European Journal of General Practice最新文献

{"title":"Impact of nurse practitioners in primary care on patients with chronic diseases in rural and underserved areas: A systematic review.","authors":"Ariane Sacchetti, Mélanie Berube, Christophe Pison, Marc-Aurèle Gagnon, Alexandre Bellier","doi":"10.1080/13814788.2026.2613495","DOIUrl":"10.1080/13814788.2026.2613495","url":null,"abstract":"<p><strong>Background: </strong>Ageing, multimorbidity, and workforce shortages increasingly limit access to primary healthcare, especially in rural and underserved areas.</p><p><strong>Objectives: </strong>To document impact of nurse practitioners (NPs) in primary care on patients with chronic diseases.</p><p><strong>Methods: </strong>Searches were conducted in Medline, EMBASE, CINAHL, and CENTRAL (March 1978-October 2023). This systematic review followed MECIR and PRISMA guidelines (PRISMA 2020 checklist: EQUATOR Network) with SWiM used as a PRISMA extension due to the lack of meta-analysis. The focus was on NPs' roles in chronic disease management and primary care in underserved or remote areas, excluding mental health, cancer, and dental care.</p><p><strong>Results: </strong>Among 3,684 citations, 25 studies were selected, including 10 RCT. NPs may improve access to primary care and chronic disease management, particularly in underserved areas. Although not all studies directly compared NPs to traditional models, they were most often assessed against General Practitioners (GPs) alone. Seven studies also evaluated collaborative NP-GP models versus GP-only care. Patient satisfaction was generally higher with NPs, possibly due to longer consultations and greater patient education. Clinical and biological outcomes were often comparable between NPs and GPs, with the best results in collaborative models, which were also associated with higher costs.</p><p><strong>Conclusion: </strong>NPs may enhance access to care, particularly for vulnerable populations. Higher patient satisfaction may be linked to longer consultations and patient education. While clinical outcomes were comparable to those of GPs, collaborative models yielded the best results, though potentially at a higher cost.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2613495"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12849805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068597","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":"Evaluation of Dutch General Practitioners ultrasound referrals and opportunities for point-of-care ultrasound: A retrospective analysis.","authors":"Jelien Geivers, Ralph T H Leijenaar, Lola Ramakers, Jochen W L Cals, Frank M Zijta, J Martijn Nobel, Ramon P G Ottenheijm","doi":"10.1080/13814788.2025.2606572","DOIUrl":"10.1080/13814788.2025.2606572","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) frequently refer patients for abdominal ultrasound. Depending on the clinical context, a 'triage ultrasound' can assess multiple potential causes of abdominal symptoms, while a 'targeted ultrasound' (point-of-care ultrasound, POCUS) focuses on specific indications (e.g. cholelithiasis).</p><p><strong>Objective: </strong>To assess whether medical questions posed by GPs in abdominal ultrasound referral letters are adequate for radiologists to perform their examination, and to identify indications for POCUS by GPs based on exclusion rates and alternative findings in radiological reports.</p><p><strong>Methods: </strong>Retrospective study analysing GP referral letters with corresponding radiology reports referred for abdominal ultrasound. Key variables: GP's medical question, indication type and the radiologist's final interpretation, following established diagnostic guidelines.</p><p><strong>Results: </strong>A total of 1,196 referral letters with corresponding reports were reviewed. Of these, 143 (12%) were excluded, primarily due to missing clinical information from the GP (102; 8.5%). The final sample comprised 1053 referral letters with reports (mean age 59.2 years; 60% female). Sixteen percent of referral letters lacked a medical question, and 33% included exclusively guideline-based indications. The most common guideline-based indications were urolithiasis (43%) and cholelithiasis (39%). For guideline-based requests, radiologists excluded the indicated condition in 75% of cases, and an alternative diagnosis was identified in fewer than 10%.</p><p><strong>Conclusion: </strong>GPs frequently provide insufficient clinically relevant information in abdominal ultrasound referral letters. Simple cases with well-defined clinical queries like cholelithiasis, urolithiasis, hydronephrosis and abdominal aortic aneurysm seem suitable for POCUS evaluation, as these are often excluded conditions for which the risk of overlooking serious diagnoses is low.