European Journal of General Practice最新文献

{"title":"Patient involvement in the encounter between general practice and patients with a chronic disease. Results of a scoping review focusing on type 2 diabetes and obstructive pulmonary disease.","authors":"Signe Beck Titlestad,&nbsp;Michael Marcussen,&nbsp;Marie Sandstød Rasmussen,&nbsp;Birgitte Nørgaard","doi":"10.1080/13814788.2022.2153827","DOIUrl":"https://doi.org/10.1080/13814788.2022.2153827","url":null,"abstract":"<p><strong>Introduction: </strong>Research has shown improved health outcomes when patients are involved in managing their health conditions and when their individual needs are considered.</p><p><strong>Objectives: </strong>This scoping review aimed to map the existing research regarding chronic disease patients' involvement in their encounters with general practice, with a specific focus on patients with Type 2 diabetes (TD2) or chronic obstructive pulmonary disease (COPD) and from the perspectives of both general practitioners and patients.</p><p><strong>Methods: </strong>Studies of any design, date, and language were included. A systematic search was conducted using the following databases: Medline, CINAHL, PsycInfo, Scopus, and EMBASE from August until October 2020 and renewed September 2021. Data were systematically charted by the following study characteristics: bibliographic aims; study aims; setting; area of interest; results; conclusion.</p><p><strong>Results: </strong>Eighteen studies were included; they conducted qualitative methods, surveys or mixed methods. From the patients' perspectives, the importance of being more involved in treatment discussions during consultations as well as a friendly environment, was underscored. A good relationship and relational continuity make it easier for patients to be more involved in treatment decisions. From the general practitioner (GP) perspectives, they mentioned their high workload, long-standing relationships, knowledge about the patients and prepared patients as factors influencing their ability to involve patients in treatment discussions.</p><p><strong>Conclusion: </strong>A good GP-patient relationship was considered an important aspect to providing and facilitating for involvement of patients with COPD or TD2. Scoping review registration: https://osf.io/ynqt2.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"28 1","pages":"260-269"},"PeriodicalIF":3.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9754033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10711259","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 qualitative study of parental views of HPV vaccination in Ireland.","authors":"Stephanie Creed,&nbsp;Elaine Walsh,&nbsp;Tony Foley","doi":"10.1080/13814788.2020.1851677","DOIUrl":"https://doi.org/10.1080/13814788.2020.1851677","url":null,"abstract":"<p><strong>Background: </strong>Despite significant evidence supporting the Human Papillomavirus (HPV) vaccine in the prevention of cervical cancer, uptake of this vaccine is below target in many countries. HPV uptake in Ireland has declined from 87% in 2014-15 to 51% in 2016-17 and currently remains suboptimal at 64.1% in 2017-18.</p><p><strong>Objectives: </strong>This study aimed to explore parental views of the HPV vaccine; elucidate specific concerns relating to this vaccine and to identify relevant influences on the decision to vaccinate against HPV to inform strategies to optimise uptake.</p><p><strong>Methods: </strong>An in-depth qualitative study, using semi-structured interviews was conducted among parents of 11-13-year-old girls (<i>n</i> = 18) who had not yet been offered the HPV vaccine. Convenience sampling was used. Interviews, conducted in the Republic of Ireland over six-months in 2018, were audio-recorded, transcribed, and analysed by thematic analysis.</p><p><strong>Results: </strong>Eighteen interviews were conducted (14 female and 4 male participants). Parents favoured HPV vaccination to protect their daughters and prevent disease. Barriers to vaccination included; the fear of long-term side effects, lack of knowledge and the risk versus benefit ratio. General practitioners (GPs) were identified as having a strong influence over parental vaccination decisions, as did media reports and the recent cervical screening programme controversy in Ireland.</p><p><strong>Conclusion: </strong>This study suggests that significant parental concerns remain to the HPV vaccine. More comprehensive information on the research surrounding this vaccine's safety profile is required. GP's may play a pivotal role in HPV vaccination going forward.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"27 1","pages":"1-9"},"PeriodicalIF":3.