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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
Task shifting from general practitioners to other health professionals in out-of-hours primary care - a systematic literature review on content and quality of task shifting. 全科医生在非工作时间基层医疗服务中向其他医疗专业人员的任务转移--关于任务转移的内容和质量的系统文献综述。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-05-23 DOI: 10.1080/13814788.2024.2351807
Katrine Bjørnshave Bomholt, Mette Amalie Nebsbjerg, Viola Burau, Anna Mygind, Morten Bondo Christensen, Linda Huibers

Background: Task shifting from general practitioners (GPs) to other health professionals could solve the increased workload, but an overview of the evidence is lacking for out-of-hours primary care (OOH-PC).

Objectives: To evaluate the content and quality of task shifting from GPs to other health professionals in clinic consultations and home visits in OOH-PC.

Methods: Four database literature searches were performed on 13 December 2021, and updated in August 2023. We included articles that studied content (patient characteristics, reason for encounter) and/or quality (patient satisfaction, safety, efficiency) of task shifting in face-to-face contacts at OOH-PC. Two authors independently screened articles for inclusion and assessed the methodological quality of included articles using the JBI critical appraisal checklist. Data was extracted and results were synthesised in a narrative summary.

Results: The search identified 1,829 articles, resulting in the final inclusion of seven articles conducted in the UK or the Netherlands. Studies compared GPs with other health professionals (mainly nurses). These other health professionals saw patients with less urgent health problems, younger patients, and patients with less complex health problems than GPs. Most studies concluded that other health professionals provided safe and vastly efficient care corresponding to the level of GPs but findings about productivity were inconclusive.

Conclusion: The level of safety and efficiency of care provided by other health professionals in OOH-PC seems like that of GPs, although they mainly see patients presenting with less urgent and less complex health problems.

背景:将任务从全科医生(GP)转移到其他医疗专业人员身上可以解决工作量增加的问题,但对于非工作时间的初级保健(OOH-PC)却缺乏相关证据:全科医生(GPs)向其他医疗专业人员的任务转移可以解决工作量增加的问题,但缺乏对非工作时间初级医疗(OOH-PC)证据的概述:目的:评估在非工作时间初级保健的门诊咨询和家访中由全科医生向其他医疗专业人员进行任务转移的内容和质量:于 2021 年 12 月 13 日进行了四次数据库文献检索,并于 2023 年 8 月进行了更新。我们收录了对其他医疗机构面对面接触中任务转移的内容(患者特征、接触原因)和/或质量(患者满意度、安全性、效率)进行研究的文章。两位作者独立筛选纳入文章,并使用 JBI 临界评估清单评估纳入文章的方法学质量。对数据进行提取,并在叙述性摘要中对结果进行综合:检索共发现 1,829 篇文章,最终纳入了 7 篇在英国或荷兰进行的文章。研究将全科医生与其他医疗专业人员(主要是护士)进行了比较。与全科医生相比,这些其他医疗专业人员所诊治的患者健康问题不那么紧急、患者年龄更小、患者健康问题不那么复杂。大多数研究得出结论,其他医疗专业人员提供的医疗服务安全高效,与全科医生的水平相当,但关于工作效率的研究结果尚无定论:结论:其他医疗专业人员在门诊-急诊室提供的医疗服务的安全和效率水平似乎与全科医生相当,尽管他们主要接诊的是病情不太紧急和不太复杂的病人。
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引用次数: 0
Changing of the Guard. A dialogue between the former and the new Editor-in-Chief. 换岗。前任主编与新任主编之间的对话。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-07-12 DOI: 10.1080/13814788.2024.2373125
Jelle Stoffers, Jako S Burgers
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引用次数: 0
German general practitioners' experiences of managing post-COVID-19 syndrome: A qualitative interview study. 德国全科医生处理后 COVID-19 综合征的经验:定性访谈研究。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-10-21 DOI: 10.1080/13814788.2024.2413095
Josefine Schulze, Lennart Lind, Alina Rojas Albert, Laura Lüdtke, Jens Hensen, Corinna Bergelt, Martin Härter, Nadine Janis Pohontsch

Background: The management of the long-term sequelae of coronavirus disease 2019 (COVID-19) infection, known as post-COVID-19 syndrome (PCS), continues to challenge the medical community, largely owing to a significant gap in the understanding of its aetiology, diagnosis and effective treatment.

