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Primary healthcare professionals' perceptions, attitudes and ideas regarding asthma management in Greece: A mixed-method study. 希腊初级医疗保健专业人员对哮喘管理的认识、态度和想法:混合方法研究。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-10-25 DOI: 10.1080/13814788.2024.2418301
Izolde Bouloukaki, Christos Spanias, Despo Ierodiakonou, Nikolaos Tzanakis, Siân Williams, Ioanna Tsiligianni

Background: Implementing asthma guideline recommendations is challenging and there is variation between countries, and different healthcare professionals (HCPs). The International Primary Care Respiratory Group (IPCRG) has introduced the Asthma Right Care (ARC) programme implemented in 24 low, middle, and high countries, including Greece. It offers a promising approach drawn from social movements for health to improve asthma care by engaging HCPs in implementing guideline-based asthma care.

Objectives: To explore HCPs' perspectives on current provision of asthma care and their willingness to improve implementation of recommended guidelines using ARC programme tools in Greece.

Methods: A mixed methods study conducted from September 2020 to April 2021. A convenience sample of 30 pharmacists, and 10 General Practitioners (GPs), responded to a questionnaire investigating perceptions, and attitudes, towards implementation of asthma guidelines. Then, a qualitative survey followed with semi-structured interviews to evaluate the feedback obtained from HCPs to assess the content, and applicability of the ARC tools. Data were analysed using thematic analysis.

Results: A range of practical challenges in implementing guideline-recommended interventions, improving asthma control and management were described by all HCPs, including lack of time and education, high workload, patients' perceptions, and poor communication contributing to poor management and inadequate follow-up of people with asthma. However, most HCPs were willing to use ARC interventions to improve guideline implementation.

Conclusion: HCPs in Greece encounter challenges in implementing asthma guidelines; however, they can overcome these challenges by using ARC interventions and engagement tools to address barriers and implement efficient asthma management strategies.

背景:实施哮喘指南建议具有挑战性,不同国家和不同医疗保健专业人员(HCPs)之间存在差异。国际初级保健呼吸系统小组(IPCRG)推出了 "哮喘正确护理"(ARC)计划,在包括希腊在内的 24 个低、中、高水平国家实施。该计划提供了一种很有前景的方法,它借鉴了促进健康的社会运动,通过让初级保健人员参与实施基于指南的哮喘护理来改善哮喘护理:目的:在希腊探讨保健医生对当前哮喘护理服务的看法,以及他们是否愿意利用 ARC 计划工具改进推荐指南的实施:方法:2020 年 9 月至 2021 年 4 月进行的一项混合方法研究。30 名药剂师和 10 名全科医生(GPs)对调查问卷进行了回答,调查内容包括对哮喘指南实施的看法和态度。随后进行了定性调查和半结构式访谈,以评估从 HCP 那里获得的反馈,从而评估 ARC 工具的内容和适用性。采用主题分析法对数据进行了分析:结果:所有高级保健人员都描述了在实施指南推荐的干预措施、改善哮喘控制和管理方面所面临的一系列实际挑战,包括缺乏时间和教育、工作量大、患者的看法以及沟通不畅,这些都是导致哮喘患者管理不善和随访不足的原因。然而,大多数卫生保健人员愿意使用 ARC 干预措施来改善指南的实施:希腊的保健医生在实施哮喘指南时遇到了挑战;但是,他们可以通过使用 ARC 干预和参与工具来克服这些挑战,从而消除障碍并实施高效的哮喘管理策略。
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引用次数: 0
Impact of COVID-19 pandemic on the accuracy of telephone triage of callers with shortness of breath and/or chest discomfort in Dutch out-of-hours primary care: A retrospective observational study.
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-11-28 DOI: 10.1080/13814788.2024.2430508
Michelle Spek, Anna S M Dobbe, Dorien L Zwart, Daphne C A Erkelens, Geert-Jan Geersing, Esther de Groot, Mathé Delissen, Frans H Rutten, Roderick P Venekamp

Background: Anecdotal reports suggest that missed diagnosis in general practice during the first wave of the COVID-19 pandemic contributed to a drop in life-threatening events (LTEs) detected in hospitals.

