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Management and characteristics of patients suffering from Clostridiodes difficile infection in primary care. 初级保健中艰难梭菌感染患者的管理和特点。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-12-01 DOI: 10.1080/13814788.2021.1998447
Maria Klezovich-Bénard, Frédérique Bouchand, Elisabeth Rouveix, Pierre L Goossens, Benjamin Davido

Background: Clostridioides difficile 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.

Objectives: To characterise patients suffering from CDI, managed in primary care and describe their clinical outcomes.

Methods: 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.

Results: Participation rate was 8.6% (n = 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 (p = 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) (p = 0.03). Cooperation with hospital specialists was reported in 28% of the recovery group versus 87.5% of the recurrent group (p = 0.0003). Overall, GPs managed successfully 82.9% of cases without need of hospital admission.

Conclusion: 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.

背景:艰难梭菌感染(CDI)正在上升,并且由于住院时间延长,检查和药物治疗增加了患者的医疗费用。法国初级保健对CDI的管理报道很少。目的:描述在初级保健中管理的CDI患者的特征,并描述他们的临床结果。方法:基于2018年9月至2019年4月在法国随机抽取的500名全科医生(gp)的调查数据进行回顾性观察研究。全科医生被要求为每个报告的CDI患者完成一份多项选择问卷。根据临床特点分析疗效。根据治疗结果进行比较:恢复或复发感染。结果:参与率为8.6% (n = 43/500),问卷不完整2份。分析了41例实际诊断为CDI的患者的数据。经确诊的CDI患者中有61%的患者康复。在康复组中,这完全是一次原发性发作,大多数患者(72%)没有合并症,明显比复发患者年轻(p = 0.02), 92%的患者口服甲硝唑治疗成功。恢复组开始抗菌药物治疗后腹泻持续时间显著缩短(≤48 h) (p = 0.03)。28%的康复组与87.5%的复发组合作(p = 0.0003)。总体而言,全科医生成功管理了82.9%无需住院的病例。结论:全科医生口服甲硝唑可为轻度原发性CDI患者提供相应的门诊护理。尽管服用了适当的抗梭状芽孢杆菌治疗方案,但持续腹泻应被解释为复发的早期预测因子。
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引用次数: 0
To prevent being stressed-out: Allostatic overload and resilience of general practitioners in the era of COVID-19. A cross-sectional observational study. 防止压力过大:2019冠状病毒病时代全科医生的适应负荷和复原力横断面观察研究。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-12-01 DOI: 10.1080/13814788.2021.1982889
Dóra Békési, Illés Teker, Péter Torzsa, László Kalabay, Sándor Rózsa, Ajándék Eőry

Background: 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.

Objectives: 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.

Methods: 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.

Results: 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, p = 0.032) and other life stresses (OR: 1.4; CI: 1.2; 1.6, p < 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, p = 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.

Conclusion: 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.

背景:全科医生在提供安全有效护理方面的责任始终很高,但在2019冠状病毒病大流行期间,他们面临的压力甚至越来越大,可能导致无法承受的压力负荷(适应超负荷,AO),从而导致疾病。目的:我们旨在测量匈牙利全科医生在COVID-19大流行期间的AO,并探索他们的娱乐资源,以确定对应激负荷的潜在保护因素。方法:采用混合方法设计,将Fava的AO临床计量方法与社会心理指数(PSI)一起应用;用Kellner症状问卷(SQ)测量抑郁、焦虑、敌意和躯体化,用公共卫生监测幸福感量表(PHS-WB)测定心理、社会和身体幸福感。绘制了娱乐资源地图。除卡方检验和Kruskal-Wallis检验外,还采用回归分析确定AO的解释变量。结果:对228例全科医生(女性68%)的资料进行分析。在60%的样本中,与工作相关的变化是导致AO的最大挑战。而女性(OR: 1.99;CI: 1.06;3.74, p = 0.032)和其他生活压力(OR: 1.4;CI: 1.2;1.6, p p = 0.020)。每周保证有3-4天的时间用于娱乐,与精神和身体健康有关,而5-7天的时间与较低的抑郁和焦虑症状、躯体化和敌意有关。结论:在不断变化的环境下,应重视通过增加娱乐时间来提高心理弹性,以防止全科医生受到压力负荷的不良健康后果。
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引用次数: 5
Task shifting in primary care to tackle healthcare worker shortages: An umbrella review. 解决医护人员短缺问题的基层医疗任务转移:综述。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-12-01 DOI: 10.1080/13814788.2021.1954616
Siew Lian Leong, Siew Li Teoh, Weng Hong Fun, Shaun Wen Huey Lee

Background: Task shifting is an approach to help address the shortage of healthcare workers through reallocating human resources but its impact on primary care is unclear.

