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Advance care planning among older adults in Belgium with Turkish backgrounds and palliative care needs: A qualitative interview study. 具有土耳其背景和姑息治疗需求的比利时老年人的预先护理计划:一项定性访谈研究。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-01 Epub Date: 2023-10-23 DOI: 10.1080/13814788.2023.2271661
Hakki Demirkapu, Lieve Van den Block, Stéphanie De Maesschalck, Aline De Vleminck, F Zehra Colak, Dirk Devroey

Background: Data on advance care planning (ACP) among migrants in Europe is lacking. Research has shown that few older migrants in the United States perform ACP due to healthcare system distrust, collectivistic values and spirituality/religion.

Objectives: To explore the ACP knowledge and perspectives of older Turkish-origin adults in Belgium requiring palliative care.

Method: General practitioners (GPs) in Brussels and Antwerp recruited Turkish-origin participants aged ≥ 65 years with palliative care eligibility for this qualitative study. A GP conducted semi-structured interviews in Turkish in respondents' homes between May 2019 and February 2022 using a topic guide. Two researchers performed combined inductive/deductive thematic data analysis.

Results: All 15 interviewees (average age, 79 years) lacked ACP awareness and information. Some had discussed specific end-of-life preferences (e.g. care location, burial place) with family. Still, many did not feel the need to discuss future healthcare preferences, due mainly to trust in God and family for caretaking and decision-making. Some respondents viewed ACP discussions as applicable, relieving the burden on family and enabling proactive addressing of 'what if' questions. Self-identified ACP barriers were fear of making wrong decisions, 'living in the moment' and difficulty discussing death. Facilitators were obtaining sufficient ACP information and recent family illness or death.

Conclusion: Our sample of Turkish-origin older adults in Belgium requiring palliative care lacked ACP knowledge. Our findings suggest that their lack of engagement in discussing end-of-life medical care planning was linked to their family dynamics and religion. The findings have implications for healthcare providers to ethnic-minority groups.

背景:缺乏关于欧洲移民预先护理计划(ACP)的数据。研究表明,由于医疗系统的不信任、集体主义价值观和精神/宗教,美国很少有老年移民进行ACP。目的:探索比利时需要姑息治疗的土耳其裔老年人的ACP知识和观点。方法:布鲁塞尔和安特卫普的全科医生招募年龄≥65岁的土耳其裔参与者 符合姑息治疗资格的年数。2019年5月至2022年2月,一名全科医生在受访者家中使用主题指南进行了土耳其语的半结构化采访。两名研究人员进行了归纳/演绎相结合的主题数据分析。结果:所有15名受访者(平均年龄79岁 年)缺乏ACP意识和信息。一些人与家人讨论了特定的临终偏好(如护理地点、埋葬地点)。尽管如此,许多人并不觉得有必要讨论未来的医疗偏好,主要是因为他们信任上帝和家人的照顾和决策。一些答复者认为非加太方案的讨论是适用的,可以减轻家庭负担,并能够积极解决“如果”的问题。自我认同的ACP障碍是害怕做出错误的决定、“活在当下”和难以讨论死亡。促进者正在获得足够的ACP信息和最近的家庭疾病或死亡。结论:我们对比利时需要姑息治疗的土耳其裔老年人样本缺乏ACP知识。我们的研究结果表明,他们没有参与讨论临终医疗保健计划,这与他们的家庭动态和宗教有关。这一发现对少数族裔群体的医疗保健提供者具有启示意义。
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引用次数: 0
Patients' perceptions of climate-sensitive health counselling in primary care: Qualitative results from Germany. 患者对初级保健中气候敏感健康咨询的看法:来自德国的定性结果。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-01 Epub Date: 2023-11-27 DOI: 10.1080/13814788.2023.2284261
Silvan Griesel, Patricia Nayna Schwerdtle, Claudia Quitmann, Ina Danquah, Alina Herrmann

Background: Climate change is the greatest threat to global health in the twenty first century, yet combating it entails substantial health co-benefits. Physicians and other health professionals have not yet fully embraced their responsibilities in the climate crisis, especially about their communication with patients. While medical associations are calling on physicians to integrate climate change into health counselling, there is little empirical evidence about corresponding perceptions of patients.

