The European Journal Of General Practice[JOURNAL]
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200 papers
Impact of COVID-19 pandemic on the accuracy of telephone triage of callers with shortness of breath and/or chest discomfort in Dutch out-of-hours primary care: A retrospective observational study.
Spek M, Dobbe ASM, Zwart DL … +6 more , Erkelens DCA, Geersing GJ, de Groot E, Delissen M, Rutten FH, Venekamp RP
Eur J Gen Pract · 2024 Dec · PMID 39607878 · Full text
BACKGROUND: Anecdotal reports suggest that missed diagnosis in general practice during the first wave of the COVID-19 pandemic contributed to a drop in life-threatening events (LTEs) detected in hospitals. OBJECTIVES: To...
BACKGROUND: Anecdotal reports suggest that missed diagnosis in general practice during the first wave of the COVID-19 pandemic contributed to a drop in life-threatening events (LTEs) detected in hospitals. OBJECTIVES: To investigate the impact of the COVID-19 pandemic on the accuracy of urgency allocation by telephone triage of patients with shortness of breath and/or chest discomfort in out-of-hours primary care (OHS-PC). Accuracy is defined as the correct allocation of high urgency to patients with LTEs and low urgency to those without. METHODS: Retrospective observational study with data from callers contacting OHS-PC for shortness of breath and/or chest discomfort, between 1 March and 1 June 2019 (pre-pandemic) and 1 March to 1 June 2020 (first wave COVID-19 pandemic). Sensitivity and specificity of telephone urgency allocation were compared during both periods with LTEs, including acute coronary syndrome, and pulmonary embolism, as the reference. RESULTS: 3,064 adults (1,840 COVID-19 pandemic and 1,224 pre-pandemic, < 0.001) were included in the study. The sensitivity of urgency allocation was similar during and before the COVID-19 pandemic (0.68, 95% CI 0.59 to 0.75 vs. 0.68, 95% CI 0.60 to 0.75, = 0.944). Specificity was slightly higher during the COVID-19 pandemic (0.52, 95% CI 0.50 to 0.55 vs. 0.45, 95% CI 0.42 to 0.48, < 0.001). CONCLUSION: Despite a surge in calls from adults with shortness of breath and/or chest discomfort during the COVID-19 pandemic, the accuracy of telephone triage for LTEs in OHS-PC remained similar to the pre-pandemic era. Improvement of telephone triage seems necessary in both periods.
'I just felt either I'm going to kill someone or I'm going to end up killing myself'. How does it feel to be burnt out as a practicing UK GP?
Whitehead IO, Moffatt S, Hanratty B
Eur J Gen Pract · 2024 Dec · PMID 39584540 · Full text
OBJECTIVE: To explore how it feels to be a burnt out GP in the NHS. DESIGN: In depth qualitative interviews with 16 UK GPs with self-declared 'lived experience' of burnout. SETTING: United Kingdom Primary Care. RESULTS:...
OBJECTIVE: To explore how it feels to be a burnt out GP in the NHS. DESIGN: In depth qualitative interviews with 16 UK GPs with self-declared 'lived experience' of burnout. SETTING: United Kingdom Primary Care. RESULTS: Seven male and nine female GPs described their experiences of burnout to a peer researcher. Themes identified were exhaustion and depersonalisation, mental and physical illness, identity and existential crises, and finally tenacity and resilience. Participants were self-reflective and described distress, shame, stigma, and guilt, including times of suicidal behaviour and isolation due to their burnout. CONCLUSIONS: Burnout threatens a GP's sense of identity, purpose, and functioning in their lives, and ultimately can be life-threatening. Active listening to GP distress and a system wide approach to managing distress and burnout is urgently required.
Contemporary perspectives regarding domestic violence and abuse in primary care: Cross-sectional NHS patients survey.
Sivarajasingam V, Karki M, Bagkeris E … +1 more , El-Osta A
Eur J Gen Pract · 2024 Dec · PMID 39564979 · Full text
BACKGROUND: Primary care plays a key role in addressing domestic violence and abuse (DVA) globally. However, DVA remains underdiagnosed and inadequately addressed in primary care, necessitating a deeper understanding of...
