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mHealth technologies for pregnancy prevention: A challenge for patient-centred contraceptive counselling in Dutch general practice. 用于避孕的移动保健技术:荷兰全科医生以病人为中心的避孕咨询面临的挑战。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-01-24 DOI: 10.1080/13814788.2024.2302435
Ellen Algera, Peter Leusink, Trudie Gerrits, Jeannette Pols, Jan Hindrik Ravesloot

Background: A general practitioner (GP) standardly provides contraceptive counselling and care in the Netherlands. Recent years have seen the rise of mobile health technologies that aim to prevent pregnancy based on fertility awareness-based methods (FABMs). We lack high-quality evidence of these methods' effectiveness and clarity on how healthcare professionals include them in contraceptive counselling.

Objectives: To analyse how Dutch healthcare professionals include pregnancy-prevention mobile health technologies (mHealth contraception) in contraceptive counselling and to propose practice recommendations based on our findings.

Methods: We used ethnographic methods, including semi-structured interviews with nine professionals who were recruited using purposive sampling, 10 observations of contraceptive counselling by four professionals, six observations of teaching sessions in medical training on contraception and reproductive health, one national clinical guideline, and seven Dutch patient decision aids. Data were collected between 2018 and 2021 and analysed inductively using praxiographic and thematic analysis.

Results: In contraceptive counselling and care, professionals tended to blend two approaches: 1) individual patient-tailored treatment and 2) risk minimisation. When interviewed about mHealth contraception, most professionals prioritised risk minimisation and forewent tailored treatment. Some did not consider mHealth contraception or FABMs as contraceptives or deemed them inferior methods.

Conclusion: To minimise risk of unintended pregnancy, professionals hesitated to include mHealth contraception or other FABMs in contraceptive consultations. This may hamper adequate patient-centred counselling for patients with preference for mHealth contraception.Based on these results, we proposed recommendations that foster a patient-tailored approach to mHealth contraceptives.

背景:在荷兰,全科医生(GP)通常会提供避孕咨询和护理。近年来,基于生育意识的避孕方法(FABMs)的移动医疗技术开始兴起。我们缺乏这些方法有效性的高质量证据,也不清楚医疗保健专业人员如何将这些方法纳入避孕咨询:分析荷兰医疗保健专业人员如何将避孕移动医疗技术(移动医疗避孕)纳入避孕咨询,并根据我们的研究结果提出实践建议:我们采用了人种学方法,包括对九名专业人员进行半结构化访谈,这些人员是通过有目的的抽样调查招募的;对四名专业人员的避孕咨询进行了 10 次观察;对避孕和生殖健康医疗培训的教学课程进行了 6 次观察;制定了一项国家临床指南;以及七份荷兰患者决策辅助工具。数据收集时间为 2018 年至 2021 年,并采用表象分析法和主题分析法对数据进行归纳分析:在避孕咨询和护理中,专业人员倾向于融合两种方法:1)针对患者的个体治疗;2)风险最小化。在接受有关移动保健避孕的访谈时,大多数专业人员都将风险最小化放在首位,放弃了有针对性的治疗。有些人不认为移动医疗避孕或 FABMs 是避孕药具,或认为它们是次等方法:为了将意外怀孕的风险降至最低,专业人员在将移动医疗避孕或其他 FABM 纳入避孕咨询时犹豫不决。基于这些结果,我们提出了一些建议,以促进针对患者的移动医疗避孕方法。
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引用次数: 0
Preventing cardiovascular disease in at-risk patients: Results of a pilot behavioural health programme in general practice. 预防高危患者的心血管疾病:全科医生行为健康试点计划的成果。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-10-18 DOI: 10.1080/13814788.2024.2413106
John Broughan, Emīls Sietiņš, J T Treanor, Ka Yuet Emily Siu, Janis Morrissey, Orla Doyle, Mary Casey, Patricia Fitzpatrick, Geoff McCombe, Walter Cullen

Background: The 'High-Risk Prevention Programme' (HRPP) involved a six-week health behaviour change programme based in general practices and aimed to address cardiovascular disease (CVD) risk in disadvantaged Irish communities.

Objectives: This pilot study aimed to establish the HRPP's likely effectiveness and acceptability to inform the development of a future definitive trial.

Methods: The HRPP was conducted at six general practices in disadvantaged areas in the Ireland East region. Patients with high CVD risk were recruited by participating practices and were allocated to either a General Practice Nurse (GPN) or Health Promotion Professional (HPP) led programme focusing on positive health behavioural change. Baseline and 12-month follow-up data were collected to capture the HRPP's likely effectiveness in promoting health outcomes and health behavioural change.

Results: The HRPP programme was completed by 270 patients. Out of these 270 patients, 245 (90.74%) completed baseline assessments, and 176 (65.19%) completed follow-up assessments at 12 months. Baseline data indicated a high level of CVD risk among patients and follow-up demonstrated positive change in several areas, especially weight (-1.95 kg, p < 0.001), BMI (-0.72, p < 0.001), exercise during the last week (p<0.001), and consumption of healthy fats in the HPP group (+60%, p< 0.001).

