European Journal of General Practice最新文献

Background: LGBT* (lesbian, gay, bisexual, trans, others) individuals are known to experience poorer health and restricted access to healthcare compared to cisgender-heterosexual individuals.

Objective: As General Practitioners (GPs) are a patient's first point of contact with the healthcare system in Germany, this study examines GPs' perspectives on LGBT healthcare.

Methods: In this qualitative study, we conducted 19 semi-structured episodic interviews with GPs in urban and rural areas of Germany. The interviews were analysed using framework analysis.

Results: Our study shows LGBT* doctors feel more responsible for LGBT* healthcare than their cis-heterosexual colleagues. There is a perceived lack of knowledge and learning opportunities on LGBT* health needs for most interviewees. Cis-heterosexual GPs often feel unprepared to provide specific healthcare interventions to LGBT* patients and believe they lack the resources to improve their education on the topic. LGBT*-specific primary healthcare seems to be delivered by a small number of GP practices and primarily by LGBT* doctors. These LGBT* doctors recommend more widespread knowledge of LGBT* primary care and lives, to allow their colleagues to provide better care for these patients.

Conclusion: There is a lack of knowledge on LGBT health needs and challenges among GPs in Germany, which needs to be addressed through structured training in medical school, and on a postgraduate level. This lack of knowledge leads to cis-heterosexual GPs feeling more insecure in providing care to LGBT* patients and LGBT* GPs providing a bigger share of LGBT* healthcare than their cis-heterosexual colleagues.

Background: Disclosure ('coming out') is an ongoing process for LGBT+ individuals, impacting various aspects of their lives. While research underscores the importance of disclosure for the health and well-being of LGBT+ people, concerns about stigma and discrimination often lead to non-disclosure, affecting healthcare access and outcomes. In Slovenia, where general practitioners (GPs) play a pivotal role in healthcare, understanding the dynamics of disclosure within primary healthcare settings is crucial.

Methods: This qualitative study utilised an online survey with open-ended questions to explore the experiences and expectations of both LGBT+ individuals and GPs regarding disclosure. Thematic analysis was employed to identify key themes and subthemes from the data collected between October and December 2021.

Results: Among 214 LGBT+ participants and 28 GPs, four main themes emerged: the necessity and relevance of disclosure; fear, insecurity, or neutrality towards non-disclosure; characteristics and actions of GPs helpful for disclosure; and GPs' self-evaluation of reactions to disclosure. Some participants viewed disclosure as essential for quality healthcare, disclosing their sexual orientation when necessary for medical treatment or to establish a trusting relationship with their GP, but others feared discrimination and preferred non-disclosure. GPs' characteristics and actions, such as creating a safe environment and using inclusive language, were crucial for facilitating disclosure.

Conclusions: Our findings reinforce the significance of GP engagement in fostering safe and supportive environments for disclosure, ultimately improving healthcare access and outcomes for LGBT+ individuals in Slovenia.

Background: Musculoskeletal pain is a leading reason for primary care visits and often requires pharmacological treatment. Despite rising prescription rates for non-opioid analgesics in Germany, little is known about GPs' broader prescribing behaviour beyond opioid-related discussions. Understanding how GPs navigate pain management is key to supporting evidence-based prescribing.

Objectives: This study explored GPs' decision-making strategies when prescribing for musculoskeletal pain and identified clinical challenges.

Methods: A qualitative study using semi-structured interviews was conducted with 15 GPs from Central and Northern Hesse, Germany. Participants were purposively recruited via a regional practice network. Interviews were analysed using Braun and Clarke's thematic analysis, applying a combined deductive-inductive approach.

Results: Five major themes emerged: (1) prescribing approaches, (2) medication preferences, (3) doctor-patient relationship, (4) addressing psychosomatic factors, and (5) support needs. GPs preferred cautious prescribing, favouring metamizole and NSAIDs over opioids. Chronic pain was viewed as complex and required individualised, multimodal treatment and shared decision-making. Decision-making strategies were mainly shaped by guidelines like the WHO analgesic ladder and personal clinical experience; other guidelines were rarely mentioned. The doctor-patient relationship was considered essential, particularly in chronic pain contexts. Challenges included managing psychosomatic aspects and aligning treatment expectations.

Conclusion: GPs' prescribing decisions are shaped by a combination of clinical judgement, patient dynamics, and systemic factors. The findings highlight the need for practical support tools that are integrated into daily workflows and emphasise shared decision-making, especially for chronic pain management. These insights can inform future interventions aimed at optimising prescribing practices in primary care.

Background: Person-centred care (PCC) is a fundamental principle in general practice, emphasising practices tailored to individual patient preferences, needs, and values. Despite the importance of PCC, general practitioners (GPs) face obstacles in effectively implementing it, with associated factors remaining unclear.

Objectives: The PACE GP/FP study aims to explore GPs' attitudes towards PCC and the factors facilitating or hindering its implementation in daily practice across European countries. This paper outlines the PACE GP/FP study protocol.

Methods: The cross-sectional design with data collection via an online survey distribution to GPs in 24 European countries. Study instruments include two validated questionnaires (Perceived Stress Scale (PSS) and Patient Physician Orientation Scale (PPOS)) and additional items covering general information about the doctor and their practice, as well as facilitators and barriers to PCC. These additional items were specifically developed for the study, translated using the forward-backward method, evaluated through cognitive debriefing, and integrated into the REDCap platform to create language and country-specific survey links. The STROBE checklist guides the reporting of the manuscript.