BACKGROUND: Primary care plays a key role in addressing domestic violence and abuse (DVA) globally. However, DVA remains underdiagnosed and inadequately addressed in primary care, necessitating a deeper understanding of patients' perspectives in the UK. OBJECTIVES: To explore patients' perceptions of their awareness of DVA signs and their attitudes towards using the Woman Abuse Screening Tool (WAST)-short during routine primary care encounters. METHODS: An anonymous 29-item e-Survey, available in 18 languages and including information about DVA support services, was administered via the Qualtrics XM Platform from March to October 2022. Eligible UK National Health Service patients aged 18+ were identified by GP practices in Northwest London and invited via SMS to participate. RESULTS: Data were collected from 6,967 NHS patients. The majority (78.0%) claimed awareness of the signs of DVA in adults and children, while about 22% were unaware or unsure of the signs of DVA. Nearly 85% reported insufficient public awareness about DVA. Around 70% recommended implementing the WAST-short screening tool during primary care encounters to raise awareness and support survivors. Over 50% viewed general practice as the optimal setting for identifying and referring survivors. CONCLUSION: Improved public education on DVA is needed, as a significant proportion of patients remain unaware or unsure of its signs, with the majority deeming public knowledge insufficient. Patients' strong support for using standardised screening tools like the WAST-short reflects their trust in healthcare providers to conduct sensitive assessments. Integrating these tools into routine practice could enhance DVA interventions.
Registration and management of children with overweight by general practitioners in The Netherlands.
Hassan H, van den Driest J, Bosman A … +3 more , Koes BW, Bindels PJE, van Middelkoop M
Eur J Gen Pract · 2024 Dec · PMID 39541168 · Full text
BACKGROUND: General practitioners (GPs) form the gateway to healthcare in numerous European countries. Their role in addressing and managing overweight/obesity in children is crucial. In Dutch guidelines, GPs are encoura...
BACKGROUND: General practitioners (GPs) form the gateway to healthcare in numerous European countries. Their role in addressing and managing overweight/obesity in children is crucial. In Dutch guidelines, GPs are encouraged to proactively address weight-related issues during patient consultations, regardless of the initial reason of the visit. OBJECTIVE(S): To examine the frequency, management and follow-up of GP visits of children for overweight/obesity and the identification by GPs of these children presenting with other complaints. METHODS: A retrospective cohort study. Health records from 2012-2021 in the Rijnmond Primary Care Database (RPCD) of children aged 2-18 with overweight/obesity who visited the GP were analysed. Children were categorised into two groups: those visiting for weight-related issues (group 1) and those visiting for other complaints but identified as overweight or obese by GPs (group 2). Data on patient demographics, reasons for contact, and management strategies were extracted. RESULTS: From the 120,991 children, 3035 children with documented overweight or obesity were identified, 208 were excluded. The study population comprised 2827 individuals: 55% belonging to group 1, 45% to group 2. The frequency of first visits remained stable at approximately 0.5% visits per total person-years each year. Group 1 received more referrals (74%) and follow-up consultations (45.5%) than group 2 with 17% referrals and 19.7% follow-up consultations. CONCLUSION: This study highlights a concerning difference in the management of the two groups. Strategies for effective management of overweight in children and the GP's role, warrant further investigation. Especially when overweight is not the primary reason for visit.
Task shifting to improve practice efficiency: A survey among general practitioners in non-urban Baden-Wuerttemberg, Germany.
Averbeck H, Raedler J, Dhami R … +2 more , Schwill S, Fischer JE
Eur J Gen Pract · 2024 Dec · PMID 39466891 · Full text
BACKGROUND: Germany is challenged by an increasing shortage in general practice services, especially in non-urban areas. Task shifting from general practitioners (GPs) to other health professionals may improve practice e...
BACKGROUND: Germany is challenged by an increasing shortage in general practice services, especially in non-urban areas. Task shifting from general practitioners (GPs) to other health professionals may improve practice efficiency to address this mismatch. OBJECTIVES: Exploring GPs' motives and beliefs towards task shifting in non-urban Germany and identifying potential factors influencing these. METHODS: The cross-sectional survey was disseminated by mail in three waves between July 2021 and August 2022 among all GPs in non-urban Baden-Wuerttemberg, Germany. It included items on demographics and practice characteristics as well as 15 Likert-scale items addressing motives and beliefs towards task shifting, based on the Theoretical Domain Framework. Likert-scale items were analysed descriptively, influencing factors on motives and beliefs were identified using multiple linear regression. RESULTS: Response rate was 24.2% (281/1162), with respondents comparable in age and gender to all GPs in Baden-Wuerttemberg. GPs' motives and beliefs towards task shifting are positive overall. The majority expects task shifting to reduce their workload (87.9%) and increase practice efficiency (74.7%). They are open to shift additional tasks to other professionals (69.1%), even in the currently prohibited form of substitution (51.2%). Motives and beliefs were significantly more positive among younger GPs and those participating in the GP-centred care programme. CONCLUSION: This study describes GPs' motives and beliefs towards task shifting in non-urban Germany. Identifying younger GPs and those participating in the GP-centred care programme as particularly endorsing may help design future interventions aiming to improve efficiency in general practice in non-urban Germany.
