European Journal of General Practice最新文献

{"title":"Familial colonoscopic screening: how do French general practitioners deal with patients and their high-risk relatives. A qualitative study.","authors":"Isabelle Ingrand,&nbsp;Nicolas Palierne,&nbsp;Pauline Sarrazin,&nbsp;Yvan Desbordes,&nbsp;Clara Blanchard,&nbsp;Pierre Ingrand","doi":"10.1080/13814788.2022.2089353","DOIUrl":"https://doi.org/10.1080/13814788.2022.2089353","url":null,"abstract":"<p><strong>Background: </strong>Screening of colorectal cancer (CRC) can reduce incidence and mortality. First-degree relatives (FDRs) of patients with CRC or advanced adenoma before the age of 65 (index patients) are at increased risk of CRC; however, the guidelines for screening of FDRs by colonoscopy are poorly followed.</p><p><strong>Objectives: </strong>The present study, conducted in the context of the COLOR3 interventional study project, aimed to explore the positioning of general practitioners (GPs) in familial CRC screening in France.</p><p><strong>Methods: </strong>From February 2020 to April 2021, 35 semi-structured interviews with GPs of index patients and/or their FDRs were conducted by telephone. The full-data transcribed corpus was subjected to horizontal thematic analysis.</p><p><strong>Results: </strong>Knowledge and compliance with the guidelines vary greatly between GPs. Although initiating the diagnostic process, GPs do not consider themselves as actors in the flow of information concerning familial risk. Their accompaniment of index patients in this role varies. GPs should overcome barriers to implementing colonoscopic screening for FDRs. They underline the importance of exploring family history, but they lack the time and doubt the reliability of the information given by FDRs.</p><p><strong>Conclusion: </strong>Challenges include circumventing gaps in knowledge, adherence to guidelines and improving family history updates. The GPs interviewed suggested personalised guidelines in specialists' reports to initiate information campaigns raising awareness of familial risk, and to enhance coordination between organised screening and familial screening.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9272923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40478067","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":"Digital technologies in primary care: Implications for patient care and future research.","authors":"Ana Luísa Neves,&nbsp;Jako Burgers","doi":"10.1080/13814788.2022.2052041","DOIUrl":"https://doi.org/10.1080/13814788.2022.2052041","url":null,"abstract":"<p><p>Digital health is the convergence of digital technologies with health, healthcare, living, and society. Contrasting with the slow trend during the last decades, in the last few years, we have observed an expansion and widespread adoption and implementation. In this paper, we revisit the potential that digital health presents for the delivery of higher quality, safer and more equitable care. Focussing on three examples - patient access to health records, big data analytics, and virtual care - we discuss the emerging opportunities and challenges of digital health, and how they can change primary care. We also reflect on the implications for research to evaluate digital interventions: the need to evaluate clear outcomes in light of the six dimensions of quality of care (patient-centredness, efficiency, effectiveness, safety, timeliness, and equity); to define clear populations to understand what works and for which patients; and to involve different stakeholders in the formulation and evaluation of the research questions. Finally, we share five wishes for the future of digital care in General Practice: the involvement of primary healthcare professionals and patients in the design and maintenance of digital solutions; improving infrastructure, support, and training; development of clear regulations and best practice standards; ensuring patient safety and privacy; and working towards more equitable digital solutions, that leave no one behind.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9278419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40492055","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":"GPs' involvement in specialised palliative home care: A mixed methods study in Germany.","authors":"Sophie Peter,&nbsp;Anna Maria Volkert,&nbsp;Lukas Radbruch,&nbsp;Roman Rolke,&nbsp;Raymond Voltz,&nbsp;Holger Pfaff,&nbsp;Nadine Scholten","doi":"10.1080/13814788.2022.2139824","DOIUrl":"https://doi.org/10.1080/13814788.2022.2139824","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) are important providers of palliative home care (PHC). To deliver adequate palliative care, cooperation with specialised PHC teams is necessary. Specialised PHC is a type of care for severely ill patients by specialised providers. Little is known about the involvement of German GPs in specialised PHC.