Conclusion: The HRPP was a much-needed pilot intervention, and positive results were seen in both GPN and HPP arms, especially with regards to weight loss, exercise, and dietary improvements. Future definitive trials of the HRPP are likely to be effective and acceptable in terms of combatting these issues among high-risk patients.

背景:"高风险预防计划"(HRPP高风险预防计划"(HRPP)涉及一项为期六周的健康行为改变计划,该计划以全科实践为基础,旨在解决爱尔兰弱势社区的心血管疾病(CVD)风险问题:这项试点研究旨在确定 HRPP 可能的有效性和可接受性,为今后开展确定性试验提供依据:方法:在爱尔兰东部贫困地区的六家全科诊所开展 HRPP 项目。参与试验的诊所招募了心血管疾病高风险患者,并将他们分配到由全科护士(GPN)或健康促进专业人员(HPP)主导的项目中,该项目侧重于积极的健康行为改变。我们收集了基线数据和 12 个月的随访数据,以了解 HRPP 在促进健康结果和健康行为改变方面可能取得的成效:结果:270 名患者完成了 HRPP 计划。在这 270 名患者中,245 人(90.74%)完成了基线评估,176 人(65.19%)完成了 12 个月的随访评估。基线数据显示,患者的心血管疾病风险水平较高,随访结果显示,患者在多个方面发生了积极变化,尤其是体重(-1.95 千克,p < 0.001)、体重指数(-0.72,p < 0.001)和最近一周的运动量(pp < 0.001):HRPP是一项亟需的试验性干预措施,在GPN和HPP两组均取得了积极的成果,尤其是在体重减轻、运动和饮食改善方面。未来,HRPP 的最终试验很可能会有效且可接受地解决高危患者的这些问题。
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引用次数: 0
Biomarkers for predicting atrial fibrillation: An explorative sub-analysis of the randomised SCREEN-AF trial. 预测心房颤动的生物标志物:随机 SCREEN-AF 试验的探索性子分析。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-03-18 DOI: 10.1080/13814788.2024.2327367
Katharina Schmalstieg-Bahr, David J Gladstone, Eva Hummers, Johanna Suerbaum, Jeff S Healey, Antonia Zapf, Denise Köster, Stefanie M Werhahn, Rolf Wachter

Background: Atrial fibrillation (AF) is a common treatable risk factor for stroke. Screening for paroxysmal AF in general practice is difficult, but biomarkers might help improve screening strategies.

Objectives: We investigated six blood biomarkers for predicting paroxysmal AF in general practice.

Methods: This was a pre-specified sub-study of the SCREEN-AF RCT done in Germany. Between 12/2017-03/2019, we enrolled ambulatory individuals aged 75 years or older with a history of hypertension but without known AF. Participants in the intervention group received active AF screening with a wearable patch, continuous ECG monitoring for 2x2 weeks and usual care in the control group. The primary endpoint was ECG-confirmed AF within six months after randomisation. High-sensitive Troponin I (hsTnI), brain natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-pro BNP), N-terminal pro atrial natriuretic peptide (NT-ANP), mid-regional pro atrial natriuretic peptide (MR-pro ANP) and C-reactive protein (CRP) plasma levels were investigated at randomisation for predicting AF within six months after randomisation.

Results: Blood samples were available for 291 of 301 (96.7%) participants, including 8 with AF (3%). Five biomarkers showed higher median results in AF-patients: BNP 78 vs. 41 ng/L (p = 0.012), NT-pro BNP 273 vs. 186 ng/L (p = 0.029), NT-proANP 4.4 vs. 3.5 nmol/L (p = 0.027), MR-pro ANP 164 vs. 125 pmol/L (p = 0.016) and hsTnI 7.4 vs. 3.9 ng/L (p = 0.012). CRP levels were not different between groups (2.8 vs 1.9 mg/L, p = 0.1706).

Conclusion: Natriuretic peptide levels and hsTnI are higher in patients with AF than without and may help select patients for AF screening, but larger trials are needed.