Primary healthcare professionals' perceptions, attitudes and ideas regarding asthma management in Greece: A mixed-method study.
Bouloukaki I, Spanias C, Ierodiakonou D … +3 more , Tzanakis N, Williams S, Tsiligianni I
Eur J Gen Pract · 2024 Dec · PMID 39453405 · Full text
BACKGROUND: Implementing asthma guideline recommendations is challenging and there is variation between countries, and different healthcare professionals (HCPs). The International Primary Care Respiratory Group (IPCRG) h...
BACKGROUND: Implementing asthma guideline recommendations is challenging and there is variation between countries, and different healthcare professionals (HCPs). The International Primary Care Respiratory Group (IPCRG) has introduced the Asthma Right Care (ARC) programme implemented in 24 low, middle, and high countries, including Greece. It offers a promising approach drawn from social movements for health to improve asthma care by engaging HCPs in implementing guideline-based asthma care. OBJECTIVES: To explore HCPs' perspectives on current provision of asthma care and their willingness to improve implementation of recommended guidelines using ARC programme tools in Greece. METHODS: A mixed methods study conducted from September 2020 to April 2021. A convenience sample of 30 pharmacists, and 10 General Practitioners (GPs), responded to a questionnaire investigating perceptions, and attitudes, towards implementation of asthma guidelines. Then, a qualitative survey followed with semi-structured interviews to evaluate the feedback obtained from HCPs to assess the content, and applicability of the ARC tools. Data were analysed using thematic analysis. RESULTS: A range of practical challenges in implementing guideline-recommended interventions, improving asthma control and management were described by all HCPs, including lack of time and education, high workload, patients' perceptions, and poor communication contributing to poor management and inadequate follow-up of people with asthma. However, most HCPs were willing to use ARC interventions to improve guideline implementation. CONCLUSION: HCPs in Greece encounter challenges in implementing asthma guidelines; however, they can overcome these challenges by using ARC interventions and engagement tools to address barriers and implement efficient asthma management strategies.
Navigating sarcoidosis: Recognizing, managing, and supporting patients in primary care.
Drent M, Jans N
Eur J Gen Pract · 2024 Dec · PMID 39445489 · Full text
BACKGROUND: Sarcoidosis is a chronic multisystem inflammatory disease of unknown aetiology, characterised by noncaseating granulomas and a variable clinical presentation. Despite its global distribution, sarcoidosis is r...
BACKGROUND: Sarcoidosis is a chronic multisystem inflammatory disease of unknown aetiology, characterised by noncaseating granulomas and a variable clinical presentation. Despite its global distribution, sarcoidosis is relatively rare, with the highest prevalence in northern Europe. This poses challenges for primary care physicians due to its broad spectrum of symptoms, from organ-specific manifestations to general complaints like fatigue and concentration difficulties. OBJECTIVES: This article aims to provide primary care physicians with practical tools for the early recognition and management of sarcoidosis, emphasising their role in monitoring disease progression and providing supportive care. METHODS: Key strategies for diagnosis and management are reviewed, focusing on holistic patient care addressing both somatic and psychosocial aspects of the disease. RESULTS: Early recognition, careful monitoring of disease progression, and individualised treatment plans are crucial. Pharmacotherapy is not always required and should be carefully balanced. The role of supportive, patient-centered counseling is illustrated with two cases. CONCLUSION: Primary care physicians play a critical role in managing sarcoidosis, particularly in early recognition and monitoring. Given the absence of standardised treatment protocols, a flexible, holistic approach that includes psychosocial support is essential. This article provides a practical framework for general practitioners to address the challenges of sarcoidosis management and improve patient outcomes.
Screening tools assessing mental illness in primary care: A systematic review.
Neulinger B, Ebert C, Lochbühler K … +3 more , Bergmann A, Gensichen J, Lukaschek K
Eur J Gen Pract · 2024 Dec · PMID 39441668 · Full text
BACKGROUND: To better manage patients with a wide range of mental health problems, general practitioners would benefit from diagnostically accurate and time-efficient screening tools that comprehensively assess mental il...
