European Journal of General Practice最新文献

Background: A smoking partner is a major risk factor for passive smoking and continued maternal smoking.

Objective: To assess the smoking habits, knowledge, and information received to stop smoking of smoking partners during their spouse's pregnancy.

Method: This was a cross-sectional study of partners who smoked at the start of pregnancy and whose spouses had just given birth. Recruitment was carried out in maternity hospitals in the Auvergne-Rhône-Alpes region from June 2021 to December 2021. Data were collected using a self-administered questionnaire.

Results: A total of 105 men using tobacco were recruited, average age 34 years (± 6.4). Of these, 46 (44%) had modified their consumption during pregnancy: 11 (10.5%) had stopped smoking until maternity hospital entry, 24 (23%) had cut down and 11 (10.5%) had relapsed after initial total cessation. A multivariate analysis revealed a statistically significant relationship between men's change in smoking behaviour during pregnancy and a first pregnancy, an overweight participant, not living in a rural area, and information provided by the General Practitioner (GP). GPs are the first point of contact for participants looking for help to quit smoking. Among men who have not changed their smoking habits, 46% have not received any information from health professionals.

Conclusions: Intervention and medical information provided by GPs to smoking partners may be associated with changes in smoking habits during pregnancy. Additional prospective, comparative studies are needed to support a robust conclusion.

Background: The broad range of definitions of low back pain (LBP) and the many associated risk factors on which management strategies are based do not seem to be relevant for general practitioners.

Objectives: Given the challenges of treating LBP and its impact on individuals' life, we aimed to explore the lived experiences of LBP patients to better understand their feelings, needs, and the internal and external resources they use for coping and treatment.

Methods: We used a comprehensive, qualitative, biographical approach to understand the patient's life events and the origins of these events in social life. First, each patient's life story was analysed individually to understand how they constructed their experiences. Then, a joint analysis identified common themes and overlapping patterns across different patient trajectories.

Results: We identified two main action profiles. The first ('risk-taking') reflected a desire for personal independence, where patients struggled to change their habits despite experiencing pain. In the second profile ('quest for meaning'), painful experiences led patients to reflect on their lifestyle and self-functioning, prompting adjustments in their daily habits.

Conclusion: A comprehensive approach to understanding the patients' behaviour in relation to their LBP can improve care strategies. General practitioners should consider not only the physical symptoms but also the patient's social and personal context, including relationships, living environment, work activity, limitations, and guiding values.

Background: The war in Ukraine led to a flood of refugees consisting mainly of women, children and elderly.

Objectives: This study aimed to explore healthcare use by elderly Ukrainian refugees.

Methods: In this retrospective cohort study, we examined patterns of healthcare services used by elderly Ukrainian refugees in Israel between 30 July 2022 and 1 May 2023 (N = 2269). We compared them to controls, matched for age and gender, among the general Israeli population (N = 2271). We performed Poisson regressions for statistical analysis.

Results: The Ukrainian refugee cohort was predominantly female (77.4%) with a mean age of 71.4 ± 7.1 years. Compared to their controls, the refugees were much less likely to participate in face-to-face, digital and video doctor visits (IRR = 0.838, 0.457 and 0.329, respectively; p value < 0.001). Across almost all medical fields (except cardiology), refugees were less likely to have consultations with specialists. Additionally, refugees had fewer emergency room visits (IRR = 0.42, p value < 0.001), fewer hospitalisations (IRR = 0.54, p value < 0.001) and shorter hospitalisations (IRR = 0.489, p value < 0.001).

Conclusions: In a healthcare system with full coverage, Ukrainian refugees were less likely to utilise healthcare services. These findings suggest that refugees may face significant barriers to access and may be underutilising needed care. Healthcare systems should adopt proactive and culturally responsive approaches to address these disparities and ensure equitable access. This study highlights the need for targeted interventions and further research to better understand and reduce healthcare barriers among refugee populations.

Background: Long-term use of antidepressants frequently extends beyond clinical guidelines, with limited structured support for deprescribing in primary care. Little is known about the factors that influence general practitioners (GPs) in Germany regarding deprescribing of antidepressants.