背景:心房颤动(房颤)是一种常见的可治疗的中风危险因素。在全科医生中筛查阵发性房颤很困难,但生物标志物可能有助于改进筛查策略:我们研究了在全科医生中预测阵发性房颤的六种血液生物标志物:这是在德国进行的 SCREEN-AF RCT 的一项预先指定的子研究。在 2017 年 12 月至 2019 年 3 月期间,我们招募了年龄在 75 岁或以上、有高血压病史但未发现房颤的流动人口。干预组参与者接受可穿戴贴片主动房颤筛查、2x2 周连续心电图监测,对照组接受常规护理。主要终点是随机分组后六个月内经心电图证实的房颤。随机化时对高敏肌钙蛋白I(hsTnI)、脑钠肽(BNP)、N末端前B型钠尿肽(NT-pro BNP)、N末端前心房钠尿肽(NT-ANP)、中区域前心房钠尿肽(MR-pro ANP)和C反应蛋白(CRP)血浆水平进行了调查,以预测随机化后6个月内的房颤:301 名参与者中有 291 人(96.7%)获得了血样,其中包括 8 名房颤患者(3%)。心房颤动患者的五种生物标志物的中位结果较高:BNP 78 vs. 41 ng/L(p = 0.012)、NT-pro BNP 273 vs. 186 ng/L(p = 0.029)、NT-proANP 4.4 vs. 3.5 nmol/L(p = 0.027)、MR-pro ANP 164 vs. 125 pmol/L(p = 0.016)和hsTnI 7.4 vs. 3.9 ng/L(p = 0.012)。CRP水平在各组之间没有差异(2.8 vs 1.9 mg/L,p = 0.1706):结论:房颤患者的钠尿肽水平和 hsTnI 均高于非房颤患者,可能有助于选择房颤患者进行筛查,但需要进行更大规模的试验。
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引用次数: 0
Primary mental healthcare for adults with mild intellectual disabilities: Patients' perspectives. 轻度智障成人的初级精神保健:患者的观点。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-05-17 DOI: 10.1080/13814788.2024.2354414
Katrien Pm Pouls, Mathilde Mastebroek, Suzanne J Ligthart, Willem Jj Assendelft, Geraline L Leusink, Monique Cj Koks-Leensen

Background: People with mild intellectual disabilities (MID) experience more mental health (MH) problems than the general population but often do not receive appropriate primary MH care. Primary MH care is essential in integrative MH care and, therefore, demands high quality. To improve primary MH care for this patient group, account must be taken of the experiences of people with MID. So far, their perspectives have been largely absent from primary MH care research.

Objectives: To explore patients' experiences, needs, and suggestions for improvement regarding primary MH care for people with MID.

Methods: Qualitative study among adults with MID who visited their GP with MH problems in the previous 12 months. Semi-structured interviews were conducted using a guide based on Person-Centred Primary Care Measures. Transcripts were analysed thematically.

Results: The 11 interviews that we conducted revealed four themes. The first theme, cumulative vulnerability, describes the vulnerability - instigated by the MID and reinforced by MH problems - experienced on a GP visit. The other themes (needs regarding the GP, needs regarding the network, self-determination) arise from this vulnerability.

Conclusion: People with both MID and MH problems are extra vulnerable in primary care but desire self-determination regarding their MH care trajectory. This requires investment in a good GP-patient relationship and the organisation of additional support to meet these patients' needs, for which collaborative care with the patient, the patient's network, and other (care) professionals is of utmost importance.

背景:轻度智障人士(MID)比普通人面临更多的心理健康(MH)问题,但他们往往得不到适当的初级心理健康护理。初级精神健康护理在综合精神健康护理中至关重要,因此要求高质量。要改善针对这一患者群体的初级医疗保健服务,就必须考虑到 MID 患者的经历。迄今为止,他们的观点在初级精神健康护理研究中基本缺席:探讨 MID 患者在初级 MH 护理方面的经验、需求和改进建议:方法:对在过去 12 个月中因精神健康问题到全科医生处就诊的成年 MID 患者进行定性研究。采用以人为本的初级保健措施为基础的指南进行了半结构化访谈。对访谈记录进行了专题分析:我们进行的 11 次访谈揭示了四个主题。第一个主题是 "累积的脆弱性",描述了在全科医生就诊时经历的脆弱性--由 MID 引发,并因精神健康问题而加剧。其他主题(对全科医生的需求、对网络的需求、自决)都源于这种脆弱性:结论:同时患有 MID 和 MH 问题的人在初级保健中特别容易受到伤害,但他们希望对自己的 MH 护理轨迹进行自我决定。这就需要全科医生与患者建立良好的关系,并组织额外的支持以满足这些患者的需求,为此,与患者、患者网络以及其他(护理)专业人员的合作护理至关重要。
{"title":"Primary mental healthcare for adults with mild intellectual disabilities: Patients' perspectives.","authors":"Katrien Pm Pouls, Mathilde Mastebroek, Suzanne J Ligthart, Willem Jj Assendelft, Geraline L Leusink, Monique Cj Koks-Leensen","doi":"10.1080/13814788.2024.2354414","DOIUrl":"10.1080/13814788.2024.2354414","url":null,"abstract":"<p><strong>Background: </strong>People with mild intellectual disabilities (MID) experience more mental health (MH) problems than the general population but often do not receive appropriate primary MH care. Primary MH care is essential in integrative MH care and, therefore, demands high quality. To improve primary MH care for this patient group, account must be taken of the experiences of people with MID. So far, their perspectives have been largely absent from primary MH care research.</p><p><strong>Objectives: </strong>To explore patients' experiences, needs, and suggestions for improvement regarding primary MH care for people with MID.</p><p><strong>Methods: </strong>Qualitative study among adults with MID who visited their GP with MH problems in the previous 12 months. Semi-structured interviews were conducted using a guide based on Person-Centred Primary Care Measures. Transcripts were analysed thematically.</p><p><strong>Results: </strong>The 11 interviews that we conducted revealed four themes. The first theme, cumulative vulnerability, describes the vulnerability - instigated by the MID and reinforced by MH problems - experienced on a GP visit. The other themes (needs regarding the GP, needs regarding the network, self-determination) arise from this vulnerability.</p><p><strong>Conclusion: </strong>People with both MID and MH problems are extra vulnerable in primary care but desire self-determination regarding their MH care trajectory. This requires investment in a good GP-patient relationship and the organisation of additional support to meet these patients' needs, for which collaborative care with the patient, the patient's network, and other (care) professionals is of utmost importance.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2354414"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11104687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960773","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
Appropriateness of intended antibiotic prescribing using clinical case vignettes in primary care, and related factors. 在初级保健中使用临床病例小故事开具抗生素处方的适当性及相关因素。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-05-20 DOI: 10.1080/13814788.2024.2351811
Tristan Delory, Alexis Maillard, Florence Tubach, Pierre-Yves Böelle, Elisabeth Bouvet, Sylvie Lariven, Pauline Jeanmougin, Josselin Le Bel