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/13814788.2020.1851677","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9569148","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":"Virtual primary care in high-income countries during the COVID-19 pandemic: Policy responses and lessons for the future.","authors":"Ana Luisa Neves,&nbsp;Edmond Li,&nbsp;Pramendra Prasad Gupta,&nbsp;Gianluca Fontana,&nbsp;Ara Darzi","doi":"10.1080/13814788.2021.1965120","DOIUrl":"https://doi.org/10.1080/13814788.2021.1965120","url":null,"abstract":"<p><strong>Background: </strong>Telemedicine, once defined merely as the treatment of certain conditions remotely, has now often been supplanted in use by broader terms such as 'virtual care', in recognition of its increasing capability to deliver a diverse range of healthcare services from afar. With the unexpected onset of COVID-19, virtual care (e.g. telephone, video, online) has become essential to facilitating the continuation of primary care globally. Over several short weeks, existing healthcare policies have adapted quickly and empowered clinicians to use digital means to fulfil a wide range of clinical responsibilities, which until then have required face-to-face consultations.</p><p><strong>Objectives: </strong>This paper aims to explore the virtual care policies and guidance material published during the initial months of the pandemic and examine their potential limitations and impact on transforming the delivery of primary care in high-income countries.</p><p><strong>Methods: </strong>A rapid review of publicly available national policies guiding the use of virtual care in General Practice was conducted. Documents were included if issued in the first six months of the pandemic (March to August of 2020) and focussed primarily on high-income countries. Documents must have been issued by a national health authority, accreditation body, or professional organisation, and directly refer to the delivery of primary care.</p><p><strong>Results: </strong>We extracted six areas of relevance: primary care transformation during COVID-19, the continued delivery of preventative care, the delivery of acute care, remote triaging, funding & reimbursement, and security standards.</p><p><strong>Conclusion: </strong>Virtual care use in primary care saw a transformative change during the pandemic. However, despite the advances in the various governmental guidance offered, much work remains in addressing the shortcomings exposed during COVID-19 and strengthening viable policies to better incorporate novel technologies into the modern primary care clinical environment.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"27 1","pages":"241-247"},"PeriodicalIF":3.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8404680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9924716","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":"Characteristics and economic burden of frequent attenders with medically unexplained symptoms in primary care in Israel.","authors":"Oded Hammerman,&nbsp;Daniel Halperin,&nbsp;Daniel Tsalihin,&nbsp;Dan Greenberg,&nbsp;Talma Kushnir,&nbsp;Yacov Ezra","doi":"10.1080/13814788.2021.1985997","DOIUrl":"https://doi.org/10.1080/13814788.2021.1985997","url":null,"abstract":"<p><strong>Background: </strong>Frequent Attenders with Medically Unexplained Symptoms (FA/MUS) are common in primary care, though challenging to identify and treat.</p><p><strong>Objectives: </strong>This study sought to compare FA/MUS to FA with organic illnesses (FA/OI) and the general clinic population (Non-FA) to understand their demographic characteristics and healthcare utilisation patterns.</p><p><strong>Methods: </strong>For this retrospective, observational study, Electronic Medical Records (EMR) were obtained from Clalit Health Services, regarding the population of a sizeable primary care clinic in Be'er-Sheva, Israel. Electronic medical records were screened to identify the top 5% of FA. FA were stratified based on whether they had OI. FA without OI were then corroborated as having MUS by their physicians. Demographics, healthcare utilisation and costs were analysed for FA/OI, FA/MUS and Non-FA.</p><p><strong>Results: </strong>Out of 594 FA, 305 (53.6%) were FA/OI and 264 (46.4%) were FA/MUS. FA/OI were older (69.1 vs. 56.4 years, <i>p</i><.001) and costlier (ILS27693 vs. ILS9075, <i>p</i><.001) than FA/MUS. Average costs for FA/MUS were over four times higher than Non-FA (ILS9075 vs. ILS2035, <i>p</i><.001). The largest disparities between FA/OI and FA/MUS were in hospitalisations (ILS6998 vs. ILS2033) and surgical procedures (ILS8143 vs. ILS3175). Regarding laboratory tests, differences were smaller between groups of FA but significantly different between FA and Non-FA.</p><p><strong>Conclusion: </strong>FA/MUS are more costly than Non-FA and exhibit unique healthcare utilisation and costs patterns. FA/OI had more severe illnesses necessitating hospitalisations and surgical interventions, while FA/MUS had more investigations and tests, attempting to find an explanation for their symptoms.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"27 1","pages":"294-302"},"PeriodicalIF":3.