Aim: To examine general practitioners' (GPs) experiences of caring for patients with PCS and to identify unmet care needs and opportunities for improvement.

Design and setting: This study follows a qualitative design, using in-depth semi-structured telephone interviews with GPs (N = 31) from across Germany.

Method: Interviews were audio-recorded, transcribed verbatim and analysed using qualitative content analysis.

Results: GPs reported that they were often the first point of contact for patients with persistent symptoms following SARS-CoV-2 infection, with symptoms typically resolving within weeks. While ongoing symptomatic COVID-19 is perceived to be more common, the relevance of PCS to GP practices is considerable given its severe impact on patients' functioning, social participation and the substantial time required for patient care. GPs coordinate diagnosis and treatment but face challenges because of the unclear definition of PCS and difficulties in attributing symptoms, resulting in a cautious approach to ICD-10 coding. Interviewees highlight lengthy diagnostic pathways and barriers to accessing specialist care.

Conclusion: The findings confirm the high functional limitations and psychosocial burden of PCS on patients, and the central role of GPs in their care. The study suggests a need for further research and health policy measures to support GPs in navigating diagnostic uncertainty, interprofessional communication and the limited evidence on effective treatments.

背景:冠状病毒病2019(COVID-19)感染的长期后遗症(即COVID-19后综合征(PCS))的管理仍然是医学界面临的挑战,这主要是由于对其病因、诊断和有效治疗的认识存在巨大差距。目的:研究全科医生(GPs)护理PCS患者的经验,并确定未满足的护理需求和改进机会:本研究采用定性设计,对德国各地的全科医生(31 人)进行了深入的半结构化电话访谈:方法:对访谈进行录音、逐字转录,并采用定性内容分析法进行分析:结果:全科医生报告说,他们通常是 SARS-CoV-2 感染后出现持续症状病人的第一联系人,症状通常在几周内缓解。虽然持续的 COVID-19 症状被认为更为常见,但鉴于其对患者的功能、社会参与和患者护理所需的大量时间的严重影响,PCS 与全科医生的工作密切相关。全科医生负责协调诊断和治疗工作,但由于 PCS 的定义不明确、症状归因困难,导致他们对 ICD-10 编码采取谨慎态度,因而面临着种种挑战。受访者强调了冗长的诊断路径和获得专科护理的障碍:研究结果证实了 PCS 对患者造成的高度功能限制和社会心理负担,以及全科医生在患者护理中的核心作用。该研究表明,有必要开展进一步研究并采取卫生政策措施,以支持全科医生在诊断不确定性、专业间沟通和有效治疗证据有限等方面的工作。
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引用次数: 0
Navigating sarcoidosis: Recognizing, managing, and supporting patients in primary care. 引领肉样瘤病:在初级医疗中识别、管理和支持患者。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-10-24 DOI: 10.1080/13814788.2024.2418307
Marjolein Drent, Nellie Jans

Background: Sarcoidosis is a chronic multisystem inflammatory disease of unknown aetiology, characterised by noncaseating granulomas and a variable clinical presentation. Despite its global distribution, sarcoidosis is relatively rare, with the highest prevalence in northern Europe. This poses challenges for primary care physicians due to its broad spectrum of symptoms, from organ-specific manifestations to general complaints like fatigue and concentration difficulties.

Objectives: This article aims to provide primary care physicians with practical tools for the early recognition and management of sarcoidosis, emphasising their role in monitoring disease progression and providing supportive care.

Methods: Key strategies for diagnosis and management are reviewed, focusing on holistic patient care addressing both somatic and psychosocial aspects of the disease.

Results: Early recognition, careful monitoring of disease progression, and individualised treatment plans are crucial. Pharmacotherapy is not always required and should be carefully balanced. The role of supportive, patient-centered counseling is illustrated with two cases.

Conclusion: Primary care physicians play a critical role in managing sarcoidosis, particularly in early recognition and monitoring. Given the absence of standardised treatment protocols, a flexible, holistic approach that includes psychosocial support is essential. This article provides a practical framework for general practitioners to address the challenges of sarcoidosis management and improve patient outcomes.