Background: Factors associated with the appropriateness of antibiotic prescribing in primary care have been poorly explored. In particular, the impact of computerised decision-support systems (CDSS) remains unknown.

Objectives: We aim at investigating the uptake of CDSS and its association with physician characteristics and professional activity.

Methods: Since May 2022, users of a CDSS for antibiotic prescribing in primary care in France have been invited, when registering, to complete three case vignettes assessing clinical situations frequently encountered in general practice and identified as at risk of antibiotic misuse. Appropriateness of antibiotic prescribing was defined as the rate of answers in line with the current guidelines, computed by individuals and by specific questions. Physician's characteristics associated with individual appropriate antibiotic prescribing (< 50%, 50-75% and > 75% appropriateness) were identified by multivariate ordinal logistic regression.

Results: In June 2023, 60,067 physicians had registered on the CDSS. Among the 13,851 physicians who answered all case vignettes, the median individual appropriateness level of antibiotic prescribing was 77.8% [Interquartile range, 66.7%-88.9%], and was < 50% for 1,353 physicians (10%). In the multivariate analysis, physicians' characteristics associated with appropriateness were prior use of the CDSS (OR = 1.71, 95% CI 1.56-1.87), being a general practitioner vs. other specialist (OR = 1.34, 95% CI 1.20-1.49), working in primary care (OR = 1.14, 95% CI 1.02-1.27), mentoring students (OR = 1.12, 95% CI 1.04-1.21) age (OR = 0.69 per 10 years increase, 95% CI 0.67-0.71).

Conclusion: Individual appropriateness for antibiotic prescribing was high among CDSS users, with a higher rate in young general practitioners, previously using the system. CDSS could improve antibiotic prescribing in primary care.

背景:与初级医疗中抗生素处方适当性相关的因素尚未得到充分探讨。尤其是计算机化决策支持系统(CDSS)的影响仍是未知数:我们旨在调查 CDSS 的使用情况及其与医生特征和职业活动的关系:自 2022 年 5 月起,法国初级医疗抗生素处方 CDSS 的用户在注册时被邀请完成三个病例小故事,评估在全科医疗中经常遇到的临床情况,并确定其存在滥用抗生素的风险。抗生素处方的适当性被定义为符合现行指南的回答率,按个人和具体问题计算。通过多变量序数逻辑回归确定了与个人抗生素处方适当性(适当性<50%、50-75%和>75%)相关的医生特征:截至 2023 年 6 月,共有 60067 名医生在 CDSS 上注册。在回答了所有病例小故事的 13851 名医生中,抗生素处方的个人适当性水平中位数为 77.8% [四分位距为 66.7%-88.9%] ,有 1353 名医生(10%)的适当性水平低于 50%。在多变量分析中,与适当性相关的医生特征有:曾使用 CDSS(OR = 1.71,95% CI 1.56-1.87)、全科医生与其他专科医生(OR = 1.34,95% CI 1.20-1.49)、在基层医疗机构工作(OR = 1.14,95% CI 1.02-1.27)、指导学生(OR = 1.12,95% CI 1.04-1.21)、年龄(每增加 10 岁,OR = 0.69,95% CI 0.67-0.71):结论:CDSS用户抗生素处方的个人适宜性较高,以前使用过该系统的年轻全科医生的适宜性更高。CDSS 可以改善基层医疗机构的抗生素处方。
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引用次数: 0
Democratising the design and delivery of large-scale randomised, controlled clinical trials in primary care: A personal view. 在初级保健中设计和实施大规模随机对照临床试验的民主化:个人观点。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-01-05 DOI: 10.1080/13814788.2023.2293702
Christopher C Butler

Background: Rapid identification of effective treatments for use in the community during a pandemic is vital for the well-being of individuals and the sustainability of healthcare systems and society. Furthermore, identifying treatments that do not work reduces research wastage, spares people unnecessary side effects, rationalises the cost of purchasing and stockpiling medication, and reduces inappropriate medication use. Nevertheless, only a small minority of therapeutic trials for SARS-CoV-2 infections have been in primary care: most opened too late, struggled to recruit, and few produced actionable results. Participation in research is often limited by where one lives or receives health care, and trial participants may not represent those for whom the treatments are intended.