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2606572"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12802515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960980","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":"External validation of risk scores and multivariate models for the diagnosis of community-acquired pneumonia in outpatients.","authors":"Mark Ebell, Dan J Merenstein, Bruce Barrett, Theo Verheij, Paul Little","doi":"10.1080/13814788.2026.2628370","DOIUrl":"10.1080/13814788.2026.2628370","url":null,"abstract":"<p><strong>Background: </strong>While several risk scores for the diagnosis of community-acquired pneumonia (CAP) have been developed, they require prospective external validation.</p><p><strong>Objectives: </strong>To externally validate existing prediction models, risk scores, and heuristics for the diagnosis of CAP in adults.</p><p><strong>Methods: </strong>The Enhancing Antibiotic Stewardship in Primary Care (EAST-PC) study recorded signs, symptoms, demographics, and vitals in 718 adults presenting to primary or urgent care clinics with acute lower respiratory tract infection between 2019 and 2023. C-reactive protein (CRP) was available for 575. The diagnosis of CAP was based on the clinician diagnosis and/or chest radiograph. Literature was searched for previous risk scores. Using the EAST-PC population, the area under the receiver operating characteristic curve (AUROCC), calibration curves, and percentage with CAP in each risk group were calculated for each risk score.</p><p><strong>Results: </strong>We identified 11 studies describing 4 risk scores, 9 multivariate models, and 5 simple heuristics. The Genomics to Combat Resistance Against Antibiotics in Community-acquired LRTI in Europe (GRACE) risk score using the absence of a runny nose, the presence of breathlessness, crackles, diminished vesicular breathing, heart rate > 100/min, temperature >37.8 °C, and CRP > 30 mg/L was the most accurate (AUROCC 0.81). It classified 280 patients as low (0.7% CAP), 265 as moderate (5.7%) and 30 as high risk (33.3%) for CAP. The GRACE score without CRP performed similarly. Other risk scores had poor calibration or failed to accurately classify patients as low or high risk.</p><p><strong>Conclusions: </strong>The previously derived GRACE risk scores were successfully externally validated in a contemporary US outpatient population.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2628370"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146260084","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":"The power of peers.","authors":"Jako Burgers","doi":"10.1080/13814788.2026.2678753","DOIUrl":"10.1080/13814788.2026.2678753","url":null,"abstract":"","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2678753"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044412","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":"Understanding the diagnostic process of endometriosis in primary care: An interview study with general practitioners in Denmark using clinical vignettes.","authors":"Maria Pencheri, Karina Ejgaard Hansen, Liv Juul Nielsen, Sharon Dixon, Lisa Hinton, Anders Prior, Axel Forman, Henrik Marschall, Mikkel Seyer-Hansen, Ulrik Bak Kirk","doi":"10.1080/13814788.2026.2648318","DOIUrl":"10.1080/13814788.2026.2648318","url":null,"abstract":"<p><strong>Introduction: </strong>Endometriosis is a chronic, systemic condition affecting 5-10% of individuals assigned female at birth. Due to its non-specific symptoms, diagnosis is often delayed.</p><p><strong>Objectives: </strong>This study aims to explore diagnostic challenges and decision-making processes that general practitioners (GPs) encounter when managing patients with symptoms suggestive of endometriosis in Denmark.</p><p><strong>Methods: </strong>A qualitative research approach was employed, incorporating the co-production of three fictional clinical vignettes representing diverse endometriosis presentations. Semi-structured interviews were conducted with 27 practicing GPs (7 males and 20 females) from urban and rural areas. Participants had a mean age of 50 years (range 41-66) and clinical experience ranging from newly qualified to 27 years. Interviews involved engagement with the vignettes, and data were analysed using thematic analysis.</p><p><strong>Results: </strong>Findings reveal the challenge of the non-specific nature of symptoms, the role of cyclical symptom patterns in diagnosis, the influence of diagnostic hierarchies, patient-centred care approaches, the bio-psycho-social perspective in management, the persistent stigma surrounding gynaecological symptoms, and GPs limited trust in general gynaecologists. GPs were more likely to suspect endometriosis when symptoms followed a cyclical pattern, whereas gastrointestinal presentations were less commonly linked to the condition. While many GPs adopted a patient-centred, shared decision-making approach, some still adhered to mind-body dualism in their clinical reasoning.