Objectives: This study aimed to explore primary care patients' perceptions of climate-sensitive health counselling.

Methods: From July to December 2021, 27 qualitative interviews with patients were conducted and analysed using thematic analysis. A purposive sampling technique was applied to identify patients who had already experienced climate-sensitive health counselling in Germany.

Results: Patients' perceptions of climate-sensitive health counselling were characterised by a high level of acceptance, which was enhanced by stressing the link between climate change and health, being credible concerning physician's own climate-friendly lifestyle, building upon good therapeutic relationships, creating a sense of solidarity, and working in a patient centred manner. Challenges and risks for acceptance were patients' disinterest or surprise, time constraints, feared politicisation of consultations, and evoking feelings of guilt and shame.

Conclusion: These findings suggest that primary care patients can accept climate-sensitive health counselling, if it follows certain principles of communication, including patient-centredness. Our findings can be useful for developing communication guidelines, respective policies as well as well-designed intervention studies, which are needed to test the health and environmental effects of climate-sensitive health counselling.

背景:气候变化是21世纪全球健康面临的最大威胁,但与气候变化作斗争将带来巨大的健康附带效益。医生和其他卫生专业人员尚未完全承担起他们在气候危机中的责任,特别是在与患者的沟通方面。虽然医学协会呼吁医生将气候变化纳入健康咨询,但几乎没有关于患者相应看法的经验证据。目的:本研究旨在探讨初级保健患者对气候敏感健康咨询的看法。方法:于2021年7月至12月对27例患者进行定性访谈,采用专题分析法进行分析。采用了一种有目的的抽样技术,以确定已经在德国接受过气候敏感健康咨询的患者。结果:患者对气候敏感型健康咨询的看法的特点是接受程度很高,强调气候变化与健康之间的联系,在医生自己的气候友好型生活方式方面值得信赖,建立良好的治疗关系,建立团结感,并以患者为中心的方式工作,从而增强了这种接受程度。接受的挑战和风险是患者不感兴趣或惊讶,时间限制,担心咨询政治化,以及引起内疚和羞耻感。结论:这些发现表明,如果遵循一定的沟通原则,包括以患者为中心,初级保健患者可以接受气候敏感型健康咨询。我们的研究结果可用于制定沟通准则、相应政策以及精心设计的干预研究,这些研究是测试气候敏感健康咨询对健康和环境的影响所必需的。
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引用次数: 0
Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic. 严重急性呼吸系统综合征冠状病毒2型感染的临床诊断:大流行早期初级保健中呼吸道感染的观察性研究。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-01 Epub Date: 2023-10-23 DOI: 10.1080/13814788.2023.2270707
Alike W van der Velden, Milensu Shanyinde, Emily Bongard, Femke Böhmer, Slawomir Chlabicz, Annelies Colliers, Ana García-Sangenís, Lile Malania, Jozsef Pauer, Angela Tomacinschii, Ly-Mee Yu, Katherine Loens, Margareta Ieven, Theo J Verheij, Herman Goossens, Akke Vellinga, Christopher C Butler

Background: Early in the COVID-19 pandemic, GPs had to distinguish SARS-CoV-2 from other aetiologies in patients presenting with respiratory tract infection (RTI) symptoms on clinical grounds and adapt management accordingly.

Objectives: To test the diagnostic accuracy of GPs' clinical diagnosis of a SARS-CoV-2 infection in a period when COVID-19 was a new disease. To describe GPs' management of patients presenting with RTI for whom no confirmed diagnosis was available. To investigate associations between patient and clinical features with a SARS-CoV-2 infection.

Methods: In April 2020-March 2021, 876 patients (9 countries) were recruited when they contacted their GP with symptoms of an RTI of unknown aetiology. A swab was taken at baseline for later analysis. Aetiology (PCR), diagnostic accuracy of GPs' clinical SARS-CoV-2 diagnosis, and patient management were explored. Factors related to SARS-CoV-2 infection were determined by logistic regression modelling.

