European Journal of General Practice最新文献

Background: Germany is challenged by an increasing shortage in general practice services, especially in non-urban areas. Task shifting from general practitioners (GPs) to other health professionals may improve practice efficiency to address this mismatch.

Objectives: Exploring GPs' motives and beliefs towards task shifting in non-urban Germany and identifying potential factors influencing these.

Methods: The cross-sectional survey was disseminated by mail in three waves between July 2021 and August 2022 among all GPs in non-urban Baden-Wuerttemberg, Germany. It included items on demographics and practice characteristics as well as 15 Likert-scale items addressing motives and beliefs towards task shifting, based on the Theoretical Domain Framework. Likert-scale items were analysed descriptively, influencing factors on motives and beliefs were identified using multiple linear regression.

Results: Response rate was 24.2% (281/1162), with respondents comparable in age and gender to all GPs in Baden-Wuerttemberg. GPs' motives and beliefs towards task shifting are positive overall. The majority expects task shifting to reduce their workload (87.9%) and increase practice efficiency (74.7%). They are open to shift additional tasks to other professionals (69.1%), even in the currently prohibited form of substitution (51.2%). Motives and beliefs were significantly more positive among younger GPs and those participating in the GP-centred care programme.

Conclusion: This study describes GPs' motives and beliefs towards task shifting in non-urban Germany. Identifying younger GPs and those participating in the GP-centred care programme as particularly endorsing may help design future interventions aiming to improve efficiency in general practice in non-urban Germany.

Background: Male urinary tract infections (mUTIs) are rare in primary care. The definition of mUTIs varies across countries. The therapeutic management of mUTIs in France is based on a 14-day course of fluoroquinolones despite a high risk of antimicrobial resistance.

Objectives: The objective of this qualitative study was to explore general practitioners' (GPs) experiences and behaviours regarding the diagnostic and therapeutic management of mUTIs.

Methods: GPs were recruited by convenience sampling in Haute Normandie (France) and interviewed individually with semi-structured guides. GPs' experiences and behaviours were recorded and analysed using an interpretive phenomenological approach.

Results: From March 2021 to May 2022, 20 GPs were included in the study. Defining a mUTI was perceived as a diagnostic challenge. A diagnosis based on clinical evidence alone was insufficient and complementary tests were required. For GPs: 'male cystitis does not exist'. A mUTI was considered an unusual disease that could reveal an underlying condition. GPs considered fluoroquinolones to be 'potent' antibiotics and treated all patients with the same 14-day course. GPs implemented improvement strategies for antibiotic stewardship and followed the guidelines using a computerised decision support system.

Conclusions: GPs' experiences of mUTIs are limited due to low exposure and variable clinical presentations in primary care, representing a diagnostic and therapeutic challenge. In order to modify GPs' antibiotic prescribing behaviours, a paradigm shift in the guidelines will need to be proposed.KEY MESSAGESDefining a male urinary tract infection represents a diagnostic challenge for GPs.A diagnosis based on clinical evidence alone is insufficient and complementary tests are required.A male urinary tract infection is an unusual disease in primary care and suggests a more serious underlying condition.

Background: Worldwide, there are concerns about declining mental health of children and young people (CYP).

Objectives: To examine trends in GP consultation rates for psychosocial problems and the impact of the COVID-19 pandemic.

Methods: We performed a population-based cohort study using electronic GP records of CYP (0-24 years) living in the Rotterdam metropolitan area between 2016 and 2021. We calculated monthly consultation rates for psychosocial problems, stratified by age group and sex. We used negative binomial models to model the pre-COVID-19 trend, and estimate expected rates post-COVID-19 onset. We modelled the effect of COVID-19 infection rate and school closure on consultation rates per sex and age group.