Objectives: To investigate the impact of the COVID-19 pandemic on the accuracy of urgency allocation by telephone triage of patients with shortness of breath and/or chest discomfort in out-of-hours primary care (OHS-PC). Accuracy is defined as the correct allocation of high urgency to patients with LTEs and low urgency to those without.

Methods: Retrospective observational study with data from callers contacting OHS-PC for shortness of breath and/or chest discomfort, between 1 March and 1 June 2019 (pre-pandemic) and 1 March to 1 June 2020 (first wave COVID-19 pandemic). Sensitivity and specificity of telephone urgency allocation were compared during both periods with LTEs, including acute coronary syndrome, and pulmonary embolism, as the reference.

Results: 3,064 adults (1,840 COVID-19 pandemic and 1,224 pre-pandemic, p < 0.001) were included in the study. The sensitivity of urgency allocation was similar during and before the COVID-19 pandemic (0.68, 95% CI 0.59 to 0.75 vs. 0.68, 95% CI 0.60 to 0.75, p = 0.944). Specificity was slightly higher during the COVID-19 pandemic (0.52, 95% CI 0.50 to 0.55 vs. 0.45, 95% CI 0.42 to 0.48, p < 0.001).

Conclusion: Despite a surge in calls from adults with shortness of breath and/or chest discomfort during the COVID-19 pandemic, the accuracy of telephone triage for LTEs in OHS-PC remained similar to the pre-pandemic era. Improvement of telephone triage seems necessary in both periods.

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引用次数: 0
Setting targets for antibiotic use in general practice in Europe: A scoping review.
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-11-28 DOI: 10.1080/13814788.2024.2430507
Nathaly Garzón-Orjuela, Kevin Roche, Heike Vornhagen, Aoife Moran, Scott Walkin, Walter Cullen, Catherine Blake, Akke Vellinga

Background: National Action Plans (NAPs) aim to address antimicrobial resistance (AMR) understanding and awareness but struggle to translate targets into clinically relevant guidance for general practice.

Objective: To identify and map antibiotic use targets in European general practice and explore if and how these targets are linked to NAPs.

Methods: A systematic search was carried out in MEDLINE (OVID), EMBASE and SCOPUS, with additional manual searches. The research questions were: What are existing targets for antibiotic use in general practice in the 31 European countries? and How are these targets linked to the NAPs on AMR?. The results are presented narratively.

Results: 77 reports were included, of which 33 focused on national targets and general practice or linking national and local targets. Reports describe local strategies to achieve targets, such as prescriber feedback, benchmarking systems and financial incentives. However, these reports provide aggregated targets for general practice, such as a percentage reduction of antibiotics prescribed. These targets are set in general, for a specific type of antibiotic, for an amount per number of patients, in defined daily doses or items. None of the reports translate national targets into clinically relevant or practical targets for general practitioners.

Conclusion: Most European countries have an NAP with established targets, but the type and implementation of these targets vary between nations. Translating national targets into daily clinical practice is challenging and often lacks the involvement of prescribers. Aligning national and local targets would enhance coherence and more effectively contribute to improvements in antibiotic use.

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引用次数: 0
Comment on: Climate change is a health issue. The general practitioner and planetary health by Stoffers & Muris 2023. 发表评论:气候变化是一个健康问题。全科医生与地球健康》(Stoffers & Muris 2023)。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-01-24 DOI: 10.1080/13814788.2023.2298332
Oisín Brady Bates, Natasha Freeman
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引用次数: 0
Why are our medicines so expensive? Spoiler: Not for the reasons you are being told…. 我们的药品为何如此昂贵?剧透:不是因为你们被告知的原因....
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-02-01 DOI: 10.1080/13814788.2024.2308006
Els Torreele

