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Barriers and facilitators of the reporting by family doctors of cases of domestic violence – a qualitative study across Portugal 家庭医生报告家庭暴力案件的障碍和促进因素--葡萄牙全国定性研究
IF 2.9 3区 医学
BMC Family Practice Pub Date : 2024-04-05 DOI: 10.1186/s12875-024-02329-0
Diana Nadine Moreira, Mariana Pinto da Costa
{"title":"Barriers and facilitators of the reporting by family doctors of cases of domestic violence – a qualitative study across Portugal","authors":"Diana Nadine Moreira, Mariana Pinto da Costa","doi":"10.1186/s12875-024-02329-0","DOIUrl":"https://doi.org/10.1186/s12875-024-02329-0","url":null,"abstract":"Domestic violence (DV) is a serious and prevalent public health problem with devastating consequences for the victims and their families. Whilst the number of cases reported to the authorities has risen in recent years, many victims still chose not to present a complaint. In Portugal, to address this, DV became a public crime. As victims of DV present multiple health problems and frequently seek professional help, family doctors are in a privileged position to detect and report cases of DV to the authorities. However, little is known about what motivates these professionals to report or not the DV cases they encounter in their practice to the authorities. We conducted semi-structured interviews with family doctors from all regional health administrations of continental Portugal. Interviews occurred between July 2020 and September 2022, were conducted in person or remotely, audio recorded, transcribed, and analysed using thematic analysis. Content analysis was conducted to assess the agreement or disagreement regarding mandatory reporting in each of the themes and subthemes. Fifty-four family doctors took part in this study (n = 39 women, n = 15 men). The main themes that arose from the analysis were: “Barriers related to the physician’s activity,” “Barriers related to the victim or aggressor,” “Facilitators related to the physician’s activity,” “Facilitators related to the victim or aggressor.” Although different barriers were described, most doctors agreed with the mandatory reporting of DV cases. Family doctors encounter multiple barriers and facilitators when considering reporting a DV case to the authorities. The results of this study can help develop new interventions to address the barriers described by the doctors, increasing their compliance with mandatory reporting, the protection of victims and the just persecution of the aggressor.","PeriodicalId":9019,"journal":{"name":"BMC Family Practice","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140602844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exploring how people achieve recommended levels of physical activity, despite self-reported economic difficulties: a sense of coherence perspective 探索人们在自述经济困难的情况下如何达到建议的体育锻炼水平:协调感视角
IF 2.9 3区 医学
BMC Family Practice Pub Date : 2024-04-04 DOI: 10.1186/s12875-024-02354-z
Lisbeth M. Johansson, Eleonor I. Fransson, Hans Lingfors, Marie Golsäter
{"title":"Exploring how people achieve recommended levels of physical activity, despite self-reported economic difficulties: a sense of coherence perspective","authors":"Lisbeth M. Johansson, Eleonor I. Fransson, Hans Lingfors, Marie Golsäter","doi":"10.1186/s12875-024-02354-z","DOIUrl":"https://doi.org/10.1186/s12875-024-02354-z","url":null,"abstract":"The salutogenic theory forms the basis for health promotion and describes health as a continuum from a dis-ease pole of health to an ease pole. The core concept for the salutogenic theory is sense of coherence (SOC). For a strong SOC, general resistance resources, such as solid economic situation, are essential. The aim was to explore how people – despite self-reported economic difficulties – comprehend, manage and find it meaningful to achieve the level of physical activity recommended by World Health Organisation (WHO). The study is based on interviews with people achieving the recommended physical activity (PA) level despite economic difficulties. The interviews were conducted at primary health care centres and family centres after a targeted health dialogue. We used a qualitative deductive content analysis based on sense of coherence as the main category, with the three generic categories of comprehensibility, manageability and meaningfulness. The findings elucidate a pattern of a process. In this process, the participants comprehend their knowledge of the health benefits of PA and have a plan for performing their PA. They utilise their resources in order to manage to apply their knowledge and plan for PA in their lives despite their challenges. When PA becomes meaningful to them, they have an intrinsic motivation to perform it and experience its benefits. This study suggests a possible process that might help in achieving the recommended PA level among people with economic difficulties and other challenges. The findings might be used in health promotion work, such as targeted health dialogues in primary health care, to reduce health inequalities when supporting people who are not achieving the recommended levels of PA. Not applicable.","PeriodicalId":9019,"journal":{"name":"BMC Family Practice","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140576148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Low-value chronic prescription of acid reducing medication among Dutch general practitioners: impact of a patient education intervention 荷兰全科医生长期开具的低价值减酸药处方:患者教育干预措施的影响