Results: The cohort increased from 64801 to 92093 CYP between January 2016 and December 2021. Median age was 12.5 years and 49.3% was female. Monthly consultation rates increased from 2,443 to 4,542 consultations per 100,000 patient months over the six years. This trend (RR 1.009, 95%CI 1.008-1.011) started well before the COVID-19 pandemic. Consultation rates of adolescent girls and young women increased most strongly. Between March and May 2020, there was a temporary reduction in consultation rates, whereupon these returned to expected levels. COVID-19 infection rate and school closures showed small but significant associations with consultation rates for psychosocial problems but this did not affect the overall trend. Although consultation rates for psychosocial problems increased, this increment was stable over the entire study period.

Conclusion: The COVID-19 pandemic did not significantly increase consultation rates for psychosocial problems in CYP. The consultation rates increased, especially in adolescent girls and young women.

Background: The COVID-19 vaccination campaign in several European countries involved collaboration between public health and Primary Health Care (PHC).

Objective: To highlight the role of PHC professionals in the COVID-19 vaccination rollout, specifically in terms of vaccine administration, communication and contributing to vaccination population coverage.

Methods: A descriptive retrospective study of the COVID-19 vaccination campaign across 28 European countries was conducted, covering data from December 2020 to November 2021. Data were collected by key informants recruited from each country, who were health professionals involved in their national vaccination campaigns. Utilising an ad-hoc semi-structured questionnaire, information was gathered on organisation, communication strategies, priority groups, vaccine types, and vaccination pathways in PHC.

Results: PHC participated in communication strategies in 10 out of 28 countries, and vaccination was voluntary in most of them. The priority groups for vaccination varied across Europe, and the availability of vaccines in PHC differed between countries within the European Union (EU) and non-EU countries. The BioNTech Pfizer vaccine was the most widely available vaccine in most countries, followed by Moderna and AstraZeneca. PHC administered COVID-19 vaccines to the population, being the nurses the most involved, followed by general practitioners. Vaccination appointments were available online in 18/28 or by phone in 15/28, direct appointments at health centres were available in 8/28. In several countries, healthcare professionals who administered vaccines were given extra compensation for their role.

Conclusion: PHC professionals played a crucial role in the successful distribution and administration of COVID-19 vaccines in European countries.

Background: General practitioners (GPs) could play an important role in the management of overweight and obesity in children. However, GPs experience different barriers and are in need of supportive tools. In order to support GPs to identify, address and refer these children, new tools should be developed.

Objective: To establish consensus among GPs about the content topics of a supportive tool to identify, address and refer children with overweight and obesity in general practice.

Methods: A two-round Delphi study was conducted with GPs identified as experts. A concept of a supportive tool was constructed based on focus-group interviews with GPs, practice nurses and parents of children with and without overweight and literature. The tool was categorised into five topics: identifying, initiating and continuing weight-related conversations, referring and evaluating a tool manual. GPs evaluated statements on the tool's topics in terms of importance. All statements were rated on a 5-point Likert scale and consensus was set at ≥70% of respondents agreeing with the statements.

Results: GPs agreed that a supportive tool must contain a child's specialised BMI calculator; examples to initiate and to continue weight-related conversations with parents and children; a map with available interventions; and a manual including information and resources about health risks of overweight and obesity during childhood.

Conclusion: The content topics of a supportive tool for GPs to identify, discuss and refer children with overweight and obesity were determined through a consensus-driven process. Further validation and assessment are required through a feasibility and implementation study.

Background: The strict isolation measures for the population imposed by the health authorities caused a prolonged disruption of informal social support networks. Both this new social situation and the decrease in accessibility to health care have generated new needs in people with severe mental illness (SMI) and their caregivers.

Objectives: This study provides insight into life experiences and health needs of a population with SMI during the first year of the COVID-19 pandemic in Spain.

Methods: Qualitative design using semi-structured dyadic interviews, conducted from January through December 2022. A purposive sampling of patients with SMI and their caregivers was carried out through key informants in rural and urban localities in southern Spain. Verbatims were identified and classified by triangulation after the evaluation of the interview transcripts. The codes were defined through content analysis using the NVivo software.