</p><p><strong>Conclusion: </strong>Diagnosing endometriosis in primary care is challenging due to non-specific symptoms, diagnostic hierarchies, and stigma. Encouraging GPs to routinely inquire about the cyclical nature of symptoms may serve as a valuable diagnostic tool, particularly in cases involving gastrointestinal complaints.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2648318"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13040569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583094","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":"Distinguishing bipolar disorder from unipolar depression in general practice: A systematic review.","authors":"Docteur Scheherazade Niktabe, Catherine Massoubre","doi":"10.1080/13814788.2026.2733396","DOIUrl":"10.1080/13814788.2026.2733396","url":null,"abstract":"<p><strong>Objective: </strong>Bipolar disorder affects approximately 1% of the population, although some studies report prevalence rates of up to 6%. Distinguishing it from unipolar depression remains challenging, with diagnostic delays often exceeding ten years. This systematic review aims to identify clinical and historical features of depressive episodes that support the earlier detection of bipolar disorder in general practice.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines. The PubMed database was searched using MeSH terms. Study quality was assessed using the Newcastle-Ottawa Scale and the PRISMA checklist.</p><p><strong>Results: </strong>Of the 525 articles identified, 36 met the inclusion criteria. Early age at onset, recurrent episodes, family history of bipolar disorder, cyclothymic temperament, suicide attempts, postpartum depression, psychotic features and mixed episodes emerged as the most consistently associated indicators of bipolar disorder. Other clinical characteristics showed more heterogeneous or limited associations. Although individual features lack sufficient predictive value when considered in isolation, their combined presence may enhance clinical suspicion and facilitate earlier identification of bipolar disorder in primary care settings.</p><p><strong>Conclusion: </strong>This review identified a combination of clinical and historical features of depressive episodes that help distinguish between bipolar disorder and unipolar depression in general practice. Identifying these features through a structured clinical interview, as a complement to existing screening tools such as the Mood Disorder Questionnaire, may help reduce diagnostic delays and improve outcomes.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2733396"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002984","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":"The future is now: Towards intelligent use of Generative AI in general practice.","authors":"Jako S Burgers, Angelina Müller","doi":"10.1080/13814788.2025.2602356","DOIUrl":"10.1080/13814788.2025.2602356","url":null,"abstract":"","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2602356"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12781954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913595","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":"Point-of-care ultrasound teaching in general practice and family medicine: EURACT position paper.","authors":"Vesna Homar, Nele Roos Michels, Marek Kucera, Jachym Bednar, Yolanda Ortega, Camilla Vaskjær Aakjær Andersen, Martine Granek-Catarivas","doi":"10.1080/13814788.2026.2666751","DOIUrl":"10.1080/13814788.2026.2666751","url":null,"abstract":"<p><p><b>Background:</b> Point-of-care ultrasound (POCUS) is an increasingly valuable tool in general practice/family medicine (GP/FM). This position paper from the European Academy of Teachers in General Practice/Family Medicine outlines recommendations for integrating POCUS education across the continuum of training: undergraduate, specialty, and continuing medical education.</p><p><p><b>Recommendations:</b> POCUS should complement, not replace, the clinical examination. Key priorities include GP/FM-targeted curriculum development, early exposure during basic medical education, mandatory residency training, context-sensitive continuing professional development, train-the-trainer programmes, and GP/FM-led implementation.</p><p><p><b>Discussion:</b> Integrating POCUS teaching across all stages of GP/FM education may support effective and sustainable adoption in primary care. Educational strategies should be adapted to local contexts and healthcare systems while maintaining a focus on clinically relevant and evidence-informed use.</p><p><p><b>Conclusion:</b> EURACT recommends the longitudinal integration of POCUS education throughout GP/FM training and professional development. These principles aim to guide the effective, sustainable, and context-sensitive implementation of POCUS in primary care.