IF 2.9 3区 医学
BMC Family Practice Pub Date : 2024-04-04 DOI: 10.1186/s12875-024-02351-2
Joris L. J. M. Müskens, Simone A. van Dulmen, Karin Hek, Gert P. Westert, Rudolf B. Kool
{"title":"Low-value chronic prescription of acid reducing medication among Dutch general practitioners: impact of a patient education intervention","authors":"Joris L. J. M. Müskens, Simone A. van Dulmen, Karin Hek, Gert P. Westert, Rudolf B. Kool","doi":"10.1186/s12875-024-02351-2","DOIUrl":"https://doi.org/10.1186/s12875-024-02351-2","url":null,"abstract":"Dyspepsia is a commonly encountered clinical condition in Dutch general practice, which is often treated through the prescription of acid-reducing medication (ARM). However, recent studies indicate that the majority of chronic ARM users lack an indication for their use and that their long-term use is associated with adverse outcomes. We developed a patient-focussed educational intervention aiming to reduce low-value (chronic) use of ARM. We conducted a randomized controlled study, and evaluated its effect on the low-value chronic prescription of ARM using data from a subset (n = 26) of practices from the Nivel Primary Care Database. The intervention involved distributing an educational waiting room posters and flyers informing both patients and general practitioners (GPs) regarding the appropriate indications for prescription of an ARM for dyspepsia, which also referred to an online decision aid. The interventions’ effect was evaluated through calculation of the odds ratio of a patient receiving a low-value chronic ARM prescription over the second half of 2021 and 2022 (i.e. pre-intervention vs. post-intervention). In both the control and intervention groups, the proportion of patients receiving chronic low-value ARM prescriptions slightly increased. In the control group, it decreased from 50.3% in 2021 to 49.7% in 2022, and in the intervention group it increased from 51.3% in 2021 to 53.1% in 2022. Subsequent statistical analysis revealed no significant difference in low-value chronic prescriptions between the control and intervention groups (Odds ratio: 1.11 [0.84–1.47], p > 0.05). Our educational intervention did not result in a change in the low-value chronic prescription of ARM; approximately half of the patients of the intervention and control still received low-value chronic ARM prescriptions. The absence of effect might be explained by selection bias of participating practices, awareness on the topic of chronic AMR prescriptions and the relative low proportion of low-value chronic ARM prescribing in the intervention as well as the control group compared to an assessment conducted two years prior. 10/31/2023 NCT06108817.","PeriodicalId":9019,"journal":{"name":"BMC Family Practice","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140576080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outreach work in Belgian primary care practices during COVID-19: results from the cross-sectional PRICOV-19 study COVID-19 期间比利时初级保健实践中的外联工作:PRICOV-19 横向研究的结果
IF 2.9 3区 医学
BMC Family Practice Pub Date : 2024-04-03 DOI: 10.1186/s12875-024-02323-6
Dorien Vanden Bossche, Esther Van Poel, Pierre Vanden Bussche, Benoit Petré, Cécile Ponsar, Peter Decat, Sara Willems
{"title":"Outreach work in Belgian primary care practices during COVID-19: results from the cross-sectional PRICOV-19 study","authors":"Dorien Vanden Bossche, Esther Van Poel, Pierre Vanden Bussche, Benoit Petré, Cécile Ponsar, Peter Decat, Sara Willems","doi":"10.1186/s12875-024-02323-6","DOIUrl":"https://doi.org/10.1186/s12875-024-02323-6","url":null,"abstract":"General practitioners (GPs) have a vital role in reaching out to vulnerable populations during and after the COVID-19 pandemic. Nonetheless, they experience many challenges to fulfill this role. This study aimed to examine associations between practice characteristics, patient population characteristics and the extent of deprivation of practice area on the one hand, and the level of outreach work performed by primary care practices (PCPs) during the COVID-19 pandemic on the other hand. Belgian data from the international PRICOV-19 study were analyzed. Data were collected between December 2020 and August 2021 using an online survey in PCPs. Practices were recruited through randomized and convenience sampling. Descriptive statistics and ordinal logistic regression analyses were performed. Four survey questions related to outreach work constitute the outcome variable. The adjusted models included four practice characteristics (practice type, being a teaching practice for GP trainees; the presence of a nurse or a nurse assistant and the presence of a social worker or health promotor), two patient population characteristics (social vulnerability and medical complexity) and an area deprivation index. Data from 462 respondents were included. First, the factors significantly associated