Often described as a natural economic trend, the prices that pharmaceutical companies charge for new medicines have skyrocketed in recent years. Companies claim these prices are justified because of the 'value' new treatments represent or that they reflect the high costs and risks associated with the research and development process. They also claim that the revenues generated through these high prices are required to pay for continued innovation.This paper argues that high prices are not inevitable but the result of a societal and political choice to rely on a for-profit business model for medical innovation, selling medicines at the highest price possible. Instead of focusing on therapeutic advances, it prioritises profit maximisation to benefit shareholders and investors over improving people's health outcomes or equitable access.As a result, people and health systems worldwide struggle to pay for the increasingly expensive health products, with growing inequities in access to even life-saving medicines while the biopharmaceutical industry and its financiers are the most lucrative business sectors.As the extreme COVID-19 vaccine inequities once again highlighted, we urgently need to reform the social contract between governments, the biopharmaceutical industry, and the public and restore its original health purpose. Policymakers must redesign policies and financing of the pharmaceutical research and development ecosystem such that public and private sectors work together towards the shared objective of responding to public health and patients' needs, rather than maximising financial return because medicines should not be a luxury.

制药公司对新药收取的价格近年来一路飙升,这通常被描述为一种自然经济趋势。制药公司声称这些价格是合理的,因为新疗法代表了 "价值",或反映了研发过程中的高成本和高风险。本文认为,高价并非不可避免,而是社会和政治选择的结果,即依靠营利性商业模式进行医疗创新,以尽可能高的价格销售药品。因此,全世界的人们和医疗系统都在为支付日益昂贵的医疗产品而挣扎,甚至在获得救命药物方面的不公平现象也日益加剧,而生物制药行业及其金融家却成了最赚钱的商业部门。正如 COVID-19 疫苗的极端不公平再次凸显的那样,我们迫切需要改革政府、生物制药行业和公众之间的社会契约,恢复其最初的健康目的。政策制定者必须重新设计医药研发生态系统的政策和融资方式,使公共和私营部门共同努力,实现满足公众健康和患者需求的共同目标,而不是追求经济回报的最大化,因为药品不应是奢侈品。
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引用次数: 0
Development and validation of a risk prediction model for hospital admission in COVID-19 patients presenting to primary care. 开发并验证 COVID-19 初级医疗患者入院风险预测模型。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-04-29 DOI: 10.1080/13814788.2024.2339488
Laure Wynants, Natascha Jh Broers, Tamara N Platteel, Roderick P Venekamp, Dennis G Barten, Mathie Pg Leers, Theo Jm Verheij, Patricia M Stassen, Jochen Wl Cals, Eefje Gpm de Bont

Background: There is a paucity of prognostic models for COVID-19 that are usable for in-office patient assessment in general practice (GP).

Objectives: To develop and validate a risk prediction model for hospital admission with readily available predictors.

Methods: A retrospective cohort study linking GP records from 8 COVID-19 centres and 55 general practices in the Netherlands to hospital admission records. The development cohort spanned March to June 2020, the validation cohort March to June 2021. The primary outcome was hospital admission within 14 days. We used geographic leave-region-out cross-validation in the development cohort and temporal validation in the validation cohort.

Results: In the development cohort, 4,806 adult patients with COVID-19 consulted their GP (median age 56, 56% female); in the validation cohort 830 patients did (median age 56, 52% female). In the development and validation cohort respectively, 292 (6.1%) and 126 (15.2%) were admitted to the hospital within 14 days, respectively. A logistic regression model based on sex, smoking, symptoms, vital signs and comorbidities predicted hospital admission with a c-index of 0.84 (95% CI 0.83 to 0.86) at geographic cross-validation and 0.79 (95% CI 0.74 to 0.83) at temporal validation, and was reasonably well calibrated (intercept -0.08, 95% CI -0.98 to 0.52, slope 0.89, 95% CI 0.71 to 1.07 at geographic cross-validation and intercept 0.02, 95% CI -0.21 to 0.24, slope 0.82, 95% CI 0.64 to 1.00 at temporal validation).

Conclusion: We derived a risk model using readily available variables at GP assessment to predict hospital admission for COVID-19. It performed accurately across regions and waves. Further validation on cohorts with acquired immunity and newer SARS-CoV-2 variants is recommended.