BACKGROUND: To better manage patients with a wide range of mental health problems, general practitioners would benefit from diagnostically accurate and time-efficient screening tools that comprehensively assess mental illness. Therefore, the aim of this systematic review was to identify screening tools that either take a multiple-mental disorder or a transdiagnostic approach. As primary and secondary outcomes, diagnostic accuracy and time efficiency were investigated. METHODS: The data bases MEDLINE, Embase, Cochrane Library, Psyndex and PsycINFO were searched. Studies reporting on multiple-mental disorder or transdiagnostic screening tools used in primary care with adult patients were included. Sensitivity, specificity, positive and negative predictive value served as measures of diagnostic accuracy. Time efficiency was evaluated by the number of items of a screening tool and the time required for its completion and evaluation. RESULTS: Eleven studies met the inclusion criteria. The majority of screening tools assessed multiple mental disorders separately. A sub-group of screening tools took a transdiagnostic approach by examining the spectrum of mood, anxiety and stress-related disorders. One screening tool used internalised, cognitive/somatic and externalised dysfunction as transdiagnostic domains of mental illness. Mostly, a sufficient sensitivity and specificity was reported. All screening tools were found to be time efficient. CONCLUSION: The eleven identified screening tools can support general practitioners to identify patients with mental health problems. However, there was great heterogeneity concerning their diagnostic scope of psychopathology. Further screening tools for primary care are needed that target broad constructs of mental illness, such as transdiagnostic factors or personality dysfunction.
Looking beyond effectiveness: Integration of social science research within international infectious disease research in primary care.
Anthierens S
Eur J Gen Pract · 2024 Dec · PMID 39440849 · Full text
BACKGROUND: As researchers in primary care, we want to drive change in practice and conduct research that sparks meaningful transformation. These changes can only happen if our research work resonates in a meaningful way...
BACKGROUND: As researchers in primary care, we want to drive change in practice and conduct research that sparks meaningful transformation. These changes can only happen if our research work resonates in a meaningful way with the people who they are designed for, i.e. the healthcare professionals and the patients. VIEWPOINT: This viewpoint stems from first-hand insights gained as a social scientist engaged in trials and primary care research amidst epidemics and pandemics. Some examples stemming from the EU Funded GRACE INTRO, RECOVER and Prudence trial illustrate these experiences. I outline how primary care can effectively address the pressing challenges it encounters, whether as researchers, members of the public, or healthcare professionals, and how to integrate successfully social sciences within clinical primary care research. CONCLUSION: As interdisciplinary researchers, social scientists and medical researchers can work together under certain conditions, i.e. equal status, adequate resources, and seamless integration within trial structures.
Diverse roles of Primary Health Care in COVID-19 vaccination across 28 European countries - Insights from the Eurodata study.
Guisado-Clavero M, Gómez-Bravo R, Gefaell Larrondo I … +50 more , Ramos Del Rio L, Fitzgerald L, Vinker S, Vaes B, Tsigarovski G, Torzsa P, Ticmane G, Sentker T, Serafini A, Sattler M, Streit S, Petricek G, Petrazzuoli F, Petek D, Perjés Á, Penakacherla N, Senn O, Neves AL, Nessler K, Murauskienė L, Mossong J, Kozlovska L, Segernäs A, Krztoń-Królewiecka A, Kostić M, Kırkoç Üçüncü E, Çimen Korkmaz B, Knežević S, Jandrić-Kočić M, Kastbom L, Shushman I, Ilkov O, Hoffmann K, Heleno B, Hanževački M, Gjorgjievski D, Feldman S, Domeyer PR, Delphin Peña M, Ćosić Divjak A, Busneag IC, Brutskaya-Stempkovskaya E, Bensemmane S, Bayen S, Bakola M, Adler L, Assenova R, Ares-Blanco S, Astier-Peña MP, Lingner H
Eur J Gen Pract · 2024 Dec · PMID 39435869 · Full text
BACKGROUND: The COVID-19 vaccination campaign in several European countries involved collaboration between public health and Primary Health Care (PHC). OBJECTIVE: To highlight the role of PHC professionals in the COVID-1...
BACKGROUND: The COVID-19 vaccination campaign in several European countries involved collaboration between public health and Primary Health Care (PHC). OBJECTIVE: To highlight the role of PHC professionals in the COVID-19 vaccination rollout, specifically in terms of vaccine administration, communication and contributing to vaccination population coverage. METHODS: A descriptive retrospective study of the COVID-19 vaccination campaign across 28 European countries was conducted, covering data from December 2020 to November 2021. Data were collected by key informants recruited from each country, who were health professionals involved in their national vaccination campaigns. Utilising an ad-hoc semi-structured questionnaire, information was gathered on organisation, communication strategies, priority groups, vaccine types, and vaccination pathways in PHC. RESULTS: PHC participated in communication strategies in 10 out of 28 countries, and vaccination was voluntary in most of them. The priority groups for vaccination varied across Europe, and the availability of vaccines in PHC differed between countries within the European Union (EU) and non-EU countries. The BioNTech Pfizer vaccine was the most widely available vaccine in most countries, followed by Moderna and AstraZeneca. PHC administered COVID-19 vaccines to the population, being the nurses the most involved, followed by general practitioners. Vaccination appointments were available online in 18/28 or by phone in 15/28, direct appointments at health centres were available in 8/28. In several countries, healthcare professionals who administered vaccines were given extra compensation for their role. CONCLUSION: PHC professionals played a crucial role in the successful distribution and administration of COVID-19 vaccines in European countries.