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2666751"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989960","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":"Motivational factors for general practice training and career establishment: A cross-sectional study in Flanders, Belgium.","authors":"Lotta E Coenen, Madieke Maseman, Janique Lobbestael, Guy Gielis, Ann Gils, Johan Vansintejan, Inès Van Rossem","doi":"10.1080/13814788.2026.2628411","DOIUrl":"10.1080/13814788.2026.2628411","url":null,"abstract":"<p><strong>Background: </strong>In Flanders, Belgium, the 3-year specialised training in General Practice includes a specialty training rotation, for which trainees may choose their training site. After graduation, General Practitioners (GPs) decide where to establish their practice.</p><p><strong>Objective: </strong>This study explored the factors influencing GP trainees' choice of training location, reasons for settling in a specific region after graduation, and motivations for remaining in or leaving a practice.</p><p><strong>Methods: </strong>In May 2024, the Interuniversity Centre for Education of General Practitioners distributed an anonymous online survey with closed- and open-ended questions to all GP alumni graduating between 2014 and 2023. Quantitative data were analysed using linear regression; qualitative data underwent content analysis.</p><p><strong>Results: </strong>Of 772 alumni respondents (26.7% response rate), 93.4% were still practising as a GP. Most were female (70.9%), and 37.2% engaged in additional professional roles. Key influences on training location choice and practice settlement included colleague connections, proximity to home, and opportunities to work in group practices. Decisions to stay in or leave a practice were shaped by interpersonal relationships, practice organisation, and work-life balance. Working as a substitute GP was a frequent reason for changing practices, especially among recent graduates, to explore varied working environments.</p><p><strong>Conclusion: </strong>Both interpersonal and logistical factors strongly influence training practice choice and later GP practice settlement. High-quality training practices and supportive work environments are essential to promote sustainable GP careers and achieve a more balanced geographical distribution of GPs.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2628411"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286340","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":"Beyond diagnosis in general practice: Predictive processing, a novel framework for persistent physical symptoms.","authors":"Kees van Boven, Peter Lucassen, Tim C Olde Hartman, Omer Van den Bergh","doi":"10.1080/13814788.2026.2717019","DOIUrl":"10.1080/13814788.2026.2717019","url":null,"abstract":"<p><strong>Background: </strong>Persistent physical symptoms are among the most common and challenging presentations in general practice, whether investigations are normal or reveal pathology insufficient to explain their severity. Patients and clinicians alike often experience these presentations as a dead end. Traditional biomedical models assume that symptoms passively reflect structural pathology, and that normal test results imply the absence of illness.</p><p><strong>Objectives: </strong>To introduce predictive processing as a theoretical framework for understanding persistent physical symptoms in general practice, and to outline its implications for clinical explanation and management.</p><p><strong>Methods: </strong>This opinion paper draws on the predictive processing and active inference literature to develop a clinically applicable account of symptom perception, illustrated with clinical scenarios from general practice.</p><p><strong>Results: </strong>Predictive processing proposes that symptoms are active perceptual constructions, generated by the brain as it infers the state of the body from incoming signals and prior beliefs. When prior beliefs of danger or irreversibility are strong, and peripheral signals are weak or ambiguous, these prior beliefs can dominate perception, producing substantial suffering in the absence of clear pathology. This framework explains symptom-test discordance and reframes normal results: they do not end clinical responsibility, but shift it towards modifying symptom-sustaining priors towards expectations of safety and recovery.</p><p><strong>Conclusion: </strong>For the general practitioner, this framework provides a coherent scientific rationale for explanation, continuity of care, expectation management, cognitive approaches and graded activity. These interventions emerge as core clinical tools, not consolation, when \"nothing is found\".</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2717019"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801690","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}