</p><p><strong>Objectives: </strong>To analyse GPs' experience with realised and desired involvement in specialised PHC. Realised involvement means GPs took part in specialised PHC patients' care. Desired involvement is GPs' hoped-for cooperation with specialised PHC teams: GPs could state whether they want to stay involved, be informed, or provide medical services themselves after referral to specialised PHC.</p><p><strong>Methods: </strong>Mixed methods design (focus group with 6 GPs; survey of 445 GPs in North Rhine, Germany, about their experiences in PHC/specialised PHC): Qualitative data was interpreted using content analysis. The authors developed a questionnaire and performed descriptive analysis based on qualitative results.</p><p><strong>Results: </strong>GPs are mostly satisfied with specialised PHC teams' care, although they report cooperation is not always optimal. GPs describe a high satisfaction with quality of care by specialised PHC teams. However, physicians with higher PC knowledge are less satisfied with specialised PHC. Also, GPs are often less involved in specialised PHC than they wish, especially when they have a higher PC qualification.</p><p><strong>Conclusion: </strong>In general, GPs are satisfied with the quality of care provided by specialised PHC teams but GPs do not always perceive cooperation as optimal. Involvement of GPs in specialised PHC needs to be improved.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9665080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40683927","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":"Cardiovascular risk management in patients with severe mental illness or taking antipsychotics: A qualitative study on barriers and facilitators among dutch general practitioners.","authors":"Kirsti Jakobs,&nbsp;Latoya Lautan,&nbsp;Peter Lucassen,&nbsp;Joost Janzing,&nbsp;Jan van Lieshout,&nbsp;Marion C J Biermans,&nbsp;Erik W M A Bischoff","doi":"10.1080/13814788.2022.2092093","DOIUrl":"https://doi.org/10.1080/13814788.2022.2092093","url":null,"abstract":"<p><strong>Background: </strong>Patients with severe mental illness (SMI) or receiving treatment with antipsychotics (APs) have an increased risk of cardiovascular disease. Cardiovascular risk management (CVRM) increasingly depends on general practitioners (GPs) because of the shift of mental healthcare from secondary to primary care and the surge of off-label AP prescriptions. Nevertheless, the uptake of patients with SMI/APs in CVRM programmes in Dutch primary care is low.</p><p><strong>Objectives: </strong>To explore which barriers and facilitators GPs foresee when including and treating patients with SMI or using APs in an existing CVRM programme.</p><p><strong>Methods: </strong>In 2019, we conducted a qualitative study among 13 Dutch GPs. During individual in-depth, semi-structured interviews a computer-generated list of eligible patients who lacked annual cardiovascular risk (CVR) screening guided the interview. Data was analysed thematically.</p><p><strong>Results: </strong>The main barriers identified were: (i) underestimation of patient CVR and ambivalence to apply risk-lowering strategies such as smoking cessation, (ii) disproportionate burden on GPs in deprived areas, (iii) poor information exchange between GPs and psychiatrists, and (iv) scepticism about patient compliance, especially those with more complex conditions. The main facilitators included: (i) support of GPs through a computer-generated list of eligible patients and (ii) involvement of family or carers.</p><p><strong>Conclusion: </strong>This study displays a range of barriers and facilitators anticipated by GPs. These indicate the preconditions required to remove barriers and facilitate GPs, namely adequate recommendations in practice guidelines, improved consultation opportunities with psychiatrists, practical advice to support patient adherence and incentives for practices in deprived areas.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9272927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40477673","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":"Correction.","authors":"","doi":"10.1080/13814788.2022.2155364","DOIUrl":"https://doi.org/10.1080/13814788.2022.2155364","url":null,"abstract":"","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9754031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10711261","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 ill physician who self-discloses: What do patients think?","authors":"Barry Knishkowy,&nbsp;Noga Guggenheim","doi":"10.1080/13814788.2022.2146091","DOIUrl":"https://doi.org/10.1080/13814788.2022.2146091","url":null,"abstract":"<p><strong>Background: </strong>Physicians with a serious illness face difficult decisions about revealing this sensitive information to patients. Self-disclosure of illness is a largely unexplored topic, particularly from the patient's perspective.</p><p><strong>Objectives: </strong>To learn about patients' emotions and reactions to their family physician's sharing with them about having a major illness.