German general practitioners' experiences of managing post-COVID-19 syndrome: A qualitative interview study.
Schulze J, Lind L, Rojas Albert A … +5 more , Lüdtke L, Hensen J, Bergelt C, Härter M, Pohontsch NJ
Eur J Gen Pract · 2024 Dec · PMID 39432372 · Full text
BACKGROUND: The management of the long-term sequelae of coronavirus disease 2019 (COVID-19) infection, known as post-COVID-19 syndrome (PCS), continues to challenge the medical community, largely owing to a significant g...
BACKGROUND: The management of the long-term sequelae of coronavirus disease 2019 (COVID-19) infection, known as post-COVID-19 syndrome (PCS), continues to challenge the medical community, largely owing to a significant gap in the understanding of its aetiology, diagnosis and effective treatment. AIM: To examine general practitioners' (GPs) experiences of caring for patients with PCS and to identify unmet care needs and opportunities for improvement. DESIGN AND SETTING: This study follows a qualitative design, using in-depth semi-structured telephone interviews with GPs ( = 31) from across Germany. METHOD: Interviews were audio-recorded, transcribed verbatim and analysed using qualitative content analysis. RESULTS: GPs reported that they were often the first point of contact for patients with persistent symptoms following SARS-CoV-2 infection, with symptoms typically resolving within weeks. While ongoing symptomatic COVID-19 is perceived to be more common, the relevance of PCS to GP practices is considerable given its severe impact on patients' functioning, social participation and the substantial time required for patient care. GPs coordinate diagnosis and treatment but face challenges because of the unclear definition of PCS and difficulties in attributing symptoms, resulting in a cautious approach to ICD-10 coding. Interviewees highlight lengthy diagnostic pathways and barriers to accessing specialist care. CONCLUSION: The findings confirm the high functional limitations and psychosocial burden of PCS on patients, and the central role of GPs in their care. The study suggests a need for further research and health policy measures to support GPs in navigating diagnostic uncertainty, interprofessional communication and the limited evidence on effective treatments.
The development of a tool for GPs to manage overweight and obesity in children: A Delphi study.
van der Velden MAM, van Tilborg-den Boeft M, Buis S … +3 more , Jansen W, Bindels PJE, van Middelkoop M
Eur J Gen Pract · 2024 Dec · PMID 39431956 · Full text
BACKGROUND: General practitioners (GPs) could play an important role in the management of overweight and obesity in children. However, GPs experience different barriers and are in need of supportive tools. In order to su...
BACKGROUND: General practitioners (GPs) could play an important role in the management of overweight and obesity in children. However, GPs experience different barriers and are in need of supportive tools. In order to support GPs to identify, address and refer these children, new tools should be developed. OBJECTIVE: To establish consensus among GPs about the content topics of a supportive tool to identify, address and refer children with overweight and obesity in general practice. METHODS: A two-round Delphi study was conducted with GPs identified as experts. A concept of a supportive tool was constructed based on focus-group interviews with GPs, practice nurses and parents of children with and without overweight and literature. The tool was categorised into five topics: identifying, initiating and continuing weight-related conversations, referring and evaluating a tool manual. GPs evaluated statements on the tool's topics in terms of importance. All statements were rated on a 5-point Likert scale and consensus was set at ≥70% of respondents agreeing with the statements. RESULTS: GPs agreed that a supportive tool must contain a child's specialised BMI calculator; examples to initiate and to continue weight-related conversations with parents and children; a map with available interventions; and a manual including information and resources about health risks of overweight and obesity during childhood. CONCLUSION: The content topics of a supportive tool for GPs to identify, discuss and refer children with overweight and obesity were determined through a consensus-driven process. Further validation and assessment are required through a feasibility and implementation study.
Preventing cardiovascular disease in at-risk patients: Results of a pilot behavioural health programme in general practice.
Broughan J, Sietiņš E, Treanor JT … +7 more , Siu KYE, Morrissey J, Doyle O, Casey M, Fitzpatrick P, McCombe G, Cullen W
Eur J Gen Pract · 2024 Dec · PMID 39422594 · Full text
BACKGROUND: The 'High-Risk Prevention Programme' (HRPP) involved a six-week health behaviour change programme based in general practices and aimed to address cardiovascular disease (CVD) risk in disadvantaged Irish commu...
