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Screening tools assessing mental illness in primary care: A systematic review. 初级保健中评估精神疾病的筛查工具:系统综述。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-10-23 DOI: 10.1080/13814788.2024.2418299
Bernadette Neulinger, Christopher Ebert, Kirsten Lochbühler, Antje Bergmann, Jochen Gensichen, Karoline Lukaschek

Background: To better manage patients with a wide range of mental health problems, general practitioners would benefit from diagnostically accurate and time-efficient screening tools that comprehensively assess mental illness. Therefore, the aim of this systematic review was to identify screening tools that either take a multiple-mental disorder or a transdiagnostic approach. As primary and secondary outcomes, diagnostic accuracy and time efficiency were investigated.

Methods: The data bases MEDLINE, Embase, Cochrane Library, Psyndex and PsycINFO were searched. Studies reporting on multiple-mental disorder or transdiagnostic screening tools used in primary care with adult patients were included. Sensitivity, specificity, positive and negative predictive value served as measures of diagnostic accuracy. Time efficiency was evaluated by the number of items of a screening tool and the time required for its completion and evaluation.

Results: Eleven studies met the inclusion criteria. The majority of screening tools assessed multiple mental disorders separately. A sub-group of screening tools took a transdiagnostic approach by examining the spectrum of mood, anxiety and stress-related disorders. One screening tool used internalised, cognitive/somatic and externalised dysfunction as transdiagnostic domains of mental illness. Mostly, a sufficient sensitivity and specificity was reported. All screening tools were found to be time efficient.

Conclusion: The eleven identified screening tools can support general practitioners to identify patients with mental health problems. However, there was great heterogeneity concerning their diagnostic scope of psychopathology. Further screening tools for primary care are needed that target broad constructs of mental illness, such as transdiagnostic factors or personality dysfunction.

背景:为了更好地管理有各种精神健康问题的患者,全科医生将受益于诊断准确、省时高效、能全面评估精神疾病的筛查工具。因此,本系统性综述的目的是找出采用多重精神障碍或跨诊断方法的筛查工具。作为主要和次要结果,对诊断准确性和时间效率进行了调查:方法:检索了 MEDLINE、Embase、Cochrane Library、Psyndex 和 PsycINFO 等数据库。方法:检索了 MEDLINE、Embrane Library、Cochrane Library、Pynsdex 和 PsyinFO 等数据库,纳入了有关成人患者初级保健中使用的多重精神障碍或跨诊断筛查工具的研究报告。灵敏度、特异性、阳性预测值和阴性预测值作为诊断准确性的衡量标准。通过筛查工具的项目数量以及完成和评估所需的时间来评估时间效率:结果:11 项研究符合纳入标准。大多数筛查工具分别评估了多种精神障碍。有一小部分筛查工具采用了跨诊断的方法,对情绪、焦虑和压力相关障碍进行检查。一种筛查工具将内化、认知/症状和外化功能障碍作为精神疾病的跨诊断领域。据报告,这些筛查工具大多具有足够的敏感性和特异性。所有筛查工具都具有时间效率:结论:已确定的 11 种筛查工具可帮助全科医生识别有精神健康问题的病人。结论:已确定的 11 种筛查工具可帮助全科医生识别有精神健康问题的患者,但这些工具在精神病理学诊断范围方面存在很大差异。我们需要更多的筛查工具,以广泛的精神疾病结构为目标,如跨诊断因素或人格功能障碍。
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引用次数: 0
Relationship between patient-perceived quality of primary care and self-reported hospital utilisation in China: A cross-sectional study. 中国患者感知的基础医疗质量与自我报告的医院使用率之间的关系:一项横断面研究。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-02-26 DOI: 10.1080/13814788.2024.2308740
Chenwen Zhong, Junjie Huang, Lina Li, Zhuojun Luo, Cuiying Liang, Mengping Zhou, Nan Hu, Li Kuang

Background: Reducing avoidable hospital admissions is a global healthcare priority, with optimal primary care recognised as pivotal for achieving this objective. However, in developing systems like China, where primary care is evolving without compulsory gatekeeping, the relationship between patient-perceived primary care quality and hospital utilisation remains underexplored.

Objectives: This study aimed to explore the association between patient-perceived primary care quality and self-reported hospital utilisation in China.

