European Journal of General Practice最新文献

Background: COVID-19 pandemic caused a significant impact on healthcare workers' mental health and burnout, which continues after the pandemic.

Objectives: To assess the levels of burnout in general practitioners (GP) in Catalonia at three different times.

Methods: Cross-sectional study involving members of the GPs' Catalan Society (n = 4700). A self-administered survey was sent via institutional email in June-July 2021 (T1), in March-April 2022 (T2), and in May-June 2023 (T3). Probable burnout was assessed through Maslach Burnout Inventory (MBI) test, with three independent dimensions: emotional exhaustion, depersonalisation, and personal achievement. A descriptive analysis was performed, as well as a comparison between T1, T2, and T3 results.

Results: 500 GPs responded in T1, 454 in T2, and 386 in T3. Samples were similar in demographic variables. Regarding burnout dimensions, the level of emotional exhaustion was 67.5% in T1, with a statistically significant decrease in T2 and T3 (56.4 and 58.1%, respectively, p = 0.001); levels of depersonalisation were 42.7% in T1, 37.0% in T2 and 36.7% in T3 (p = 0.091); levels of personal achievement were 29.9% in T1, 30.4% in T2 and 24.2% in T3 (p = 0.086).  Starting at high levels of emotional exhaustion and depersonalisation, the prevalence decreased significantly over time in two groups: women and GPs who worked <10 years at the same workplace.

Conclusion: Catalan GPs experienced significant burnout during the COVID-19 pandemic with emotional exhaustion being particularly high. Although the prevalence of burnout decreased slightly over time, over half of the participants consistently reported high levels of emotional exhaustion.

Background: The transition from trainee to professional marks a key milestone in a family doctor's career, bringing both emotional and mental challenges. This critical period of specialisation shapes how young doctors adapt and influences their future career choices.

Objectives: We explored trainees' experiences during their first year of advanced medical training in family medicine/general practice, including barriers and facilitators.

Methods: Using qualitative methodology, we conducted ten focus group interviews with 111 trainees. These group interviews were held as part of small-group sessions integrated into a self-guided reflection course. All interviews were held between February 2021 and March 2021, conducted online via MS Teams, recorded, and transcribed verbatim for analysis.

Findings: Our analysis uncovered two adaptational processes during this transition period: personal adaptation and professional socialisation. We interpreted this as a complex balancing act, with impact on mental health aspects such as energy, exhaustion, and self-confidence. Multiple elements at different levels influenced these processes, including the workplace (e.g. interactions with colleagues and patients), the educational program (e.g. assignments, courses), and societal expectations (e.g. role expectations, support).

Conclusion: The findings highlight the importance of understanding both personal adaptation and professional socialisation to support trainees effectively during their transition into practice. Future studies should validate these findings and explore their evolution over time, particularly in relation to adaptation and career choices.

Background: Capillary self-blood collection (SBC) with mailed samples enables remote laboratory monitoring without in-person healthcare visits. This approach may improve continuity of care for patients, especially with chronic conditions.

Objectives: Compare pain perception between venous blood draws and capillary SBC and evaluate the usability and blood volume yield of SBC devices.

Methods: In this cross-sectional study, general practice patients from mid of Germany, Germany performed SBC using the Tasso+^® upper-arm device and mailed samples to a laboratory. Pain, usability, SBC volume, and associated factors were analysed using bivariate and general linear models.

Results: Of 106 patients, 57.5% performed SBC without assistance. Self-perceived pain was lower among SBC draws (0.13, SD = 0.42) versus venous draws (1.21, SD = 1.60) (p < .001). 59.4% self-collected ≥130 μL blood plasma. Patient characteristics were not associated with SBC volume in regression analysis. Overall, the mean System Usability Scale (SUS) score was 86.2, indicating high usability. Lower school education was associated with lower usability scores, while lower fear of blood and needles were associated with higher usability scores in regression analysis.

Conclusions: Capillary SBC had high feasibility and usability and caused less pain than venous draws in the general practice setting. SBC shows promises for enabling remote laboratory monitoring.

Background: Shared decision-making (SDM) is considered the preferred communication model, yet its applicability in the diagnostic process is understudied.

Objective: To identify clinical situations in the diagnostic process that could benefit from SDM.

Methods: An observational study of closed malpractice claims against general practitioners (2012-2020) related to problems of diagnosis, obtained from a liability insurance company in the Netherlands. We established SDM-selection criteria, specified for the diagnostic process (i.e. diagnostic uncertainty, multiple options and clinical equipoise). Phase 1: We selected and categorised eligible cases, using summarised information from a claim database. Phase 2: We analysed 90 fully documented claims and extracted information from GPs and patients related to the diagnostic process. Using this data, we conducted an inductive thematic analysis.

Results: Phase 1: 261 out of 1477 claims (18%) met the SDM-selection criteria. The main reason for complaints was (omitted) test-ordering (155 claims, 59.4%). The most frequent final diagnoses were: fracture (49%), malignancy (10%), infection (9%), tendon rupture (8%) and cardiovascular disease (4%). Phase 2: Six types of diagnostic considerations emerged from the data: diagnostic uncertainty, using time as a diagnostic tool, management consequences, information about test indication or procedure, indications for re-evaluation and individual patient context. Contradictory statements from GPs and patients demonstrated a lack of shared understanding.

