitioners. We have chosen a "middle-of-the-road" approach to teach general practitioners by means of a time-saving psychiatric training programme how to make their own psychiatric diagnoses. This pilot study aimed at assessing the acceptance of this programme, its impact on general practitioners' knowledge of 12 ICD-10 disorders - depressive, anxiety and alcohol-related disorders - and the short-term persistence of the knowledge acquired., Methods: The training programme consisted of two 3-hour sessions four weeks apart. An educational instrument, a short interview named TRIPS (Training for Interactive Psychiatric Screening), a shortened and adapted form of PRIME-MD, was used to train single-handed general practitioners in Vienna, Austria. TRIPS had to be used by the participants in daily practice in between sessions. Five weeks after the second training session a follow-up evaluation was held to assess the persistence of the knowledge acquired. The perceived usefulness of TRIPS was assessed by a short questionnaire. Knowledge was assessed by a separate 15-item questionnaire., Results: Of the 31 participating general practitioners 26 attended all three sessions. There was a significant increase in the mean number of correctly answered questions between baseline (5.5 of 15) and session two (9.8; p<0.0001), and a further increase between the second and the follow-up session (11.3; p<0.05). Also, general practitioners rated TRIPS as a practical and useful tool for family practice and stated that its use met with patients' approval., Conclusion: The format chosen was successful in its intended educational endpoints. According to participants TRIPS is appropriate for the family practice situation and is accepted by patients.

Drug replacement therapy using synthetic opioids is in Vienna mostly carried out by primary care physicians. Group teaching in quality assurance groups has been installed in order to give these doctors the necessary personal and informational assistance. Evaluation has shown that: 1. 90% of the doctors were highly or well satisfied with the teaching. Only 10% were slightly critical. 2. They could better communicate with, and were able to show more tolerance towards, the "difficult" patients. 3. Specialized knowledge increased (risk of infection, "management of hepatitis", contact with authorities, co-medication). 4. Some critical remarks pointed towards ways in which this particular further education could in future be better organized and dealt with more intensively.

The aim of this study was to examine the frequency of prescription of analgesic drugs by General Practitioners in Austria, the reasons for which they are prescribed, as well as relevant organizational details. A questionnaire was designed to prospectively collect data from 14 participating General Practitioners over a period of at least 20 days each. The type of analgesic drugs prescribed during direct (doctor) or indirect (receptionist) consultations was recorded, coded according to the ATC classification and separated into first and repeat consultations. Furthermore, the diagnostic terms and the individual intensity of pain perception by the patients were noted. During 7248 consultations recorded, 1083 prescriptions of analgesics were issued. The majority of first prescriptions are issued during direct consultations, whereas a large number of repeat prescriptions are prepared for the doctor's supervision by the receptionists via indirect consultations. Almost half of the patients receive repeat prescriptions. In both, direct and indirect consultations with patients, approximately every 7th contact results in the prescription of an analgesic drug. The antirheumatic drug group is the most frequently prescribed group of painkillers whereas opioids are rarely prescribed. Selection of drugs is not clearly related to the degree of pain experienced by individual patients. Problems of the musculo-skeletal system rank first among the classifications leading to prescription of an analgesic. Pain needs quick and efficient therapy. Prescriptions of analgesics in General Practice ought to be issued in such a way as to serve this large group of patients without, however, taking extensive risks: repeat and first prescriptions issued during indirect consultations have to be precisely recorded and need the doctor's personal supervision.

Daytime emergency visits (7 a.m.-8 p.m.) requested in a general practice on the outskirts of Vienna were investigated between 1985 and 1992. Altogether 56 such calls were registered, on average 7.1 per year, with a decreasing tendency over the investigated period. The average visit started 9 minutes after demand and lasted for 17 minutes. An objective assessment after the visits revealed 35.7% life-threatening indications, 57.1% absolute, 3.6% relative and 3.6% trivial indications. Only 34% of all patients were referred to hospital for inpatient treatment. This form of general practitioner home visiting based on telephone assessment of urgency by the doctor personally keeps calls to a minimum, saves money and is efficient.

In 5 Viennese general practice offices we investigated patients by spirometry with the following indications: differential diagnosis of dyspnea; every 3rd smoker of more than 10 cigarettes a day (including asymptomatic ones); cough and nasal disorders of more than 4 weeks duration; indicative physical findings (cyanosis or auscultation). The sample control group was matched for age and gender and did not have any symptoms characteristic of the indication group. Nevertheless a spirometric test was also carried out in these patients. A total of 212 patients were examined in 4673 consultations on 202 workdays in the 5 offices. In the group of 109 patients 62 (56.9%) had dyspnea and/or positive signs on auscultation. Of these 62 patients 39 (62.9%) had 1 or more positive findings either from PEF or FEV 1 or both. There were significantly more referrals for X-rays in case of abnormal lung function. The control group of 103 obviously healthy persons in particular showed a significantly higher number of abnormal PEF values than expected (31 persons, 30.1%).