Methods: Data were collected from 16 primary care settings. Patient-perceived quality of primary care was measured using the Assessment Survey of Primary Care scale across six domains (first-contact care, continuity, comprehensiveness, accessibility, coordination, and patient-centredness). Hospital utilisation included patient self-reported outpatient visits, hospital admissions, and emergency department (ED) visits in the last six months. Logistic regression analyses were examined associations between self-reported hospital utilisation and perceived primary care quality adjusted for potential confounders.

Results: Of 1,185 patients recruited, 398 (33.6%) reported hospital utilisation. Logistic regression analyses showed that higher total scores for patient-perceived quality of primary care were associated with decreased odds of hospital utilisation (adjusted odds ratio(AOR): 0.417, 95% confidence interval (CI): 0.308-0.565), outpatient visits (AOR: 0.394, 95% CI: 0.275-0.566) and hospital admissions (AOR: 0.496, 95% CI: 0.276-0.891). However, continuity of care was positively associated with ED visits (AOR: 2.252, 95% CI: 1.051-4.825).

Conclusion: Enhanced patient-perceived quality of primary care in China is associated with a reduction in self-reported overall hospital utilisation, including outpatient visits and hospital admissions. However, better continuity of care may be associated with increased ED visits. Further research is warranted for precise insights and validation of these findings.

背景:减少可避免的入院治疗是全球医疗保健的首要任务,而最佳的初级医疗服务被认为是实现这一目标的关键。然而,在中国这样的发展中经济体制下,初级医疗在没有强制把关的情况下不断发展,患者感知的初级医疗质量与医院使用率之间的关系仍未得到充分探讨:本研究旨在探讨中国患者感知的初级医疗质量与自我报告的医院使用率之间的关系:方法:从16个基层医疗机构收集数据。方法:从 16 个基层医疗机构收集数据,采用 "基层医疗质量评估调查 "量表测量患者感知的基层医疗质量,包括六个方面(首次接触医疗、连续性、全面性、可及性、协调性和以患者为中心)。医院使用情况包括患者自我报告的最近六个月的门诊就诊、入院和急诊室就诊情况。在对潜在的混杂因素进行调整后,对自我报告的医院使用情况与感知的初级医疗质量之间的关系进行了逻辑回归分析:在招募的 1,185 名患者中,有 398 人(33.6%)报告了医院使用情况。逻辑回归分析表明,患者感知的初级医疗质量总分越高,住院率(调整后的几率比(AOR):0.417,95% 置信区间(CI):0.308-0.565)、门诊就诊率(AOR:0.394,95% 置信区间(CI):0.275-0.566)和入院率(AOR:0.496,95% 置信区间(CI):0.276-0.891)就越低。然而,医疗服务的连续性与急诊室就诊率呈正相关(AOR:2.252,95% CI:1.051-4.825):结论:在中国,患者感知到的基层医疗质量的提高与自我报告的总体医院使用率(包括门诊就诊和住院)的降低有关。然而,更好的持续性医疗服务可能与急诊室就诊次数的增加有关。要准确了解和验证这些发现,还需要进一步的研究。
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引用次数: 0
Enhancing LGBT + primary healthcare in Slovenia: A national qualitative study of experiences and expectations of LGBT + people and family doctors. 加强斯洛文尼亚的 LGBT + 初级医疗保健:关于男女同性恋、双性恋和变性者以及家庭医生的经历和期望的全国性定性研究。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-07-09 DOI: 10.1080/13814788.2024.2373121
Nina Jerala, Davorina Petek

Background: Despite growing acceptance of LGBT + individuals, an underlying stigma persists even in healthcare, resulting in substandard care and worse healthcare outcomes for LGBT + individuals.

Objectives: To examine and compare the experiences and expectations regarding primary healthcare among LGBT + individuals and general practitioners (GPs) in Slovenia.

Methods: We conducted an online national qualitative study using open-ended questions. To reach LGBT + population snowball method of recruitment was employed by sharing the questionnaire through LGBT + organisations, while GPs were invited by email of Association of family doctors in Slovenia. Anonymous data was collected from October to December 2021 and the questionnaires of 25 GPs and 90 LGBT + individuals of various ages, backgrounds, gender identities and sexual orientations were reviewed using thematic analysis.