Innovative trials: The ALIC4E, PRINCIPLE and the ongoing PANORAMIC trial have randomised over 40,500 people with COVID-19. This personal view describes how these trials have innovated in: trial design (by using novel adaptive platform designs); trial delivery (by complementing traditional site-based recruitment ('the patient comes to the research') with mechanisms to enable sick, infectious people to participate without having to leave home ('taking research to the people'), and by addressing the 'inverse research participation law,' which highlights disproportionate barriers faced by those who have the most to contribute, and benefit from, research, and; in transforming the evidence base by evaluating nine medicines to support guidelines and care decisions world-wide for COVID-19 and contribute to antimicrobial stewardship.

Conclusion: The PRINCIPLE and PANORAMIC trials represent models of innovation and inclusivity, and exemplify the potential of primary care to lead the way in addressing pressing global health challenges.

背景:在大流行病期间,迅速确定社区使用的有效治疗方法对于个人的福祉以及医疗保健系统和社会的可持续发展至关重要。此外,找出无效的治疗方法可减少研究浪费,使人们避免不必要的副作用,合理降低购买和储存药物的成本,并减少不适当的药物使用。然而,只有极少数针对 SARS-CoV-2 感染的治疗试验是在初级保健领域进行的:大多数试验开展得太晚,很难招募到人员,而且几乎没有产生可操作的结果。参与研究往往受到居住地或接受医疗服务地点的限制,而且试验参与者可能并不代表治疗对象:ALIC4E、PRINCIPLE 和正在进行的 PANORAMIC 试验已随机抽取了 40500 多名 COVID-19 患者。这篇个人观点描述了这些试验如何在以下方面进行创新:试验设计(采用新颖的适应性平台设计);试验实施(对传统的现场招募("病人来参加研究")进行补充,建立机制让病人、感染者足不出户就能参加试验("将研究带到人们身边"),并解决 "反向研究参与法 "问题,该法强调了那些对研究贡献最大并能从研究中获益的人所面临的不成比例的障碍,以及通过评估九种药物来改变证据基础,为全世界 COVID-19 的指导方针和护理决策提供支持,并为抗菌药物管理做出贡献。结论:PRINCIPLE 试验和 PANORAMIC 试验是创新和包容性的典范,体现了初级保健在应对全球紧迫健康挑战方面的领导潜力。
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引用次数: 0
Contemporary perspectives regarding domestic violence and abuse in primary care: Cross-sectional NHS patients survey. 关于初级保健中的家庭暴力和虐待的当代观点:国家医疗服务系统患者横向调查。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-11-20 DOI: 10.1080/13814788.2024.2427006
Vasumathy Sivarajasingam, Manisha Karki, Emmanouil Bagkeris, Austen El-Osta

Background: Primary care plays a key role in addressing domestic violence and abuse (DVA) globally. However, DVA remains underdiagnosed and inadequately addressed in primary care, necessitating a deeper understanding of patients' perspectives in the UK.

Objectives: To explore patients' perceptions of their awareness of DVA signs and their attitudes towards using the Woman Abuse Screening Tool (WAST)-short during routine primary care encounters.

Methods: An anonymous 29-item e-Survey, available in 18 languages and including information about DVA support services, was administered via the Qualtrics XM Platform from March to October 2022. Eligible UK National Health Service patients aged 18+ were identified by GP practices in Northwest London and invited via SMS to participate.

Results: Data were collected from 6,967 NHS patients. The majority (78.0%) claimed awareness of the signs of DVA in adults and children, while about 22% were unaware or unsure of the signs of DVA. Nearly 85% reported insufficient public awareness about DVA. Around 70% recommended implementing the WAST-short screening tool during primary care encounters to raise awareness and support survivors. Over 50% viewed general practice as the optimal setting for identifying and referring survivors.

Conclusion: Improved public education on DVA is needed, as a significant proportion of patients remain unaware or unsure of its signs, with the majority deeming public knowledge insufficient. Patients' strong support for using standardised screening tools like the WAST-short reflects their trust in healthcare providers to conduct sensitive assessments. Integrating these tools into routine practice could enhance DVA interventions.