Objectives: To provide an overview of reviews describing task shifts from physicians to allied healthcare workers in primary care and its impact on clinical outcomes.

Methods: Six electronic databases were searched up to 15 December 2020, to identify reviews describing task shifting in primary care. Two reviewers independently screened the references for relevant studies, extracted the data and assessed the methodological quality of included reviews using AMSTAR-2.

Results: Twenty-one reviews that described task shifting in primary care were included. Task shifted include provision of care for people with chronic conditions, medication prescribing, and health education. We found that task shifting could potentially improve several health outcomes such as blood pressure, HbA1c, and mental health while achieving cost savings. Key elements for successful implementation of task shifting include collaboration among all parties, a system for coordinated care, provider empowerment, patient preference, shared decision making, training and competency, supportive organisation system, clear process outcome, and financing.

Conclusion: Evidence suggests that allied healthcare workers such as pharmacists and nurses can potentially undertake substantially expanded roles to support physicians in primary care in response to the changing health service demand. Tasks include providing care to patients, independent prescribing, counselling and education, with comparable quality of care.

背景:任务转移是一种通过重新分配人力资源来帮助解决医护人员短缺问题的方法,但其对初级医疗的影响尚不明确:综述初级医疗中从医生到专职医疗工作者的任务转移及其对临床结果的影响:方法:检索了截至 2020 年 12 月 15 日的六个电子数据库,以确定描述初级医疗中任务转移的综述。两名审稿人独立筛选了相关研究的参考文献,提取了数据,并使用 AMSTAR-2 评估了纳入综述的方法学质量:结果:共纳入了 21 篇描述初级护理中任务转移的综述。任务转移包括为慢性病患者提供护理、开药和健康教育。我们发现,任务转移有可能改善血压、HbA1c 和心理健康等多项健康结果,同时节约成本。成功实施任务转移的关键因素包括各方合作、协调护理系统、提供者授权、患者偏好、共同决策、培训和能力、支持性组织系统、明确的过程结果和融资:有证据表明,药剂师和护士等专职医疗保健工作者有可能在初级医疗保健中发挥更大的作用,为医生提供支持,以应对不断变化的医疗服务需求。其任务包括为病人提供护理、独立开处方、咨询和教育,并提供质量相当的护理。
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引用次数: 0
Insight in the diagnosis and treatment of coeliac disease in general practice: A survey and case vignette study among 106 general practitioners. 全科医生诊断和治疗乳糜泻的洞察力:对106名全科医生的调查和病例研究。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-12-01 DOI: 10.1080/13814788.2021.1985455
Maxine D Rouvroye, Pauline Slottje, Tom van Gils, Chris J Mulder, Jean W Muris, Dick Walstock, Marcel Reinders, Gerd Bouma

Background: Coeliac disease (CD) is a highly prevalent (∼1%) disease that allegedly remains undiagnosed in over 80% of the cases because of atypical symptoms or silent disease. Currently, it is unknown how GPs deal with (suspected) CD.

Objectives: This study aimed to better understand the diagnostic approach and the clinical reasoning process of GPs concerning CD and concurrently address diagnostic pitfalls.

Methods: A questionnaire with case vignettes to assess the knowledge, diagnostic reasoning pattern and practice for CD by GPs was developed. It was sent through academic GP research networks (encompassing over 1500 GPs) in two large cities and to smaller practices in rural areas. The questionnaire was composed of seven background questions, 13 questions related to four case vignettes and six additional CD-related questions.

Results: Responses were received from 106 GPs. Knowledge on risk factors for CD and appropriate testing of at-risk populations was limited. Twenty-two percent would diagnose CD in adults exclusively based on serology, without histopathological confirmation. In total, 99% would refer a newly diagnosed patient to a dietitian to initiate a gluten-free diet (GFD). In the absence of symptoms, only 33% would initiate a GFD.

