European Journal of General Practice最新文献

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.

Background: Information about the incidence of persisting symptoms after COVID-19 and its impact on patients treated in primary care are scarce.

Objectives: To determine differences in health-related quality of life (HRQoL) and symptomatology between adults with and without SARS-CoV-2 moderately severe lower respiratory tract infection (LRTI) in the 12 months following their primary care visit.

Methods: Prospective cohort study in 35 Dutch practices. Individuals aged ≥18 years who presented to their general practitioner (GP) with a moderately severe LRTI during the first COVID-19 waive in The Netherlands (March-June 2020, n = 277; 268 (97%) with complete follow-up) were included between September and December 2020, then underwent serology testing (participants, GPs and study personnel remained blinded for serology outcomes during study conduct) and completed baseline and follow-up questionnaires. Main outcome measures: (1) SF-36 scores, and (2) risk of persisting symptoms during 12 months follow-up.

Results: The change in SF-36 PSC (p = 0.13), MCS (p = 0.30) during 12 months follow-up did not differ between SARS-CoV-2 serology positive and negative participants after adjusting for sex, age, BMI, diabetes, and chronic pulmonary conditions. The risk of any persisting symptom during 12 months follow-up did not significantly differ between the groups (aHR 0.61, 95% CI 0.33-1.15), nor did the risk of individual symptoms.

Conclusions: In the 12 months following their moderately severe LRTI, primary care patients with and without confirmed SARS-CoV-2 infection had a comparable HRQoL profile. A substantial proportion of participants reported persisting symptoms, indicating that persisting symptoms can occur following LRTIs irrespective of causative pathogen.

Background: Clinical placements significantly impact medical students' career choices. Primary care physicians supervising these placements can influence students' career decisions through role modelling and by creating supportive learning environments.

Objectives: This qualitative study aimed to identify factors contributing to role modelling and students' sense of integration during placements and their influence on career decisions, with a focus on primary care.

Methods: Semi-structured interviews were conducted with postgraduate trainees selected based on interest in primary care, exploring their experiences during undergraduate clinical placements and factors influencing career choices. Data were thematically analysed to identify key themes related to student integration, well-being, and supervisor role modelling.

Results: Analysis revealed four key domains where primary care physicians can positively influence students' career interest: onboarding students effectively, fostering positive and inclusive team dynamics, involving students in patient care, and providing high-quality supervision and feedback. Students reported that feeling valued and socially included contributed to their well-being and professional self-efficacy, which in turn impacted their career choices.

Conclusion: Supportive and inclusive learning environments during placements are critical to fostering students' professional growth. While relevant across clinical settings, this study's findings hold particular significance for primary care due to the challenge of balancing clinical and practice management duties and teaching. Implementing structured onboarding, team integration, and effective supervision can enhance students' experiences and promote interest in primary care. Future research should extend these findings beyond primary care. The proposed roadmap could both spark interest in primary care and promote future collaboration between primary and secondary care.

Background: Generative AI (Gen AI) is frequently cited as an innovation to address the current challenges in healthcare, also for primary care. Examples include automating tasks like voice-to-notes transcription or chatbots using large language models. Additionally, it may facilitate a learning healthcare system by generating personalised learning resources and real-time literature summaries. Yet - probably with the highest expectations - Gen AI may extend diagnostic and therapeutic capabilities in general practice by integrating complex, multimodal patient data for personalised care, enabling earlier disease detection, and providing real-time guidance for diagnostics, prognostics and treatments.

Method & discussion: The authors of this opinion paper recently hosted a workshop at the WONCA Europe 2024 conference. From discussions at that workshop, three priorities emerge: practice support, education support, and clinical decision-making support. In this opinion paper, we argue that GPs and academic departments of primary care should lead in evaluating Gen AI across these three priorities. Primary care research must prioritise rigorous scientific evaluations, to ensure that developed tools actually work for GPs and their patients.