with outreach work in PCPs are the type of PCP (with GPs working in a group performing more outreach work), and the presence of a nurse (assistant), social worker or health promotor. Second, the extent of outreach work done by a PCP is significantly associated with the social vulnerability of the practice’s patient population. This social vulnerability factor, affecting outreach work, differed with the level of medical complexity of the practice’s patient population and with the level of deprivation of the municipality where the practice is situated. In this study, outreach work in PCPs during the COVID-19 pandemic is facilitated by the group-type cooperation of GPs and by the support of at least one staff member of the disciplines of nursing, social work, or health promotion. These findings suggest that improving the effectiveness of outreach efforts in PCPs requires addressing organizational factors at the practice level. This applies in particular to PCPs having a more socially vulnerable patient population.","PeriodicalId":9019,"journal":{"name":"BMC Family Practice","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140576033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Classification system for primary care provider eConsults about medications for older adults with frailty 初级保健提供者关于体弱老年人用药的电子咨询分类系统
IF 2.9 3区 医学
BMC Family Practice Pub Date : 2024-04-02 DOI: 10.1186/s12875-024-02340-5
T Schneider, B Farrell, S Karunananthan, A Afkham, E Keely, C Liddy, L. M. McCarthy
{"title":"Classification system for primary care provider eConsults about medications for older adults with frailty","authors":"T Schneider, B Farrell, S Karunananthan, A Afkham, E Keely, C Liddy, L. M. McCarthy","doi":"10.1186/s12875-024-02340-5","DOIUrl":"https://doi.org/10.1186/s12875-024-02340-5","url":null,"abstract":"Providing primary care for people with frailty can be challenging due to an increased risk of adverse outcomes and use of potentially inappropriate medications which may exacerbate characteristics of frailty. eConsult is a service where primary care providers can receive timely specialist advice for their patients through a secure web-based application. We aimed to develop a classification system to characterize medication-focused eConsult questions for older adults with frailty and assess its usability. A classification system was developed and refined over three cycles of improvement through a cross-sectional study of 35 cases categorized as medication-focused from cases submitted in 2019 for patients aged 65 or older with frailty through the Champlain BASE eConsult service (Ontario, Canada). The final classification system was then applied to each case. The classification system contains 5 sections: (1) case descriptives; (2) intent and type of question; (3) medication recommendations and additional information in the response; (4) medication classification; and (5) potentially inappropriate medications. Among the 35 medication-focused cases, the most common specialties consulted were endocrinology (9 cases, 26%) and cardiology (5 cases, 14%). Medication histories were available for 29 cases (83%). Many patients were prescribed potentially inappropriate medications based on explicit tools (AGS Beers Criteria®, STOPPFall, Anticholinergic Cognitive Burden Scale, ThinkCascades) yet few consults inquired about these medications. A classification system to describe medication-related eConsult cases for patients experiencing frailty was developed and applied to 35 eConsult cases. It can be applied to more cases to identify professional development opportunities and enhancements for eConsult services.","PeriodicalId":9019,"journal":{"name":"BMC Family Practice","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140576030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Training Australian general practitioners to counsel women experiencing intimate partner abuse (WEAVE): a pre-post training analysis 培训澳大利亚全科医生为遭受亲密伴侣虐待的妇女提供咨询(WEAVE):培训前后分析
IF 2.9 3区 医学
BMC Family Practice Pub Date : 2024-03-20 DOI: 10.1186/s12875-024-02337-0
Felicity Young, Mohajer Hameed, Leesa Hooker, Angela Taft, Kelsey Hegarty
{"title":"Training Australian general practitioners to counsel women experiencing intimate partner abuse (WEAVE): a pre-post training analysis","authors":"Felicity Young, Mohajer Hameed, Leesa Hooker, Angela Taft, Kelsey Hegarty","doi":"10.1186/s12875-024-02337-0","DOIUrl":"https://doi.org/10.1186/s12875-024-02337-0","url":null,"abstract":"Evaluations of Intimate Partner Abuse training for general practitioners is limited. The Women’s Evaluation of Abuse and Violence Care study trialled in Australia was a primary care intervention that included delivering the Health Relationships training, a program that educates practitioners on how to provide supportive counselling and assistance to women afraid of an intimate partner. We report on effectiveness of the Healthy Relationships training program within a cluster-randomised controlled trial. General practitioners filled out a baseline survey and surveys before and after training, including quantitative and open-text questions on barriers and enablers to supporting