背景:全科医生(GP)在诊室内对患者进行评估时,COVID-19的预后模型很少:方法:一项回顾性队列研究,将全科医生中心(GP)的病人与全科医生中心(GP)的病人联系起来:一项回顾性队列研究,将荷兰 8 个 COVID-19 中心和 55 个全科诊所的全科医生记录与入院记录联系起来。开发队列的时间跨度为 2020 年 3 月至 6 月,验证队列的时间跨度为 2021 年 3 月至 6 月。主要结果是 14 天内入院。我们在开发队列中使用了地理离区交叉验证,在验证队列中使用了时间验证:在开发队列中,4806 名患有 COVID-19 的成年患者咨询了全科医生(中位年龄 56 岁,56% 为女性);在验证队列中,830 名患者咨询了全科医生(中位年龄 56 岁,52% 为女性)。在开发队列和验证队列中,分别有 292 人(6.1%)和 126 人(15.2%)在 14 天内入院治疗。基于性别、吸烟、症状、生命体征和合并症的逻辑回归模型在地理交叉验证中预测入院的 c 指数为 0.84(95% CI 0.83 至 0.86),在时间验证中预测入院的 c 指数为 0.79(95% CI 0.74 至 0.83)。在时间验证中,c 指数为 0.84(95% CI 0.83 至 0.86);在地域交叉验证中,c 指数为 0.79(95% CI 0.74 至 0.83);在时间验证中,c 指数为 0.02(95% CI -0.21 至 0.24),斜率为 0.82(95% CI 0.64 至 1.00):我们利用全科医生评估时容易获得的变量推导出了一个风险模型,用于预测 COVID-19 的入院情况。该模型在不同地区和不同波次中均表现准确。建议对获得性免疫和较新的 SARS-CoV-2 变体的队列进行进一步验证。
{"title":"Development and validation of a risk prediction model for hospital admission in COVID-19 patients presenting to primary care.","authors":"Laure Wynants, Natascha Jh Broers, Tamara N Platteel, Roderick P Venekamp, Dennis G Barten, Mathie Pg Leers, Theo Jm Verheij, Patricia M Stassen, Jochen Wl Cals, Eefje Gpm de Bont","doi":"10.1080/13814788.2024.2339488","DOIUrl":"https://doi.org/10.1080/13814788.2024.2339488","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of prognostic models for COVID-19 that are usable for in-office patient assessment in general practice (GP).</p><p><strong>Objectives: </strong>To develop and validate a risk prediction model for hospital admission with readily available predictors.</p><p><strong>Methods: </strong>A retrospective cohort study linking GP records from 8 COVID-19 centres and 55 general practices in the Netherlands to hospital admission records. The development cohort spanned March to June 2020, the validation cohort March to June 2021. The primary outcome was hospital admission within 14 days. We used geographic leave-region-out cross-validation in the development cohort and temporal validation in the validation cohort.</p><p><strong>Results: </strong>In the development cohort, 4,806 adult patients with COVID-19 consulted their GP (median age 56, 56% female); in the validation cohort 830 patients did (median age 56, 52% female). In the development and validation cohort respectively, 292 (6.1%) and 126 (15.2%) were admitted to the hospital within 14 days, respectively. A logistic regression model based on sex, smoking, symptoms, vital signs and comorbidities predicted hospital admission with a c-index of 0.84 (95% CI 0.83 to 0.86) at geographic cross-validation and 0.79 (95% CI 0.74 to 0.83) at temporal validation, and was reasonably well calibrated (intercept -0.08, 95% CI -0.98 to 0.52, slope 0.89, 95% CI 0.71 to 1.07 at geographic cross-validation and intercept 0.02, 95% CI -0.21 to 0.24, slope 0.82, 95% CI 0.64 to 1.00 at temporal validation).</p><p><strong>Conclusion: </strong>We derived a risk model using readily available variables at GP assessment to predict hospital admission for COVID-19. It performed accurately across regions and waves. Further validation on cohorts with acquired immunity and newer SARS-CoV-2 variants is recommended.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2339488"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11060008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854432","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
Looking back at the EJGP in 2023: What a rich harvest of relevant publications for primary care medicine! 回顾 2023 年的 EJGP:基层医疗相关出版物收获颇丰!
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-05-23 DOI: 10.1080/13814788.2024.2353237
Jelle Stoffers
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引用次数: 0
Development of the face-to-face component and recruitment strategy of a primary care digital social intervention for patients with asthma: Qualitative focus groups and interviews with stakeholders. 针对哮喘患者的初级保健数字社交干预的面对面部分和招募策略的开发:定性焦点小组和利益相关者访谈。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-09-27 DOI: 10.1080/13814788.2024.2407594
Georgios Dimitrios Karampatakis, Samuel Kimber, Helen E Wood, Chris J Griffiths, Stephanie J C Taylor, Xiancheng Li, Bill Day, Jonathan Mant, Clare Relton, Jane S Watson, Viv Marsh, Neil S Coulson, Anna De Simoni