背景:肉样瘤病是一种病因不明的慢性多系统炎症性疾病,以非鳞屑性肉芽肿和多变的临床表现为特征。尽管肉样瘤病遍布全球,但却相对罕见,在北欧发病率最高。由于肉样瘤病的症状范围很广,从器官特异性表现到疲劳和注意力不集中等一般主诉,这给初级保健医生带来了挑战:本文旨在为初级保健医生提供早期识别和管理肉样瘤病的实用工具,强调他们在监测疾病进展和提供支持性护理方面的作用:方法:文章回顾了诊断和管理的主要策略,重点是针对疾病的躯体和社会心理方面为患者提供整体护理:结果:早期识别、仔细监测疾病进展和个性化治疗方案至关重要。药物治疗并不总是必需的,应谨慎平衡。通过两个病例说明了以患者为中心的支持性咨询的作用:结论:初级保健医生在管理肉样瘤病方面发挥着关键作用,尤其是在早期识别和监测方面。由于缺乏标准化的治疗方案,因此必须采取灵活、全面的方法,包括社会心理支持。本文为全科医生提供了一个实用的框架,以应对肉样瘤病管理方面的挑战并改善患者的治疗效果。
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引用次数: 0
Evaluation of the psychometric performance of the Spanish and Catalan versions of the patient reported experiences and Outcomes of Safety in Primary Care (PREOS-PC)-Compact questionnaire. 评估西班牙文和加泰罗尼亚文版本的 "患者报告的基层医疗安全经历和结果 (PREOS-PC)-Compact 问卷 "的心理测量性能。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-01-10 DOI: 10.1080/13814788.2023.2296573
Maria A Fiol-deRoque, José M Valderas, Jorge Arias de la Torre, Maria J Serrano-Ripoll, Montserrat Gens-Barberà, Encarna Sánchez-Freire, Francisco M Martín-Luján, Antonio Olry de Labry, Ignacio Ricci-Cabello

Background: Patients provide a unique, irreplaceable, and essential perspective in evaluating patient safety. The suite of Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) tools are a notable exception to the scarcity of patient-reported patient safety measures. Full evaluation of their performance has only been attempted for the English version, thereby limiting its international applicability.

Objectives: To assess the psychometric performance of the Spanish and Catalan versions of the PREOS-PC-Compact.

Methods: Cross-sectional validation study. We used Classical Test Theory methods to examine scale score distribution, internal consistency, and construct validity; and Item Response Theory (IRT) methods to further explore construct validity.

Results: 3287 patients completed the Spanish version, and 1007 the Catalan version. Similar results were obtained for both versions. Confirmatory Factor Analysis supported a single construct for each scale. The correlations between PREOS-PC-Compact scales and known group analysis suggested adequate construct validity (inconclusive for known groups at the provider level). All four multi-item scales demonstrated adequate internal consistency reliability (α > 0.7), which was only confirmed for test-retest reliability for 'Practice activation.' A sample between 60-90 patients per practice was estimated sufficient to produce scores with reliability > 0.7 for all scales except for harm scales. IRT models showed disordered thresholds for 'Practice activation' and 'Harm burden' but showed excellent fit after reducing the response categories.

Conclusion: The Spanish and Catalan versions of the PREOS-PC-Compact are broadly valid and reliable tools to measure patient safety in Spanish primary care centres; confirmation of lower-than-expected test-rest reliability merits further examination .