Results: GPs suspected SARS-CoV-2 in 53% of patients whereas 27% of patients tested positive for SARS-CoV-2. True-positive patients (23%) were more intensively managed for follow-up, antiviral prescribing and advice than true-negatives (42%). False negatives (5%) were under-advised, particularly for social distancing and isolation. Older age (OR: 1.02 (1.01-1.03)), male sex (OR: 1.68 (1.16-2.41)), loss of taste/smell (OR: 5.8 (3.7-9)), fever (OR: 1.9 (1.3-2.8)), muscle aches (OR: 2.1 (1.5-3)), and a known risk factor for COVID-19 (travel, health care worker, contact with proven case; OR: 2.7 (1.8-4)) were predictive of SARS-CoV-2 infection. Absence of loss of taste/smell, fever, muscle aches and a known risk factor for COVID-19 correctly excluded SARS-CoV-2 in 92.3% of patients, whereas presence of 3, or 4 of these variables correctly classified SARS-CoV-2 in 57.7% and 87.1%.

Conclusion: Correct clinical diagnosis of SARS-CoV-2 infection, without POC-testing available, appeared to be complicated.

背景:在新冠肺炎大流行早期,全科医生必须在临床上将出现呼吸道感染(RTI)症状的患者的SARS-CoV-2与其他病因区分开来,并相应地调整管理。目的:在新冠肺炎是一种新疾病的时期,测试全科医生对SARS-CoV-2感染的临床诊断的准确性。描述全科医生对没有确诊诊断的RTI患者的管理。研究严重急性呼吸系统综合征冠状病毒2型感染患者和临床特征之间的关系。方法:2020年4月至2021年3月,876名患者(9个国家)因病因不明的RTI症状联系了他们的全科医生。在基线处取拭子进行后续分析。探讨了病因(PCR)、全科医生临床诊断严重急性呼吸系统综合征冠状病毒2型的诊断准确性和患者管理。通过逻辑回归模型确定与严重急性呼吸系统综合征冠状病毒2型感染相关的因素。结果:53%的患者被全科医生怀疑为严重急性呼吸系统综合征冠状病毒2型,而27%的患者检测为严重急性急性呼吸系统综合症冠状病毒2型阳性。与真阴性患者(42%)相比,真阳性患者(23%)在随访、抗病毒处方和建议方面得到了更严格的管理。假阴性(5%)建议不足,尤其是在社交距离和隔离方面。年龄较大(OR:1.02(1.01-1.03))、男性(OR:1.68(1.16-2.41))、味觉/嗅觉丧失(OR:5.8(3.7-9))、发烧(OR:1.9(1.3-2.8))、肌肉疼痛(OR:2.1(1.5-3))和已知的新冠肺炎危险因素(旅行、医护人员、与确诊病例接触;OR:2.7(1.8-4))可预测SARS-CoV-2感染。在92.3%的患者中,没有味觉/嗅觉丧失、发烧、肌肉疼痛和已知的新冠肺炎危险因素,正确地排除了SARS-CoV-2,而其中3或4个变量的存在正确地将SARS-CoV-2分类为57.7%和87.1%。
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引用次数: 0
Transitioning from face-to-face to distance education. Part 2: A qualitative study in the former Yugoslavia during COVID-19. 从面对面教育过渡到远程教育。第二部分:新冠疫情期间前南斯拉夫的定性研究。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-01 Epub Date: 2023-11-27 DOI: 10.1080/13814788.2023.2283834
Davorina Petek, Irena Zakarija-Grković, Aleksandar Stepanović, Marion Tomičić, Zlata Ožvačić Adžić, Venija Cerovečki, Igor Švab, Vesna Homar

Background: Similar to other countries, Departments of Family Medicine in the former Yugoslavia had to transition from face-to-face to distance education during COVID-19.

Objectives: To elucidate obstacles and facilitators of the transition from face-to-face to distance education.