</p><p><strong>Methods: </strong>The study was carried out in a family practice office in a suburb of Jerusalem, beginning the day that a family physician returned to work after a prolonged illness. A questionnaire study was performed with nine closed and four open questions relating to patients' reactions to learning about the illness. The questionnaire was distributed to 200 consecutive patients ages 18 years or older. Data extraction, compilation, and content analysis were performed to elicit and categorise major themes and issues that arose.</p><p><strong>Results: </strong>A total of 82% of the patients were pleased that the physician shared the information with them and none were displeased. Patients expressed a wide range of reactions to being told of the illness by the physician himself, among them: empathy, surprise, appreciation, pride, criticism, comfort/discomfort, and closeness. The value of sharing personal experience and the unique connection with the family physician were emphasised.</p><p><strong>Conclusion: </strong>Physician self-disclosure of major illnesses to patients can reveal the physician's humanity, encourage empathy on the part of patients and strengthen the physician-patient relationship. This report adds to current knowledge about when to share this powerful information with patients and highlights the topic's importance in the education of future doctors.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9718545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40493353","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":"Frequency and management of emergencies in primary care offices: A cross-sectional study in northwestern Germany.","authors":"Max Melzel,&nbsp;Falk Hoffmann,&nbsp;Michael H Freitag,&nbsp;Ove Spreckelsen","doi":"10.1080/13814788.2022.2094912","DOIUrl":"https://doi.org/10.1080/13814788.2022.2094912","url":null,"abstract":"<p><strong>Background: </strong>Little literature exists on emergencies within primary care offices.</p><p><strong>Objectives: </strong>We aimed to study the occurrence of emergencies and confidence in dealing with them among primary care physicians (PCPs) in Germany.</p><p><strong>Methods: </strong>We conducted a cross-sectional study among all PCPs with licences to practice with an own office (<i>n</i> = 915) in a northwestern region in Germany in 2019. Participants were asked to estimate the frequency and type of emergencies that occurred in the last 12 months in their office and about their confidence in managing emergency situations.</p><p><strong>Results: </strong>Answers from 375 PCPs could be analysed (response: 41.0%); 95.7% reported at least one emergency in their office within the last 12 months (mean 12.9). PCPs from rural offices reported more emergencies (on average 13.7 vs. 9.6). Acute coronary syndrome, cardiac arrhythmia and dyspnoea were the most common emergencies. A greater likelihood of feeling more confident in managing medical emergencies was found among male physicians, general internists, PCPs additionally qualified as emergency physicians and those with previous training in the emergency department and intensive care unit. In contrast, more general practitioners felt secure treating paediatric emergencies than general internists (highest level of confidence 22.1% vs. 16.3%).</p><p><strong>Conclusion: </strong>In Germany, emergencies in primary care offices occur on average once a month and more often in rural than urban areas. While most PCPs are confident in managing medical emergencies, some differences related to the training path became apparent. Ongoing training programmes may be tailored to improve emergency skills.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9291701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40514266","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":"Learning objectives of Belgian general practitioner trainees regarding their hospital training: A qualitative study.","authors":"Kimberley De Vocht,&nbsp;Katleen Verheyen,&nbsp;Nele R Michels","doi":"10.1080/13814788.2022.2081319","DOIUrl":"https://doi.org/10.1080/13814788.2022.2081319","url":null,"abstract":"<p><strong>Background: </strong>In Europe, hospital training is integrated in the postgraduate curriculum of General Practitioners (GPs) according to the European Directives. However, little is known about the specific learning objectives of GP trainees during this training.</p><p><strong>Objectives: </strong>This exploratory study investigated GP trainees' expected learning objectives for their hospital training and the factors influencing the learning process.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted in three focus groups consisting of first-year GP trainees before their hospital training. Data were coded thematically and analysed in NVivo.