LETTERS Distance learning package for eye disease Helen Houston and L Beck 325 Exercise on prescription Richard Ayres and Emma Pocock 325 Diagnostic delay in appendicitis D Wilson and WA McCallion 326 Urban community hospitals William Hamilton and Alison Round 326 Reducing benzodiazepine usage R M Wylie 327 Bereavement care Craig K Brown 327 Management of angina Robert K McKinley and Kamlesh Khunti; David Paynton; Damian F McHugh 328 Prescribing lipid lowering agents G Wheatley 329 Health records John Rivett 329 Note to authors of letters: Please note that all letters submitted for publication should be typed with double spacing. Failure to comply with this may lead to delay in publication. Distance learning package for eye disease Sir, One in 14 people consults a doctor with an eye problem each year, two thirds of these consultations being in general practice, accounting for 1.5% of all general practice consultations.1 2 There is evidence that the general practice management of eye prob- lems could be improved.3-5 Our aim was to develop a distance learning package related to eye disease for general practitioners and to evaluate its effectiveness. The package, consisting of videotape material to demonstrate clinical method and physical signs, and an accom- panying book concentrating on facts, knowledge and reference material, was developed following an audit of eye prob- lems in 13 general practices. General practitioners and an ophthalmologist developed a consensus of desired know- ledge and management patterns for gener- al practitioners. After piloting, the final package was offered to all general practi- tioners in Wales, outcome measures being knowledge change for each topic covered and a change in theoretical patient man- agement. A total of 270 Welsh general practi- tioners (15.6%) enrolled for the distance learning package, of whom 203 (75.2%) completed the course. There was a marked increase in knowledge: mean mark of 54.4% among 270 respondents answering questions before the course compared with a mean mark of 85.5% among 203 respondents afterwards (paired t-test, P<0.01). Knowledge increased for all six clinical topics: glaucoma, squint, visual problems, wet/dry eyes, acute red eye and ophthalmoscopy. Mean percentage of par- ticipants answering questions correctly on glaucoma and squint are shown in Table 1, as examples. There was a significant improvement in theoretical patient man- agement decisions, the mean mark among respondents rising from 66.2% to 78.6% (paired t-test, P<0.01). These results were sustained at two months. The package seems to have been suc- cessful because it was related to real need, and because it was available in a format which suited the learner. This conflicts with Rosenthal's statement that general practitioners will need to be kept up to date with the technological advances in ophthalmology, this education being the responsibility of ophthalmologists.5 The study has shown that knowledge and skills need to be wider than this, encompassing common and important problems and should respond to the identified needs of general practitioners. HELEN HOUSTON L BECK Department of General Practice University of Wales College of Medicine Health Centre Maelfa Llanedeyrn Cardiff CF3 7PN References 1. Sheldrick JH, Vernon SA, Wilson AD, Read SJ. Demand incidence and episode rates of ophthalmic disease in a defined population. BMJ 1992; 305: 933-936. 2. Sheldrick JH, Wilson AD, Vernon SA, Sheldrick CM. Management of ophthalmic disease in general practice. Br J Gen Pract 1993; 43: 459-462. 3. Harrison RJ, Wild JM, Hobley AJ. Referral patterns to an ophthalmic outpatient clinic by general practitioners and ophthalmic opticians and the role of these professionals in screening for ocular disease. BMJ 1988; 297: 1162-1167. 4. Perkins P. Outcome of referrals by optometrists to general practitioners: an 18 month study in one practice. Br J Gen Pract 1990; 40: 59-61. 5. Rosenthal AR. The demand for ophthalmic services [editorial]. BMJ 1992; 305: 904-905. Exercise on prescription Sir, Everyone agrees that exercise is good for people. It reduces the risk of stroke,' coron- ary heart disease2 and osteoporosis3 and is beneficial in many other conditions. Advice from general practitioners can influence exercise habits,4 but doubts have been expressed about schemes that pre- scribe exercise.5 There are several schemes operating around the United Kingdom such as the Oasis leisure centre project in Hailsham and Pals (practice activity and leisure scheme) in Kirklees. Most exercise sessions take place in leisure centres; such sessions are usually enthusiastically welcomed by the leisure centres because they bring people in at times when business is normally slack. For many people, however, the mention of a leisure centre brings visions of slim bodies and crowded changing rooms, which may put off the very people such schemes are hoping to reach. In addition, transport is often a problem, especially in rural areas where it may be many miles to the nearest leisure centre. In the summer of 1994 an exercise scheme was started in South Motton. It has proved to be popular, was easy to set Table 1. Proportion of respondents answering questions on glaucoma and squint cor- rectly before and after the distance learning course. Mean % of GPs answering each question correctly Before course After course Topic (n= 270) (n= 203) Glaucoma questions A 52.2 85.2 B 68.5 89.2** C 78.1 90.1** D 62.2 93.1** Squint questions A 33.3 91.6** B 75.9 93. 1** C 27.8 62. 1** D 50.7 94. 1** Paired t-test: **P<0.01. British Journal of General Practice, June 1995 325