Objectives: To identify barriers and facilitators that influence GPs in Germany regarding antidepressant deprescribing. To provide points of departure for developing a targeted intervention to address these challenges.

Methods: We conducted semi-structured interviews with 20 GPs in Bavaria and purposively sampled for diversity in gender and professional experience. The interview topic guide was informed by the Capability-Opportunity-Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Interviews were transcribed verbatim. Thematic analysis was conducted using a structured coding approach.

Results: Key barriers to deprescribing included time constraints, limited practical tools, and inadequate collaboration with specialists, as well as uncertainty about when to deprescribe. Social and psychological factors, such as patient fears, were also significant. Facilitators included strong GP-patient communication, the use of digital tools, pharmacist support, and positive attitudes towards deprescribing.

Conclusion: Antidepressant deprescribing in German primary care is shaped by systemic, social, and behavioural factors. Addressing time constraints, enhancing interdisciplinary collaboration, and integrating decision-support tools into clinical practice could facilitate deprescribing. These insights inform targeted interventions to promote safe and evidence-based antidepressant use. Further research is recommended to develop an intervention suitable for real-world usage.

Background: Computed tomography coronary calcium scoring (CT-CCS) shows higher sensitivity for obstructive coronary artery disease (OCAD) detection than exercise electrocardiography (x-ECG), but its role as initial diagnostic test in primary care remains unclear.

Objective(s): This study assessed patients' perspectives on CT-CCS or x-ECG testing and diagnostic results.

Methods: In this one-year pilot study, 38 general practitioner practices were included. After cluster randomisation, 19 practices were assigned to refer patients with atypical angina pectoris or non-specific thoracic complaints for CT-CCS and 19 practices were assigned to request x-ECG. Patients' management remained at the discretion of the GPs. Patients' perspectives on the diagnostic test were assessed through a questionnaire, and clinical data were collected using electronic patient records. Outcome measures included patients' perspectives, OCAD diagnosis and initiation of cardiovascular risk management (CVRM).

Results: 101 patients (25 x-ECG; 76 CT-CCS) were included. Overall, CT-CCS patients were more satisfied with the test compared to x-ECG patients (p < 0.001), found the test easier to undergo (p < 0.001), had a higher willingness to retest (p = 0.01) and better perception of the information received from the GP (p = 0.03). Four of 17 CT-CCS patients (24%) with CT-CCS ≥100 were diagnosed with OCAD, and 14 (82%) started CVRM. The only patient with a positive x-ECG out of 25 (4%) was included in CVRM but not diagnosed with OCAD.

Conclusion: CT-CCS patients were overall more satisfied with their test than x-ECG patients. Coronary calcium scoring is a promising diagnostic tool for detecting OCAD in primary care.

Background: As the first point of contact with the healthcare system, primary care (PC) provides a unique setting for clinical research, enabling longitudinal follow-up, early disease detection, and study of prevalent illnesses. In Spain, however, PC research remains largely untapped, despite the country's leadership in overall clinical trial initiations within the European Union.

Objectives: To analyse the main challenges and opportunities of PC research in Spain and to draw lessons from successful European models to inform future priorities.

Methods: This opinion paper presents a narrative, cross-country comparative synthesis (1993-2025) of peer-reviewed and gray literature.

Results: European models demonstrate how interoperable data, dedicated infrastructure, and protected research time enable pragmatic and decentralised trials with high external validity. In Spain, major barriers include heavy workloads, limited research training, uneven infrastructure, and regulatory hurdles. Nevertheless, opportunities are emerging through digital platforms, interoperable registries, remote monitoring, and the integration of patient-reported outcomes (PROs).

Conclusion: Spain can unlock the untapped research capacity of PC by prioritising four reforms: (1) interoperable registries across care levels; (2) protected time and support roles for PC professionals; (3) targeted, sustained funding and minimum viable infrastructure; and (4) streamlined ethical/regulatory pathways for multicentre and decentralised trials. These steps would align research with daily practice, enhance inclusivity and equity, and strengthen PC as a hub for patient-centered innovation.