Results: Both LGBT + participants and GPs expressed a desire for equal treatment. However, while all GPs claimed to treat all patients equally, LGBT + participants reported more varied experiences. Specific knowledge, especially on LGBT + terminology and healthcare, was perceived as lacking among GPs, leading LGBT + individuals to seek advice from specialists or community counselling. Systemic barriers, including societal stigmatisation and limited formal education on LGBT + issues, were identified, highlighting the need for designated safe spaces and improved GP training. Safety emerged as a central theme, crucial for fostering trust and disclosure between patients and healthcare providers.

Conclusion: The study underscores the significance of a sense of safety in the patient-doctor relationship and highlights the need for improved training and attitudes to provide inclusive and affirming healthcare for LGBT + individuals.

背景:尽管对 LGBT + 个人的接受度不断提高,但即使在医疗保健领域,潜在的污名化现象依然存在,导致 LGBT + 个人的医疗保健不达标,医疗保健结果更差:研究和比较斯洛文尼亚 LGBT + 个人和全科医生(GPs)在初级医疗保健方面的经验和期望:我们使用开放式问题开展了一项全国性在线定性研究。为了接触到 LGBT + 群体,我们采用了滚雪球的方法,通过 LGBT + 组织分享问卷,同时通过斯洛文尼亚家庭医生协会的电子邮件邀请全科医生。2021 年 10 月至 12 月期间收集了匿名数据,并采用主题分析法对 25 名全科医生和 90 名不同年龄、背景、性别认同和性取向的 LGBT + 个人的问卷进行了审查:LGBT + 参与者和全科医生都表示希望获得平等待遇。然而,尽管所有全科医生都声称会平等对待所有患者,但 LGBT + 参与者却报告了更多不同的经历。他们认为全科医生缺乏特殊知识,特别是有关 LGBT + 术语和医疗保健的知识,这导致 LGBT + 个人向专家或社区咨询机构寻求建议。他们还发现了一些系统性障碍,包括社会污名化和有关 LGBT + 问题的正规教育有限,这凸显了指定安全空间和改善全科医生培训的必要性。安全是一个核心主题,对于促进患者与医疗服务提供者之间的信任和信息披露至关重要:本研究强调了患者与医生关系中安全感的重要性,并强调需要改进培训和态度,以便为 LGBT + 个人提供包容和肯定的医疗保健服务。
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引用次数: 0
Exploring the experiences of GPs in establishing and operating the chronic disease management programme in clinical practice in Ireland. A qualitative study.
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-11-28 DOI: 10.1080/13814788.2024.2430521
Stephen Buckley, James O' Flynn, Tony Foley

Background: The management of chronic diseases, in the context of an ageing population and increasing life expectancy, is one of the major challenges facing the Irish health system. In 2020, a chronic disease management programme [CDM] was introduced in Irish general practice as part of a transformation in health policy to meet the changing needs of the population.

Objectives: To explore GPs' experiences and perceptions of the impact of the introduction of CDM on general practice in Ireland.

Methods: 18 semi-structured interviews were conducted with GPs in clinical practice from across Ireland. GPs were purposefully recruited to capture the differing experiences faced by GPs in large and small practices in both urban and rural settings. Interviews were analysed using reflexive thematic analysis.

Results: GPs were enthusiastic about aspects of CDM, which they felt provided an improved framework for their approach to the management of chronic diseases. However, they described several challenges to implementation, especially around capacity constraints. CDM could have unintended consequences for aspects of routine GP care. GPs described how practice nurses had taken on a central role in both clinical and administrative aspects of the programme.

Conclusions: GPs value the framework provided by CDM for their approach to the management of chronic disease. However, challenges around practice capacity and its impact both on the delivery of CDM and aspects of routine care highlight the importance for policy makers to provide continued support to strengthen the general practice infrastructure.

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引用次数: 0
Effectiveness of the Assessment of Burden of Chronic Conditions (ABCC)-tool in patients with asthma, COPD, type 2 diabetes mellitus, and heart failure: A pragmatic clustered quasi-experimental study in the Netherlands. 慢性病负担评估(ABCC)工具对哮喘、慢性阻塞性肺病、2 型糖尿病和心力衰竭患者的疗效:荷兰的一项实用分组准实验研究。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-05-13 DOI: 10.1080/13814788.2024.2343364
Esther A Boudewijns, Danny Claessens, Onno C P van Schayck, Mascha Twellaar, Bjorn Winkens, Manuela A Joore, Lotte C E M Keijsers, Stijn Krol, Mathijs Urlings, Annerika H M Gidding-Slok

Background: The Assessment of Burden of Chronic Conditions (ABCC)-tool was developed to optimise chronic care.