Results: Semi-structured dyadic interviews (21), identifying three main categories: 1. Social isolation: increased, causing greater personal vulnerability, exacerbation of psychiatric symptoms and exhaustion in caregivers. 2. Accessibility to Health Services: decreased with fewer face-to-face consultations, with difficulty in managing urgent situations and telephone attention in decompensated and disabled patients. 3. Continuity of healthcare: decreased with distrust in health professionals due to lack of communication between primary care and the hospital.

Conclusion: COVID-19 confinement exacerbated loneliness and worse health self-perception in SMI people. Greater formal social support was required. GPs role is key to avoiding delays in appointments and lack of coordination between primary and specialised care.

Public engagement in health research is vital for addressing health disparities and promoting inclusivity among minoritised communities who often face barriers to accessing healthcare. Minoritised communities are groups, which have been made minorities by a dominant culture, race, ethnic group and/or social class and may experience health inequalities as a result. By incorporating diverse perspectives and lived experiences of minoritised communities, this approach aims to achieve contextually relevant research outcomes that reduce health inequalities and improve overall well-being. However, underrepresentation and lack of inclusivity challenges persist, necessitating the establishment of inclusive partnerships and grassroots participatory methodologies.

To foster inclusive public engagement, it is important to overcome structural and cultural barriers, address socioeconomic challenges, and build trust with minoritised communities. This can be achieved by promoting a cultural shift that values inclusivity, providing comprehensive training to researchers, and collecting rigorous data on engagement demographics for transparency and accountability. Involving minoritised communities in decision-making through participatory research approaches enhances trust and yields successful outcomes. Additionally, allocating sufficient resources, collaborating in co-production, and prioritising the diverse needs and perspectives of stakeholders contribute to fostering inclusive public engagement in research.

Overall, inclusive engagement practices particularly in primary care research have the potential to reduce health inequalities and cater to the unique requirements of minoritised communities, thereby creating more impactful outcomes and promoting equitable healthcare access.

Background: Social prescribing (SP) is a patient pathway by which healthcare professionals connect patients with other sources of support, groups, or activities within their community. The awareness, practice, and perception of SP among GPs across Europe remains unclear.

Objectives: To explore the awareness, practice, and perception of GPs on SP in the WONCA Europe region.

Methods: An anonymous, cross-sectional online survey was distributed through a snowballing system, mailing lists, and at three international conferences in 2022/2023 to explore GPs' awareness, practice, and perception of SP. The questionnaire in English contained 21 open and closed questions.

Results: Of the 208 participating GPs from 33 countries, 116 (56%) previously heard of 'social prescribing' and 66 (32%) regularly referred patients to community activities through a formal system. These 66 GPs reported different funding sources and varied activities, with an average of four activities and physical exercise being the most prevalent. Among them, 25 (38%) knew about national or local SP awareness campaigns. Of these 25, 17 (68%) agreed that SP increases their job satisfaction and 21 (84%) agreed that it has a positive impact on their patients. Variations in SP awareness and referral practice were evident across and within countries.

Conclusion: Despite disparities in awareness and referral practice as well as a diversity of activities and funding sources, most GPs who actively referred patients and were informed about SP campaigns agreed that SP positively impacts them and their patients.

Background: As researchers in primary care, we want to drive change in practice and conduct research that sparks meaningful transformation. These changes can only happen if our research work resonates in a meaningful way with the people who they are designed for, i.e. the healthcare professionals and the patients.

Viewpoint: This viewpoint stems from first-hand insights gained as a social scientist engaged in trials and primary care research amidst epidemics and pandemics. Some examples stemming from the EU Funded GRACE INTRO, RECOVER and Prudence trial illustrate these experiences. I outline how primary care can effectively address the pressing challenges it encounters, whether as researchers, members of the public, or healthcare professionals, and how to integrate successfully social sciences within clinical primary care research.

Conclusion: As interdisciplinary researchers, social scientists and medical researchers can work together under certain conditions, i.e. equal status, adequate resources, and seamless integration within trial structures.