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8510588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9924719","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":"Primary care is the frontline for help-seeking insomnia patients.","authors":"Isabel Torrens Darder,&nbsp;Rosmary Argüelles-Vázquez,&nbsp;Patricia Lorente-Montalvo,&nbsp;Maria Del Mar Torrens-Darder,&nbsp;Magdalena Esteva","doi":"10.1080/13814788.2021.1960308","DOIUrl":"https://doi.org/10.1080/13814788.2021.1960308","url":null,"abstract":"<p><strong>Background: </strong>Although insomnia is a very common disorder, few people seek medical help.</p><p><strong>Objectives: </strong>To determine the proportion of people who consult a healthcare professional about insomnia and examine reasons for help seeking.</p><p><strong>Methods: </strong>Descriptive study of 99 patients diagnosed with insomnia following a telephone survey of 466 adults assigned to a primary healthcare unit in Majorca (Spain). Data were obtained from interviews and subsequent review of electronic medical records.</p><p><strong>Results: </strong>Thirty-nine patients (39.8%) consulted at least once with one health care professional; 36(92.2%) consulted a general practitioner. Only 12.2% had an insomnia diagnosis registered in their medical record. Insomnia consultation was not associated with any sociodemographic variables analysed, anxiety, depression or comorbidities. Also, there was no association with sleep quality, duration, and sleep efficiency. Patients with clinical insomnia (OR, 2.48; 95% CI, 1.03-5.94), those who were more worried (OR, 2.93; 95% CI 1.08-7.95) or felt that others noticed the impact of insomnia on their quality of life (OR, 2.48; 95% CI, 1.02-19.08) are more likely to seek medical help. Patients taking sleep medication were 21.54 (95% CI, 7.34-63.20) times more likely to have asked for medical assistance.</p><p><strong>Conclusion: </strong>Insomnia is an under-reported problem for both patients and doctors. When patients decide to consult for insomnia problems, they first go to the GP, and the vast majority take medications for their sleep problem. Those who consult most are people with more severe insomnia and those who are more worried.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"27 1","pages":"286-293"},"PeriodicalIF":3.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8510604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9941173","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":"Future-proofing the primary care workforce: A qualitative study of home visits by emergency care practitioners in the UK.","authors":"Robert Oliver Barker,&nbsp;Rachel Stocker,&nbsp;Siân Russell,&nbsp;Barbara Hanratty","doi":"10.1080/13814788.2021.1909565","DOIUrl":"https://doi.org/10.1080/13814788.2021.1909565","url":null,"abstract":"<p><strong>Background: </strong>Broadening the skill-mix in general practice is advocated to build resilience into the primary care workforce. However, there is little understanding of how extended-scope practitioners from different disciplines, such as paramedicine and nursing, embed into roles traditionally ascribed to general practitioners (GPs).</p><p><strong>Objectives: </strong>This study sought to explore patients' and professionals' experiences of a primary care home visiting service delivered by emergency care practitioners (ECPs), in place of GPs; to determine positive impacts/unintended consequences and establish whether interdisciplinary working was achieved.</p><p><strong>Methods: </strong>Three practices in England piloted an ECP (extended-scope practitioners with a paramedic or nursing background) home visiting service (November 2018-March 2019). Following the pilot, focus groups were conducted with each of the three primary healthcare teams (14 participants, including eight GPs), and one with ECPs (five participants) and nine individual patient interviews. Data were analysed using a modified framework approach.</p><p><strong>Results: </strong>The impact of ECP home visiting on GP workload and patient care was perceived as positive by patients, GPs and ECPs. Initial preconceptions of GPs and patients about the ECP role and expertise, and reservations about the appropriacy of ECPs for home visiting, were perceived to have been overcome by the expertise and interpersonal skills of ECPs. Fostering a culture of collaboration between ECPs and GPs was instrumental to remodelling professional boundaries at the practice level.</p><p><strong>Conclusion: </strong>Broadening the skill-mix to incorporate extended-scope practitioners such as ECPs, to deliver primary care home visiting, presents an opportunity to increase resilience in the general practice workforce.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"27 1","pages":"68-76"},"PeriodicalIF":3.