European Journal of General Practice最新文献

{"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}

{"title":"Series: Practical guidance to qualitative research. Part 6: Longitudinal qualitative and mixed-methods approaches for longitudinal and complex health themes in primary care research.","authors":"Irene Korstjens,&nbsp;Albine Moser","doi":"10.1080/13814788.2022.2053106","DOIUrl":"https://doi.org/10.1080/13814788.2022.2053106","url":null,"abstract":"<p><p>This article, the sixth in a series aiming to provide practical guidance for qualitative research in primary care, introduces two approaches for addressing longitudinal and complex health themes in primary care research. The first approach - longitudinal qualitative research - supports the study of change during the life course. The second approach - mixed-methods research - integrates quantitative and qualitative research to gain new insights to address the complex and multifaceted themes in primary care.We discuss the context, what, why, when and how of these approaches and their main practical and methodological challenges. We provide examples of empirical studies using these approaches and sources for further reading.</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/7e/be/IGEN_28_2053106.PMC9132407.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10757571","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 world is getting smaller: The importance of a global approach to general practice research and practice.","authors":"Christian Mallen","doi":"10.1080/13814788.2022.2143686","DOIUrl":"https://doi.org/10.1080/13814788.2022.2143686","url":null,"abstract":"Not even Nostradamus predicted what has happened over the past two years. The world often seemed to stand still as everyone watched with shock and fear as the events related to the COVID-19 pandemic unfolded. The pandemic has opened the eyes of patients, clinicians, and policymakers to the importance of global health. It is increasingly apparent that health problems in one part of the world can rapidly impact our populations. There are many examples of how health in local populations have been influenced by global patterns of disease. A mutation of the monkeypox virus results in previously unheard-of cases across Europe, the war in Ukraine triggers unprecedented increases in the costs of daily living and widening social inequality, and the devastating effects related to global warming continue to have an everincreasing impact on health. Health is truly international and can no longer be contained in regional silos. The world is getting smaller every day. General practitioners increasingly need to think globally. Our academic endeavours are typically focussed on regional and national clinical priorities, yet the skills possessed can benefit much broader international populations as demonstrated throughout the COVID-19 pandemic. This expertise can be translated to tackling other global challenges – but this does represent a shift in how we currently work. The clinical and academic workforce needs to prepare our existing and future practitioners for the new challenges they will inevitably face during their careers. GPs need to plan, prepare and be ready for the next problem encountered – whatever that may be and wherever it may come from. Primary care and general practice are critical to improving health and well-being in lowand middleincome countries. The World Health Organisation’s Sustainable Development Goal 3 aims to achieve ‘good health and wellbeing for all’ [1]. This is an ambitious target that can only be met by primary care. Primary care can help reduce health inequalities, providing the broadest range of services in a cost-effective manner embedded in local communities [2]. Primary care takes a holistic approach to the patient journey, considering the wider needs of individuals and their families [3]. Growing the evidence base to support this, especially in lowand middle-income countries is a key component to future success. Internationally we have seen significant investment in global health research through organisations including the Bill and Melinda Gates Foundation and the National Institute for Health Research [4,5]. Such funding is aimed at tackling the most pressing global challenges and whilst as clinicians we are often impatient for results, we are already starting to see major advances from working more closely together. Novel technologies used to develop the first COVID-19 vaccines are now directed towards other serious infections, such as Ebola [6]. For the first time, effective malaria vaccination feels like a real possibili","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/PMC9704095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40482758","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":"Series: Practical guidance to qualitative research. Part 5: Co-creative qualitative approaches for emerging themes in primary care research: Experience-based co-design, user-centred design and community-based participatory research.","authors":"Albine Moser, Irene Korstjens","doi":"10.1080/13814788.2021.2010700","DOIUrl":"10.1080/13814788.2021.2010700","url":null,"abstract":"<p><p>This article, the fifth in a series aiming to provide practical