背景:患者为评估患者安全提供了独特的、不可替代的重要视角。在患者报告的患者安全措施匮乏的情况下,一套患者报告的基层医疗安全体验和结果(PREOS-PC)工具是一个明显的例外。对其性能的全面评估只针对英文版本,因此限制了其国际适用性:方法:横断面验证研究:方法:横断面验证研究。我们采用经典测验理论方法研究量表得分分布、内部一致性和结构效度;采用项目反应理论(IRT)方法进一步研究结构效度:共有 3287 名患者完成了西班牙语版本,1007 名患者完成了加泰罗尼亚语版本。两个版本的结果相似。确认性因子分析支持每个量表的单一结构。PREOS-PC-Compact 量表与已知群体分析之间的相关性表明其具有充分的结构效度(在提供者层面上,已知群体的相关性尚无定论)。所有四个多项目量表都显示出足够的内部一致性可靠性(α > 0.7),只有 "实践激活 "的测试-再测可靠性得到了证实。据估计,每个诊所 60-90 名患者的样本足以产生除伤害量表外信度大于 0.7 的所有量表得分。IRT模型显示,"实践激活 "和 "伤害负担 "的阈值紊乱,但在减少反应类别后显示出极佳的拟合度:西班牙和加泰罗尼亚语版本的 PREOS-PC-Compact 是衡量西班牙初级医疗中心患者安全状况的有效、可靠的工具。
{"title":"Evaluation of the psychometric performance of the Spanish and Catalan versions of the patient reported experiences and Outcomes of Safety in Primary Care (PREOS-PC)-Compact questionnaire.","authors":"Maria A Fiol-deRoque, José M Valderas, Jorge Arias de la Torre, Maria J Serrano-Ripoll, Montserrat Gens-Barberà, Encarna Sánchez-Freire, Francisco M Martín-Luján, Antonio Olry de Labry, Ignacio Ricci-Cabello","doi":"10.1080/13814788.2023.2296573","DOIUrl":"10.1080/13814788.2023.2296573","url":null,"abstract":"<p><strong>Background: </strong>Patients provide a unique, irreplaceable, and essential perspective in evaluating patient safety. The suite of Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) tools are a notable exception to the scarcity of patient-reported patient safety measures. Full evaluation of their performance has only been attempted for the English version, thereby limiting its international applicability.</p><p><strong>Objectives: </strong>To assess the psychometric performance of the Spanish and Catalan versions of the PREOS-PC-Compact.</p><p><strong>Methods: </strong>Cross-sectional validation study. We used Classical Test Theory methods to examine scale score distribution, internal consistency, and construct validity; and Item Response Theory (IRT) methods to further explore construct validity.</p><p><strong>Results: </strong>3287 patients completed the Spanish version, and 1007 the Catalan version. Similar results were obtained for both versions. Confirmatory Factor Analysis supported a single construct for each scale. The correlations between PREOS-PC-Compact scales and known group analysis suggested adequate construct validity (inconclusive for known groups at the provider level). All four multi-item scales demonstrated adequate internal consistency reliability (α > 0.7), which was only confirmed for test-retest reliability for 'Practice activation.' A sample between 60-90 patients per practice was estimated sufficient to produce scores with reliability > 0.7 for all scales except for harm scales. IRT models showed disordered thresholds for 'Practice activation' and 'Harm burden' but showed excellent fit after reducing the response categories.</p><p><strong>Conclusion: </strong>The Spanish and Catalan versions of the PREOS-PC-Compact are broadly valid and reliable tools to measure patient safety in Spanish primary care centres; confirmation of lower-than-expected test-rest reliability merits further examination .</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2296573"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10783822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405138","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
The experiences of transgender and nonbinary adults in primary care: A systematic review. 变性和非二元成人在初级保健中的经历:系统回顾。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-01-10 DOI: 10.1080/13814788.2023.2296571
Daisy Holland, Luka C J White, Marija Pantelic, Carrie Llewellyn

Background: Transgender and nonbinary (TNB) people face barriers to primary care, which remains the main entry point for accessing gender-affirming healthcare in the UK.

Objectives: This systematic review aims to summarise the evidence regarding TNB people's experiences of primary care to inform improvements in service and patient outcomes.

Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A systematic literature search was conducted across articles from 2005 to April 2023 across Ovid Medline, Ovid Embase and PsychInfo using established keywords relating to gender identity, primary care and experiences. Qualitative data were thematically analysed and quantitative data were compiled using a descriptive narrative.

Results: Following eligibility criteria, 16 articles were included in this review. This review identified both facilitators and limitations and barriers experienced by TNB people related to primary care provider knowledge; the patient-provider relationship, and healthcare settings. Quantitative findings reported up to 54.4% of participants were uncomfortable discussing TNB issues with their physician. Overall findings suggest TNB people face discrimination on a systemic level utilising primary care services, though positive healthcare encounters at a local level were reported. Participants expressed a desire for primary care-led gender-affirming healthcare services, with involvement from local TNB communities.