Methods: A cross-sectional, multicentre, qualitative study design was used to analyse nine open-ended questions from an online survey using inductive thematic analysis. The questionnaire was distributed to 21 medical schools, inviting them to involve at least two teachers/students/trainees. Data were collected between December 2021 and March 2022.

Results: In 17 medical schools, 23 students, 54 trainees and 40 teachers participated. The following themes were identified: facilitators and barriers of transition, innovations for enhancing distance education, convenience of distance education, classical teaching for better communication, the future of distance education, reaching learning outcomes and experience of online assessment. Innovations referred mainly to new online technologies for interactive education and communication. Distance education allowed for greater flexibility in scheduling and self-directed learning; however, participants felt that classical education allowed better communication and practical learning. Teachers believed knowledge-related learning outcomes could be achieved through distance education but not teaching clinical skills. Participants anticipated a future where a combination of teaching methods is used.

Conclusion: The transition to distance education was made possible thanks to its flexible scheduling, innovative tools and possibility of self-directed learning. However, face-to-face education was considered preferable for fostering interpersonal relations and teaching clinical skills. Educators should strive to strike a balance between innovative approaches and the preservation of personal experiences.

背景:与其他国家类似,前南斯拉夫的家庭医学部门在COVID-19期间不得不从面对面教育过渡到远程教育。目的:阐明面对面教育向远程教育过渡的障碍和促进因素。方法:采用横断面、多中心、定性研究设计,采用归纳主题分析方法对在线调查中的9个开放式问题进行分析。调查问卷已分发给21所医学院,邀请它们至少有两名教师/学生/学员参与。数据收集于2021年12月至2022年3月。结果:17所医学院共有学生23人,学员54人,教师40人。会议确定了以下主题:过渡的促进因素和障碍、加强远程教育的创新、远程教育的便利性、促进更好交流的经典教学、远程教育的未来、取得学习成果和在线评估的经验。创新主要指用于互动式教育和交流的新的在线技术。远程教育在安排时间和自主学习方面具有更大的灵活性;然而,与会者认为古典教育可以更好地交流和实践学习。教师认为通过远程教育可以获得与知识相关的学习成果,但不能通过教授临床技能来实现。与会者预期未来将采用多种教学方法。结论:远程教育具有灵活的时间安排、创新的工具和自主学习的可能性,使其向远程教育过渡成为可能。然而,面对面的教育被认为更有利于培养人际关系和教授临床技能。教育工作者应该努力在创新方法和保留个人经验之间取得平衡。
{"title":"Transitioning from face-to-face to distance education. Part 2: A qualitative study in the former Yugoslavia during COVID-19.","authors":"Davorina Petek, Irena Zakarija-Grković, Aleksandar Stepanović, Marion Tomičić, Zlata Ožvačić Adžić, Venija Cerovečki, Igor Švab, Vesna Homar","doi":"10.1080/13814788.2023.2283834","DOIUrl":"10.1080/13814788.2023.2283834","url":null,"abstract":"<p><strong>Background: </strong>Similar to other countries, Departments of Family Medicine in the former Yugoslavia had to transition from face-to-face to distance education during COVID-19.</p><p><strong>Objectives: </strong>To elucidate obstacles and facilitators of the transition from face-to-face to distance education.</p><p><strong>Methods: </strong>A cross-sectional, multicentre, qualitative study design was used to analyse nine open-ended questions from an online survey using inductive thematic analysis. The questionnaire was distributed to 21 medical schools, inviting them to involve at least two teachers/students/trainees. Data were collected between December 2021 and March 2022.</p><p><strong>Results: </strong>In 17 medical schools, 23 students, 54 trainees and 40 teachers participated. The following themes were identified: facilitators and barriers of transition, innovations for enhancing distance education, convenience of distance education, classical teaching for better communication, the future of distance education, reaching learning outcomes and experience of online assessment. Innovations referred mainly to new online technologies for interactive education and communication. Distance education allowed for greater flexibility in scheduling and self-directed learning; however, participants felt that classical education allowed better communication and practical learning. Teachers believed knowledge-related learning outcomes could be achieved through distance education but not teaching clinical skills. Participants anticipated a future where a combination of teaching methods is used.</p><p><strong>Conclusion: </strong>The transition to distance education was made possible thanks to its flexible scheduling, innovative tools and possibility of self-directed learning. However, face-to-face education was considered preferable for fostering interpersonal relations and teaching clinical skills. Educators should strive to strike a balance between innovative approaches and the preservation of personal experiences.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"29 1","pages":"2283834"},"PeriodicalIF":3.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138447048","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
Effectiveness of the spirometry-based motivational intervention to quit smoking: RESET randomised trial. 基于肺活量测定的动机干预对戒烟的有效性:RESET随机试验。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-01 Epub Date: 2023-11-07 DOI: 10.1080/13814788.2023.2276764
Francisco Martín-Luján, Antoni Santigosa-Ayala, Meritxell Pallejà-Millán, Cristina Rey-Reñones, Felipe Villalobos, Rosa Solà