guidance for qualitative research in primary care, introduces three qualitative approaches with co-creative characteristics for addressing emerging themes in primary care research: experience-based co-design, user-centred design and community-based participatory research. Co-creation aims to define the (research) problem, develop and implement interventions and evaluate and define (research and practice) outcomes in partnership with patients, family carers, researchers, care professionals and other relevant stakeholders. Experience-based co-design seeks to understand how people experience a health care process or service. User-centred design is an approach to assess, design and develop technological and organisational systems, for example, eHealth, involving end-users in the design and decision-making processes. Community-based participatory research is a collaborative approach addressing a locally relevant health issue. It is often directed at hard-to-reach and vulnerable people. We address the context, what, why, when and how of these co-creative approaches, and their main practical and methodological challenges. We provide examples of empirical studies using these approaches and sources for further reading.</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/1e/36/IGEN_28_2010700.PMC8765256.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39826938","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 mental healthcare for adults with mild intellectual disabilities: a Dutch database study.","authors":"Katrien P M Pouls, Monique C J Koks-Leensen, Willem J J Assendelft, Mathilde Mastebroek, Geraline L Leusink","doi":"10.1080/13814788.2022.2142936","DOIUrl":"10.1080/13814788.2022.2142936","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) are increasingly confronted with people with both mild intellectual disability (MID) and mental health (MH) problems. Little is known about the type of MH problems for which people with MID visit their GP and the care provided.</p><p><strong>Objectives: </strong>To identify the type and prevalence of MH disorders and MH-related complaints in people with MID in primary care and care provided, compared to people without ID.</p><p><strong>Methods: </strong>By linking the Netherlands Institute for Health Services Research's primary care databases, comprising electronic health records, with Statistic Netherlands' social services and chronic care databases, we identified 11,887 people with MID. In this four-year retrospective study, MH-related International Classification of Primary Care (ICPC) codes and care characteristics were compared between people with MID and without ID.</p><p><strong>Results: </strong>Of the people with MID, 48.8% had MH problems recorded vs. 30.4% of the people without ID, with significant differences in substance abuse, suicide attempts, and psychosis. Of the MID group, 80.3% were not registered by their GP with the ICPC code mental retardation. GPs provided more care to people with MID and MH problems than people without ID but with MH-problems regarding consultations (median 6.4 vs. 4.0 per year) and variety of prescribed medications (median 2.7 vs. 2.0 per year).</p><p><strong>Conclusion: </strong>In primary care, the prevalence of MH problems and care provided is high in people with MID. To improve primary mental healthcare for this group, it is essential to increase GPs' awareness and knowledge on the combination of MID and MH.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9683063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40701289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis of diagnostic delay in pulmonary embolism.","authors":"R van Maanen, E M Trinks-Roerdink, F H Rutten, G J Geersing","doi":"10.1080/13814788.2022.2086232","DOIUrl":"10.1080/13814788.2022.2086232","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic delay in patients with pulmonary embolism (PE) is typical, yet the proportion of patients with PE that experienced delay and for how many days is less well described, nor are determinants for such delay.</p><p><strong>Objectives: </strong>This study aimed to assess the prevalence and extent of delay in diagnosing PE.</p><p><strong>Methods: </strong>A systematic literature search was performed to identify articles reporting delays in diagnosing PE. The primary outcome was mean delay (in days) or a percentage of patients with diagnostic delay (defined as PE diagnosis more than seven days after symptom onset). The secondary outcome was determinants of delay. Random-effect meta-analyses were applied to calculate a pooled estimate for mean delay and to explore heterogeneity in subgroups.</p><p><strong>Results: </strong>The literature search yielded 10,933 studies, of which 24 were included in the final analysis. The pooled estimate of the mean diagnostic delay based on 12 studies was 6.3 days (95% prediction interval 2.5 to 15.8). The percentage of patients having more than seven days of delay varied between 18% and 38%. All studies assessing the determinants of coughing (<i>n</i> = 3), chronic lung disease (<i>n</i> = 6) and heart failure (<i>n</i> = 8) found a positive association with diagnostic delay. Similarly, all studies assessing recent surgery (<i>n</i> = 7) and hypotension (<i>n</i> = 6), as well as most studies assessing chest pain (<i>n</i> = 8), found a negative association with diagnostic delay of PE.