Objectives: This study aimed to assess the effectiveness of the ABCC-tool in patients with COPD, asthma, type 2 diabetes, and/or heart failure in primary care in the Netherlands.

Methods: The study had a pragmatic, clustered, two-armed, quasi-experimental design. The intervention group (41 general practices; 176 patients) used the ABCC-tool during routine consultations and the control group (14 general practices; 61 patients) received usual care. The primary outcome was a change in perceived quality of care (PACIC; Patient Assessment of Chronic Illness Care) after 18 months. Secondary outcomes included change in the PACIC after 6 and 12 months, and in quality of life (EQ-5D-5L; EuroQol-5D-5L), capability well-being (ICECAP-A; ICEpop CAPability measure for Adults), and patients' activation (PAM; Patient Activation Measure) after 6, 12, and 18 months for the total group and conditions separately.

Results: We observed a significant difference in the PACIC after 6, 12, and 18 months (18 months: 0.388 points; 95%CI: 0.089-0.687; p = 0.011) for the total group and after 6 and 12 months for type 2 diabetes. After 18 months, we observed a significant difference in the PAM for the total group but not at 6 and 12 months, and not for type 2 diabetes. All significant effects were in favour of the intervention group. No significant differences were found for the EQ-5D-5L and the ICECAP-A.

Conclusion: Use of the ABCC-tool has a positive effect on perceived quality of care and patients' activation, which makes the tool ready for use in clinical practice. Healthcare providers (e.g. general practitioners and practice nurses) can use the tool to provide person-centred care.Trial registration number: ClinicalTrials.gov Registry (NCT04127383).

背景:慢性病负担评估(ABCC)工具是为优化慢性病护理而开发的:慢性病负担评估(ABCC)工具是为优化慢性病护理而开发的:本研究旨在评估 ABCC 工具对荷兰初级医疗中慢性阻塞性肺病、哮喘、2 型糖尿病和/或心力衰竭患者的疗效:该研究采用务实、分组、双臂、准实验设计。干预组(41 家全科诊所;176 名患者)在常规咨询中使用 ABCC 工具,对照组(14 家全科诊所;61 名患者)接受常规护理。主要结果是18个月后患者对护理质量(PACIC;患者对慢性病护理的评估)的感知变化。次要结果包括 6 个月和 12 个月后 PACIC 的变化,以及 6 个月、12 个月和 18 个月后总组和各病症的生活质量(EQ-5D-5L;EuroQol-5D-5L)、能力幸福感(ICECAP-A;ICEpop CAPability measure for Adults)和患者激活度(PAM;Patient Activation Measure)的变化:我们观察到,在 6 个月、12 个月和 18 个月后,整个组的 PACIC 有明显差异(18 个月:0.388 分;95%CI:0.089-0.687;P = 0.011),而在 6 个月和 12 个月后,2 型糖尿病患者的 PACIC 有明显差异(18 个月:0.388 分;95%CI:0.089-0.687;P = 0.011)。18 个月后,我们观察到整个组的 PAM 有显著差异,但 6 个月和 12 个月后的 PAM 没有显著差异,2 型糖尿病患者的 PAM 也没有显著差异。所有明显的效果都有利于干预组。EQ-5D-5L和ICECAP-A没有发现明显差异:ABCC工具的使用对护理质量感知和患者积极性有积极影响,因此该工具可用于临床实践。医疗服务提供者(如全科医生和执业护士)可以使用该工具提供以人为本的护理:试验注册号:ClinicalTrials.gov Registry (NCT04127383)。