背景:在全球范围内,初级医疗在解决家庭暴力和虐待(DVA)问题方面发挥着关键作用。然而,基层医疗机构对家庭暴力和虐待的诊断和处理仍然不足,因此有必要深入了解英国患者的观点:目的:探讨患者对 DVA 迹象的认识,以及他们对在常规初级医疗就诊过程中使用妇女虐待筛查工具 (WAST)-short 的态度:2022 年 3 月至 10 月,我们通过 Qualtrics XM Platform™ 进行了一项 29 个项目的匿名电子调查,该调查有 18 种语言可供选择,其中包括有关 DVA 支持服务的信息。伦敦西北部的全科医生诊所确定了符合条件的 18 岁以上英国国民健康服务患者,并通过短信邀请他们参与调查:结果:共收集了 6967 名国民健康服务患者的数据。大多数患者(78.0%)声称了解成人和儿童的 DVA 症状,约 22% 的患者不了解或不确定 DVA 症状。近 85% 的人表示公众对 DVA 的认识不足。约 70% 的人建议在初级保健过程中使用 WAST 短程筛查工具,以提高对 DVA 的认识并为幸存者提供支持。50%以上的人认为全科诊所是识别和转介幸存者的最佳场所:结论:需要加强有关 DVA 的公众教育,因为相当一部分患者仍不了解或不确定其征兆,大多数人认为公众知识不足。患者对使用 WAST-short 等标准化筛查工具的大力支持反映了他们对医疗服务提供者进行敏感评估的信任。将这些工具纳入日常实践可以加强对 DVA 的干预。
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引用次数: 0
Follow-up of patients with chronic conditions within primary care practices during COVID-19: Results from 7 Central and Eastern-European countries from the cross-sectional PRICOV-19 study. 在 COVID-19 期间对初级保健实践中的慢性病患者进行随访:PRICOV-19 横向研究中 7 个中欧和东欧国家的结果。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-08-29 DOI: 10.1080/13814788.2024.2391468
Giulia Delvento, Christian Schindler, Cristina Rotaru, Ala Curteanu, Ghenadie Curochicin, Helen Prytherch, Victoria Tkachenko, Bohumil Seifert, Peter Torzsa, Radost Asenova, Carmen Busneag, Adam Windak, Sara Willems, Esther Van Poel, Claire Collins

Background: The COVID-19 pandemic posed severe challenges to delivery of services at Primary Care level and for achieving follow-up of patients with chronic diseases.

Objectives: We analysed data from the PRICOV-19 study to explore determinants of active follow-up for chronic disease patients in seven Central and Eastern European (CEE) countries during the pandemic.

Methods: Pricov-19 was a cross-sectional study conducted within PC (Primary Care) practices in 37 European countries. We analysed data from 7 CEE countries (Bulgaria, Czech Republic, Hungary, Poland, Moldova, Romania, Ukraine) collected between November 2020 and December 2021. Practices were recruited through random or convenience sampling and participation of practices was voluntary. We performed descriptive statistics to identify the level of follow-up of chronic disease and what health system and practice-specific factors were associated with better follow-up. We used logistic regression and meta-analysis techniques to explore associations and heterogeneity between countries.

Results: 67.8% out of 978 practices reported actively following up chronic patients. Positive associations were found between active follow-up and such as having more GPs (aOR = 1.18, p-value = 0.005), an above-average chronic patient population (aOR = 3.13, p-value = 0.006), adequate government support (aOR = 2.35, p-value = 0.001), and GPs having time for guideline reading (aOR = 0.008, p-value = 1.71).

Conclusions: Patient follow-up, was influenced by different health system and practice-specific factors. The implications suggest the need for government support to enhance PC practice organisation during crises and solutions to decrease GP workload and provide tailored care for patients with chronic disease.