Conclusion: The results of this study have given us insight into the diagnostic process of GPs encountering patient with gluten-related complaints. Multiple serology test is available and used, while a positive serology test is not always followed up by a gastroduodenal biopsy to confirm the diagnosis. Most GPs would refer a symptomatic CD patient to a dietician for a GFD.

背景:乳糜泻(CD)是一种非常普遍(约1%)的疾病,据称在80%以上的病例中由于症状不典型或无症状而未被诊断。目前,全科医生如何处理(疑似)CD尚不清楚。目的:本研究旨在更好地了解全科医生对CD的诊断方法和临床推理过程,同时解决诊断缺陷。方法:采用问卷调查法,对全科医生对乳糜泻的认识、诊断推理模式和实践情况进行评估。它通过两个大城市的全科医生学术研究网络(包括1500多名全科医生)和农村地区较小的诊所发送。问卷由7个背景问题、13个与4个案例相关的问题和6个与cd相关的附加问题组成。结果:共收到106名gp的回复。对乳糜泻危险因素的了解和对高危人群的适当检测是有限的。22%的人只会根据血清学诊断成人乳糜泻,而不需要组织病理学证实。总的来说,99%的人会将新诊断的病人推荐给营养师,开始无麸质饮食(GFD)。在没有症状的情况下,只有33%的人会启动GFD。结论:本研究的结果让我们了解了全科医生遇到麸质相关疾病患者的诊断过程。多种血清学检查是可用和使用的,而阳性血清学检查并不总是随后进行胃十二指肠活检以确认诊断。大多数全科医生会将有症状的乳糜泻患者转介给营养师,让他们做GFD。
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引用次数: 1
Non-random relations in drug use expressed as patterns comprising prescription and over-the-counter drugs in multimorbid elderly patients in primary care: Data of the exploratory analysis of the multicentre, observational cohort study MultiCare. 初级保健中多病老年患者处方药和非处方药使用模式的非随机关系:多中心观察性队列研究MultiCare的探索性分析数据
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-12-01 DOI: 10.1080/13814788.2021.1933425
Caroline Krüger, Ingmar Schäfer, Hendrik van den Bussche, Michael Baehr, Horst Bickel, Angela Fuchs, Jochen Gensichen, Wolfgang Maier, Steffi G Riedel-Heller, Hans-Helmut König, Anne Dahlhaus, Gerhard Schön, Siegfried Weyerer, Birgitt Wiese, Wolfgang von Renteln-Kruse, Claudia Langebrake, Martin Scherer

Background: The elderly population deals with multimorbidity (three chronic conditions) and increasinged drug use with age. A comprehensive characterisation of the medication - including prescription and over-the-counter (OTC) drugs - of elderly patients in primary care is still insufficient.

Objectives: This study aims to characterise the medication (prescription and OTC) of multimorbid elderly patients in primary care and living at home by identifying drug patterns to evaluate the relationship between drugs and drug groups and reveal associations with recently published multimorbidity clusters of the same cohort.

Methods: MultiCare was a multicentre, prospective, observational cohort study of 3189 multimorbid patients aged 65 to 85 years in primary care in Germany. Patients and general practitioners were interviewed between 2008 and 2009. Drug patterns were identified using exploratory factor analysis. The relations between the drug patterns with the three multimorbidity clusters were analysed with Spearman-Rank-Correlation.

Results: Patients (59.3% female) used in mean 7.7 drugs; in total 24,535 drugs (23.7% OTC) were detected. Five drug patterns for men (drugs for obstructive pulmonary diseases (D-OPD), drugs for coronary heart diseases and hypertension (D-CHD), drugs for osteoporosis (D-Osteo), drugs for heart failure and drugs for pain) and four drug patterns for women (D-Osteo, D-CHD, D-OPD and drugs for diuretics and gout) were detected. Significant associations between multimorbidity clusters and drug patterns were detectable (D-CHD and CMD: male: ρ = 0.376, CI 0.322-0.430; female: ρ = 0.301, CI 0.624-0.340).