Information about the acute and emergency care of patients with cardiovascular diseases in Vienna up to now has been sparse. We used the routine data of the Vienna Doctors' Chamber's central deputizing service to throw light upon the diagnostic situation and at the method of management at the start of acute and emergency care in these patients. The most frequent disease visited was angina, followed by hypertension, cardiac failure, paroxysmal tachycardia and hypertensive crisis. The suspicion of coronary infarction (mostly before ECG) follows as the sixth in line. The patient's condition is more frequently described in terms of symptoms before the visit than after the visit. Diagnostic information at the telephone fails completely only in single cases which stay below statistical significance. An improvement in the author's opinion could only be attained by standardized telephone assessment and cooperation with patients. If a visit needs acceleration, it is mostly ordered as a blue light, most accelerated, visit, which happens in 9% of all visits. In over 50% of blue light visits cars are on their way in the first 10 minutes after the phone call.

Data relevant to the management and post-hospital care of cancer patients were collected in six Austrian General Practices. The prevalence of the most frequent malignant diseases was the same as in extensive Austrian statistics. 10% of our patients were in observance at our practices for more than ten years. Diagnosis was attained in 30% by follow-up of relevant symptoms with the means available to the General Practitioner. 43.3% could be considered healed and had no treatment whatever. Patients being treated in an oncologic centre were significantly younger than patients staying with the General Practitioner. Even in doctors highly motivated to personally inform patients about their diagnosis, 29% of patients had, for valid reasons, not been informed. Only two of 36 patients died at home.

In a double blind designed treatment trial with three randomized groups of patients the effect of a fixed betablocker diuretic combination (Torrat, Boehringer Mannheim GmbH) was compared with the effect of the single components. 66 patients with essential and renal hypertension stage I and II according to the WHO definition were evaluated. 27 patients were treated with 1 tablet, 32 with 2 X 1 tablet, and 7 patients with 3 X 1 tablet daily. Besides of the blood pressure lowering effect over an observation period of 10 weeks the influence on pulse rate, potassium, blood sugar and uric acid were investigated. It could be shown that the blood pressure lowering effect was highest under the combination-drug. The treatment with the single components showed a less pronounced influence on the blood pressure, thus hinting at an additive effect of the 2 components metipranolol and butizide when given together. The combination exerts few side effects and does not influence the investigated parameters of metabolism over a longer period of time.

498 discharge letters, written by physicians at the Second Department of Medicine, University of Vienna were subjected to the following content analysis: procedures employed to reach a diagnostic result, length and preferred content of letters, delay between discharge of patient and posting of letter and relationship between pragmatic versus knowledge-oriented concepts. Routine hospital diagnostic procedures achieved a marked increase in accuracy in terms of medical diagnosis over initial admittance diagnosis. Enlarged diagnostic evaluation mostly occurred due to the assistance of X-rays. Letters addressed to general practitioners were longer and contained more assessment of the patient's condition than letters to specialists. Letters on average left the hospital 30 days after the patient's discharge.

Which are the signs the emergency service uses most to initiate an urgent home visit? What degree of diagnostic certainty can be attained at the telephone? These questions were answered by a study of the Vienna emergency doctor's service, a General Practitioner deputizing service operating during all the nights and on weekend days. The 3 diagnostic items leading to an urgent visit most frequently after a phone call were angina, bronchial asthma and dyspnoea. The doctor at the telephone decides in favour of an urgent visit, if a symptom relates to a prevalently dangerous group of diseases; he follows these signs urgently when the time of the day frequently relates to dangerous diseases containing such a symptom. The decision to do an urgent house call is more often made up in terms of diagnoses than by mere symptoms.

In order to determine whether patients with microhaematuria seen in general practice should be followed up in order to establish an aetiological diagnosis, a study was performed in a general practice in Vienna. Over a period of 2 1/2 years 87 patients with haematuria were found by a systematic procedure among a clientele of 2500 persons. This gives a one-year incidence rate of about seven per 1 000. By systematic investigation, three main groups of patients could be found: patients with microhaematuria and additional leukocyturia and bacteriuria (40%), most of them needing no further investigation after treatment of their urine infection; patients with microhaematuria showing different degrees of pathological changes after a complete urological check-up (43%); patients where the complete checkup did not reveal any aetiological diagnosis (13%).