European Journal of General Practice最新文献

Background: Continuity of care (COC) is a core value in general practice. It has been deteriorating in Finnish primary health care, but there are now attempts to improve it.

Objectives: This study focused on gathering insights of primary care physicians (PCPs) on how COC can be improved within Finnish primary health care.

Methods: We conducted a nationwide survey targeting all PCPs working in primary health care. A web-based questionnaire was sent to PCPs in Finland from May to October of 2023. The questionnaire included the question 'How would you improve continuity of care in your workplace?' Data were analysed using a descriptive approach that involved iterative and inductive thematic analysis.

Results: We received a total of 291 responses from PCPs across Finland (7% response rate). We identified themes related to organisation (e.g. arrangement of practical work including the size of a health centre), practice-level (e.g. autonomy, including the opportunity to perform COC in daily work), and themes related to digital solutions (e.g. data of COC measured and available). PCPs had considerable insight into the development of COC in day-to-day operations.

Conclusion(s): Enhancing COC for a primary care patient population requires a systemic perspective and structured, goal-oriented development efforts. However, small and discrete steps can also contribute to improving COC for individual patients. Our findings highlight the link between COC enhancement and the development of the health care system as a whole.

Background: Healthcare demand in English general practice exceeds supply, necessitating practice efficiency. To our knowledge, no study has explored factors associated with practice efficiency in England using a quality-adjusted output.

Objectives: To determine practice-level efficiency in England and identify associated factors using a quality-adjusted output.

Methods: We conducted a cross-sectional study using NHS datasets from 2023. Practice efficiency was determined by comparing input (measured using funding and workforce) with output (measured using clinical quality, patient experience, and service volume). Practices were classified as efficient (low input, high output), neutral (same input and output levels), or inefficient (high input, low output) using K-medoids clustering, a machine learning technique. Multivariable logistic regression was used to identify factors associated with practice efficiency (i.e. efficient or inefficient, excluding neutral).

Results: Of 5069 practices, 1117 were classified as efficient, 2773 as neutral, and 1179 as inefficient. Efficiency was lower in practices with a larger patient list (adjusted odds ratio 0.23, 95% CI 0.19-0.28), those with a higher percentage of patients with a chronic condition (0.47, 0.38-0.58) or patients ≥ 65 years (0.63, 0.49-0.81), those in a higher deprivation area (0.25, 0.20-0.32), those that dispense medications (0.52, 0.37-0.73), and those with an alternative provider medical services (vs. general medical services) contract (0.15, 0.07-0.33). Efficiency was higher in urban practices (1.38, 1.00-1.90) and practices with a higher percentage of mixed (1.66, 1.24-2.21) or other ethnicity patients (1.78, 1.22-2.60).

Conclusion: Smaller practices were more efficient. Therefore, policies that encourage practice mergers may not deliver the efficiency gains expected.

Context: The ageing population in Europe, particularly in rural areas, creates new health challenges, including patients with multiple comorbidities and difficult access to care. Advanced Practice Nurses (APNs) could play a key role in improving access and care for frail older patients in France's rural areas, although how to achieve this remains unclear.

Aim: This study aimed to identify the healthcare needs of frail patients living at home in rural areas and those of their healthcare providers to assess the potential role of APNs in addressing these needs.

Methods: This interpretive descriptive qualitative study was conducted from June to September 2023, using focus groups (FGs). Three FGs with 20 participants, including healthcare providers and frail older people, were conducted in two French rural areas. Data were analysed using thematic analyse to identify key needs and potential APN contributions.

Results: The healthcare needs identified were: improving access to care, maintaining human interactions, and providing coordinated, preventive care. Participants emphasised the importance of interprofessional collaboration and the central role of APNs, whose expanded skillset enables them to coordinate care with caregivers and professionals. However, challenges remain, including a lack of understanding of the APN's skills and concerns about their integration within the care team.

Conclusion: APNs could support access to person-centred, coordinated home care in rural areas by acting as key references for patients, caregivers, and teams. However, limited awareness of their role and concerns from other professionals remain barriers to their integration.

Introduction: Cancer screening uptake in Georgia is only 13%. We aimed to assess cancer screening recommendations and referral practices among primary health care providers (PHC) and factors associated with these practices.

Methods: We conducted a cross-sectional survey of 2,958 doctors and nurses in PHC in November 2023, using descriptive, bivariate, and multivariate analyses to assess the association between provider characteristics, system-level factors, and practices in recommending and referring for cancer screening.

Results: Respondents were predominantly female (95%), mean age of 57.5 years, family doctors (56%), with >20 years' work experience (60%) and rural practice (67%). Almost all (98%) reported actively recommending and referring patients for cancer screening; however, 64.7% did so for only 1-5 patients per week, while 12% reported none. Predictors of higher recommendation and referral rates (≥6 patients per week) included being a family doctor (AOR 1.36; 95% CI: 1.11-1.67; p = 0.003), working in the capital city - Tbilisi (AOR 1.36; 95% CI: 1.14-1.95; p = 0.003), receiving comprehensive cancer screening training (AOR 1.49; 95% CI: 1.04-1.68; p = 0.024), reporting adequate infrastructure (AOR 1.39; 95% CI: 1.07-1.81; p = 0.015), reporting proper public promotion (AOR 1.41; 95% CI: 1.12-1.78; p = 0.003), and perceiving screening as part of their role (AOR 1.87; 95% CI: 1.52-2.30; p < 0.001).

Conclusions: Despite strong belief in cancer screening, recommendation and referral rates remain low, underscoring the urgent need for policy reforms to enhance education, raise awareness, and improve infrastructure for effective cancer screening initiatives.