victim-survivors. The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool, a validated measure, was included to assess practitioner knowledge, skills, confidence, and attitudes. General linear model repeated analysis of variance tested the difference between trial groups over time. Fifty-two general practitioners completed the baseline demographic survey, with 65% (19 intervention, 18 comparison) completing both pre-and-post-training surveys. There were no between-group differences in baseline characteristics. Post-training, the intervention group had significantly higher average scores than the comparison on perceived preparation to address abuse (p = .000), perceived knowledge (p = .000), actual knowledge (p = .03), and greater awareness of practice-related issues (p = .000). There were no between-group differences in PREMIS opinion domain scores on workplace issues, self-efficacy and understanding of victims. Post-training, the qualitative data indicated that the intervention practitioners (n = 24) reported increased knowledge, awareness, and confidence, while time pressures and lack of referral options impeded addressing abuse. The Healthy Relationships Training program for general practitioners increased aspects of practitioner knowledge, skills, and confidence. However, more support is needed to change opinions and support victim-survivors sustainably. The WEAVE trial was registered on 21/01/2008 with the Australian New Zealand Clinical Trial Registry, number ACTRN12608000032358.","PeriodicalId":9019,"journal":{"name":"BMC Family Practice","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140170837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Attitudes and knowledge about weight management among primary care physicians in Israel: a cross-sectional study 以色列初级保健医生对体重管理的态度和知识:一项横断面研究
IF 2.9 3区 医学
BMC Family Practice Pub Date : 2024-03-19 DOI: 10.1186/s12875-024-02324-5
Keren Or Unger Freinkel, Ilan Yehoshua, Bar Cohen, Roni Peleg, Limor Adler
{"title":"Attitudes and knowledge about weight management among primary care physicians in Israel: a cross-sectional study","authors":"Keren Or Unger Freinkel, Ilan Yehoshua, Bar Cohen, Roni Peleg, Limor Adler","doi":"10.1186/s12875-024-02324-5","DOIUrl":"https://doi.org/10.1186/s12875-024-02324-5","url":null,"abstract":"The prevalence of obesity has been increasing worldwide and is associated with increased risk of morbidity and mortality. Weight management can reduce the risk of complications and improve the quality of life of patients with obesity. This study explored primary care physicians’ (PCPs’) attitudes and knowledge about weight management. An anonymous questionnaire was distributed to 400 PCPs between 2020 and 2021. The survey included questions on treatment approaches (pharmaceutical and surgical) and items regarding the respondents’ demographic characteristics. We compared PCPs with low or high proactivity toward weight management. We explored attitudes and knowledge with the chi-square test for categorical variables or the Mann-Whitney test for continuous variables. A total of 145 PCPs answered our survey (a response rate of 36.25%). More than half (53.8%) of the respondents showed low proactivity toward weight management in their practice. Proactive respondents were more likely to believe that pharmaceutical treatment effectively reduces weight and offered medical and surgical treatment options more frequently to their patients. Lack of knowledge was the most predominant reason for PCPs avoiding offering treatment to their patients, especially in less proactive PCPs (33.3% vs. 5.3%, p-value < 0.001). When comparing different pharmaceutical options, 46.6% of PCPs report they tend to prescribe liraglutide to their patients compared with only 11% who prescribe orlistat and 10.3% who prescribe phentermine (p-value < 0.001). Many PCPs still do not actively provide obesity treatment despite improved awareness and therapeutic options. PCPs’ proactivity and attitudes are vital to this effort.","PeriodicalId":9019,"journal":{"name":"BMC Family Practice","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140171195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How useful do communities find the health and wellness centres? A qualitative assessment of India’s new policy for primary health care 社区认为保健和健康中心有多大用处?对印度初级保健新政策的定性评估
IF 2.9 3区 医学
BMC Family Practice Pub Date : 2024-03-19 DOI: 10.1186/s12875-024-02343-2
Shriyuta Abhishek, Samir Garg, Vikash Ranjan Keshri