Conclusion: Hereto, a coordinated effort, driven by the primary care academic community, is needed, starting with research agenda drafting. A broad, international follow-up is scheduled following this WONCA Europe 2024 workshop.

Prevention is a fundamental aspect of the work of general practitioners (GPs) and family doctors (FDs); however, its implementation poses significant challenges due to conflicting guidelines, time constraints, competing demands, and equity concerns. This position paper proposes seven guiding principles to help GPs and FDs navigate preventive care effectively. It encourages GPs/FDs to recognise the intrinsic preventive value of high-quality general practice and adopt a critical approach to the evidence underpinning preventive recommendations. Prioritising a limited number of preventive services with a strong evidence base and targeting those patients most likely to benefit will contribute to sustainable, evidence-based, and equitable patient care.

Background: The growing adoption of digital health applications (apps) presents new opportunities for General Practitioners (GPs) to enhance care and empower patients. However, little is known about how Portuguese GPs incorporate these apps into their practice.

Objectives: To identify the distinguishing characteristics of Portuguese GPs recommending the use of digital health apps to patients, and to investigate the facilitators and barriers influencing this behaviour.

Methods: A cross-sectional study was conducted using an online questionnaire distributed to Portuguese GPs between July 2023 and January 2024. Univariate logistic regressions identified predictors of app recommendation. Wilcoxon rank-sum tests compared facilitators and barriers between groups.

Results: A total of 126 GPs responded (72.2% women; median age 36 years [IQR: 31.8-43.0]); 45.2% recommended digital health apps. The most common were for apps for physical activity (32.4%), nutrition (21.3%), and chronic disease management (21.3%). Among GPs recommending apps, 70.2% did 1-4 times monthly. Most GPs believed that apps could improve chronic disease self-management (97.6%) and reduce face-to-face consultations (74.6%). GPs recommending apps were more likely to personally use health and fitness apps (OR 3.03), clinical decision apps (OR 3.79), and to believe that apps reduce face-to-face consultations (OR 3.46). GPs not recommending apps more often rated scientific validity as 'very important' (84.1% vs 61.4%, p = 0.006).

Conclusion: Nearly half of Portuguese GPs surveyed recommended digital apps, highlighting their potential to support self-management and reduce face-to-face consultation. Broader adoption may depend on fostering greater physician confidence in app use by strengthening the scientific evidence of apps.

Background: Emergency room (ER) utilisation by ambulatory patients with low urgency medical problems leads to ER-capacity use and long waiting times. Establishing General Practice (GP)-led urgent care practices (UCP) adjacent to ERs allows to triage patients from the ER to the UCP. However, patients may perceive themselves as ER-cases and expect ER-treatment including extensive diagnostics.

Objectives: To assess UCP-patients' satisfaction compared to ambulatory ER-patients.

Methods: Sub-analysis (11/2019-01/2020) of a prospective, monocentric observational study at the University Medical Centre Hamburg-Eppendorf ER and co-located UCP focusing on patient survey data including demographics, waiting time and diagnoses. Satisfaction, uncertainty and appropriateness of waiting time was assessed with 4-point Likert-scales.

Results: Analysing 1196 UCP- and 597 ER-patients, patient satisfaction correlated positively with perceived appropriate waiting time in both groups. But more UCP-patients deemed their waiting time appropriate (76.7% vs. 70.4%; p = 0.004) and reported to be very satisfied with the treatment (64.7% vs. 55.8%; p < 0.001). Time until the first physician contact was nearly equal, but the entire length of stay was shorter in the UCP (104 ± 88.0 min vs. 179 ± 301 min; p < 0.001). In both groups, satisfaction was reduced by on-going uncertainty after the visit, but uncertainty was higher among UCP-patients (32% vs. 25%; p = 0.003). Age, gender or diagnosis had no influence on patients' satisfaction. More UCP-patients stated that today's problem could have been treated by a GP (57% vs. 15%; p < 0.001) and were advised to follow up in an outpatient setting.