Conclusion: The drug patterns demonstrate non-random relations in drug use in multimorbid elderly patients and systematic associations between drug patterns and multimorbidity clusters were found in primary care.

背景:老年人群面临多种疾病(三种慢性疾病)和随着年龄增长而增加的药物使用。对初级保健中老年患者的药物——包括处方药和非处方药(OTC)——的全面描述仍然不够。目的:本研究旨在通过识别药物模式来评估药物和药物组之间的关系,并揭示与最近发表的同一队列的多病集群的关联,从而表征初级保健和居家生活的多病老年患者的用药(处方和OTC)。方法:MultiCare是一项多中心、前瞻性、观察性队列研究,在德国进行了3189例年龄在65至85岁的多病患者的初级保健。患者和全科医生在2008年至2009年间接受了采访。使用探索性因子分析确定药物模式。采用spearman - rank相关分析药物类型与3种多病聚类之间的关系。结果:患者平均使用7.7种药物,女性占59.3%;共检出药品24535种,其中OTC占23.7%。检测到男性的五种药物模式(阻塞性肺疾病药物(D-OPD)、冠心病和高血压药物(D-CHD)、骨质疏松药物(D-Osteo)、心力衰竭药物和疼痛药物)和女性的四种药物模式(D-Osteo、D-CHD、D-OPD以及利尿剂和痛风药物)。多病集群与药物模式之间存在显著相关性(D-CHD和CMD:男性:ρ = 0.376, CI 0.322-0.430;女性:ρ = 0.301, CI 0.624-0.340)。结论:老年多病患者用药模式具有非随机关系,在初级保健中,用药模式与多病聚集性存在系统关联。
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引用次数: 1
Vital signs of the systemic inflammatory response syndrome in adult patients with acute infections presenting in out-of-hours primary care: A cross-sectional study. 在非工作时间的初级保健中出现急性感染的成年患者的全身炎症反应综合征的生命体征:一项横断面研究。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-12-01 DOI: 10.1080/13814788.2021.1917544
Feike J Loots, Daan Smulders, Paul Giesen, Rogier M Hopstaken, Marleen Smits

Background: Signs of the systemic inflammatory response syndrome (SIRS) - fever (or hypothermia), tachycardia and tachypnoea - are used in the hospital setting to identify patients with possible sepsis.

Objectives: To determine how frequently abnormalities in the vital signs of SIRS are present in adult out-of-hours (OOH) primary care patients with suspected infections and assess the association with acute hospital referral.

Methods: We conducted a cross-sectional study at the OOH GP cooperative in Nijmegen, the Netherlands, between August and October 2015. GPs were instructed to record the body temperature, heart rate and respiratory rate of all patients with suspected acute infections. Vital signs of SIRS, other relevant signs and symptoms, and referral state were extracted from the electronic registration system of the OOH GP cooperative retrospectively. Logistic regression analysis was used to evaluate the association between clinical signs and hospital referral.

Results: A total of 558 patients with suspected infections were included. At least two SIRS vital signs were abnormal in 35/409 (8.6%) of the clinic consultations and 60/149 (40.3%) of the home visits. Referral rate increased from 13% when no SIRS vital sign was abnormal to 68% when all three SIRS vital signs were abnormal. Independent associations for referral were found for decreased oxygen saturation, hypotension and rapid illness progression, but not for individual SIRS vital signs.

Conclusion: Although patients with abnormal vital signs of SIRS were referred more often, decreased oxygen saturation, hypotension and rapid illness progression seem to be most important for GPs to guide further management.