{"title":"Effectiveness of the Assessment of Burden of Chronic Conditions (ABCC)-tool in patients with asthma, COPD, type 2 diabetes mellitus, and heart failure: A pragmatic clustered quasi-experimental study in the Netherlands.","authors":"Esther A Boudewijns, Danny Claessens, Onno C P van Schayck, Mascha Twellaar, Bjorn Winkens, Manuela A Joore, Lotte C E M Keijsers, Stijn Krol, Mathijs Urlings, Annerika H M Gidding-Slok","doi":"10.1080/13814788.2024.2343364","DOIUrl":"10.1080/13814788.2024.2343364","url":null,"abstract":"<p><strong>Background: </strong>The Assessment of Burden of Chronic Conditions (ABCC)-tool was developed to optimise chronic care.</p><p><strong>Objectives: </strong>This study aimed to assess the effectiveness of the ABCC-tool in patients with COPD, asthma, type 2 diabetes, and/or heart failure in primary care in the Netherlands.</p><p><strong>Methods: </strong>The study had a pragmatic, clustered, two-armed, quasi-experimental design. The intervention group (41 general practices; 176 patients) used the ABCC-tool during routine consultations and the control group (14 general practices; 61 patients) received usual care. The primary outcome was a change in perceived quality of care (PACIC; Patient Assessment of Chronic Illness Care) after 18 months. Secondary outcomes included change in the PACIC after 6 and 12 months, and in quality of life (EQ-5D-5L; EuroQol-5D-5L), capability well-being (ICECAP-A; ICEpop CAPability measure for Adults), and patients' activation (PAM; Patient Activation Measure) after 6, 12, and 18 months for the total group and conditions separately.</p><p><strong>Results: </strong>We observed a significant difference in the PACIC after 6, 12, and 18 months (18 months: 0.388 points; 95%CI: 0.089-0.687; <i>p</i> = 0.011) for the total group and after 6 and 12 months for type 2 diabetes. After 18 months, we observed a significant difference in the PAM for the total group but not at 6 and 12 months, and not for type 2 diabetes. All significant effects were in favour of the intervention group. No significant differences were found for the EQ-5D-5L and the ICECAP-A.</p><p><strong>Conclusion: </strong>Use of the ABCC-tool has a positive effect on perceived quality of care and patients' activation, which makes the tool ready for use in clinical practice. Healthcare providers (e.g. general practitioners and practice nurses) can use the tool to provide person-centred care.<b>Trial registration number:</b> ClinicalTrials.gov Registry (NCT04127383).</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2343364"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11104697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913155","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}
引用次数: 0
Person-centred care, a core concept of family medicine. 以人为本的护理,家庭医学的核心理念。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-08-27 DOI: 10.1080/13814788.2024.2393860
Igor Švab, Venija Cerovečki
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引用次数: 0
Early-career general practitioners' career intentions in Estonia: A qualitative study. 爱沙尼亚早期全科医生的职业意向:定性研究。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-07-03 DOI: 10.1080/13814788.2024.2368557
Marta Velgan, Anett Uibu, Elinor Õunap, Mari Katariina Kangasniemi, Nele R Michels, Ruth Kalda