BACKGROUND: The 'High-Risk Prevention Programme' (HRPP) involved a six-week health behaviour change programme based in general practices and aimed to address cardiovascular disease (CVD) risk in disadvantaged Irish communities. OBJECTIVES: This pilot study aimed to establish the HRPP's likely effectiveness and acceptability to inform the development of a future definitive trial. METHODS: The HRPP was conducted at six general practices in disadvantaged areas in the Ireland East region. Patients with high CVD risk were recruited by participating practices and were allocated to either a General Practice Nurse (GPN) or Health Promotion Professional (HPP) led programme focusing on positive health behavioural change. Baseline and 12-month follow-up data were collected to capture the HRPP's likely effectiveness in promoting health outcomes and health behavioural change. RESULTS: The HRPP programme was completed by 270 patients. Out of these 270 patients, 245 (90.74%) completed baseline assessments, and 176 (65.19%) completed follow-up assessments at 12 months. Baseline data indicated a high level of CVD risk among patients and follow-up demonstrated positive change in several areas, especially weight (-1.95 kg, < 0.001), BMI (-0.72, < 0.001), exercise during the last week (<0.001), and consumption of healthy fats in the HPP group (+60%, < 0.001). CONCLUSION: The HRPP was a much-needed pilot intervention, and positive results were seen in both GPN and HPP arms, especially with regards to weight loss, exercise, and dietary improvements. Future definitive trials of the HRPP are likely to be effective and acceptable in terms of combatting these issues among high-risk patients.
Generic dispensing rates for substitutable drugs prescribed by general practitioners compared with other private ambulatory specialists: A study based on a French national reimbursement database.
Figoni H, Robert S, Bonello K … +3 more , Ibanez G, Chastang J, Estellat C
Eur J Gen Pract · 2024 Dec · PMID 39397787 · Full text
BACKGROUND: The use of generic drugs is a way for healthcare systems to reduce costs, particularly in ambulatory care. Several studies suggest that the prescriber's speciality is associated with the use of generic drugs,...
BACKGROUND: The use of generic drugs is a way for healthcare systems to reduce costs, particularly in ambulatory care. Several studies suggest that the prescriber's speciality is associated with the use of generic drugs, and that substitutable drugs prescribed by General Practitioners (GPs) are more often generic, but this association has never been studied in France. In the French legislative context, except in rare situations, all substitutable drugs prescribed should be dispensed in generic form. OBJECTIVES: Compare the generic drugs dispensing rate among substitutable drugs dispensed in community pharmacies prescribed by French private GPs with that of other private specialists, all other specialities combined (first objective) or each other speciality taken individually (second objective). METHODS: We used a sample of an open available semi-aggregated database from the 2019 French health insurance system database. We compared with logistic regression models GPs to all other specialities combined, then GPs to the 19 other specialties taken individually, only on the substitutable drugs they prescribe in common. RESULTS: In 2019, 53.4% of the drugs prescribed by French private ambulatory physicians were substitutable drugs, and 81.5% of them were dispensed in generic form. After adjustment, the generic dispensing rate for substitutable drugs was significantly higher for GPs than for other specialties (ORa 0.74 [IC95% 0.72-0.76]). Thirteen of the nineteen other specialities taken individually, such as endocrinologists (ORa 0.64 [IC95% 0.57-0.72]) and cardiologists (ORa 0.60 [0.56-0.63]) had significantly lower generic dispensing rates than GPs. No other speciality had a rate significantly higher than GPs. CONCLUSIONS: Substitutable drugs prescribed by French private GPs are more often dispensed in generic form than those from other private ambulatory specialties. To understand this result and optimise the use of generic drugs in outpatient settings, we need to study the different stages of drug use, from prescription by the physician to dispensing by the pharmacist and acceptance by the patient.
Medication management during risk of dehydration: A qualitative study among elderly patients with impaired renal function and informal caregivers.
Coppes T, Philbert D, Van Riet M … +3 more , van Gelder T, Bouvy M, Koster E
Eur J Gen Pract · 2024 Dec · PMID 39392439 · Full text
BACKGROUND: Patients with impaired renal function are at an increased risk of dehydration due to vomiting, diarrhoea or fever (so-called sick days). Temporary medication adjustment during sick days is necessary and curre...