Background: 5.4 million people in the UK have asthma, with one third experiencing suboptimal control, leading to co-morbidities and increased healthcare use. A quarter of people with long-term conditions informally access peer support through online health communities (OHCs). However, integrating online peer support into primary care services to facilitate self-management is a new concept.

Objectives: To develop together with stakeholders the content, delivery, and recruitment strategy of a digital social intervention to promote use of online peer support amongst asthma patients in primary care.

Methods: Data was collected by qualitative, audio-recorded, one-to-one interviews with clinicians, and focus groups with patients with asthma from East London general practices. The topic guide was informed by patient and public involvement work. Data collected was iterative (i.e. new ideas were added to subsequent interviews and focus groups). Verbatim transcripts were uploaded to NVivo12 and thematically analysed.

Results: Twenty patients from several ethnicities participated across five focus groups, and three general practitioners and three practice nurses were interviewed. The study's outputs included: the intervention's face-to-face content; content of clinician training; patient-facing leaflets/material; and a survey to recruit eligible patients. An intervention consisting of a structured consultation with a primary care clinician followed by OHC engagement, was developed based on three generated themes: 'introducing OHCs', describing how clinicians should introduce OHCs; 'OHC engagement', describing factors influencing OHC engagement; and 'clinician training'.

Conclusion: Findings will assist clinicians in consultations about supporting self-management of patients through OHCs. Future research should evaluate feasibility, effectiveness, and cost-effectiveness of such support.

背景:英国有 540 万哮喘患者,其中三分之一的患者病情控制不理想,导致并发症和医疗费用的增加。四分之一的长期病患者通过在线健康社区(OHCs)非正式地获得同伴支持。然而,将在线同伴支持纳入初级保健服务以促进自我管理还是一个新概念:与利益相关者共同制定数字社交干预的内容、交付和招募策略,以促进初级医疗中的哮喘患者使用在线同伴支持:方法:通过对临床医生进行一对一的定性录音访谈,以及与东伦敦全科诊所的哮喘患者进行焦点小组讨论来收集数据。患者和公众参与工作为主题指南提供了信息。收集的数据是反复进行的(即在随后的访谈和焦点小组中加入新的想法)。逐字记录稿被上传到 NVivo12 中,并进行了主题分析:来自不同种族的 20 名患者参加了 5 个焦点小组,3 名全科医生和 3 名执业护士接受了访谈。研究成果包括:面对面的干预内容;临床医生培训内容;面向患者的宣传单/材料;招募合格患者的调查。根据产生的三个主题:"引入户外保健",描述临床医生应如何引入户外保健;"户外保健参与",描述影响户外保健参与的因素;以及 "临床医生培训",制定了一项干预措施,包括与一名初级保健临床医生进行结构化咨询,然后参与户外保健:结论:研究结果将有助于临床医生通过开放式健康中心支持患者自我管理。未来的研究应评估此类支持的可行性、有效性和成本效益。
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引用次数: 0
General Practitioners practice nurses and parents' perspectives on childhood overweight management - a qualitative study. 全科医生、执业护士和家长对儿童超重管理的看法--一项定性研究。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-09-27 DOI: 10.1080/13814788.2024.2402259
Maxime Adriana Maria van der Velden, Hevy Hassan, Dieuwke Schiphof, Madelon van Tilborg-den Boeft, Sylvia Buis, Wilma Jansen, Patrick Jan Eugène Bindels, Marienke van Middelkoop

Background: Overweight and obesity in children is a major health problem. General practice might be a promising setting for identifying and for the first steps in the management of overweight and obesity in children.

Objective: To explore opinions, needs and preferences about the role of general practice in the management of overweight and obesity in children from the perspectives of Dutch general practitioners (GPs), practice nurses (PNs) and parents of children with and without overweight.