Conclusion: This review demonstrates TNB people's mixed experiences of primary care alongside their recommendations for service improvement. This is the first systematically reviewed evidence on the topic, emphasising the need for clinicians and policymakers to centre the voices of the TNB community in service design and improvement.

背景:变性人和非二元人(TNB)在初级医疗服务中面临障碍,而初级医疗服务仍是英国人获得性别确认医疗服务的主要切入点:本系统性综述旨在总结有关变性人和非二元性(TNB)人群在初级医疗服务中的经历的证据,为改善服务和患者疗效提供参考:本综述遵循系统综述和荟萃分析首选报告项目(PRISMA)报告指南。我们使用与性别认同、初级保健和经历相关的既定关键词,在 Ovid Medline、Ovid Embase 和 PsychInfo 上对 2005 年至 2023 年 4 月期间的文章进行了系统性文献检索。对定性数据进行了专题分析,并使用描述性叙述对定量数据进行了汇编:根据资格标准,16 篇文章被纳入本综述。本综述确定了TNB人群在初级医疗服务提供者知识、患者与提供者的关系以及医疗环境等方面遇到的促进因素、限制因素和障碍。定量研究结果显示,多达54.4%的参与者在与医生讨论TNB问题时感到不自在。总体研究结果表明,TNB人群在使用初级医疗服务时面临着系统性歧视,但也有报道称他们在当地遇到了积极的医疗服务。受访者表示,希望在当地TNB社区的参与下,提供以初级医疗为主导的性别平等医疗服务:本综述展示了TNB人群对初级医疗服务的不同体验,以及他们对改善服务的建议。这是首次对该主题的证据进行系统回顾,强调了临床医生和政策制定者在服务设计和改进过程中以TNB群体的声音为中心的必要性。
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引用次数: 0
Diagnostic flow for all patients referred with non-specific symptoms of cancer to a diagnostic centre in Denmark: A descriptive study. 丹麦一家诊断中心对所有因癌症非特异性症状转诊患者的诊断流程:描述性研究。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-01-05 DOI: 10.1080/13814788.2023.2296108
Christina Sadolin Damhus, John Brandt Brodersen, Gunnar Lauge Nielsen

Background: Since 2012, Cancer Patient Pathways for Non-specific Symptoms and Signs of Cancer (NSSC-CPP) have been implemented in Scandinavia and UK.

Objectives: This study aimed to describe the diagnostic flow for all patients referred from 1 January to 30 June 2020 to the NSSC-CPP in the Diagnostic Centre in Farsø (DC-F), Denmark.

Methods: During the study period, we prospectively recorded information on the diagnostic flow, including: pathway trajectory, symptoms and findings leading to referral, diagnostic procedures and diagnoses at the end of DC Farsø work-up and within 6-months for all patients referred to the NSSC-CPP in DC Farsø using electronic patient files and the Danish National Patient Registry (DNPR).

Results: Of the 314 referrals to DC Farsø, 227 had diagnostic work-up in DC Farsø, the remaining were redirected to other CPPs (n = 11), outpatient clinics (n = 45) or redirected to general practice (n = 25). Of total referrals, 25 (8%) received a malignant diagnosis, 20 (6%) a non-malignant but clinically relevant diagnosis with initiation of treatment, 16 (5%) a non-malignant diagnosis but no treatment needed and in 253 (81%) referrals no severe new condition was diagnosed. Two (1%) additional malignancies were diagnosed within a 6-month follow-up period.

Conclusion: By tracking all patients referred to the NSSC-CPP in DC Farsø, including those redirected, this is the first study to describe the diagnostic flow for all patients referred to a diagnostic centre in Denmark. This knowledge is important for further organisation and planning of the NSSC-CPP.