背景COVID-19 大流行给基层医疗机构提供服务和实现对慢性病患者的随访带来了严峻挑战:我们分析了 PRICOV-19 研究的数据,以探讨大流行期间七个中东欧(CEE)国家慢性病患者积极随访的决定因素:Pricov-19 是一项横断面研究,在 37 个欧洲国家的 PC(初级保健)实践中进行。我们分析了 2020 年 11 月至 2021 年 12 月期间收集的 7 个中东欧国家(保加利亚、捷克共和国、匈牙利、波兰、摩尔多瓦、罗马尼亚和乌克兰)的数据。我们通过随机或方便抽样的方式招募医疗机构,医疗机构的参与是自愿的。我们进行了描述性统计,以确定慢性病的随访水平,以及哪些卫生系统和医疗机构的特定因素与更好的随访相关。我们使用逻辑回归和荟萃分析技术来探讨各国之间的关联性和异质性:结果:在 978 家医疗机构中,有 67.8%的医疗机构报告对慢性病患者进行了积极随访。结果:在 978 家诊所中,67.8% 的诊所报告对慢性病患者进行了积极随访。积极随访与以下因素呈正相关:全科医生人数较多(aOR = 1.18,p 值 = 0.005)、慢性病患者人数高于平均水平(aOR = 3.13,p 值 = 0.006)、政府支持充足(aOR = 2.35,p 值 = 0.001)、全科医生有时间阅读指南(aOR = 0.008,p 值 = 1.71):患者随访受不同医疗系统和具体实践因素的影响。研究结果表明,政府有必要提供支持,在危机期间加强个人护理实践的组织工作,并提供解决方案,减轻全科医生的工作量,为慢性病患者提供量身定制的护理服务。
{"title":"Follow-up of patients with chronic conditions within primary care practices during COVID-19: Results from 7 Central and Eastern-European countries from the cross-sectional PRICOV-19 study.","authors":"Giulia Delvento, Christian Schindler, Cristina Rotaru, Ala Curteanu, Ghenadie Curochicin, Helen Prytherch, Victoria Tkachenko, Bohumil Seifert, Peter Torzsa, Radost Asenova, Carmen Busneag, Adam Windak, Sara Willems, Esther Van Poel, Claire Collins","doi":"10.1080/13814788.2024.2391468","DOIUrl":"https://doi.org/10.1080/13814788.2024.2391468","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic posed severe challenges to delivery of services at Primary Care level and for achieving follow-up of patients with chronic diseases.</p><p><strong>Objectives: </strong>We analysed data from the PRICOV-19 study to explore determinants of active follow-up for chronic disease patients in seven Central and Eastern European (CEE) countries during the pandemic.</p><p><strong>Methods: </strong>Pricov-19 was a cross-sectional study conducted within PC (Primary Care) practices in 37 European countries. We analysed data from 7 CEE countries (Bulgaria, Czech Republic, Hungary, Poland, Moldova, Romania, Ukraine) collected between November 2020 and December 2021. Practices were recruited through random or convenience sampling and participation of practices was voluntary. We performed descriptive statistics to identify the level of follow-up of chronic disease and what health system and practice-specific factors were associated with better follow-up. We used logistic regression and meta-analysis techniques to explore associations and heterogeneity between countries.</p><p><strong>Results: </strong>67.8% out of 978 practices reported actively following up chronic patients. Positive associations were found between active follow-up and such as having more GPs (aOR = 1.18, p-value = 0.005), an above-average chronic patient population (aOR = 3.13, p-value = 0.006), adequate government support (aOR = 2.35, p-value = 0.001), and GPs having time for guideline reading (aOR = 0.008, p-value = 1.71).</p><p><strong>Conclusions: </strong>Patient follow-up, was influenced by different health system and practice-specific factors. The implications suggest the need for government support to enhance PC practice organisation during crises and solutions to decrease GP workload and provide tailored care for patients with chronic disease.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2391468"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114733","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
Registration and management of children with overweight by general practitioners in The Netherlands. 荷兰全科医生对超重儿童的登记和管理。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-11-14 DOI: 10.1080/13814788.2024.2425186
Hevy Hassan, Jacoline van den Driest, Angeline Bosman, Bart Willem Koes, Patrick Jan Eugène Bindels, Marienke van Middelkoop

Background: General practitioners (GPs) form the gateway to healthcare in numerous European countries. Their role in addressing and managing overweight/obesity in children is crucial. In Dutch guidelines, GPs are encouraged to proactively address weight-related issues during patient consultations, regardless of the initial reason of the visit.

Objective(s): To examine the frequency, management and follow-up of GP visits of children for overweight/obesity and the identification by GPs of these children presenting with other complaints.

Methods: A retrospective cohort study. Health records from 2012-2021 in the Rijnmond Primary Care Database (RPCD) of children aged 2-18 with overweight/obesity who visited the GP were analysed. Children were categorised into two groups: those visiting for weight-related issues (group 1) and those visiting for other complaints but identified as overweight or obese by GPs (group 2). Data on patient demographics, reasons for contact, and management strategies were extracted.

Results: From the 120,991 children, 3035 children with documented overweight or obesity were identified, 208 were excluded. The study population comprised 2827 individuals: 55% belonging to group 1, 45% to group 2. The frequency of first visits remained stable at approximately 0.5% visits per total person-years each year. Group 1 received more referrals (74%) and follow-up consultations (45.5%) than group 2 with 17% referrals and 19.7% follow-up consultations.

Conclusion: This study highlights a concerning difference in the management of the two groups. Strategies for effective management of overweight in children and the GP's role, warrant further investigation. Especially when overweight is not the primary reason for visit.