BACKGROUND: Patients with impaired renal function are at an increased risk of dehydration due to vomiting, diarrhoea or fever (so-called sick days). Temporary medication adjustment during sick days is necessary and current initiatives and information materials for patients are available. However, the knowledge, experiences and information needs of patients and informal caregivers about sick day guidance are unknown. AIM: To gain insight into the understanding of safe medication use during periods of dehydration risk in elderly patients with impaired renal function and their informal caregivers. DESIGN AND SETTING: Qualitative interview study with patients with impaired renal function and unrelated informal caregivers from three community pharmacies in the Netherlands. METHOD: The interviews were conducted by telephone or live by two researchers in November 2020-September 2021 and audiotaped and transcribed verbatim. The coding of transcripts was performed deductively and inductively in Nvivo 12, a thematic analysis was applied. RESULTS: In total 12 patients and 11 unrelated informal caregivers were included. Three main themes were derived from the interview guide and subthemes emerged from the transcripts. The included patients and informal caregivers had limited knowledge about medication management during sick days. In contrast to patients, informal caregivers seemed interested in a medication management protocol for sick days. CONCLUSION: Patients with impaired renal function and informal caregivers have little knowledge about and experience with dehydration and safe use of medication during sick days. General practitioners and pharmacists should involve the care network, including informal caregivers, when implementing sick day guidance.
Development of the face-to-face component and recruitment strategy of a primary care digital social intervention for patients with asthma: Qualitative focus groups and interviews with stakeholders.
Karampatakis GD, Kimber S, Wood HE … +10 more , Griffiths CJ, Taylor SJC, Li X, Day B, Mant J, Relton C, Watson JS, Marsh V, Coulson NS, De Simoni A
Eur J Gen Pract · 2024 Dec · PMID 39329323 · Full text
BACKGROUND: 5.4 million people in the UK have asthma, with one third experiencing suboptimal control, leading to co-morbidities and increased healthcare use. A quarter of people with long-term conditions informally acces...
BACKGROUND: 5.4 million people in the UK have asthma, with one third experiencing suboptimal control, leading to co-morbidities and increased healthcare use. A quarter of people with long-term conditions informally access peer support through online health communities (OHCs). However, integrating online peer support into primary care services to facilitate self-management is a new concept. OBJECTIVES: To develop together with stakeholders the content, delivery, and recruitment strategy of a digital social intervention to promote use of online peer support amongst asthma patients in primary care. METHODS: Data was collected by qualitative, audio-recorded, one-to-one interviews with clinicians, and focus groups with patients with asthma from East London general practices. The topic guide was informed by patient and public involvement work. Data collected was iterative (i.e. new ideas were added to subsequent interviews and focus groups). Verbatim transcripts were uploaded to NVivo12 and thematically analysed. RESULTS: Twenty patients from several ethnicities participated across five focus groups, and three general practitioners and three practice nurses were interviewed. The study's outputs included: the intervention's face-to-face content; content of clinician training; patient-facing leaflets/material; and a survey to recruit eligible patients. An intervention consisting of a structured consultation with a primary care clinician followed by OHC engagement, was developed based on three generated themes: 'introducing OHCs', describing how clinicians should introduce OHCs; 'OHC engagement', describing factors influencing OHC engagement; and 'clinician training'. CONCLUSION: Findings will assist clinicians in consultations about supporting self-management of patients through OHCs. Future research should evaluate feasibility, effectiveness, and cost-effectiveness of such support.
General Practitioners practice nurses and parents' perspectives on childhood overweight management - a qualitative study.
van der Velden MAM, Hassan H, Schiphof D … +5 more , van Tilborg-den Boeft M, Buis S, Jansen W, Bindels PJE, Middelkoop MV
Eur J Gen Pract · 2024 Dec · PMID 39329295 · Full text
BACKGROUND: Overweight and obesity in children is a major health problem. General practice might be a promising setting for identifying and for the first steps in the management of overweight and obesity in children. OBJ...
BACKGROUND: Overweight and obesity in children is a major health problem. General practice might be a promising setting for identifying and for the first steps in the management of overweight and obesity in children. OBJECTIVE: To explore opinions, needs and preferences about the role of general practice in the management of overweight and obesity in children from the perspectives of Dutch general practitioners (GPs), practice nurses (PNs) and parents of children with and without overweight. METHODS: A qualitative study using semi-structured focus group interviews. GPs and PNs were recruited from general practices from the region South-Western. Parents were mainly recruited via social media and primary schools. Twenty-five GPs, seven PNs and 18 parents were interviewed. All interviews were audio recorded, transcribed and thematically analysed. RESULTS: GPs, PNs and parents agreed that it is the task of the GP to identify, address and refer children with overweight and obesity. However, GPs find it difficult to start this conversation due to time constraints; fear for the reaction of parents and children; lack of clarity about treatment and referral options. Parents indicated they are open to a conversation if the GP is non-judgmental, honest and respectful. PNs saw no role in managing overweight and obesity in children. CONCLUSION: Although GPs experience several barriers, GPs, PNs and parents all agreed that GPs should play a role in identifying, addressing and referring children with overweight and obesity. Supportive tools are required for GPs in order to play this role.