Background: The effectiveness of providing feedback on spirometry results for smoking cessation remains inconclusive according to the current evidence.

Objectives: To assess the effectiveness of a motivational intervention based on spirometry results in achieving prolonged smoking abstinence (12 months post-intervention).

Design and setting: A randomised, controlled, observer-blinded, multicentre clinical trial was conducted (from January 2012 to December 2015) in 20 primary healthcare centres in the Tarragona province, Spain.

Methods: Participants, active smokers aged 35-70 without known respiratory disease, were recruited from primary healthcare centres by family doctors and nurses. They were randomly assigned to either the intervention group (IG = 308) or the control group (CG = 306). Both groups received brief smoking cessation counselling. Additionally, the IG underwent spirometry and received detailed information about the results, including lung age. The primary outcome was prolonged abstinence, defined as lasting at least 12 months and validated through cotinine measurement in urine.

Results: The prolonged abstinence rate was 7.8% in the IG, compared to 2.6% in the CG (p = 0.004). At 12 months, in the multivariate analysis, the intervention was identified as an independent factor for smoking cessation (OR 2.8; 95%CI 1.2 to 7.7), a trend maintained throughout the follow-up (HR 2.74; 95%CI 1.13 to 6.62). Moreover, according to the Prochaska and DiClemente model, the preparation or action phase to quit was also associated with smoking cessation (HR 2.55, 95%CI 1.07 to 6.09).

Conclusion: A primary care-delivered intervention involving brief counselling and detailed spirometry information proves effective in increasing abstinence rates among active smokers without known respiratory disease. Additionally, smoking cessation is also influenced by the individual's stage of change.

Trial registration: ClinicatTrials.gov NCT02153047.

背景:根据目前的证据,提供肺活量测定结果反馈戒烟的有效性仍然没有定论。目的:评估基于肺活量测定结果的动机干预在实现长期戒烟方面的有效性(12 干预后数月)。设计和设置:2012年1月至2015年12月,在西班牙塔拉戈纳省的20个初级保健中心进行了一项随机、对照、观察者盲法的多中心临床试验。方法:由家庭医生和护士从初级保健中心招募参与者,年龄35-70岁,无已知呼吸道疾病的活跃吸烟者。他们被随机分配到干预组(IG=308)或对照组(CG=306)。两组都接受了简短的戒烟咨询。此外,IG接受了肺活量测定,并收到了有关结果的详细信息,包括肺部年龄。主要结果是长期禁欲,定义为持续至少12 月,并通过尿液中可替宁的测量进行验证。结果:IG组的长期禁欲率为7.8%,而CG组为2.6%(p = 0.004) 在多变量分析中,干预被确定为戒烟的独立因素(OR 2.8;95%CI 1.2至7.7),这一趋势在整个随访期间保持(HR 2.74;95%CI 1.13至6.62)。此外,根据Prochaska和DiClemente模型,戒烟的准备或行动阶段也与戒烟有关(HR 2.55,95%CI 1.07至6.09)。此外,戒烟也受到个人变化阶段的影响。试验注册:ClinicalsTrials.gov NCT02153047。
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引用次数: 0
Direct-to-patient digital diagnostics in primary care: Opportunities, challenges, and conditions necessary for responsible digital diagnostics. 初级保健中的直接面向患者的数字诊断:负责任的数字诊断的机会、挑战和必要条件。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-01 Epub Date: 2023-11-10 DOI: 10.1080/13814788.2023.2273615
María Villalobos-Quesada, Kendall Ho, Niels H Chavannes, Esther Pwa Talboom-Kamp