Methods: A qualitative study using semi-structured focus group interviews. GPs and PNs were recruited from general practices from the region South-Western. Parents were mainly recruited via social media and primary schools. Twenty-five GPs, seven PNs and 18 parents were interviewed. All interviews were audio recorded, transcribed and thematically analysed.

Results: GPs, PNs and parents agreed that it is the task of the GP to identify, address and refer children with overweight and obesity. However, GPs find it difficult to start this conversation due to time constraints; fear for the reaction of parents and children; lack of clarity about treatment and referral options. Parents indicated they are open to a conversation if the GP is non-judgmental, honest and respectful. PNs saw no role in managing overweight and obesity in children.

Conclusion: Although GPs experience several barriers, GPs, PNs and parents all agreed that GPs should play a role in identifying, addressing and referring children with overweight and obesity. Supportive tools are required for GPs in order to play this role.

背景:儿童超重和肥胖是一个主要的健康问题。全科医生可能是发现儿童超重和肥胖症并对其采取初步治疗措施的理想场所:从荷兰全科医生(GPs)、执业护士(PNs)以及超重和未超重儿童家长的角度,探讨全科医生在儿童超重和肥胖症管理中的作用:采用半结构化焦点小组访谈法进行定性研究。全科医生和执业护士是从西南地区的全科诊所招募的。家长主要通过社交媒体和小学招募。对 25 名全科医生、7 名初级护士和 18 名家长进行了访谈。所有访谈均进行了录音、转录和主题分析:结果:全科医生、儿科护士和家长一致认为,全科医生的任务是识别、处理和转诊超重和肥胖儿童。然而,全科医生发现,由于时间限制、担心家长和儿童的反应、治疗和转诊选择不明确等原因,很难开始这种对话。家长们表示,如果全科医生不做评判、诚实并尊重他们,他们愿意进行对话。全科医生在管理儿童超重和肥胖症方面没有发挥任何作用:尽管全科医生会遇到一些障碍,但全科医生、初级营养师和家长都认为全科医生应在识别、处理和转诊超重和肥胖儿童方面发挥作用。全科医生需要辅助工具来发挥这一作用。
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引用次数: 0
Generic dispensing rates for substitutable drugs prescribed by general practitioners compared with other private ambulatory specialists: A study based on a French national reimbursement database. 全科医生与其他私人门诊专科医生开具的可替代药物的非专利配药率比较:基于法国国家报销数据库的研究。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-01 Epub Date: 2024-10-14 DOI: 10.1080/13814788.2024.2407600
Hugo Figoni, Sarah Robert, Kim Bonello, Gladys Ibanez, Julie Chastang, Candice Estellat

Background: The use of generic drugs is a way for healthcare systems to reduce costs, particularly in ambulatory care. Several studies suggest that the prescriber's speciality is associated with the use of generic drugs, and that substitutable drugs prescribed by General Practitioners (GPs) are more often generic, but this association has never been studied in France. In the French legislative context, except in rare situations, all substitutable drugs prescribed should be dispensed in generic form.

Objectives: Compare the generic drugs dispensing rate among substitutable drugs dispensed in community pharmacies prescribed by French private GPs with that of other private specialists, all other specialities combined (first objective) or each other speciality taken individually (second objective).

Methods: We used a sample of an open available semi-aggregated database from the 2019 French health insurance system database. We compared with logistic regression models GPs to all other specialities combined, then GPs to the 19 other specialties taken individually, only on the substitutable drugs they prescribe in common.

Results: In 2019, 53.4% of the drugs prescribed by French private ambulatory physicians were substitutable drugs, and 81.5% of them were dispensed in generic form. After adjustment, the generic dispensing rate for substitutable drugs was significantly higher for GPs than for other specialties (ORa 0.74 [IC95% 0.72-0.76]). Thirteen of the nineteen other specialities taken individually, such as endocrinologists (ORa 0.64 [IC95% 0.57-0.72]) and cardiologists (ORa 0.60 [0.56-0.63]) had significantly lower generic dispensing rates than GPs. No other speciality had a rate significantly higher than GPs.