背景:全身性炎症反应综合征(SIRS)的体征——发烧(或体温过低)、心动过速和呼吸急促——在医院被用来识别可能的败血症患者。目的:确定在疑似感染的成人非工作时间(OOH)初级保健患者中SIRS生命体征异常的频率,并评估其与急性医院转诊的关系。方法:2015年8月至10月,我们在荷兰奈梅亨的户外GP合作社进行了一项横断面研究。指示全科医生记录所有疑似急性感染患者的体温、心率和呼吸频率。回顾性提取户外GP合作电子登记系统中SIRS的生命体征、其他相关体征、症状及转诊状态。采用Logistic回归分析评估临床体征与医院转诊的关系。结果:共纳入疑似感染患者558例。在门诊就诊的35/409(8.6%)和家访的60/149(40.3%)中,至少有2项SIRS生命体征异常。转诊率从没有SIRS生命体征异常时的13%上升到三个SIRS生命体征均异常时的68%。转诊与血氧饱和度降低、低血压和疾病进展迅速相关,但与个体SIRS生命体征无关。结论:虽然SIRS生命体征异常患者的转诊频率更高,但血氧饱和度降低、低血压和病情进展迅速似乎是全科医生指导进一步治疗的最重要因素。
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引用次数: 0
Mammogram uptake and barriers among Palestinian women attending primary health care in North Palestine. 巴勒斯坦北部接受初级保健的巴勒斯坦妇女接受乳房x光检查的情况和障碍。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-12-01 DOI: 10.1080/13814788.2021.1985996
Suha Hamshari, Zaher Nazzal, Mariam Altell, Israa Nanaa, Rawan Jbara, Ruba Sabri

Background: Breast cancer affects women's lives worldwide, yet early detection is an effective strategy for reducing mortality. The participation of women in mammography screening is linked to their knowledge, attitudes and perceived barriers.

Objectives: Our study aims to assess mammography screening uptake and barriers among women attending primary healthcare centres (PHCs) in northern Palestine.

Methods: Using an interviewer administered questionnaire, we used a cross-sectional study design to determine mammography screening uptake, knowledge and barriers among 357 women attending PHCs in Northern Palestine between December 2018 and March 2019.

Results: The mean age was 50 years. The majority (69.2%) were considered to have adequate knowledge about breast cancer and mammography screening. Mammography screening uptake among the participants was 37%. Almost 85% of the women had a positive attitude towards breastfeeding as a prophylaxis factor against breast cancer, while the most frequent barrier to mammography screening was that the participants believed they did not have any symptoms (28.6%), followed by 22.1% of them who did not want to know if they had breast cancer.

Conclusion: The findings of this study highlighted the low mammography uptake among Palestinian women despite the adequate knowledge of those women and the fully accessible and free screening programme. Hence, interventional strategies should be implemented at several levels to enhance mammogram uptake.

背景:乳腺癌影响着全世界妇女的生活,但早期发现是降低死亡率的有效策略。妇女参与乳房x光检查与她们的知识、态度和感知到的障碍有关。目的:本研究旨在评估巴勒斯坦北部初级保健中心(PHCs)妇女乳房x光检查的接受情况和障碍。方法:采用采访者管理的问卷,采用横断面研究设计,确定2018年12月至2019年3月期间在巴勒斯坦北部PHCs就诊的357名妇女的乳房x光检查接受情况、知识和障碍。结果:患者平均年龄50岁。大多数人(69.2%)被认为对乳腺癌和乳房x光检查有足够的了解。乳房x光检查在参与者中的接受率为37%。近85%的妇女对母乳喂养作为预防乳腺癌的因素持积极态度,而乳房x光检查最常见的障碍是参与者认为自己没有任何症状(28.6%),其次是22.1%的妇女不想知道自己是否患有乳腺癌。结论:这项研究的结果强调了巴勒斯坦妇女的乳房x光检查使用率低,尽管这些妇女有足够的知识和完全可获得和免费的筛查方案。因此,介入策略应在几个层面实施,以提高乳房x光检查的吸收。
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引用次数: 2
Attitudes, behaviours and strategies towards obesity patients in primary care: A qualitative interview study with general practitioners in Germany. 对初级保健肥胖患者的态度、行为和策略:一项对德国全科医生的定性访谈研究。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-12-01 DOI: 10.1080/13814788.2021.1898582
Julian Wangler, Michael Jansky

Background: Obesity poses severe challenges for the health care system. GPs are in an advantageous position to contribute to preventing obesity by diagnosing patients and initiating treatment. Sporadic studies have shown that attitudes towards obesity management in primary care can have a major influence on treating patients successfully.

Objectives: The study focuses on attitudes and behavioural patterns towards obesity patients, willingness to provide care, approaches and strategies, and the challenges experienced.