Conclusion: The diagnostic process could benefit from SDM in several areas, including discussing diagnostic options, test conditions (e.g. timing and procedure) and follow-up. SDM training programs should be tailored to encourage clinicians to apply SDM in diagnostic decisions.

Background: Expanding access to self-management via Digital Health Technologies may supplement traditional care, mitigating pressures on primary care through self-management. Primary Care Physicians (PCP) can play a critical role in the integration of digital health technologies into patient care, but it is unclear what factors influence PCPs' recommendation of such technologies.

Aims: To identify the factors associated with PCPs recommending digital health technologies to patients for self-management before and during the pandemic.

Methods: PCPs across 20 countries completed an online questionnaire between June and September 2020. The outcome was a self-report of recommending patients to at least one of six listed forms of digital health technologies. Univariable logistic regression models were performed to explore factors associated with recommending digital health technologies to patients before and during the pandemic.

Results: 1,592 PCPs were included. Before the pandemic, the odds of recommending digital health technologies for self-management were lower for PCPs not involved in teaching, or practising in Turkey, Australia, Chile, Colombia, France, Italy, Poland, Portugal, Slovenia, and Spain. During the pandemic, PCPs practising in rural settings had higher odds of starting to recommend digital health technologies, as well as those from Brazil, Colombia, and Italy. There was no significant difference in recommending digital health technologies before and during the pandemic.

Conclusions: Involvement in teaching (pre-pandemic) and practising in a rural setting (during the pandemic) positively influenced the recommendation of digital health technologies. Significant variation in recommending digital health technologies was present across countries.

Introduction: Central and Eastern European (CEE) countries began healthcare reforms in the late twentieth century, adopting Family Medicine/General Practice (FM/GP) models. The FATMEE (Family Medicine After Transformation in Middle and Eastern Europe) study in 2012 found this process advanced but incomplete. This study (FATMEE-2) examines current FM/GP development in the CEE region that follows recent social changes and healthcare challenges.

Methods: A mixed-methods approach combined literature and dataset review with a Key Informant-based survey using the updated FATMEE questionnaire, exploring the FM/GP role in primary care.

Results: FM/GP is recognised as a separate medical speciality in all countries with robust legal frameworks. Care comprehensiveness varies, with some systems maintaining separate paediatric and adult services, and a lack of gynaecology and obstetrics services in many. Weighted capitation remains the dominant funding model, supplemented by pay-for-performance and fee-for-service schemes. Electronic medical records and teleconsultations are common. Compared to the previous FATMEE study, changes include increased use of digital tools and diversified financing. Primary care structure and professional roles changed little.

Conclusion: While the legal and technological foundations of family medicine in CEE countries have strengthened, comprehensiveness and service integration have limitations. There is a visible progress in infrastructure and digitalisation, but the structural and organisational challenges identified in 2012 largely remain. This may indicate that sustained political commitment and systemic reform - beyond legal acknowledgement and technological improvements - are essential for successful transformation. However, the examples of Estonia and Slovenia prove that under a supportive policy, such a transformation is achievable.

Factors present in early life account for much of the variation in mental wellbeing in adulthood. In regions where general practitioners (GPs) provide first-contact care for pregnant women and children, there are many opportunities to identify children at risk of later psychiatric problems. These risks are contingent on genetic and antenatal factors, parent-child interaction and family functioning, and are influenced by poverty, the neighbourhood and the educational environment. Depending on the context in which they work, GPs may be able to offer support or referral to specialist services to prevent adverse outcomes. GPs are not able to predict accurately which children will be at developmental risk, so it is important to ensure that systems exist to identify neurodevelopmental problems in the whole population, whether in general practice or elsewhere. When developmental surveillance takes place outside general practice, there are strong arguments for data sharing. Awareness and systematic recording of risk factors for later psychopathology, along with appropriate intervention when available, offer the potential for substantial benefits to population mental health in the long term.

Background: Healthcare workers are expected to identify and respond to domestic abuse among patients. However, research has neglected healthcare workers' own experiences of domestic abuse.

Objectives: Focusing on UK primary and community healthcare workers with formal support roles (e.g. line managers, human resources, employee assistance professionals), this exploratory study aimed to illustrate workplace support offered to healthcare colleagues affected by domestic abuse.

Method: We used an online cross-sectional survey with closed and qualitative free-text questions, advertised via mailing lists and social media, targeting healthcare workers. Our mixed methods embedded design involved quantitative descriptive analysis with content analysis of qualitative free text to explain and interrogate results.

Results: Sixty-two people in healthcare roles supporting colleagues responded, mostly from community hospitals, dentistry, and general practice. Few workplaces had staff domestic abuse policies. Support measures were limited. Emotional support, signposting, and adjusted working hours were the most common types of support available. Training on supporting affected colleagues was rare. Few environments had specialist domestic abuse advocates who supported staff. Along with needing policies, training, and in-house support, respondents indicated a need for a cultural shift to address myths about domestic abuse and hierarchical power, particularly regarding healthcare workers who perpetrate abuse.

Conclusion: Despite several limitations, including substantial missing data, our work highlights that primary and community healthcare workplaces should explore the implementation of practical and emotional support measures; healthcare-based domestic abuse advocates with staff support; and training on supporting colleagues. Further pan-European comparative research should surface good practice and foster cross-learning.