Background: Diagnostics are increasingly shifting to patients' home environment, facilitated by new digital technologies. Digital diagnostics (diagnostic services enabled by digital technologies) can be a tool to better respond to the challenges faced by primary care systems while aligning with patients' and healthcare professionals' needs. However, it needs to be clarified how to determine the success of these interventions.

Objectives: We aim to provide practical guidance to facilitate the adequate development and implementation of digital diagnostics.

Strategy: Here, we propose the quadruple aim (better patient experiences, health outcomes and professional satisfaction at lower costs) as a framework to determine the contribution of digital diagnostics in primary care. Using this framework, we critically analyse the advantages and challenges of digital diagnostics in primary care using scientific literature and relevant casuistry.

Results: Two use cases address the development process and implementation in the Netherlands: a patient portal for reporting laboratory results and digital diagnostics as part of hybrid care, respectively. The third use case addresses digital diagnostics for sexually transmitted diseases from an international perspective.

Conclusions: We conclude that although evidence is gathering, the often-expected value of digital diagnostics needs adequate scientific evidence. We propose striving for evidence-based 'responsible digital diagnostics' (sustainable, ethically acceptable, and socially desirable digital diagnostics). Finally, we provide a set of conditions necessary to achieve it. The analysis and actionable guidance provided can improve the chance of success of digital diagnostics interventions and overall, the positive impact of this rapidly developing field.

背景:在新的数字技术的推动下,诊断越来越多地转移到患者的家庭环境中。数字诊断(由数字技术实现的诊断服务)可以成为一种工具,更好地应对初级保健系统面临的挑战,同时满足患者和医疗保健专业人员的需求。然而,如何确定这些干预措施的成功与否还需要澄清。目标:我们旨在提供切实可行的指导,以促进数字诊断的充分开发和实施。策略:在这里,我们提出了四重目标(以更低的成本获得更好的患者体验、健康结果和专业满意度),作为确定数字诊断在初级保健中的贡献的框架。利用这一框架,我们利用科学文献和相关推理,批判性地分析了数字诊断在初级保健中的优势和挑战。结果:两个用例分别涉及荷兰的开发过程和实施:用于报告实验室结果的患者门户和作为混合护理一部分的数字诊断。第三个用例从国际角度处理性传播疾病的数字诊断。结论:我们得出的结论是,尽管证据正在收集,但数字诊断的预期价值通常需要足够的科学证据。我们建议努力实现基于证据的“负责任的数字诊断”(可持续的、道德上可接受的和社会期望的数字诊断)。最后,我们提供了实现这一目标所需的一系列条件。所提供的分析和可操作的指导可以提高数字诊断干预措施的成功几率,并总体上提高这一快速发展领域的积极影响。
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引用次数: 0
Time to treat the climate and nature crisis as one indivisible global health emergency. 是时候将气候和自然危机视为一个不可分割的全球卫生紧急事件。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-01 Epub Date: 2023-11-20 DOI: 10.1080/13814788.2023.2276514
Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Gregory E Erhabor, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski
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引用次数: 0
Sex and income inequalities in preventive services in diabetes. 糖尿病预防服务中的性别和收入不平等。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-01 DOI: 10.1080/13814788.2022.2159941
Sara Ares-Blanco, Juan A López-Rodríguez, Mario Fontán Vela, Elena Polentinos-Castro, Isabel Del Cura-González

Background: Cancer preventive services (gynaecological cancer screening, colon cancer screening) and cardiometabolic screening are recommended by guidelines to individuals. People with diabetes were less likely to receive them than those without diabetes in some studies.