Conclusion: The PACE GP/FP study will provide a comprehensive exploration of GPs' attitudes towards PCC and the factors shaping its practice in Europe. The findings from the PACE GP/FP study will provide evidence for designing future implementation strategies and guide targeted interventions to promote PCC in primary care across Europe.

Background: Primary care providers deliver the majority of medical care serving as essential first points of contact and care coordinators. Despite the significant challenges they face, primary care research seems to lag behind and stay low-funded. Since the mid-1990s, academic reforms have emphasised metrics like third-party funding and high-impact publications. Medical schools were encouraged to develop distinct research profiles and to compete both internally and externally, leading to shifts in how research areas were prioritised, potentially disadvantaging primary care research.

Objectives: To investigate the thematic priorities in German medical schools' research, assess the diversification of these priorities, and examine the role of primary care research.

Methods: We conducted an analysis of the research priorities of all 39 German medical schools associated with the German Association of Medical Faculties. Data was extracted from medical school websites in October 2023. Research priorities were categorised and analysed using descriptive statistics and relationship mapping.

Results: Research profile topics per medical school ranged from 1 to 7 (mean 3.51, SD 1.41). The most common research priorities were 'Neuroscience & Neurology' (69.2%), 'Immunology/Infectiology/Immunotherapy' (59.0%), and 'Oncology' (51.3%). Only a few institutions, primarily those in rural areas or recently established medical schools, prioritised adjacent primary care research fields such as health services research or community medicine.

Conclusion: Our analysis reveals a significant concentration of research priorities in a few biomedical fields across German medical schools, with an underrepresentation of primary care research. This suggests a potential misalignment between academic focus and societal healthcare needs.

Background: Research is vital for progress and development of healthcare and may help relieve current health service pressures through improvements and efficiencies. Research in primary care is not well established and is not part of routine practice. This study aims to investigate the barriers and facilitators to primary care staff conducting research.

Method: A systematic literature review was conducted in CINAHL, Medline, APA, PsycInfo, AHMED and EMBASE from inception to April 2023. Searches were for studies involving clinical or non-clinical staff working in primary care where barriers or facilitators to conducting research were examined.

Results: Twenty-one studies were included from 2000 to 2022. The QuADs quality appraisal method found that papers were of varying, often low quality. Five themes were found - research beliefs & understanding, time, funding & recognition, skills & knowledge, administration & support, ethics & understanding and communication & people. Staff thought research useful but optional and were impeded by time and funding. They need training and support to carry out research. Communication from the researchers before, during and after study completion would prevent problems and lead to more research participation in the future.

Conclusion: Improved communication at all stages would serve as a facilitator to primary care staff conducting research. Clear, appropriate training for all staff would allow them to complete appropriate tasks for their roles and prevent one individual taking full responsibility. Embedding research in primary care with protected time and resources to complete it would remove barriers to taking part.

Background: Recent studies indicate that the synthetic thyroid hormone levothyroxine (LTX) in many cases has no beneficial effects on patients with subclinical hypothyroidism. Still, prescriptions are increasing worldwide. If there is no clear indication for treatment, patients treated with LTX should be offered a deprescribing trial according to current guidelines. However, there is currently no protocol for deprescribing LTX in primary care.

Objectives: We aimed to explore patients' enablers and barriers towards deprescribing levothyroxine in primary care to inform the further participatory development of a deprescribing strategy.

Methods: Based on the COREQ checklist, focus group discussions were conducted with patients and general practitioners as well as patients only in 2024. Participants ranked the five most crucial enablers and barriers. Transcripts and prioritised elements were examined using the qualitative content analysis method according to Kuckartz.

Results: Patients frequently felt misinformed about their condition and the prescription of LTX. A change in their medications raised doubts and uncertainties. However, the potential advantages and opportunities of deprescribing were compelling: a (re)gain of quality of life, a decrease in probable drug side effects, savings of time and cost. Mostly, patients welcomed a gradual and managed deprescribing under their general practitioner's supervision.

Conclusion: Patients wished for medical information to reduce their doubts concerning deprescribing and expressed confidence in their general practitioner. Our findings indicate a fundamental commitment to deprescribing LTX. For an adherent process in general practitioners' practices, a strategy that considers patients' worries and concerns seems feasible.

Rural populations in Europe face health inequalities due to a multitude of factors, including the higher prevalence of multi-morbidity, inadequate access to primary and secondary health care services, and widespread health workforce shortages. Although some challenges are also present in other contexts, the multitude and interconnectedness of these factors induce significant health inequalities. Research is a prime tool to demonstrate these, examine potential rural-specific solutions and serve as an essential advocacy instrument for change. Rural primary care remains however significantly underrepresented in European research, contributing further to the health inequities as policies and interventions are often based on urban-centric data. Therefore, advancing evidence-based solutions for rural primary healthcare requires stronger research collaboration. In response, the Rural Health European Academic Network (RHEAN) was established in 2024 to expand academic partnerships beyond the WONCA Europe network EURIPA, the European Rural and Isolated Practitioners Association. This paper identifies rural-specific primary care challenges emerging from key literature and network discussions that shape RHEAN's collaborative research agenda. The agenda will be refined through a mapping survey of rural primary healthcare research and education within the networks.