European Journal of General Practice最新文献

Background: The strict isolation measures for the population imposed by the health authorities caused a prolonged disruption of informal social support networks. Both this new social situation and the decrease in accessibility to health care have generated new needs in people with severe mental illness (SMI) and their caregivers.

Objectives: This study provides insight into life experiences and health needs of a population with SMI during the first year of the COVID-19 pandemic in Spain.

Methods: Qualitative design using semi-structured dyadic interviews, conducted from January through December 2022. A purposive sampling of patients with SMI and their caregivers was carried out through key informants in rural and urban localities in southern Spain. Verbatims were identified and classified by triangulation after the evaluation of the interview transcripts. The codes were defined through content analysis using the NVivo software.

Results: Semi-structured dyadic interviews (21), identifying three main categories: 1. Social isolation: increased, causing greater personal vulnerability, exacerbation of psychiatric symptoms and exhaustion in caregivers. 2. Accessibility to Health Services: decreased with fewer face-to-face consultations, with difficulty in managing urgent situations and telephone attention in decompensated and disabled patients. 3. Continuity of healthcare: decreased with distrust in health professionals due to lack of communication between primary care and the hospital.

Conclusion: COVID-19 confinement exacerbated loneliness and worse health self-perception in SMI people. Greater formal social support was required. GPs role is key to avoiding delays in appointments and lack of coordination between primary and specialised care.

Public engagement in health research is vital for addressing health disparities and promoting inclusivity among minoritised communities who often face barriers to accessing healthcare. Minoritised communities are groups, which have been made minorities by a dominant culture, race, ethnic group and/or social class and may experience health inequalities as a result. By incorporating diverse perspectives and lived experiences of minoritised communities, this approach aims to achieve contextually relevant research outcomes that reduce health inequalities and improve overall well-being. However, underrepresentation and lack of inclusivity challenges persist, necessitating the establishment of inclusive partnerships and grassroots participatory methodologies.

To foster inclusive public engagement, it is important to overcome structural and cultural barriers, address socioeconomic challenges, and build trust with minoritised communities. This can be achieved by promoting a cultural shift that values inclusivity, providing comprehensive training to researchers, and collecting rigorous data on engagement demographics for transparency and accountability. Involving minoritised communities in decision-making through participatory research approaches enhances trust and yields successful outcomes. Additionally, allocating sufficient resources, collaborating in co-production, and prioritising the diverse needs and perspectives of stakeholders contribute to fostering inclusive public engagement in research.

Overall, inclusive engagement practices particularly in primary care research have the potential to reduce health inequalities and cater to the unique requirements of minoritised communities, thereby creating more impactful outcomes and promoting equitable healthcare access.

Background: Reducing avoidable hospital admissions is a global healthcare priority, with optimal primary care recognised as pivotal for achieving this objective. However, in developing systems like China, where primary care is evolving without compulsory gatekeeping, the relationship between patient-perceived primary care quality and hospital utilisation remains underexplored.

Objectives: This study aimed to explore the association between patient-perceived primary care quality and self-reported hospital utilisation in China.

Methods: Data were collected from 16 primary care settings. Patient-perceived quality of primary care was measured using the Assessment Survey of Primary Care scale across six domains (first-contact care, continuity, comprehensiveness, accessibility, coordination, and patient-centredness). Hospital utilisation included patient self-reported outpatient visits, hospital admissions, and emergency department (ED) visits in the last six months. Logistic regression analyses were examined associations between self-reported hospital utilisation and perceived primary care quality adjusted for potential confounders.

Results: Of 1,185 patients recruited, 398 (33.6%) reported hospital utilisation. Logistic regression analyses showed that higher total scores for patient-perceived quality of primary care were associated with decreased odds of hospital utilisation (adjusted odds ratio(AOR): 0.417, 95% confidence interval (CI): 0.308-0.565), outpatient visits (AOR: 0.394, 95% CI: 0.275-0.566) and hospital admissions (AOR: 0.496, 95% CI: 0.276-0.891). However, continuity of care was positively associated with ED visits (AOR: 2.252, 95% CI: 1.051-4.825).

Conclusion: Enhanced patient-perceived quality of primary care in China is associated with a reduction in self-reported overall hospital utilisation, including outpatient visits and hospital admissions. However, better continuity of care may be associated with increased ED visits. Further research is warranted for precise insights and validation of these findings.

Background: Social prescribing (SP) is a patient pathway by which healthcare professionals connect patients with other sources of support, groups, or activities within their community. The awareness, practice, and perception of SP among GPs across Europe remains unclear.