The 'Consensus Reporting Items for Studies in Primary Care' (CRISP) statement in the European Journal of General Practice.
Stoffers J, Burgers J
Eur J Gen Pract · 2024 Dec · PMID 39250416 · Full text
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How to overcome information and communication barriers in Human Papillomavirus vaccination? A SWOT analysis based on the opinions of European family doctors in contact with young people and their parents.
Çevik HS, Peker AGC, Görpelioğlu S … +2 more , Vinker S, Ungan M
Eur J Gen Pract · 2024 Dec · PMID 39213042 · Full text
BACKGROUND: Family doctors (FDs)/General practitioners (GPs) are the key contact points for young people and their parents regarding Human Papillomavirus (HPV) vaccination. However, their recommendations are influenced b...
BACKGROUND: Family doctors (FDs)/General practitioners (GPs) are the key contact points for young people and their parents regarding Human Papillomavirus (HPV) vaccination. However, their recommendations are influenced by communication skills. OBJECTIVES: Under the EU4Health project, PROTECT-EUROPE, WONCA Europe led a task to identify and analyse strategies for clinicians' interpersonal communication skills when discussing HPV and its vaccination with young people and their parents. METHODS: Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis using qualitative data focused on HPV vaccine acceptance and communication with the target population. FDs/GPs, members of WONCA Europe, were recruited using convenience and snowball sampling through surveys at conferences and emails. RESULTS: 223 FDs/GPs from 36 countries participated. Strengths included face-to-face communication, extensively used to promote the HPV vaccine. Weaknesses involved financial constraints, limited knowledge about gender-neutral vaccination, safety concerns, and time pressure during the consultations. Opportunities included confidentiality, open dialogue, trusting relationship between FDs/GPs and the target population, continuing medical education, school training, and questions & answers sessions to increase vaccine communication. Threats included social norms and cultures, stigmas against HPV, and anti-vaccination movements hindering discussions on HPV vaccination. CONCLUSION: It is crucial to train FDs/GPs to address knowledge gaps, enhance communication skills, and maintain a trusting relationship with patients when discussing HPV vaccination. Overcoming financial barriers and ensuring gender-neutral vaccination programs are accessible across Europe are also essential. Providing accurate information through the web- and school-based channels and developing community-oriented approaches targeting sociocultural factors and different needs to eliminate HPV vaccine stigmas should be considered when recommending the vaccine.
Follow-up of patients with chronic conditions within primary care practices during COVID-19: Results from 7 Central and Eastern-European countries from the cross-sectional PRICOV-19 study.
Delvento G, Schindler C, Rotaru C … +12 more , Curteanu A, Curochicin G, Prytherch H, Tkachenko V, Seifert B, Torzsa P, Asenova R, Busneag C, Windak A, Willems S, Van Poel E, Collins C
Eur J Gen Pract · 2024 Dec · PMID 39207040 · Full text
BACKGROUND: The COVID-19 pandemic posed severe challenges to delivery of services at Primary Care level and for achieving follow-up of patients with chronic diseases. OBJECTIVES: We analysed data from the PRICOV-19 study...
BACKGROUND: The COVID-19 pandemic posed severe challenges to delivery of services at Primary Care level and for achieving follow-up of patients with chronic diseases. OBJECTIVES: We analysed data from the PRICOV-19 study to explore determinants of active follow-up for chronic disease patients in seven Central and Eastern European (CEE) countries during the pandemic. METHODS: Pricov-19 was a cross-sectional study conducted within PC (Primary Care) practices in 37 European countries. We analysed data from 7 CEE countries (Bulgaria, Czech Republic, Hungary, Poland, Moldova, Romania, Ukraine) collected between November 2020 and December 2021. Practices were recruited through random or convenience sampling and participation of practices was voluntary. We performed descriptive statistics to identify the level of follow-up of chronic disease and what health system and practice-specific factors were associated with better follow-up. We used logistic regression and meta-analysis techniques to explore associations and heterogeneity between countries. RESULTS: 67.8% out of 978 practices reported actively following up chronic patients. Positive associations were found between active follow-up and such as having more GPs (aOR = 1.18, p-value = 0.005), an above-average chronic patient population (aOR = 3.13, p-value = 0.006), adequate government support (aOR = 2.35, p-value = 0.001), and GPs having time for guideline reading (aOR = 0.008, p-value = 1.71). CONCLUSIONS: Patient follow-up, was influenced by different health system and practice-specific factors. The implications suggest the need for government support to enhance PC practice organisation during crises and solutions to decrease GP workload and provide tailored care for patients with chronic disease.
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