Background: The shortage of general practitioners (GPs) is a worsening problem in many countries and poses a threat to the services provided by primary care and by extension for the entire healthcare system. Issues with GP workforce recruitment and retention can be reasons for this shortage.

Objectives: To describe GP trainees and newly qualified GPs experiences and perceptions on how their training and early experiences of work influence their career intentions in primary care in Estonia.

Methods: A qualitative study with GP trainees (n = 12) and newly qualified GPs (n = 13) using semi-structured group interviews (n = 6) was conducted. Interviews were conducted from October until November 2020. Data were analysed using thematic analysis with NVivo Software.

Results: Although early-career GPs in Estonia envision their future roles as GP practice owners with patient list, this is often postponed due to various reasons. Early-career GPs expressed a sense of unpreparedness to fill all the roles of GPs' and found the process of establishing a GP practice and taking on a patient lists very complicated. They value work-life balance and prefer workplaces, which offer flexible working conditions.

Conclusion: Potential strategies were identified to enhance the willingness of early-career GPs to continue their career as GP practice owners with patient list: improving the GP training program by placing more emphasis on managing skills and making the process of establishing GP practice and taking on a patient list less bureaucratic and more accessible.

背景:在许多国家,全科医生(GPs)短缺问题日益严重,对初级医疗服务乃至整个医疗保健系统构成威胁。全科医生队伍的招聘和留用问题可能是造成这一短缺的原因:描述全科医生受训者和新近获得资格的全科医生的经历和看法,即他们的培训和早期工作经历如何影响他们在爱沙尼亚全科医疗领域的职业意向:采用半结构式小组访谈(6 人)对全科医生培训生(12 人)和新晋全科医生(13 人)进行了定性研究。访谈时间为 2020 年 10 月至 11 月。使用 NVivo 软件对数据进行了专题分析:尽管爱沙尼亚的早期全科医生憧憬着自己未来的角色是全科医生,拥有病人名单,但由于种种原因,这一角色往往被推迟。初入职场的全科医生表示没有准备好扮演全科医生的所有角色,并认为建立全科医生诊所和接收病人名单的过程非常复杂。他们重视工作与生活的平衡,更喜欢提供灵活工作条件的工作场所:为提高早期职业全科医生作为全科医生诊所所有者继续其职业生涯的意愿,我们确定了一些潜在的策略:改进全科医生培训计划,更多地强调管理技能,减少建立全科医生诊所和接收病人名单过程中的官僚作风,使其更容易获得。
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引用次数: 0
Multidisciplinary management of patients with cancer in France: The SINPATIC qualitative study. 法国癌症患者的多学科管理:SINPATIC 定性研究。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-07-29 DOI: 10.1080/13814788.2024.2380722
Laura Moscova, Matthieu Lustman, Jacques Cittée, Sébastien Dawidowicz, Florence Canoui-Poitrine, Christophe Tournigand, Kelly Perlaza, William Mirat, Emilie Ferrat

Background: Health policymakers have tried to improve the care pathway for cancer patients by improving collaboration between participating healthcare professionals by involving the general practitioner (GP).

Objective(s): To explore how patients, GPs, oncologists and nurses interacted and how they perceived, in their practice, professional roles, collaboration, and cancer care pathways.

Methods: Between January 2018 and December 2021, we conducted a qualitative study that combined phenomenology and a general inductive analysis, based on semi-structured interviews with cancer patients and their GPs, oncologists, and nurses in France.

Results: Our analysis of 59 interviews showed that the stakeholders had different perceptions of the cancer care pathway. Task division was implicit and depended on what each health professional thought he/she should be doing; this led to the blurring of certain tasks (announcement of the diagnosis, coordination, and follow-up). The healthcare professionals were stuck in frameworks centred on their own needs and expectations and were unaware of the other health professionals' needs and expectations. Outside the hospital, GPs and nurses worked in isolation; they were not aware of the other stakeholders and did not communicate with them. GPs and nurses justified this attitude by the lack of a perceived need. Interprofessional communication varied as a function of the needs, involvement and knowledge of the other health professionals and was often mediated by the patient.

Conclusion: In the cancer management in France, to improve cancer care pathway, there is a need to train healthcare professionals in interprofessional collaboration delivering care tailored to patient needs and preferences.

背景:卫生政策制定者试图通过让全科医生(GP)参与进来,改善参与的医疗保健专业人员之间的合作,从而改善癌症患者的护理路径:探索患者、全科医生、肿瘤学家和护士如何互动,以及他们在实践中如何看待专业角色、协作和癌症护理路径:2018年1月至2021年12月,我们在法国对癌症患者及其全科医生、肿瘤学家和护士进行了半结构化访谈,在此基础上开展了一项结合现象学和一般归纳分析的定性研究:我们对 59 次访谈的分析表明,利益相关者对癌症护理路径有着不同的看法。任务分工是隐性的,取决于每位医护人员认为自己应该做什么;这导致某些任务(宣布诊断、协调和跟踪)变得模糊不清。医护专业人员都停留在以自己的需求和期望为中心的框架中,并没有意识到其他医护专业人员的需求和期望。在医院外,全科医生和护士孤立地工作;他们不了解其他利益相关者,也不与他们交流。全科医生和护士认为这种态度的理由是缺乏需求。各专业间的交流因其他医疗专业人员的需求、参与程度和知识水平而异,而且往往以患者为中介:结论:在法国的癌症管理中,为了改善癌症护理路径,有必要对医护人员进行跨专业合作方面的培训,以提供符合患者需求和偏好的护理服务。
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引用次数: 0
'I just felt either I'm going to kill someone or I'm going to end up killing myself'. How does it feel to be burnt out as a practicing UK GP? 我只是觉得,要么我去杀人,要么我去自杀。作为一名执业的英国全科医生,职业倦怠的感觉如何?
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-11-25 DOI: 10.1080/13814788.2024.2426981
Ishbel Orla Whitehead, Suzanne Moffatt, Barbara Hanratty

Objective: To explore how it feels to be a burnt out GP in the NHS.

Design: In depth qualitative interviews with 16 UK GPs with self-declared 'lived experience' of burnout.

Setting: United Kingdom Primary Care.

