European Journal of General Practice最新文献

{"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":null,"pages":null},"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":null,"pages":null},"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":"Health seeking behaviour among Lebanese population: A highlight on seeking care from pharmacists.","authors":"Rabih Soubra,&nbsp;Sani Hlais,&nbsp;Nadine Houmani,&nbsp;Lina Ghandour,&nbsp;Reda El Haj Hassan,&nbsp;Mohammed Joujou,&nbsp;Issam Shaarani","doi":"10.1080/13814788.2021.1917541","DOIUrl":"https://doi.org/10.1080/13814788.2021.1917541","url":null,"abstract":"<p><strong>Background: </strong>Understanding health-seeking behaviour could significantly reduce the impact of illness on patients' lives. Fragmentation of the Lebanese healthcare system and presence of variability in socio-economic factors have affected some aspects of the Lebanese population's overall health seeking behaviour. One of these aspects is seeking diagnosis from pharmacists, which is prohibited by the Lebanese law but reinforced by the absence of supervision of concerned authorities.</p><p><strong>Objectives: </strong>This study aimed to assess the Lebanese population's knowledge, attitude, and practice towards seeking health care from pharmacists, exploring particularly the practice of seeking diagnosis from pharmacists.</p><p><strong>Methods: </strong>A cross-sectional study was conducted by surveying a convenient sample of 493 participants across the eight governorates of Lebanon between July and October 2016. A self-administered questionnaire was used. Questions assessed the health care seeking behaviour of the participants.</p><p><strong>Results: </strong>Two-thirds of the study participants (63.9%) did not have a general practitioner whom they visit regularly. Nearly half of the participants (48.9%) reported seeking diagnosis from pharmacists. Noteworthy, seeking diagnosis from pharmacists' behaviour declined significantly with having a general practitioner visited regularly. More than half of participants (59.5%) believed that dealing with emergencies is among the pharmacists' duties. In addition, 62.8% perceived that pharmacists are 'often/always' capable of managing common complaints.</p><p><strong>Conclusion: </strong>Our study showed that a significant proportion of the Lebanese population seek a diagnosis from pharmacists and a significant proportion of them have a misconception about the role of pharmacists in the Lebanese healthcare system.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/13814788.2021.1917541","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38956048","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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":"Perceptions, professional responsibility and management experiences of patients with alcohol, tobacco and opioid use disorder by residents in general practice and teaching general practitioners.","authors":"Marie Rouillon, Catherine Laporte, Pierre Ingrand, Philippe Castéra, Paolo Di Patrizio, Nassir Messaadi, Philippe Binder, Julie Dupouy","doi":"10.1080/13814788.2021.1917542","DOIUrl":"10.1080/13814788.2021.1917542","url":null,"abstract":"<p><strong>Background: </strong>Substance use disorders (SUDs) are based on pathophysiological mechanisms common to all psychoactive substances. However, general practitioners (GPs) hold different views depending on the substance in question.</p><p><strong>Objectives: </strong>To determine whether the perceptions that teaching GPs and final-year residents in general practice have of patients with a SUD vary according to the substance involved and explore their professional responsibility and management experiences.</p><p><strong>Methods: </strong>A cross-sectional observational study was carried out by asking residents and teaching GPs from eight faculties of medicine about their perceptions, professional responsibility and management experience of patients with tobacco, alcohol and opioid use disorders, using an online questionnaire between June and September 2017.</p><p><strong>Results: </strong>The responses of 238 teaching GPs (mean age 50 years SD 3.5; 58% men) and 327 residents (mean age 28 years SD 9.9; 67% women) were analysed (response rates: 9 and 15% respectively). Tobacco smokers were considered to be more responsible for their acts than the other users. Teaching GPs and residents considered that it was their responsibility to discuss substance use. They did not feel able to manage alcohol and opioid use disorders. Tobacco cessation was mainly managed alone (78%). The results were quite similar among teaching GPs and residents.</p><p><strong>Conclusion: </strong>The majority of practitioners had no difficulty managing smoking cessation. During the management of alcohol and particularly opioid use disorders, practitioners did not feel competent. The gap between their perceived responsibility and competencies should be addressed by training and promoting collaborative care.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/13814788.2021.1917542","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38973466","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":null,"pages":null},"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}

{"title":"To prevent being stressed-out: Allostatic overload and resilience of general practitioners in the era of COVID-19. A cross-sectional observational study.","authors":"Dóra Békési,&nbsp;Illés Teker,&nbsp;Péter Torzsa,&nbsp;László Kalabay,&nbsp;Sándor Rózsa,&nbsp;Ajándék Eőry","doi":"10.1080/13814788.2021.1982889","DOIUrl":"https://doi.org/10.1080/13814788.2021.1982889","url":null,"abstract":"<p><strong>Background: </strong>Responsibility of general practitioners (GPs) in delivering safe and effective care is always high but during the COVID-19 pandemic they face even growing pressure that might result in unbearable stress load (allostatic overload, AO) leading to disease.</p><p><strong>Objectives: </strong>We aimed to measure AO of Hungarian GPs during the COVID-19 pandemic and explore their recreational resources to identify potential protective factors against stress load.</p><p><strong>Methods: </strong>In a mixed-method design, Fava's clinimetric approach to AO was applied alongside the Psychosocial Index (PSI); Kellner's symptom questionnaire (SQ) to measure depression, anxiety, hostility and somatisation and the Public Health Surveillance Well-being Scale (PHS-WB) to determine mental, social, and physical well-being. Recreational resources were mapped. Besides Chi-square and Kruskal-Wallis tests, regression analysis was applied to identify explanatory variables of AO.</p><p><strong>Results: </strong>Data of 228 GPs (68% females) were analysed. Work-related changes caused the biggest challenges leading to AO in 60% of the sample. While female sex (OR: 1.99; CI: 1.06; 3.74, <i>p</i> = 0.032) and other life stresses (OR: 1.4; CI: 1.2; 1.6, <i>p</i> < 0.001) associated with increased odds of AO, each additional day with 30 min for recreation purposes associated with 20% decreased odds (OR: 0.838; CI: 0.72; 0.97, <i>p</i> = 0.020). 3-4 days a week when time was ensured for recreation associated with elevated mental and physical well-being, while 5-7 days associated with lower depressive and anxiety symptoms, somatisation, and hostility.</p><p><strong>Conclusion: </strong>Under changing circumstances, resilience improvement through increasing time spent on recreation should be emphasised to prevent GPs from the adverse health consequences of stress load.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8510612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9569174","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}