Objectives: To analyse differences in the coverage of preventive services in people with diabetes compared to non-diabetic individuals and in people with diabetes according to sex and household income.

Methods: We analysed data collected from the European Health Interview Survey 2013-2015, including individuals aged 40-74 (n = 179,318), 15,172 with diabetes from 29 countries. The income of a household (HHI) was described in quintiles. The relationship between the coverage of preventive services (cardiometabolic, vaccination, cancer screening) and sociodemographic characteristics was analysed with multiple logistic regression.

Results: Women comprised 53.8% of the total and 40% were 60-74 years. People with diabetes compared to those without diabetes had higher reported coverage of cardiometabolic screening (98.4% vs. 90.0% in cholesterol measurement; 97.0% vs. 93.6% in blood pressure measurement), colorectal cancer screening (27.1% vs. 24.6%) but lower coverage of gynaecological cancer screening (mammography: 29.2% vs. 33.5%, pap smear test: 28.3% vs. 37.9%). Among diabetic patients, women were less likely to receive cholesterol screening (OR = 0.81; 95% CI: 0.72-0.91) and colon cancer screening (OR = 0.79; 95% CI: 0.73-0.86) compared to men. Being affluent was positively associated with receiving cardiometabolic screening and mammography in diabetic patients.

Conclusion: People with diabetes reported higher coverage of preventive services except gynaecological cancer screening. Disparities were found in diabetes among women and less affluent individuals.

背景:癌症预防服务(妇科癌症筛查、癌症筛查)和心脏代谢筛查由指南推荐给个人。在一些研究中,糖尿病患者比非糖尿病患者接受治疗的可能性更小。目的:根据性别和家庭收入,分析糖尿病患者与非糖尿病患者以及糖尿病患者预防服务覆盖率的差异。方法:我们分析了2013-2015年欧洲健康访谈调查收集的数据,包括40-74岁的个体(n = 179318)、15172名糖尿病患者。家庭收入(HHI)以五分位数描述。采用多元逻辑回归分析了预防服务(心脏代谢、疫苗接种、癌症筛查)的覆盖率与社会人口学特征之间的关系。结果:女性占总人数的53.8%,60-74岁占40% 年。与未患糖尿病的人相比,糖尿病患者的心脏代谢筛查报告覆盖率较高(胆固醇测量为98.4%对90.0%;血压测量为97.0%对93.6%)、结直肠癌癌症筛查(27.1%对24.6%),但妇科癌症筛查覆盖率较低(乳房X光检查:29.2%对33.5%,巴氏涂片检查:28.3%对37.9%),与男性相比,女性接受胆固醇筛查(OR=0.81;95%CI:0.72-0.91)和结肠癌癌症筛查(OR=7.79;95%CI=0.73-0.86)的可能性较低。在糖尿病患者中,富裕与接受心脏代谢筛查和乳房X光检查呈正相关。结论:除妇科癌症筛查外,糖尿病患者的预防服务覆盖率较高。糖尿病在女性和不太富裕的人群中存在差异。
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引用次数: 0
Series: Public engagement with research. Part 1: The fundamentals of public engagement with research. 系列:公众参与研究。第一部分:公众参与研究的基本原则。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-01 DOI: 10.1080/13814788.2023.2232111
Steven Blackburn, Megan Clinch, Maarten de Wit, Albine Moser, Jette Primdahl, Esther van Vliet, Christine Walker, Fiona Stevenson

Background: In the first of a four-part series, we describe the fundamentals of public engagement in primary care research.

Objectives: The article's purpose is to encourage, inform and improve the researcher's awareness about public engagement in research. For a growing number of researchers, funders and patient organisations in Europe, public engagement is a moral and ethical imperative for conducting high-quality research.