背景自2012年起,斯堪的纳维亚半岛和英国开始实施癌症患者非特异性症状和体征路径(NSSC-CPP):本研究旨在描述丹麦法尔瑟诊断中心(DC-F)从 2020 年 1 月 1 日至 6 月 30 日转诊至 NSSC-CPP 的所有患者的诊断流程:在研究期间,我们利用患者电子档案和丹麦国家患者登记处(DNPR)对所有转诊至丹麦法尔瑟诊断中心NSSC-CPP的患者的诊断流程信息进行了前瞻性记录,包括:导致转诊的路径轨迹、症状和检查结果、诊断程序以及法尔瑟诊断中心工作结束后6个月内的诊断结果:结果:在314名转诊至法尔瑟地区医疗中心的患者中,227人在法尔瑟地区医疗中心进行了诊断工作,其余患者被转至其他CPP(11人)、门诊诊所(45人)或转至全科诊所(25人)。在所有转诊患者中,25 人(8%)得到恶性诊断,20 人(6%)得到非恶性但与临床相关的诊断并开始治疗,16 人(5%)得到非恶性诊断但无需治疗,253 人(81%)未诊断出严重的新病症。在6个月的随访期内,又诊断出了2例(1%)恶性肿瘤:通过跟踪所有转诊至丹麦法尔瑟地区国家卫生服务中心-CPP的患者(包括转诊患者),该研究首次描述了所有转诊至丹麦诊断中心的患者的诊断流程。这些知识对于进一步组织和规划 NSSC-CPP 非常重要。
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引用次数: 0
The impact of COVID-19 pandemic on Primary Health Care through 'health providers' eyes': Α qualitative study of focus groups and individual interviews in Greece. 通过 "医疗服务提供者的眼睛 "看 COVID-19 大流行对初级医疗保健的影响:希腊焦点小组和个人访谈定性研究。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-07-25 DOI: 10.1080/13814788.2024.2382218
Foteini Michalaki, Korina Marina Triantafillopoulou, Ilias Pagkozidis, Ilias Tirodimos, Theodoros Dardavesis, Zoi Tsimtsiou

Background: Primary Health Care (PHC) was the cornerstone of the pandemic response.

Objectives: We aimed to explore the positive and negative impact of the pandemic, during its final wave, through 'PHC providers' eyes', as well as their recommendations towards restructuring and enhancing PHC services.

Methods: A two-phase qualitative study was conducted, pursuing data triangulation from Focus Groups (FGs) and individual, semi-structured interviews for the purposes of data completeness and confirmation (summer 2022 and spring 2023, respectively). A purposive sample of settings was employed, including in total five PHC units according to location with different population distribution; one in Athens (FGs) and four in Northern Greece (interviews). Inductive content analysis was used.

Results: In total, 24 PHC professionals participated in FGs, whereas 17 were individually interviewed. Our findings reflect a general understanding of the pandemic's positive imprint, namely acceleration of digitalisation, establishment of health protection measures, recognition of PHC's role, raise in public awareness of primary prevention, team-cooperation, increase in providers' self-efficacy, appointment of health professionals and re-organisation of accessibility. The negative impact is summarised in fatigue/burnout in PHC providers, patient safety concerns and changes in patients' behaviour. To increase resilience, participants suggest restructuring PHC, recruiting PHC personnel and enhancing digital infrastructure, maintenance of sanitary protection measures, investment in quality, and empowering patients through health literacy.

Conclusion: Based on the lessons learnt, building further on the pandemic-accelerated digitalisation, emphasising on quality improvement and patient safety, ensuring providers' well-being, and empowering citizens through health literacy could be key in promoting PHC resilience.