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/13814788.2021.1909565","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9560727","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":"Psychological outcomes amongst family medicine healthcare professionals during COVID-19 outbreak: A cross-sectional study in Croatia.","authors":"Sunčana Vlah Tomičević,&nbsp;Valerija Bralić Lang","doi":"10.1080/13814788.2021.1954154","DOIUrl":"https://doi.org/10.1080/13814788.2021.1954154","url":null,"abstract":"<p><strong>Background: </strong>Healthcare professionals (HCPs) in family medicine (FM) in Croatia work in a demanding environment caused by the SARS-CoV-2 pandemic. Besides particular circumstances in healthcare, an unknown virus, social distancing, and homeschooling, the capital was hit with the earthquake during the lockdown.</p><p><strong>Objectives: </strong>To assess the prevalence of stress, anxiety, depression, posttraumatic stress disorder (PTSD) and the influence of demographic characteristics, professional differences, medical history, and specific stressors on the psychological outcomes.</p><p><strong>Methods: </strong>A cross-sectional study with the online questionnaire containing the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R) was conducted from 1st to 15 May 2020 in FM.</p><p><strong>Results: </strong>HCPs (534, 35% response rate), predominantly female (84.5%), participated in the research. High prevalence of stress (30.9%), anxiety (33.1%), depression (30.7%), and PTSD (33.0%) were found. Female participants had higher results in the anxiety subscale of DASS-21 and IES-R scores. Pre-existing conditions were associated with higher levels of stress, anxiety, depression, and PTSD. The IES-R score for PTSD showed borderline correlation (<i>p</i> = 0.053) with working in regions with the highest incidence of COVID-19. Having schoolchildren made a difference on a stress subscale in DASS-21 (<i>p</i> < 0.043), but the earthquake did not have an impact.</p><p><strong>Conclusion: </strong>Family physicians and nurses in FM in Croatia are under a great mental load during the COVID-19 outbreak. Results suggest that HCPs of the female sex, with pre-existing chronic conditions, work in regions with a high incidence of SARS-CoV-2 or have schoolchildren at greater risk of the poor psychological outcome.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"27 1","pages":"184-190"},"PeriodicalIF":3.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/13814788.2021.1954154","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9560735","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":"Diabetes-related quality of life in six European countries measured with the DOQ-30.","authors":"Liina Pilv,&nbsp;Etienne I J J Vermeire,&nbsp;Anneli Rätsep,&nbsp;Alain Moreau,&nbsp;Davorina Petek,&nbsp;Hakan Yaman,&nbsp;Marje Oona,&nbsp;Ruth Kalda","doi":"10.1080/13814788.2021.1954615","DOIUrl":"https://doi.org/10.1080/13814788.2021.1954615","url":null,"abstract":"<p><strong>Background: </strong>The quantification of diabetes-related quality of life (DR-QoL) is an essential step in making Type 2 Diabetes (T2DM) self-management arrangements. The European General Practitioners Research Network (EGPRN) initiated the EUROBSTACLE study to develop a broadly conceptualised DR-QoL instrument for diverse cultural and ethnic groups; high and low-income countries. In 2016 the Diabetes Obstacles Questionnaire-30 (DOQ-30) was introduced.</p><p><strong>Objectives: </strong>The research aimed to study obstacles a patient with diabetes (PWD) may face in everyday life. First, we assessed how descriptive and clinical characteristics and the residential country were associated with the obstacles. Secondly, we calculated the proportion of respondents who expressed obstacles.</p><p><strong>Methods: </strong>Data were collected in 2009 in a cross-sectional survey in Belgium, France, Estonia, Serbia, Slovenia, and Turkey. Multiple linear regressions were computed to detect associations between descriptive and clinical characteristics, residential country, and obstacles. Percentages of respondents who perceived obstacles were calculated.</p><p><strong>Results: </strong>We found that although descriptive and clinical characteristics varied to quite a great extent, they were weakly associated with the perception of obstacles. The residential country was most often associated with the existence of some obstacle. The highest percent (48%) of all respondents perceived 'Uncertainty about Insulin Use' as an obstacle.</p><p><strong>Conclusion: </strong>Descriptive and clinical characteristics were weakly associated with perceived obstacles. However, the residential country plays an essential role in the decline of the QoL of PWDs. Education of both PWDs and healthcare professionals (HCPs) plays an essential role in countering the fear of insulin.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"27 1","pages":"191-197"},"PeriodicalIF":3.