背景:在许多欧洲国家,全科医生(GPs)是医疗保健的入口。他们在解决和管理儿童超重/肥胖症方面发挥着至关重要的作用。在荷兰的指导方针中,鼓励全科医生在患者就诊时积极解决与体重相关的问题,无论最初的就诊原因是什么:研究儿童因超重/肥胖而就诊全科医生的频率、管理和随访情况,以及全科医生对这些儿童出现其他不适症状的识别情况:方法:回顾性队列研究。研究分析了莱茵蒙德初级保健数据库(RPCD)中 2012-2021 年期间全科医生接诊的 2-18 岁超重/肥胖儿童的健康记录。儿童被分为两组:因体重相关问题就诊的儿童(第一组)和因其他不适就诊但被全科医生认定为超重或肥胖的儿童(第二组)。研究提取了有关患者人口统计学、接触原因和管理策略的数据:从 120,991 名儿童中确定了 3035 名有记录的超重或肥胖儿童,其中 208 名被排除在外。研究对象包括 2827 人:首次就诊频率保持稳定,每年约为每人每年 0.5%。第 1 组接受转诊(74%)和复诊(45.5%)的比例高于第 2 组(转诊率为 17%,复诊率为 19.7%):结论:本研究强调了两组在管理方面令人担忧的差异。结论:这项研究强调了两组儿童在管理方面存在的令人担忧的差异。有效管理儿童超重的策略以及全科医生的作用值得进一步研究。特别是当超重不是就诊的主要原因时。
{"title":"Registration and management of children with overweight by general practitioners in The Netherlands.","authors":"Hevy Hassan, Jacoline van den Driest, Angeline Bosman, Bart Willem Koes, Patrick Jan Eugène Bindels, Marienke van Middelkoop","doi":"10.1080/13814788.2024.2425186","DOIUrl":"10.1080/13814788.2024.2425186","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) form the gateway to healthcare in numerous European countries. Their role in addressing and managing overweight/obesity in children is crucial. In Dutch guidelines, GPs are encouraged to proactively address weight-related issues during patient consultations, regardless of the initial reason of the visit.</p><p><strong>Objective(s): </strong>To examine the frequency, management and follow-up of GP visits of children for overweight/obesity and the identification by GPs of these children presenting with other complaints.</p><p><strong>Methods: </strong>A retrospective cohort study. Health records from 2012-2021 in the Rijnmond Primary Care Database (RPCD) of children aged 2-18 with overweight/obesity who visited the GP were analysed. Children were categorised into two groups: those visiting for weight-related issues (group 1) and those visiting for other complaints but identified as overweight or obese by GPs (group 2). Data on patient demographics, reasons for contact, and management strategies were extracted.</p><p><strong>Results: </strong>From the 120,991 children, 3035 children with documented overweight or obesity were identified, 208 were excluded. The study population comprised 2827 individuals: 55% belonging to group 1, 45% to group 2. The frequency of first visits remained stable at approximately 0.5% visits per total person-years each year. Group 1 received more referrals (74%) and follow-up consultations (45.5%) than group 2 with 17% referrals and 19.7% follow-up consultations.</p><p><strong>Conclusion: </strong>This study highlights a concerning difference in the management of the two groups. Strategies for effective management of overweight in children and the GP's role, warrant further investigation. Especially when overweight is not the primary reason for visit.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2425186"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632742","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
Series: Public engagement with research. Part 3: Sharing power and building trust through partnering with communities in primary care research. 系列:公众参与研究。第 3 部分:在初级保健研究中通过与社区合作分享权力和建立信任。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-03-28 DOI: 10.1080/13814788.2024.2328707
Jessica Drinkwater, Michelle Farr, Gary Hickey, Esther Van Vliet, Sophie Söderholm Werkö, Ingrid Klingmann, Steven Blackburn

Background: This article focuses on potential strategies to support primary care researchers in working in partnership with the public and healthcare professionals. Partnership working can potentially to improve the relevance and usefulness of research and ensure better research and health outcomes.

Discussion: We describe what we mean by partnership working and the importance of reflecting on power and building trusting relationships. To share power in partnership working, it is essential to critically reflect on the multiple dimensions of power, their manifestations, and your own power. Power can influence relationships and therefore, it is essential to build trust with partners. Next, we outline how the context of primary care research and decisions about who you work with and how to work together, are vital considerations that are imbued with power. Lastly, we suggest different ways of working in partnership to address different dimensions of power. We provide examples from primary care research across Europe regarding how to recognise, tackle, and challenge, invisible, hidden and visible power.

Conclusion: We conclude by proposing three calls to actions to encourage researchers working in primary care to consider the multiple dimensions of power and move towards partnership working. First is to use participatory methods to improve the inclusivity of your research. Second is to include patients and the public in decisions about the design, delivery and development of research and its outcomes. Third is to address various systemic and institutional barriers which hinder partnership working.

背景:本文重点探讨了支持初级保健研究人员与公众和医疗保健专业人员合作的潜在策略。合作关系有可能提高研究的相关性和实用性,并确保取得更好的研究成果和健康成果:我们阐述了合作关系的含义以及反思权力和建立信任关系的重要性。要在伙伴关系工作中分享权力,就必须批判性地反思权力的多个层面、权力的表现形式以及自身的权力。权力会影响人际关系,因此,与合作伙伴建立信任关系至关重要。接下来,我们将概述初级医疗研究的背景,以及与谁合作和如何合作的决定,这些都是充满权力的重要考虑因素。最后,我们针对权力的不同层面提出了不同的合作方式。我们提供了欧洲各地初级保健研究的实例,说明如何认识、处理和挑战隐形、隐藏和可见的权力:最后,我们提出了三项行动呼吁,以鼓励从事初级保健工作的研究人员考虑权力的多个层面并开展合作。首先是使用参与式方法提高研究的包容性。第二,让患者和公众参与研究及其成果的设计、实施和发展决策。第三,解决阻碍合作的各种系统性和制度性障碍。
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引用次数: 0
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European Journal of General Practice
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