Methods: After developing the interview guides based on a literature review, 36 GPs in North Rhine-Westphalia and Saarland, Germany, were interviewed between November 2019 and March 2020. Using qualitative typing according to Kluge, different prototypes of GPs were formed. The dimensions of the interview guides were used for deriving the prototypes.

Results: GPs were categorised into four types depending on how they saw themselves and their role in treating patients. The first type (the resigned) was conspicuous through its negative attitude towards obesity management and a lack of willingness to provide care. The second type (the instructors) emphasised the value of active exercise, diet and health promotion, while the third type (the motivators) saw psychosocial support and motivation as a key element in helping patients. In contrast, type four (the educators) focussed primarily on early prevention through patient education.

Conclusion: Depending on which (proto-)type a patient visits, different focuses and strategies are pursued for obesity management and doctor-patient communication. This results in different perspectives and chances of success about therapeutic measures.

背景:肥胖对医疗保健系统提出了严峻的挑战。全科医生通过诊断和治疗,在预防肥胖方面处于有利地位。零星的研究表明,在初级保健中对肥胖管理的态度可以对成功治疗患者产生重大影响。目的:研究的重点是对肥胖患者的态度和行为模式,提供护理的意愿,方法和策略,以及所经历的挑战。方法:在文献综述的基础上制定访谈指南,于2019年11月至2020年3月对德国北莱茵-威斯特伐利亚州和萨尔州的36名全科医生进行访谈。根据Kluge的定性分类,形成了不同的GPs原型。使用访谈指南的尺寸来推导原型。结果:全科医生被分为四种类型,这取决于他们如何看待自己和他们在治疗病人中的作用。第一种类型(辞职型)对肥胖管理持消极态度,缺乏提供护理的意愿。第二种类型(指导员)强调积极锻炼、饮食和促进健康的价值,而第三种类型(激励者)认为心理社会支持和激励是帮助患者的关键因素。相比之下,第四种类型(教育者)主要侧重于通过患者教育进行早期预防。结论:肥胖管理和医患沟通的重点和策略应根据患者就诊类型的不同而不同。这导致对治疗措施的不同观点和成功机会。
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引用次数: 1
Pre-return to work consultation and therapeutic part-time work: Cross-sectional study on level of knowledge and use by general practitioners in France. 复工前咨询和治疗兼职工作:法国全科医生知识水平和使用的横断面研究。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-12-01 DOI: 10.1080/13814788.2021.1948007
Cyril Bègue, Lucille Desmidt, William Bellanger, Christine Tessier-Cazeneuve, Audrey Petit, Anne-Laure Couturier

Background: In France, general practitioners (GPs) may use two tools specifically designed to help employees who experience difficulties in returning to work after sick leave: the pre-return-to-work (PRW) medical consultation and therapeutic part-time (TPT) work.

Objectives: The objective was to investigate the level of knowledge and use of these two tools by GPs in Maine-et-Loire, France.

Methods: This cross-sectional study was performed using a telephone questionnaire to evaluate the level of knowledge of GPs and the use of these two tools in patients having difficulties returning to work.

Results: Among the 200 randomly selected GPs, 122 responded (response rate: 61%). More than half of the interviewed GPs declared they 'often' (46%) or 'always' (14%) contacted the occupational physician in these situations. Moreover, 62.2% and 32.7% believed that they had a 'vague' or 'very good' level of knowledge, and 41% and 51% declared either 'frequent' or 'regular' level of use of the PRW medical consultation, respectively. Regarding TPT work, 47% and 53% reported a 'very good' or 'vague' level of knowledge, and 41% and 51% a 'frequent' or 'regular' level of use, respectively. GPs who had a better level of knowledge of this tool reported a higher level of use (p < 0.001).

Conclusion: This study shows that while the level of knowledge and use of the PRW medical consultation and TPT work is good, it is not optimal. This could be improved by organising training courses for GPs. Obstacles to their wider use could be investigated further in a qualitative study.