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/13814788.2021.1954615","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9560738","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":"Underdiagnosis, false diagnosis and treatment of COPD in a selected population in Northern Greece.","authors":"Dionisios Spyratos,&nbsp;Diamantis Chloros,&nbsp;Dionisia Michalopoulou,&nbsp;Ioanna Tsiouprou,&nbsp;Konstantinos Christoglou,&nbsp;Lazaros Sichletidis","doi":"10.1080/13814788.2021.1912729","DOIUrl":"https://doi.org/10.1080/13814788.2021.1912729","url":null,"abstract":"<p><strong>Background: </strong>In the primary care setting, diagnosis and treatment of COPD is not always consistent with GOLD guidelines.</p><p><strong>Objectives: </strong>To calculate the prevalence of COPD underdiagnosis, false diagnosis and treatment in the general population of northern Greece.</p><p><strong>Methods: </strong>Observational study in the context of an early COPD detection and smoking cessation project. Inclusion criteria: >40-year-old, current and former smokers (>10 pack-years) in five primary care centres of northern Greece from 2012 to 2019. Participation was achieved <i>via</i> a campaign (posters and advertisements in the mass media).</p><p><strong>Results: </strong>We examined 5,226 subjects (mean age: 58.2 ± 12.7 years, 61.5% males, current smokers: 56.2%) of whom 564 (10.8%) had symptoms and spirometrically confirmed COPD. There were 5 groups of 'interest:' <b>a)</b> 117/264 (44.3%) with a previous correct diagnosis COPD and correct treatment; <b>b)</b> 139/264 (52.7%) previous correct diagnosis COPD but overtreatment; <b>c)</b> 8/264 (3%) previous correct diagnosis COPD but undertreatment; <b>d)</b> 461 subjects (63.6% of those with previous COPD diagnosis) had previous false diagnosis of COPD (= also overtreatment); <b>e)</b> 300/564 (53.2%) previously not diagnosed COPD (=underdiagnosis and also undertreatment). We found that 322/461 (69.8%) of those with a previous false diagnosis have been prescribed long-acting bronchodilators plus ICS.</p><p><strong>Conclusion: </strong>Among the general population subjects in northern Greece, more than 50% of patients with COPD were underdiagnosed, more than 50% of correctly diagnosed COPD patients were overtreated and most patients taking inhaled drugs were those with a false diagnosis of COPD (possibly GOLD stage 0).</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"27 1","pages":"97-102"},"PeriodicalIF":3.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/13814788.2021.1912729","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9562982","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":"Management and characteristics of patients suffering from <i>Clostridiodes difficile</i> infection in primary care.","authors":"Maria Klezovich-Bénard,&nbsp;Frédérique Bouchand,&nbsp;Elisabeth Rouveix,&nbsp;Pierre L Goossens,&nbsp;Benjamin Davido","doi":"10.1080/13814788.2021.1998447","DOIUrl":"https://doi.org/10.1080/13814788.2021.1998447","url":null,"abstract":"<p><strong>Background: </strong><i>Clostridioides difficile</i> infection (CDI) is rising and increases patient healthcare costs due to extended hospitalisation, tests and medications. Management of CDI in French primary care is poorly reported.</p><p><strong>Objectives: </strong>To characterise patients suffering from CDI, managed in primary care and describe their clinical outcomes.</p><p><strong>Methods: </strong>Retrospective observational study based on survey data among 500 randomly selected General Practitioners (GPs) surveyed in France from September 2018 to April 2019. GPs were asked to complete a multiple-choice questionnaire for each reported patient presenting a CDI. Responses were analysed according to clinical characteristics. Treatment strategies were compared according to the outcome: recovery or recurrent infection.</p><p><strong>Results: </strong>Participation rate was 8.6% (<i>n</i> = 43/500) with two incomplete questionnaires. Data from 41 patients with an actual diagnosis of CDI were analysed. Recovery was observed in 61% of patients with a confirmed diagnosis of CDI. In the recovery group, this was exclusively a primary episode, most patients (72%) had no comorbidities, were significantly younger (<i>p</i> = 0.02) than the ones who relapsed and 92% were successfully treated with oral metronidazole. Duration of diarrhoea after antimicrobial treatment initiation was significantly shorter in the recovery group (≤ 48 h) (<i>p</i> = 0.03). Cooperation with hospital specialists was reported in 28% of the recovery group versus 87.5% of the recurrent group (<i>p</i> = 0.0003). Overall, GPs managed successfully 82.9% of cases without need of hospital admission.</p><p><strong>Conclusion: </strong>GPs provide relevant ambulatory care for mild primary episodes of CDI using oral metronidazole. Persistent diarrhoea despite an appropriate anti-Clostridiodes regimen should be interpreted as an early predictor of relapse.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"27 1","pages":"320-325"},"PeriodicalIF":3.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8583832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9567643","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}