</p><p><strong>Results: </strong>A total of 22 Belgian GP trainees (55% females, average age of 26.2 years) were interviewed. Three major themes emerged: learning objectives, factors influencing learning and organisational aspects. GP trainees mainly wanted to improve their knowledge of common conditions by conducting consultations and follow certain patients' hospitalisation trajectory. Emergency medicine or internal medicine was the preferred specialty. Other GP trainees wanted to learn more about some specific conditions. Conversely, an overloaded work schedule was dreaded to hinder effective learning. Regular meetings and supervision from their hospital trainer were deemed crucial to strengthen GP trainees' learning trajectory.</p><p><strong>Conclusion: </strong>GP trainees wanted to learn more about both common conditions and some specific conditions. Their previous year in a GP setting strengthened their confidence and facilitated purposeful learning. Relieving GP trainees from administrative tasks when working as supplementary doctors could strike a better balance between the continuity of the clinical department and their personal learning objectives.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8c/74/IGEN_28_2081319.PMC9291655.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40602908","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":"Consequences of COVID-19 regulations on the competences of medical graduates and FM/GP interns - teachers' views.","authors":"Manfred Maier","doi":"10.1080/13814788.2022.2030589","DOIUrl":"https://doi.org/10.1080/13814788.2022.2030589","url":null,"abstract":"To reduce transmission of the coronavirus and to control the spread of COVID-19, several measures were introduced globally in early 2020. Among them was the sudden closure of educational institutions, including universities. In most countries, medical students were faced with suspension of clinical attachments and a significant change in their curriculum: theoretical lectures were presented online and clinical practice was temporarily cancelled, postponed and shortened. After almost two years, these or similar measures are still in place, albeit with local variations. Overall, medical universities and medical educators seem to have responded quickly and creatively to the new educational challenges [1]. However, can medical students under these circumstances gain the skills, experiences and attitudes they require to become competent doctors [2]? This question is, in particular, relevant for students who aim to work in General Practice/Family Medicine. Next to a broad knowledge base, the competences for this discipline require the ability to communicate empathically and efficiently with all kinds of patients. However, already before implementing the Covid 19regulations, patients were frequently complaining about the lack of good communication with their doctors. Furthermore, students need to acquire clinical reasoning skills for the outpatient setting, away from the sheltered workplace in the hospital. I did a short survey among colleagues and friends around the globe – Australia, Austria, Brazil, Estonia, Greece, Netherlands, Slovenia, Spain, Switzerland, Turkey and the UK – and asked for their views. In summary, there was agreement that the restrictions on teaching and training imposed both challenges and opportunities to Medical Faculties and Universities, that the organisation of new teaching formats and schedules was complex and that some students and teachers adapted better than others.","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8812802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39736595","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":"What are the main motivating factors for young general practitioner trainees to work in rural areas in the Czech Republic?","authors":"Kateřina Javorská,&nbsp;David Halata,&nbsp;Josef Štolfa,&nbsp;Markéta Pfeiferová","doi":"10.1080/13814788.2022.2094913","DOIUrl":"https://doi.org/10.1080/13814788.2022.2094913","url":null,"abstract":"<p><strong>Purpose: </strong>The global health workforce suffers long-term understaffing in remote and underserved areas. To attract young doctors for rural work, it is necessary to identify the main motivating factors.</p><p><strong>Materials and methods: </strong>The pilot survey with 201 general practitioner trainees in the Czech Republic was conducted using a structured questionnaire. The response rate was 67%.</p><p><strong>Results: </strong>Not only financial support motivates general practitioner trainees for rural work. A combination of incentives from sources other than medical would greatly increase the chance for general practitioner trainees to work in rural regions.</p><p><strong>Conclusions: </strong>To what extent can the survey outcomes relate with other European regions needs to be investigated further.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9272938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40488769","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}