Conclusions: Substitutable drugs prescribed by French private GPs are more often dispensed in generic form than those from other private ambulatory specialties. To understand this result and optimise the use of generic drugs in outpatient settings, we need to study the different stages of drug use, from prescription by the physician to dispensing by the pharmacist and acceptance by the patient.

背景:使用非专利药是医疗系统降低成本的一种方式,尤其是在非住院医疗中。多项研究表明,处方者的专业与非专利药的使用有关,而全科医生(GP)开具的可替代药物处方更多使用非专利药,但法国从未对这种关联进行过研究。在法国的立法背景下,除极少数情况外,所有可替代药物处方均应以非专利形式配发:比较法国私人全科医生与其他私人专科医生、所有其他专科医生(第一目标)或其他各专科医生(第二目标)在社区药房开具的可替代药物中的非专利药配药率:我们使用了 2019 年法国医疗保险系统数据库中一个公开的半汇总数据库样本。我们用逻辑回归模型比较了全科医生与所有其他专科的总和,然后比较了全科医生与其他19个专科的单独情况,仅比较了他们共同开具的可替代药物:2019年,法国私人门诊医生处方的药物中有53.4%为可替代药物,其中81.5%以仿制药形式配发。经调整后,全科医生的可替代药物仿制药配药率明显高于其他专科医生(ORa 0.74 [IC95% 0.72-0.76])。在 19 个其他专科中,有 13 个专科(如内分泌科医生(ORa 0.64 [IC95% 0.57-0.72])和心脏病医生(ORa 0.60 [0.56-0.63])的非专利药配药率明显低于全科医生。其他专科医生的配药率均明显低于全科医生:法国私人全科医生开具的可替代药物的非专利配药率高于其他私人门诊专科医生。要理解这一结果并优化非专利药在门诊环境中的使用,我们需要研究药物使用的不同阶段,从医生开处方到药剂师配药再到患者接受。
{"title":"Generic dispensing rates for substitutable drugs prescribed by general practitioners compared with other private ambulatory specialists: A study based on a French national reimbursement database.","authors":"Hugo Figoni, Sarah Robert, Kim Bonello, Gladys Ibanez, Julie Chastang, Candice Estellat","doi":"10.1080/13814788.2024.2407600","DOIUrl":"https://doi.org/10.1080/13814788.2024.2407600","url":null,"abstract":"<p><strong>Background: </strong>The use of generic drugs is a way for healthcare systems to reduce costs, particularly in ambulatory care. Several studies suggest that the prescriber's speciality is associated with the use of generic drugs, and that substitutable drugs prescribed by General Practitioners (GPs) are more often generic, but this association has never been studied in France. In the French legislative context, except in rare situations, all substitutable drugs prescribed should be dispensed in generic form.</p><p><strong>Objectives: </strong>Compare the generic drugs dispensing rate among substitutable drugs dispensed in community pharmacies prescribed by French private GPs with that of other private specialists, all other specialities combined (first objective) or each other speciality taken individually (second objective).</p><p><strong>Methods: </strong>We used a sample of an open available semi-aggregated database from the 2019 French health insurance system database. We compared with logistic regression models GPs to all other specialities combined, then GPs to the 19 other specialties taken individually, only on the substitutable drugs they prescribe in common.</p><p><strong>Results: </strong>In 2019, 53.4% of the drugs prescribed by French private ambulatory physicians were substitutable drugs, and 81.5% of them were dispensed in generic form. After adjustment, the generic dispensing rate for substitutable drugs was significantly higher for GPs than for other specialties (ORa 0.74 [IC95% 0.72-0.76]). Thirteen of the nineteen other specialities taken individually, such as endocrinologists (ORa 0.64 [IC95% 0.57-0.72]) and cardiologists (ORa 0.60 [0.56-0.63]) had significantly lower generic dispensing rates than GPs. No other speciality had a rate significantly higher than GPs.</p><p><strong>Conclusions: </strong>Substitutable drugs prescribed by French private GPs are more often dispensed in generic form than those from other private ambulatory specialties. To understand this result and optimise the use of generic drugs in outpatient settings, we need to study the different stages of drug use, from prescription by the physician to dispensing by the pharmacist and acceptance by the patient.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2407600"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11486039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480999","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}
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European Journal of General Practice
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