</p><p><strong>Conclusion: </strong>Patients may have symptoms for almost one week before PE is diagnosed and in about a quarter of patients, the diagnostic delay is even longer.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40164851","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":"Safety netting advice for respiratory tract infections in out-of-hours primary care: A qualitative analysis of consultation videos.","authors":"Annelies Colliers,&nbsp;Hilde Philips,&nbsp;Katrien Bombeke,&nbsp;Roy Remmen,&nbsp;Samuel Coenen,&nbsp;Sibyl Anthierens","doi":"10.1080/13814788.2022.2064448","DOIUrl":"https://doi.org/10.1080/13814788.2022.2064448","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) use safety netting advice to communicate with patients when and how to seek further help when their condition fails to improve or deteriorate. Although many respiratory tract infections (RTI) during out-of-hours (OOH) care are self-limiting, often antibiotics are prescribed. Providing safety netting advice could enable GPs to safely withhold an antibiotic prescription by dealing both with their uncertainty and the patients' concerns.</p><p><strong>Objectives: </strong>To explore how GPs use safety netting advice during consultations on RTIs in OOH primary care and how this advice is documented in the electronic health record.</p><p><strong>Methods: </strong>We analysed video observations of 77 consultations on RTIs from 19 GPs during OOH care using qualitative framework analysis and reviewed the medical records. Videos were collected from August until November 2018 at the Antwerp city GP cooperative, Belgium.</p><p><strong>Results: </strong>Safety netting advice on alarm symptoms, expected duration of illness and/or how and when to seek help is often lacking or vague. Communication of safety netting elements is scattered throughout the end phase of the consultation. The advice is seldom recorded in the medical health record. GPs give more safety netting advice when prescribing an antibiotic than when they do not prescribe an antibiotic.</p><p><strong>Conclusion: </strong>We provided a better understanding of how safety netting is currently carried out in OOH primary care for RTIs. Safety netting advice during OOH primary care is limited, unspecific and not documented in the medical record.</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/PMC9103350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10248517","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":"Ultrasound in primary care: Consensus recommendations on its applications and training. Results of a 3-round Delphi study.","authors":"Laura Conangla-Ferrin,&nbsp;Pere Guirado-Vila,&nbsp;Mònica Solanes-Cabús,&nbsp;David Teixidó-Gimeno,&nbsp;Lorena Díez-García,&nbsp;Jesus Pujol-Salud,&nbsp;Lidia Evangelista-Robleda,&nbsp;Josefa Bertran-Culla,&nbsp;Yolanda Ortega-Vila,&nbsp;Vicenç Canal-Casals,&nbsp;Antoni Sisó-Almirall","doi":"10.1080/13814788.2022.2150163","DOIUrl":"https://doi.org/10.1080/13814788.2022.2150163","url":null,"abstract":"<p><strong>Background: </strong>The introduction of portable and pocket ultrasound scanners has potentiated the use of ultrasound in primary care, whose many applications have been studied, analyzed and collected in the literature. However, its use is heterogeneous in Europe and there is a lack of guidelines on the necessary training and skills.</p><p><strong>Objectives: </strong>To identify the fundamental applications and indications of ultrasound for family physicians, the necessary knowledge and skills, and the definition of a framework of academic and pragmatic training for the development of these competencies.</p><p><strong>Methods: </strong>A modified 3-round Delphi study was carried out in Catalonia, with the participation of 65 family physicians experts in ultrasound. The study was carried out over six months (from September 2020 to February 2021). The indications of ultrasound for family physicians were agreed (the > = 75th percentile was considered) and prioritised, as was the necessary training plan.</p><p><strong>Results: </strong>The ultrasound applications in primary care were classified into seven main categories. For each application, the main indications (according to reason for consultation) in primary care were specified. A progressive training plan was developed, characterised by five levels of competence: A (principles of ultrasound and management of ultrasound scanners); B (basic normal ultrasound anatomy); C (advanced normal ultrasound anatomy); D (pathologic ultrasound, description of pathological images and diagnostic orientation); E (practical skills under conditions of routine clinical practice).</p><p><strong>Conclusion: </strong>Training family physicians in ultrasound may consider seven main applications and indications. The proposed training plan establishes five different levels of competencies until skill in real clinical practice is achieved.</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/PMC9754009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10711258","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}