Background: Germany is challenged by an increasing shortage in general practice services, especially in non-urban areas. Task shifting from general practitioners (GPs) to other health professionals may improve practice efficiency to address this mismatch.

Objectives: Exploring GPs' motives and beliefs towards task shifting in non-urban Germany and identifying potential factors influencing these.

Methods: The cross-sectional survey was disseminated by mail in three waves between July 2021 and August 2022 among all GPs in non-urban Baden-Wuerttemberg, Germany. It included items on demographics and practice characteristics as well as 15 Likert-scale items addressing motives and beliefs towards task shifting, based on the Theoretical Domain Framework. Likert-scale items were analysed descriptively, influencing factors on motives and beliefs were identified using multiple linear regression.

Results: Response rate was 24.2% (281/1162), with respondents comparable in age and gender to all GPs in Baden-Wuerttemberg. GPs' motives and beliefs towards task shifting are positive overall. The majority expects task shifting to reduce their workload (87.9%) and increase practice efficiency (74.7%). They are open to shift additional tasks to other professionals (69.1%), even in the currently prohibited form of substitution (51.2%). Motives and beliefs were significantly more positive among younger GPs and those participating in the GP-centred care programme.

Conclusion: This study describes GPs' motives and beliefs towards task shifting in non-urban Germany. Identifying younger GPs and those participating in the GP-centred care programme as particularly endorsing may help design future interventions aiming to improve efficiency in general practice in non-urban Germany.

Background: Male urinary tract infections (mUTIs) are rare in primary care. The definition of mUTIs varies across countries. The therapeutic management of mUTIs in France is based on a 14-day course of fluoroquinolones despite a high risk of antimicrobial resistance.

Objectives: The objective of this qualitative study was to explore general practitioners' (GPs) experiences and behaviours regarding the diagnostic and therapeutic management of mUTIs.

Methods: GPs were recruited by convenience sampling in Haute Normandie (France) and interviewed individually with semi-structured guides. GPs' experiences and behaviours were recorded and analysed using an interpretive phenomenological approach.

Results: From March 2021 to May 2022, 20 GPs were included in the study. Defining a mUTI was perceived as a diagnostic challenge. A diagnosis based on clinical evidence alone was insufficient and complementary tests were required. For GPs: 'male cystitis does not exist'. A mUTI was considered an unusual disease that could reveal an underlying condition. GPs considered fluoroquinolones to be 'potent' antibiotics and treated all patients with the same 14-day course. GPs implemented improvement strategies for antibiotic stewardship and followed the guidelines using a computerised decision support system.

Conclusions: GPs' experiences of mUTIs are limited due to low exposure and variable clinical presentations in primary care, representing a diagnostic and therapeutic challenge. In order to modify GPs' antibiotic prescribing behaviours, a paradigm shift in the guidelines will need to be proposed.KEY MESSAGESDefining a male urinary tract infection represents a diagnostic challenge for GPs.A diagnosis based on clinical evidence alone is insufficient and complementary tests are required.A male urinary tract infection is an unusual disease in primary care and suggests a more serious underlying condition.

Background: Worldwide, there are concerns about declining mental health of children and young people (CYP).

Objectives: To examine trends in GP consultation rates for psychosocial problems and the impact of the COVID-19 pandemic.

Methods: We performed a population-based cohort study using electronic GP records of CYP (0-24 years) living in the Rotterdam metropolitan area between 2016 and 2021. We calculated monthly consultation rates for psychosocial problems, stratified by age group and sex. We used negative binomial models to model the pre-COVID-19 trend, and estimate expected rates post-COVID-19 onset. We modelled the effect of COVID-19 infection rate and school closure on consultation rates per sex and age group.

Results: The cohort increased from 64801 to 92093 CYP between January 2016 and December 2021. Median age was 12.5 years and 49.3% was female. Monthly consultation rates increased from 2,443 to 4,542 consultations per 100,000 patient months over the six years. This trend (RR 1.009, 95%CI 1.008-1.011) started well before the COVID-19 pandemic. Consultation rates of adolescent girls and young women increased most strongly. Between March and May 2020, there was a temporary reduction in consultation rates, whereupon these returned to expected levels. COVID-19 infection rate and school closures showed small but significant associations with consultation rates for psychosocial problems but this did not affect the overall trend. Although consultation rates for psychosocial problems increased, this increment was stable over the entire study period.

Conclusion: The COVID-19 pandemic did not significantly increase consultation rates for psychosocial problems in CYP. The consultation rates increased, especially in adolescent girls and young women.

Background: General practitioners (GPs) could play an important role in the management of overweight and obesity in children. However, GPs experience different barriers and are in need of supportive tools. In order to support GPs to identify, address and refer these children, new tools should be developed.

Objective: To establish consensus among GPs about the content topics of a supportive tool to identify, address and refer children with overweight and obesity in general practice.

Methods: A two-round Delphi study was conducted with GPs identified as experts. A concept of a supportive tool was constructed based on focus-group interviews with GPs, practice nurses and parents of children with and without overweight and literature. The tool was categorised into five topics: identifying, initiating and continuing weight-related conversations, referring and evaluating a tool manual. GPs evaluated statements on the tool's topics in terms of importance. All statements were rated on a 5-point Likert scale and consensus was set at ≥70% of respondents agreeing with the statements.

Results: GPs agreed that a supportive tool must contain a child's specialised BMI calculator; examples to initiate and to continue weight-related conversations with parents and children; a map with available interventions; and a manual including information and resources about health risks of overweight and obesity during childhood.

Conclusion: The content topics of a supportive tool for GPs to identify, discuss and refer children with overweight and obesity were determined through a consensus-driven process. Further validation and assessment are required through a feasibility and implementation study.