背景:在法国,全科医生(全科医生)可能会使用两种专门设计的工具来帮助那些在病假后难以重返工作岗位的员工:复工前医疗咨询和治疗性兼职工作。目的:目的是调查法国缅因-卢瓦尔省全科医生对这两种工具的知识水平和使用情况。方法:本横断面研究采用电话问卷,评估全科医生的知识水平,以及在恢复工作困难的患者中这两种工具的使用情况。结果:在随机抽取的200名全科医生中,应答122人,应答率为61%。超过一半的受访全科医生表示,在这些情况下,他们“经常”(46%)或“总是”(14%)联系职业医生。此外,62.2%和32.7%的受访者认为他们对医疗谘询有“模糊”或“很好”的认识,41%和51%的受访者分别表示他们“经常”或“定期”使用医疗谘询。关于TPT工作,47%和53%的人表示“非常好”或“模糊”的知识水平,41%和51%的人分别表示“经常”或“经常”使用TPT。结论:本研究表明,虽然PRW医学咨询和TPT工作的知识水平和使用水平良好,但并非最佳。这可以通过为全科医生组织培训课程来改善。可以在定性研究中进一步调查其广泛使用的障碍。
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引用次数: 2
Patient-safety incidents during COVID-19 health crisis in France: An exploratory sequential multi-method study in primary care. 法国COVID-19健康危机期间的患者安全事件:一项探索性顺序多方法研究
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-12-01 DOI: 10.1080/13814788.2021.1945029
Jean-Pascal Fournier, Jean-Baptiste Amélineau, Sandrine Hild, Jérôme Nguyen-Soenen, Anaïs Daviot, Benoit Simonneau, Paul Bowie, Liam Donaldson, Andrew Carson-Stevens

Background: The COVID-19 pandemic has resulted in the rapid reorganisation of health and social care services. Patients are already at significant risk of healthcare-associated harm and the wholesale disruption to service delivery during the pandemic stood to heighten those risks.

Objectives: We explored the type and nature of patient safety incidents in French primary care settings during the COVID-19 first wave to make tentative recommendations for improvement.

Methods: A national patient safety incident reporting survey was distributed to General Practitioners (GPs) in France on 28 April 2020. Reports were coded using a classification system aligned to the WHO International Classification for Patient Safety (incident types, contributing factors, incident outcomes and severity of harm). Analysis involved data coding, processing, iterative generation of data summaries using descriptive statistical analysis. Clinicaltrials.gov: NCT04346121.

Results: Of 132 incidents, 58 (44%) related to delayed diagnosis, assessments and referrals. Cancellations of appointments, hospitalisations or procedures was reported in 22 (17%) of these incidents. Home confinement-related incidents accounted for 13 (10%) reports and inappropriate medication stopping for five (4%). Patients delayed attending or did not consult their general practitioner or other healthcare providers due to their fear of contracting COVID-19 infection at an in-person visit in 26 (10%) incidents or fear of burdening their GPs in eight (3%) incidents.

Conclusion: Constraints from the first wave of the COVID-19 pandemic have contributed to patient safety incidents during non-COVID-19 care. Lessons from these incidents pinpoint where primary care services in France can focus resources to design safer systems for patients.

背景:2019冠状病毒病大流行导致卫生和社会保健服务迅速重组。患者已经面临与医疗保健相关的重大伤害风险,大流行期间服务提供的大规模中断将加剧这些风险。目的:探讨法国初级保健机构在COVID-19第一波期间患者安全事件的类型和性质,提出初步改进建议。方法:于2020年4月28日向法国全科医生(gp)分发了一份全国患者安全事件报告调查。报告采用与世卫组织国际患者安全分类(事件类型、促成因素、事件结果和伤害严重程度)相一致的分类系统进行编码。分析涉及数据编码、处理、使用描述性统计分析迭代生成数据摘要。Clinicaltrials.gov: NCT04346121。结果:132例事件中,58例(44%)与延迟诊断、评估和转诊有关。这些事件中有22起(17%)报告了取消预约、住院或手术。与家庭监禁有关的事件报告有13起(10%),停止使用不当药物的报告有5起(4%)。26例(10%)患者因担心在就诊时感染COVID-19而推迟就诊或未咨询全科医生或其他医疗保健提供者,8例(3%)患者因担心给全科医生增加负担。结论:来自第一波COVID-19大流行的制约因素导致了非COVID-19护理期间的患者安全事件。这些事件的教训指出,法国的初级保健服务可以在哪些方面集中资源,为患者设计更安全的系统。
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引用次数: 11
期刊
European Journal of General Practice
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