Comparative Performance Information Plays No Role in the Referral Behaviour of GPs

Comparative performance information (CPI) about the quality of hospital care is information used to identify high-quality hospitals and providers. As the gatekeeper to secondary care, the general practitioner (GP) can use CPI to reflect on the pros and cons of the available options with the patient and choose a provider best fitted to the patient’s needs. We investigated how GPs view their role in using CPI to choose providers and support patients. Method: We used a mixed-method, sequential, exploratory design to conduct explorative interviews with 15 GPs about their referral routines, methods of referral consideration, patient involvement, and the role of CPI. Then we quantified the qualitative results by sending a survey questionnaire to 81 GPs affiliated with a representative national research network. Results: Seventy GPs (86% response rate) filled out the questionnaire. Most GPs did not know where to find CPI (87%) and had never searched for it (94%). The GPs reported that they were not motivated to use CPI due to doubts about its role as support information, uncertainty about the effect of using CPI, lack of faith in better outcomes, and uncertainty about CPI content and validity. Nonetheless, most GPs believed that patients would like to be informed about quality-of- care differences (62%), and about half the GPs discussed quality-of-care differences with their patients (46%), though these discussions were not based on CPI. Conclusion: Decisions about referrals to hospital care are not based on CPI exchanges during GP consultations. As a gatekeeper, the GP is in a good position to guide patients through the enormous amount of quality information that is available. Nevertheless, it is unclear how and whether the GP’s role in using information about quality of care in the referral process can grow, as patients hardly ever initiate a discussion based on CPI, though they seem to be increasingly more critical about differences in quality of care. Future research should address the conditions needed to support GPs’ ability and willingness to use CPI to guide their patients in the referral process

Biology of mycorrhizal associations of epacrids (Ericaceae)

Epacrids, a group of southern hemisphere plants formerly considered members of the separate family Epacridaceae, are in fact most closely allied to the Vaccinioid tribe (Ericaceae). Epacrids and other extant ericoid mycorrhiza-forming plants appear to have a monophyletic origin. In common with many Ericaceae they form ericoid mycorrhizas. ITS sequence data indicate that the fungi forming ericoid mycorrhizas with epacrids and other extant Ericaceae are broadly similar, belonging to a poorly defined group of ascomycetes with phylogenetic affinities to Helotiales. The basic development and structure of ericoid mycorrhizal infections in epacrids is similar to other Ericaceae. However, data are limited on the structure and physiology of both hair roots and ericoid mycorrhizas for all Ericaceae. Relatively little is known about the functional significance of ericoid mycorrhizas in epacrids in southern hemisphere habitats that are often poor in organic matter accumulation. However the abilities of fungal endophytes of epacrids to utilize organic N and P substrates equal those of endophytes from northern hemisphere heathland plant hosts. Investigations using ¹⁵N/¹³C-labelled organic N substrates suggest that mycorrhizal endophytes are important, at least, to the N nutrition of their epacrid hosts in some habitats

The Association between Pathological Internet Use and Comorbid Psychopathology: A Systematic Review

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