Family practice最新文献

{"title":"A scoping review of evidence-based guidance and guidelines published by general practice professional organizations.","authors":"Emer O'Brien, Seamus Duffy, Velma Harkins, Susan M Smith, Noirin O'Herlihy, Aisling Walsh, Barbara Clyne, Emma Wallace","doi":"10.1093/fampra/cmad015","DOIUrl":"10.1093/fampra/cmad015","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) need robust, up-to-date evidence to deliver high-quality patient care. There is limited literature regarding the role of international GP professional organizations in developing and publishing clinical guidelines to support GPs clinical decision making.</p><p><strong>Objective: </strong>To identify evidence-based guidance and clinical guidelines produced by GP professional organizations and summarize their content, structure, and methods of development and dissemination.</p><p><strong>Methods: </strong>Scoping review of GP professional organizations following Joanna Briggs Institute guidance. Four databases were searched and a grey literature search was conducted. Studies were included if they were: (i) evidence-based guidance documents or clinical guidelines produced de novo by a national GP professional organization, (ii) developed to support GPs clinical care, and (iii) published in the last 10 years. GP professional organizations were contacted to provide supplementary information. A narrative synthesis was performed.</p><p><strong>Results: </strong>Six GP professional organizations and 60 guidelines were included. The most common de novo guideline topics were mental health, cardiovascular disease, neurology, pregnancy and women's health and preventive care. All guidelines were developed using a standard evidence-synthesis method. All included documents were disseminated through downloadable pdfs and peer review publications. GP professional organizations indicated that they generally collaborate with or endorse guidelines developed by national or international guideline producing bodies.</p><p><strong>Conclusion: </strong>The findings of this scoping review provide an overview of de novo guideline development by GP professional organizations and can support collaboration between GP organizations worldwide thus reducing duplication of effort, facilitating reproducibility, and identifying areas of standardization.</p><p><strong>Protocol registration: </strong>Open Science Framework: https://doi.org/10.17605/OSF.IO/JXQ26.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10763983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Job satisfaction criteria to improve general practitioner recruitment: a Delphi consensus.","authors":"Bernard Le Floch, Hilde Bastiaens, Jean-Yves Le Reste, Patrice Nabbe, Perrine Le Floch, Mael Cam, Tristan Montier, Lieve Peremans","doi":"10.1093/fampra/cmac140","DOIUrl":"10.1093/fampra/cmac140","url":null,"abstract":"<p><strong>Background: </strong>The clinical general practitioner (GP) workforce is decreasing. Many studies have analysed the negative aspects of the profession but, few examine the positive aspects and job satisfaction. A European collaborative group including 8 participating countries recently conducted a qualitative study to analyse the positive factors and found 31 job satisfaction factors.</p><p><strong>Objectives: </strong>To determine which of these 31 factors are important and applicable to future policies to improve family medicine attractiveness, recruitment, and retention in France.</p><p><strong>Method: </strong>The Delphi consensus method was chosen. Two Delphi rounds were conducted in March-April 2017 and retained satisfaction factors with at least 70% of scores ≥7. The Nominal Group Technique (NGT) was used to rank these retained factors. Participants assigned 5 points to the factor they considered most important, 3 points to the second, and 1 point to the third. Factors receiving at least 5% (10 points) of the total points (198 points) were included in the final list. The expert panel included GPs and non-GPs.</p><p><strong>Results: </strong>Twenty-nine experts began the procedure and 22 completed it. Thirty factors were retained after the 2 Delphi rounds. The NGT resulted in 8 factors: (i) Engage in family medicine to take care of the patients; (ii) Care coordination, patient advocacy; (iii) Flexibility in work; (iv) Trying to be a person-centred doctor; (v) Involvement in healthcare organization; (vi) Benefiting from a well-managed practice; (vii) Being a teacher, a trainer; (viii) Efficient professional collaboration.</p><p><strong>Conclusion: </strong>These 8 job satisfaction factors are important to consider and apply to future policy development.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35349715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practitioners' views and experiences of communicating with older people about cancer screening: a qualitative study.","authors":"Jenna Smith, Rachael H Dodd, Katharine A Wallis, Vasi Naganathan, Erin Cvejic, Jesse Jansen, Kirsten J McCaffery","doi":"10.1093/fampra/cmac126","DOIUrl":"10.1093/fampra/cmac126","url":null,"abstract":"<p><strong>Background: </strong>Older adults should be supported to make informed decisions about cancer screening. However, it is unknown how general practitioners (GPs) in Australia communicate about cancer screening with older people.