背景:初级卫生保健(PHC)是应对大流行病的基石:我们旨在通过 "初级卫生保健提供者 "的视角,探讨大流行最后一波的积极和消极影响,以及他们对重组和加强初级卫生保健服务的建议:研究分为两个阶段,分别从 2022 年夏季和 2023 年春季的焦点小组(Focus Groups,FGs)和个人半结构式访谈(semi-structured interviews)中获取数据,以确保数据的完整性和确认性。研究采用了有目的的环境样本,根据不同的人口分布地点,总共包括五个初级保健单位;一个在雅典(焦点小组),四个在希腊北部(访谈)。采用归纳式内容分析法:共有 24 名初级保健专业人员参加了家庭访谈,17 人接受了个别访谈。我们的研究结果反映了对大流行病积极影响的普遍认识,即数字化进程的加快、健康保护措施的建立、对初级卫生保健作用的认可、公众初级预防意识的提高、团队合作、提供者自我效能的提高、卫生保健专业人员的任命以及可及性的重新组织。负面影响主要体现在初级保健服务提供者的疲劳/倦怠、对患者安全的担忧以及患者行为的改变。为提高复原力,与会者建议重组初级保健中心,招聘初级保健中心人员,加强数字基础设施,保持卫生防护措施,投资于质量,并通过健康知识普及增强患者的能力:根据所吸取的经验教训,在大流行病加速数字化的基础上进一步发展、强调质量改进和患者安全、确保提供者的福利以及通过卫生知识普及增强公民的能力,可能是促进初级保健中心复原力的关键。
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引用次数: 0
Monitoring COVID-19 in Belgian general practice: A tool for syndromic surveillance based on electronic health records. 监测比利时全科医生的 COVID-19:基于电子健康记录的综合征监测工具。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-01-08 DOI: 10.1080/13814788.2023.2293699
Bénédicte Vos, Laura Debouverie, Kris Doggen, Nicolas Delvaux, Bert Aertgeerts, Robrecht De Schreye, Bert Vaes

Background: COVID-19 may initially manifest as flu-like symptoms. As such, general practitioners (GPs) will likely to play an important role in monitoring the pandemic through syndromic surveillance.

Objectives: To present a COVID-19 syndromic surveillance tool in Belgian general practices.

Methods: We performed a nationwide observational prospective study in Belgian general practices. The surveillance tool extracted the daily entries of diagnostic codes for COVID-19 and associated conditions (suspected or confirmed COVID-19, acute respiratory infection and influenza-like illness) from electronic medical records. We calculated the 7-day rolling average for these diagnoses and compared them with data from two other Belgian population-based sources (laboratory-confirmed new COVID-19 cases and hospital admissions for COVID-19), using time series analysis. We also collected data from users and stakeholders about the syndromic surveillance tool and performed a thematic analysis.

Results: 4773 out of 11,935 practising GPs in Belgium participated in the study. The curve of contacts for suspected COVID-19 followed a similar trend compared with the curves of the official data sources: laboratory-confirmed COVID-19 cases and hospital admissions but with a 10-day delay for the latter. Data were quickly available and useful for decision making, but some technical and methodological components can be improved, such as a greater standardisation between EMR software developers.

Conclusion: The syndromic surveillance tool for COVID-19 in primary care provides rapidly available data useful in all phases of the COVID-19 pandemic to support data-driven decision-making. Potential enhancements were identified for a prospective surveillance tool.

背景介绍COVID-19 最初可能表现为类似流感的症状。因此,全科医生(GP)可能会在通过综合征监测来监控大流行方面发挥重要作用:介绍比利时全科医生的 COVID-19 症状监测工具:方法:我们在比利时全科诊所开展了一项全国性的前瞻性观察研究。监测工具从电子病历中提取 COVID-19 和相关疾病(疑似或确诊 COVID-19、急性呼吸道感染和流感样疾病)的每日诊断代码条目。我们计算了这些诊断的 7 天滚动平均值,并通过时间序列分析,将其与比利时其他两个基于人群的数据来源(实验室确诊的 COVID-19 新发病例和因 COVID-19 入院的病例)进行了比较。我们还从用户和利益相关者那里收集了有关综合征监测工具的数据,并进行了专题分析:比利时 11935 名执业全科医生中有 4773 人参与了研究。疑似 COVID-19 病例的联系曲线与官方数据来源的曲线相比趋势相似:COVID-19 实验室确诊病例和入院病例,但入院病例的联系曲线延迟了 10 天。数据可快速获得,对决策有用,但一些技术和方法方面的内容还有待改进,如提高 EMR 软件开发商之间的标准化程度:结论:COVID-19 在基层医疗机构的综合征监测工具可快速提供 COVID-19 大流行各阶段的有用数据,以支持数据驱动的决策。为前瞻性监测工具确定了潜在的改进措施。
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European Journal of General Practice
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