Discussion: Starting with an explanation of the role of public engagement in research, we highlight its diversity and benefits to research, researchers and the public members involved. We summarise principles of good practice and provide valuable resources for researchers to use in their public engagement activities. Finally, we discuss some of the issues encountered when researchers collaborate with members of the public and provide practical steps to address them. Case studies of real-life situations are used to illustrate and aid understanding.

Conclusion: We hope this article and the other papers in this series will encourage researchers to better consider the role and practice of public engagement and the potential added value to research that collaborating with the public could provide.

背景:在由四部分组成的系列文章的第一部分中,我们介绍了公众参与初级保健研究的基本原理。目的:本文的目的是鼓励、告知和提高研究人员对公众参与研究的意识。对于欧洲越来越多的研究人员、资助者和患者组织来说,公众参与是进行高质量研究的道德和伦理要求。讨论:从解释公众参与研究的作用开始,我们强调了其多样性以及对研究、研究人员和相关公众成员的好处。我们总结了良好实践的原则,并为研究人员在公共参与活动中使用提供了宝贵的资源。最后,我们讨论了研究人员与公众合作时遇到的一些问题,并提供了解决这些问题的实际步骤。通过对现实生活情况的个案研究来说明和帮助理解。结论:我们希望这篇文章和本系列的其他论文将鼓励研究人员更好地考虑公众参与的作用和实践,以及与公众合作可以为研究提供的潜在附加值。
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引用次数: 0
Impact of primary care physicians working part-time on patient care: A scoping review. 初级保健医生兼职对患者护理的影响:范围界定综述。
IF 3.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-01 Epub Date: 2023-11-01 DOI: 10.1080/13814788.2023.2271167
Sebastian Kegreiss, Christian Studer, Patrick E Beeler, Stefan Essig, Rebecca Tomaschek

Background: Increasing numbers of primary care physicians (PCPs) are reducing their working hours. This decline may affect the workforce and the care provided to patients.

Objectives: This scoping review aims to determine the impact of PCPs working part-time on quality of patient care.

Methods: A systematic search was conducted using the databases PubMed, CINAHL, Embase, and the Cochrane Library. Peer-reviewed, original articles with either quantitative, qualitative or mixed methods designs, published after 2000 and written in any language were considered. The search strings combined the two concepts: part-time work and primary care. Studies were included if they examined any effect of PCPs working part-time on quality of patient care.

Results: The initial search resulted in 2,323 unique studies. Abstracts were screened, and information from full texts on the study design, part-time and quality of patient care was extracted. The final dataset included 14 studies utilising data from 1996 onward. The studies suggest that PCPs working part-time may negatively affect patient care, particularly the access and continuity of care domains. Clinical outcomes and patient satisfaction seem mostly unaffected or even improved.

Conclusion: There is evidence of both negative and positive effects of PCPs working part-time on quality of patient care. Approaches that mitigate negative effects of part-time work while maintaining positive effects should be implemented.

背景:越来越多的初级保健医生正在减少他们的工作时间。这种下降可能会影响劳动力和为患者提供的护理。目的:本范围审查旨在确定兼职PCP对患者护理质量的影响。方法:使用PubMed、CINAHL、Embase和Cochrane Library数据库进行系统检索。经过同行评审,考虑了2000年后发表的以任何语言撰写的具有定量、定性或混合方法设计的原创文章。搜索字符串结合了两个概念:兼职工作和初级保健。如果研究人员检查了PCPs兼职工作对患者护理质量的任何影响,则纳入其中。结果:最初的搜索产生了2323项独特的研究。对摘要进行筛选,并从全文中提取有关研究设计、兼职和患者护理质量的信息。最终数据集包括14项利用1996年以后数据的研究。研究表明,兼职PCP可能会对患者护理产生负面影响,尤其是护理领域的可及性和连续性。临床结果和患者满意度似乎大多未受影响,甚至有所改善。结论:有证据表明,PCPs兼职工作对患者护理质量既有负面影响,也有积极影响。应采取减轻非全日制工作的负面影响,同时保持积极影响的方法。
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引用次数: 0
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European Journal of General Practice
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