</p><p><strong>Aim: </strong>To investigate GPs' views and experiences of communicating about cancer screening (breast, cervical, prostate, and bowel) with older people (≥70 years).</p><p><strong>Design and setting: </strong>Qualitative, semi-structured interviews, Australia.</p><p><strong>Method: </strong>Interviews were conducted with GPs practising in Australia (n = 28), recruited through practice-based research networks, primary health networks, social media, and email invitation. Interviews were audio-recorded and analysed thematically using Framework Analysis.</p><p><strong>Results: </strong>Findings across GPs were organized into 3 themes: (i) varied motivation to initiate cancer screening discussions; some GPs reported that they only initiated screening within recommended ages (<75 years), others described initiating discussions beyond recommended ages, and some experienced older patient-initiated discussions; (ii) GPs described the role they played in providing screening information, whereby detailed discussions about the benefits/risks of prostate screening were more likely than other nationally funded screening types (breast, cervical, and bowel); however, some GPs had limited knowledge of recommendations and found it challenging to explain why screening recommendations have upper ages; (iii) GPs reported providing tailored advice and discussion based on personal patient preferences, overall health/function, risk of cancer, and previous screening.</p><p><strong>Conclusions: </strong>Strategies to support conversations between GPs and older people about the potential benefits and harms of screening in older age and rationale for upper age limits to screening programmes may be helpful. Further research in this area is needed.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40681366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing primary care patients with posttraumatic stress disorder using electronic medical records: a retrospective cross-sectional study.","authors":"Alexander Singer, Leanne Kosowan, Dhasni Muthumuni, Alan Katz, Hasan Zafari, Farhana Zulkernine, J Don Richardson, Morgan Price, Tyler Williamson, John Queenan, Jitender Sareen","doi":"10.1093/fampra/cmac139","DOIUrl":"10.1093/fampra/cmac139","url":null,"abstract":"<p><strong>Background: </strong>Posttraumatic stress disorder (PTSD) has significant morbidity and economic costs. This study describes the prevalence and characteristics of patients with PTSD using primary care electronic medical record (EMR) data.</p><p><strong>Methods: </strong>This retrospective cross-sectional study used EMR data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). This study included 1,574 primary care providers located in 7 Canadian provinces. There were 689,301 patients that visited a CPCSSN provider between 1 January 2017 and 31 December 2019. We describe associations between PTSD and patient characteristics using descriptive statistics, chi-square, and multiple logistic regression models.</p><p><strong>Results: </strong>Among the 689,301 patients included, 8,817 (1.3%, 95% CI 1.2-1.3) had a diagnosis of PTSD. On multiple logistic regression analysis, patients with depression (OR 4.4, 95% CI 4.2-4.7, P < 0.001), alcohol abuse/dependence (OR 1.7, 95% CI 1.6-1.9, P < 0.001), and/or drug abuse/dependence (OR 2.6, 95% CI 2.5-2.8, P < 0.001) had significantly higher odds of PTSD compared with patients without those conditions. Patients residing in community areas considered the most material deprived (OR 2.1, 95% CI 1.5-2.1, P < 0.001) or the most socially deprived (OR 2.8, 95% CI 2.7-5.3, P < 0.001) had higher odds of being diagnosed with PTSD compared with patients in the least deprived areas.</p><p><strong>Conclusions: </strong>The prevalence of PTSD in Canadian primary care is 1.3% (95% CI 1.25-1.31). Using EMR records we confirmed the co-occurrence of PTSD with other mental health conditions within primary care settings suggesting benefit for improved screening and evidence-based resources to manage PTSD.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10365067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change of pulmonary function tests in hospitalized COVID-19 patients at third and sixth month follow-up.","authors":"Meltem Karakulak Kafkas, Sabah Tüzün, Nazlı Hacıağaoğlu, Hüseyin Çetin, Sevda Şener Cömert, Engin Ersin Şimşek","doi":"10.1093/fampra/cmac145","DOIUrl":"10.1093/fampra/cmac145","url":null,"abstract":"<p><strong>Background: </strong>The effect of COVID-19 infection on pulmonary function is unknown.</p><p><strong>Objective: </strong>This study aimed to evaluate pulmonary function tests (PFTs) of patients hospitalized with the diagnosis of COVID-19 pneumonia at 3 and 6 months post-discharge.</p><p><strong>Methods: </strong>Patients aged 18 years and over who had positive COVID-19 PCR test results and were hospitalized in the pandemic service between 1 May 2020 and 31 October 2020, were included in the study. All patients were evaluated with PFTs FVC, FEV1, FEV1/FVC, and FEF25-75 at 3 and 6 months after discharge.