Results: Seven male and nine female GPs described their experiences of burnout to a peer researcher. Themes identified were exhaustion and depersonalisation, mental and physical illness, identity and existential crises, and finally tenacity and resilience. Participants were self-reflective and described distress, shame, stigma, and guilt, including times of suicidal behaviour and isolation due to their burnout.

Conclusions: Burnout threatens a GP's sense of identity, purpose, and functioning in their lives, and ultimately can be life-threatening. Active listening to GP distress and a system wide approach to managing distress and burnout is urgently required.

目的探究在英国国家医疗服务体系中职业倦怠的全科医生的感受:设计:对 16 名英国全科医生进行深入的定性访谈,这些全科医生自称有职业倦怠的 "生活经历":结果:七名男性全科医生和九名女性全科医生描述了他们的职业倦怠:结果:7 名男性和 9 名女性全科医生向同行研究人员描述了他们的职业倦怠经历。确定的主题包括疲惫和人格解体、精神和身体疾病、身份认同和生存危机,最后是坚韧和复原力。参与者进行了自我反思,描述了痛苦、羞愧、耻辱和内疚,包括因职业倦怠而产生自杀行为和孤立无援的时候:职业倦怠威胁着全科医生的身份感、目标感和生活功能,最终可能危及生命。当务之急是积极倾听全科医生的苦恼,并在全系统范围内采用一种方法来管理苦恼和职业倦怠。
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引用次数: 0
Medication management during risk of dehydration: A qualitative study among elderly patients with impaired renal function and informal caregivers. 脱水风险期间的药物管理:一项针对肾功能受损的老年患者和非正式护理人员的定性研究。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-10-11 DOI: 10.1080/13814788.2024.2413097
Tristan Coppes, Daphne Philbert, Mijke Van Riet, Teun van Gelder, Marcel Bouvy, Ellen Koster

Background: Patients with impaired renal function are at an increased risk of dehydration due to vomiting, diarrhoea or fever (so-called sick days). Temporary medication adjustment during sick days is necessary and current initiatives and information materials for patients are available. However, the knowledge, experiences and information needs of patients and informal caregivers about sick day guidance are unknown.

Aim: To gain insight into the understanding of safe medication use during periods of dehydration risk in elderly patients with impaired renal function and their informal caregivers.

Design and setting: Qualitative interview study with patients with impaired renal function and unrelated informal caregivers from three community pharmacies in the Netherlands.

Method: The interviews were conducted by telephone or live by two researchers in November 2020-September 2021 and audiotaped and transcribed verbatim. The coding of transcripts was performed deductively and inductively in Nvivo 12, a thematic analysis was applied.

Results: In total 12 patients and 11 unrelated informal caregivers were included. Three main themes were derived from the interview guide and subthemes emerged from the transcripts. The included patients and informal caregivers had limited knowledge about medication management during sick days. In contrast to patients, informal caregivers seemed interested in a medication management protocol for sick days.

Conclusion: Patients with impaired renal function and informal caregivers have little knowledge about and experience with dehydration and safe use of medication during sick days. General practitioners and pharmacists should involve the care network, including informal caregivers, when implementing sick day guidance.

背景:肾功能受损患者因呕吐、腹泻或发烧(所谓的病假)而脱水的风险增加。在病假期间临时调整用药是必要的,目前已有针对患者的措施和信息资料。目的:深入了解肾功能受损的老年患者及其非正规护理人员对脱水风险期间安全用药的理解:设计与环境:对荷兰三家社区药房的肾功能受损患者及其非正式护理人员进行定性访谈研究:访谈由两名研究人员于 2020 年 11 月至 2021 年 9 月通过电话或现场方式进行,并进行录音和逐字记录。在 Nvivo 12 中对记录誊本进行了演绎和归纳编码,并进行了专题分析:结果:共纳入了 12 名患者和 11 名无关的非正式护理人员。从访谈指南中得出了三个主要主题,并从记录誊本中得出了次主题。所纳入的患者和非正规护理人员对病假期间的用药管理了解有限。与患者相比,非正式护理人员似乎对病假期间的用药管理协议很感兴趣:结论:肾功能受损患者和非正规护理人员对脱水和病假期间安全用药知之甚少,经验不足。全科医生和药剂师在实施病假指导时,应让包括非正式护理人员在内的护理网络参与进来。
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European Journal of General Practice
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