Conclusions: Treating patients in an UCP does not lead to overall dissatisfaction.

Background: The COVID-19 pandemic has significantly impacted global healthcare systems, leading to challenges in managing Long COVID. Variations in definitions and diagnostic criteria across Europe hinder recognition and treatment efforts. This study aims to analyse and compare the definitions of Long COVID used in 34 European countries.

Methods: A retrospective descriptive study was conducted involving key informants from 34 European countries, utilising an online questionnaire to gather data on Long COVID definitions. Quantitative and qualitative analyses were employed to assess the variability of definitions and challenges in managing Long COVID.

Results: The study found significant variation in Long COVID definitions among the participating countries; the most frequent definition was the other definition (n: 17, 50.0%), followed by the World Health Organisation's definition (n: 16, 47.0%) and the CDC definition (n: 11, 32.3%). Half of the countries reported using multiple definitions simultaneously, indicating a lack of standardisation. Qualitative analyses highlighted challenges such as difficulties in standardising terminology, variability in clinical criteria, and issues with implementing diagnostic codes.

Conclusion: The findings underscore the need for a unified, yet adaptable, definition of Long COVID. Such a definition would support general practitioners (GPs) by simplifying diagnostic processes, improving continuity of care, and facilitating equitable patient access to multidisciplinary resources. The current lack of consensus complicates patient care, data collection, and resource allocation, impacting health policy development. Future efforts should focus on achieving agreement on definitions to ensure equitable treatment and effective healthcare responses to Long COVID.

Background: It is important for general practitioners (GPs) to protect elderly patients with diagnosis of diabetes type 2 (DM2) from overtreatment.

Objective: To analyse the metabolic control and treatment of elderly patients with DM2 in general practices.

Methods: This cross-sectional study involved 46 general practices in a federal state of Germany. Inclusion criteria for patients were diagnosis of DM2, age of 70 years or above, no palliative care and at least one practice contact within the last six months. A study nurse randomly selected 10 eligible patients and extracted data on haemoglobin A1c (HbA1c), diabetes treatment, secondary prevention and GP's characteristics. Risk of overtreatment was defined as having a HbA1c <47.5 mmol/mol (6.5%) and receiving glucose-lowering drugs, and overtreatment as being at risk of overtreatment and being aged 80 years or above or living in a nursing home.

Results: Among 460 participants, 36.0% received oral-antidiabetic drugs, 16.7% insulin, 16.2% both and 31.1% received diet/exercise. Overtreatment occurred in 12% of elderly patients with DM2, risk of overtreatment in 24%. Overtreatment was significantly associated with urban residency (OR 2.17). Female elderly patients with DM2 were significantly less often at risk of overtreatment (OR 0.59). Cluster effects were evident between general practices' treatment and monitoring of elderly patients with DM2 in quantitative data.

Conclusion: Overtreatment is a relevant problem in elderly patients with DM2 for which GPs should regularly check and start deprescribing. Cluster effects suggest heterogeneity between general practices in diabetes management and monitoring.

While the development and use of Artificial Intelligence (AI) in health care have literally exploded in recent years, general practitioners (GPs) continue to struggle with a fragmented health care system and complex patients with multiple conditions and increasing care needs. An ageing population, task shifting from secondary care to ambulatory services without adequate resource allocation, and policy makers pushing for more accessible primary care are examples of factors driving the demand for AI-tools designed to triage patient complaints, improve workflows, ease clinicians' burden and support clinical decision-making. The paradigm shift towards digital solutions may offer answers, yet evidence often trails behind their implementation. The paper will address current challenges in European primary care today, highlight areas where AI can improve administrative tasks and patient outcomes, and discuss the potential benefits and drawbacks of adopting AI. Will AI tools enhance decision-making or simply create new care demands? Will their implementation truly add value to the holistic patient care model in general practice?