</p><p><strong>Results: </strong>The mean age of 34 patients included in the study was 47.7 ± 12.7 years. The FVC, FEV1, FEV1/FVC, and FEF25-75 measurements at 3 and 6 months post-discharge showed no significant difference (P = 0.765, P = 0.907, P = 0.707, and P = 0.674, respectively). There was no significant difference in any PFT measurements at the third month follow-up, regardless of the pharmacological treatment protocols applied during hospitalization (P > 0.05). However, FEV1/FVC and FEF25-75 levels were 83.1 [3.4]% and 91.0 [10.0]%, respectively, in those who received systemic steroid treatment, and 78.3 ± 8.5% and 72.5 ± 25.7% in those who did not (P = 0.019 and P = 0.048, respectively). In addition, FVC and FEV1 levels increased significantly from the third to the sixth month follow-up in patients who received systemic steroid therapy (P = 0.035 and P = 0.018, respectively).</p><p><strong>Conclusion: </strong>Although there is no significant difference in PFT measurements from 3 to 6 months in COVID-19 patients, systemic steroid therapy may have a beneficial effect on respiratory function in COVID-19 patients.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10480263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a dietary advice protocol for adults with obesity in primary health care according to the Brazilian Dietary Guidelines.","authors":"Lorrany S Rodrigues, Nathalia Pizato, Kenia M B Carvalho, Eliane S Dutra, Patrícia B Botelho, Laila S Andrade, Verena D Moraes, Vivian S S Gonçalves","doi":"10.1093/fampra/cmac132","DOIUrl":"10.1093/fampra/cmac132","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a non-communicable chronic disease which carries a high cost for the Brazilian Unified Health System. Standardized protocols can help primary health care (PHC) professionals manage the disease.</p><p><strong>Objectives: </strong>To describe the validation process of a protocol concerning dietary guidelines for adults with obesity in PHC by non-nutrition professionals.</p><p><strong>Methods: </strong>A validation study of a dietary advice protocol consisting of 6 recommendations was conducted according to Brazilian Dietary Guidelines. The topics incorporated into the recommendations were submitted to a panel of judges for content validity and achieved a Scale Content Validity Index (S-CVI) score >0.80. Subsequently, an online workshop was held and consisted of guiding questions to adequately improve current protocols. Face validity was assessed in a mediation workshop conducted with PHC non-nutrition professionals. Following the validation process, necessary adjustments were made to the eating protocol.</p><p><strong>Results: </strong>The validation process was conducted by a panel of 20 judges and 10 PHC professionals. The content was validated using a 0.98 S-CVI. The online workshop expert panel agreed the instrument provides a trustworthy foundation for appropriate dietary guidelines. Moreover, the judges suggested changes to the flowchart designed to support the professionals' decisions, discussed the absence of quantitative prescription guidelines, and offered additional suggestions to strengthen equity and encourage autonomy in non-nutrition healthcare professionals in PHC.</p><p><strong>Conclusion: </strong>This study describes the validation process of a dietary advice protocol for people with obesity, as well as the importance of its integration into PHC.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the patient is making the (wrong?) diagnosis: a biographical approach to patients consulting for presumed Lyme disease.","authors":"Romain Lutaud, Pierre Verger, Patrick Peretti-Watel, Carole Eldin","doi":"10.1093/fampra/cmac116","DOIUrl":"10.1093/fampra/cmac116","url":null,"abstract":"<p><strong>Background: </strong>Media coverage of Lyme disease (LD) has led to an increase in consultations for presumed LD in Europe. However, LD is confirmed in only 10%-20% of patients, with a significant number remaining in a diagnostic dead-end.</p><p><strong>Objectives: </strong>To reach a deeper understanding of how patients themselves contribute to the diagnostic process. To describe the genesis of the LD hypothesis in care pathways.</p><p><strong>Methods: </strong>In 2019, 30 patients from a prospective cohort consulting in the infectious diseases department at University Hospital in Marseille for presumed LD were recruited for semistructured interviews. The inclusion criteria were: suffering from subjective symptoms for 6 months, no clinical or paraclinical argument suggesting current LD. The patients' medical trajectories were collected using a biographical approach.</p><p><strong>Results: </strong>The diagnosis of LD was primarily triggered by identification with personal testimonies found on the Internet. Most of patients were leading their own diagnostic investigation. The majority of participants were convinced they had LD despite the lack of medical evidence and the scepticism of their referring GP.