{"title":"How useful do communities find the health and wellness centres? A qualitative assessment of India’s new policy for primary health care","authors":"Shriyuta Abhishek, Samir Garg, Vikash Ranjan Keshri","doi":"10.1186/s12875-024-02343-2","DOIUrl":"https://doi.org/10.1186/s12875-024-02343-2","url":null,"abstract":"The policy attention to primary health care has seen a global upswing in recent years, including in India. Earlier assessments had shown that a very small proportion of Indian population used the government primary health facilities. Starting in 2018, Indian government has established more than 100,000 Health and Wellness Centres (HWCs) to increase rural population’s access to primary health care. It is crucial to know how useful people find the services of HWCs. A qualitative inquiry was made to understand the perceptions, experiences and expectations of the rural communities regarding HWCs in Chhattisgarh state. Fourteen focus group discussions were conducted with community members. The study areas were chosen to include both the central and remote districts of the state. The study used accessibility, availability, acceptability and quality (AAAQ) framework to assess HWCs. Community members felt that the most important change brought about by HWCs was to offer a wider range of curative services than previously available. Services for noncommunicable diseases such as hypertension and diabetes were seen as a key value addition of HWCs. People felt improvements in services for acute ailments also. The services people found missing in HWCs were for injuries, dental care and mental health. In people’s experience, the availability of essential medicines and point-of-care tests at HWCs was satisfactory and the treatment was effective. People appreciated the supportive behaviour of health workers in HWCs. They did not find the referrals from HWCs as excessive but often faced difficulties in receiving necessary services at higher facilities. The assessment based on community perceptions showed that the services of HWCs matched well with people’s needs of curative primary care. It shows that people are willing to use the government facilities for primary health care if the services are relevant, adequately functional and accessible.","PeriodicalId":9019,"journal":{"name":"BMC Family Practice","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140170706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
European expert consensus recommendations on the primary care use of direct oral anticoagulants in patients with venous thromboembolism 欧洲专家就静脉血栓栓塞症患者使用直接口服抗凝剂的初级保健共识建议
IF 2.9 3区 医学
BMC Family Practice Pub Date : 2024-03-18 DOI: 10.1186/s12875-024-02314-7
Carter Patrice, Fuat Ahmet, Haas Sylvia, Smyth Elizabeth, Brotons Carlos, Cools Frank, Bauersachs Rupert, Hobbs F. D. Richard
{"title":"European expert consensus recommendations on the primary care use of direct oral anticoagulants in patients with venous thromboembolism","authors":"Carter Patrice, Fuat Ahmet, Haas Sylvia, Smyth Elizabeth, Brotons Carlos, Cools Frank, Bauersachs Rupert, Hobbs F. D. Richard","doi":"10.1186/s12875-024-02314-7","DOIUrl":"https://doi.org/10.1186/s12875-024-02314-7","url":null,"abstract":"Direct oral anticoagulants for the treatment of venous thromboembolism are supported by robust clinical trial evidence. Despite published guidance, general practitioners are faced with increasingly complex decisions and implementation remains sub-optimal in certain real-world scenarios. A two stage formal consensus exercise was performed to formulate consensus statements and a summary guide, facilitating optimal management of direct oral anticoagulants in venous thromboembolism patients by generalist physicians across Europe. An online questionnaire distributed to a broad panel (Phase 1), followed by a virtual panel discussion by an expert group (Phase 2) were conducted. Phase 1 statements covered nine management domains, and were developed via a literature review and expert steering committee. Participants rated statements by their level of agreement. Phase 1 responses were collated and analysed prior to discussion and iterative refinement in Phase 2. In total 56 participants from across Europe responded to Phase 1. The majority had experience working as general practitioners. Consensus indicated that direct oral anticoagulants are the treatment of choice for managing patients with venous thromboembolism, at initiation and for extended treatment, with a review at three to six months to re-assess treatment effect and risk profile. Direct oral anticoagulant choice should be based on individual patient factors and include shared treatment choice between clinicians and patients; the only sub-group of patients requiring specific guidance are those with cancer. Results demonstrate an appreciation of best practices, but highlight challenges in clinical practice. The patient pathway and consensus recommendations provided, aim to highlight key considerations for general practice decision making, and aid optimal venous thromboembolism treatment.","PeriodicalId":9019,"journal":{"name":"BMC Family Practice","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140147038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Development of the national consensus statement on ear health and hearing check recommendations for Aboriginal and Torres Strait Islander children aged under 6 years attending primary care: systematic scoping review and e-Delphi 为接受初级保健服务的 6 岁以下土著居民和托雷斯海峡岛民儿童制定关于耳部健康和听力检查建议的国家共识声明:系统范围界定审查和电子德尔菲法
IF 2.9 3区 医学
BMC Family Practice Pub Date : 2024-03-14 DOI: 10.1186/s12875-024-02307-6
Samantha Harkus, Vivienne Marnane, Isabel O’Keeffe, Carmen Kung, Meagan Ward, Neil Orr, John Skinner, Jessica Kate Hughes, Lose Fonua (Wiradjuri), Michelle Kennedy (Wiradjuri), Kelvin Kong (Worimi), Mary Belfrage
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