Background: Despite the numerous health benefits associated with physical activity (PA), many patients with chronic conditions remain inactive. We hypothesise that patients often misperceive their PA level, which affects behaviour change. We aimed to assess PA levels of patients with chronic conditions using the Global Physical activity Questionnaire (GPAQ) and compare their perception of meeting WHO guidelines (150 min of moderate-to-vigorous physical activity per week) with GPAQ measurements.

Methods: We conducted a cross-sectional analysis of the GPAQ in a sample of participants recruited from the ComPaRe e-cohort, a nationwide cohort of adult patients with chronic conditions in France. We used stratified random sampling (based on age, gender and diploma) and non-responder weighting to obtain estimates representative of PA levels of chronic patients in France. Concordance between participants' perception of meeting WHO guidelines and GPAQ measurements was assessed using Cohen's kappa coefficient.

Results: We included 629 patients (participation rate: 65.0%). The median age was 57 [46.0-65.4] years, with 348 (55.3%) women. A total of 369 (64.2%) patients were categorised as active (>750 metabolic equivalent tasks (Mets)/week) according to the GPAQ, with PA levels increasing with age among men. A total of 55 (8.6%) participants were unable to estimate their PA level, and 186 (32.4%) misperceived their PA level (cohen's kappa coefficient of 0.38 [0.31-0.45]), with 29 (5.1%) overestimating and 157 (27.4%) underestimating their activity.

Conclusion: Healthcare professionals should consider accurate screening for inactivity and patients' self-perception of their PA level, as both are key to delivering personalised and impactful counselling.

Background: Clinical scoring systems can help predict sepsis and guide treatment. We developed and validated a new sepsis prediction score for acutely ill adult patients visited at home by a general practitioner (GP) of an out-of-hours (OOH) cooperative.

Aim: To assess the feasibility and acceptability of implementing this score during OOH home visits.

Design and setting: Theory-informed mixed-methods study at two OOH GP cooperatives in the Netherlands between January and June 2024.

Method: GPs calculated the sepsis score in adult patients during home visits and completed a questionnaire about uptake and usability. Perspectives and experiences were explored through focus groups and semi-structured interviews.

Results: 106 GPs visited 271 patients at home, of whom 105 were judged acutely ill by the GP. The score's uptake was 77% in all patients and 85% in those acutely ill. 91% of GPs rated the score as convenient to use, and 66% considered the score reliable and accurate. GPs reported that the score influenced their decision to refer the patient to the hospital in 6% (15/271; 11 referred, four not referred) of all cases and 10% (10/105, all referred) in acutely ill. GPs expressed that they did not solely rely on the score but found it helpful to raise sepsis awareness and as an adjunct to clinical decision-making.

Conclusion: Implementing a new score for acutely ill adult patients visited at home during OOH primary care is feasible, and deemed acceptable and useful by GPs, however future research focusing on clinical validation and cost-effectiveness is needed.

Background: In the Netherlands and Germany, most antibiotics are prescribed in primary care, with urinary tract infections (UTIs) being the most common reason. The resistance rates of pathogens causing UTIs are rising in Europe. Differences in clinical practice guidelines may play a role and influence the prevalence of antibiotic resistance and treatment options. Therefore, we aim to explore the reality of general practices, including the diagnosis and management of uncomplicated UTIs in the Northern Dutch-German cross-border region.

Methods: From January 2023 to April 2024, a qualitative study was performed using semi-structured interviews with German and Dutch general practitioners (GPs). The number of interviews was determined when data saturation was reached. The interviews were recorded, transcribed, translated and anonymised. MAXQDA (Version 24.1.0.) was utilised to code the interviews. The analysis was done using structured qualitative content analysis.

Results: We recruited 13 GPs in Germany and 10 GPs in the Netherlands. Four main themes were identified: diagnosis, treatment options, decision making and guidelines. Dutch GPs delegated most diagnosis and treatment tasks to practice assistants, which is facilitated by the more stringent use of guidelines. More variety was seen in the types of antibiotics and herbal remedies used by German GPs.

Conclusions: This study provides valuable insights into GPs' decision making regarding the diagnosis and treatment of UTI. Increasing awareness of UTI diagnosis and treatment can help GPs assess their own practices and think more critically of their antibiotic use. Further research is needed to explore the effects on antibiotic resistance in the cross-border region.