</p><p><strong>Conclusion: </strong>GPs should first systematically explore patients' aetiologic representations in order to improve adherence to the diagnosis especially in the management of medically unexplained symptoms. Long COVID-19 syndrome challenge offers an opportunity to promote active patient involvement in diagnosis.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9619758/pdf/cmac116.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40562852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review documenting reasons whether physicians should provide treatment to their family and friends.","authors":"Francisca Beigel, Marcel Mertz, Sabine Salloch","doi":"10.1093/fampra/cmac142","DOIUrl":"10.1093/fampra/cmac142","url":null,"abstract":"<p><strong>Background: </strong>Physicians are likely to be asked to provide medical care to relatives or friends. Evidence suggests that most physicians treat loved ones during their active years. However, in the academic literature, critical approaches to the matter are dominating. Ethical guidelines often discourage physicians from treating family members and friends outside of exceptional circumstances.</p><p><strong>Objective: </strong>This systematic review aims to identify reasons for and against treating family and friends as portrayed in the literature published.</p><p><strong>Methods: </strong>A search string designed for the database \"PubMed,\" snowball sampling, and hand searching was used to identify possibly eligible publications. Seventy-six publications were screened for all reasons presented in favour of and against physicians treating loved ones. Qualitative content analysis was used for data extraction. Combining a deductive and inductive approach, a coding system was developed.</p><p><strong>Results: </strong>Many publications analysed represent articles portraying personal experiences; fewer show original research. Reasons against and in favour of treating family and friends were identified. Several publications specify conditions under which the treatment of loved ones may be legitimate. The reasons identified can be assigned to a micro or macro level of human interaction.</p><p><strong>Conclusions: </strong>This systematic review shows that the discourse of physicians treating loved ones is held predominantly in the context of personal experiences. The majority of authors seem to have a rather pragmatic interest in the topic, and systematic or analytic approaches are rare. While most authors mention various codes of ethics, several publications criticize these or consider them insufficient.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10468928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving prescribing: a feasibility study of pharmacogenetic testing with clinical decision support in primary healthcare in Singapore.","authors":"Helen Smith, Martin Dawes, Hagit Katzov-Eckert, Sarah Burrell, Sam Xin Hui, Michael D Winther","doi":"10.1093/fampra/cmac124","DOIUrl":"10.1093/fampra/cmac124","url":null,"abstract":"<p><strong>Background: </strong>The study of genetic variation as a factor influencing drug safety, efficacy, and effectiveness has brought about significant breakthroughs in understanding the clinical application of gene-drug interactions to better manage drug therapy.</p><p><strong>Objective: </strong>This study was designed to assess the feasibility of collecting buccal samples by general practitioners (GPs) at private practices in Singapore within a usual consultation, incorporating use of a pharmacogenetics-based medical decision support system to guide subsequent drug dosing.</p><p><strong>Methods: </strong>We used a prospective cohort study design, with GPs recruiting 189 patients between October 2020 and March 2021. The genotypes of 51 biallelic SNPs were determined using Illumina Infinium Global Screening Array.</p><p><strong>Results: </strong>Seven GPs from 6 private practices recruited and obtained buccal samples from a total of 189 patients. All patients had at least one actionable variant. The prevalence of patients having 2, 3, or 4 variants was 37.0%, 32.8%, and 12.7%, respectively. Potential alterations to medications were identified using the Clinical Decision Support System. Patients were accepting and the GPs were enthusiastic about the potential of pharmacogenetics to personalize medicine for their patients.</p><p><strong>Conclusion: </strong>This is the first study in Singapore to demonstrate the feasibility of pharmacogenetic testing in primary care. The high prevalence of genetic variants underscores the potential use of pharmacogenetics in this setting.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40701855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transgender care is health care: barriers and proposed model to improve access for transgender adults.","authors":"Louisa Y Xie, Skyler L Kanegi, Laureen A Gbordzoe, Landon A Marchant, Jacob Eleazer","doi":"10.1093/fampra/cmac125","DOIUrl":"10.1093/fampra/cmac125","url":null,"abstract":"","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40681367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}