Objectives: To explore the awareness, practice, and perception of GPs on SP in the WONCA Europe region.

Methods: An anonymous, cross-sectional online survey was distributed through a snowballing system, mailing lists, and at three international conferences in 2022/2023 to explore GPs' awareness, practice, and perception of SP. The questionnaire in English contained 21 open and closed questions.

Results: Of the 208 participating GPs from 33 countries, 116 (56%) previously heard of 'social prescribing' and 66 (32%) regularly referred patients to community activities through a formal system. These 66 GPs reported different funding sources and varied activities, with an average of four activities and physical exercise being the most prevalent. Among them, 25 (38%) knew about national or local SP awareness campaigns. Of these 25, 17 (68%) agreed that SP increases their job satisfaction and 21 (84%) agreed that it has a positive impact on their patients. Variations in SP awareness and referral practice were evident across and within countries.

Conclusion: Despite disparities in awareness and referral practice as well as a diversity of activities and funding sources, most GPs who actively referred patients and were informed about SP campaigns agreed that SP positively impacts them and their patients.

Background: The management of chronic diseases, in the context of an ageing population and increasing life expectancy, is one of the major challenges facing the Irish health system. In 2020, a chronic disease management programme [CDM] was introduced in Irish general practice as part of a transformation in health policy to meet the changing needs of the population.

Objectives: To explore GPs' experiences and perceptions of the impact of the introduction of CDM on general practice in Ireland.

Methods: 18 semi-structured interviews were conducted with GPs in clinical practice from across Ireland. GPs were purposefully recruited to capture the differing experiences faced by GPs in large and small practices in both urban and rural settings. Interviews were analysed using reflexive thematic analysis.

Results: GPs were enthusiastic about aspects of CDM, which they felt provided an improved framework for their approach to the management of chronic diseases. However, they described several challenges to implementation, especially around capacity constraints. CDM could have unintended consequences for aspects of routine GP care. GPs described how practice nurses had taken on a central role in both clinical and administrative aspects of the programme.

Conclusions: GPs value the framework provided by CDM for their approach to the management of chronic disease. However, challenges around practice capacity and its impact both on the delivery of CDM and aspects of routine care highlight the importance for policy makers to provide continued support to strengthen the general practice infrastructure.

Background: Despite growing acceptance of LGBT + individuals, an underlying stigma persists even in healthcare, resulting in substandard care and worse healthcare outcomes for LGBT + individuals.

Objectives: To examine and compare the experiences and expectations regarding primary healthcare among LGBT + individuals and general practitioners (GPs) in Slovenia.

Methods: We conducted an online national qualitative study using open-ended questions. To reach LGBT + population snowball method of recruitment was employed by sharing the questionnaire through LGBT + organisations, while GPs were invited by email of Association of family doctors in Slovenia. Anonymous data was collected from October to December 2021 and the questionnaires of 25 GPs and 90 LGBT + individuals of various ages, backgrounds, gender identities and sexual orientations were reviewed using thematic analysis.

Results: Both LGBT + participants and GPs expressed a desire for equal treatment. However, while all GPs claimed to treat all patients equally, LGBT + participants reported more varied experiences. Specific knowledge, especially on LGBT + terminology and healthcare, was perceived as lacking among GPs, leading LGBT + individuals to seek advice from specialists or community counselling. Systemic barriers, including societal stigmatisation and limited formal education on LGBT + issues, were identified, highlighting the need for designated safe spaces and improved GP training. Safety emerged as a central theme, crucial for fostering trust and disclosure between patients and healthcare providers.

Conclusion: The study underscores the significance of a sense of safety in the patient-doctor relationship and highlights the need for improved training and attitudes to provide inclusive and affirming healthcare for LGBT + individuals.

Background: As researchers in primary care, we want to drive change in practice and conduct research that sparks meaningful transformation. These changes can only happen if our research work resonates in a meaningful way with the people who they are designed for, i.e. the healthcare professionals and the patients.

Viewpoint: This viewpoint stems from first-hand insights gained as a social scientist engaged in trials and primary care research amidst epidemics and pandemics. Some examples stemming from the EU Funded GRACE INTRO, RECOVER and Prudence trial illustrate these experiences. I outline how primary care can effectively address the pressing challenges it encounters, whether as researchers, members of the public, or healthcare professionals, and how to integrate successfully social sciences within clinical primary care research.

Conclusion: As interdisciplinary researchers, social scientists and medical researchers can work together under certain conditions, i.e. equal status, adequate resources, and seamless integration within trial structures.

Background: To better manage patients with a wide range of mental health problems, general practitioners would benefit from diagnostically accurate and time-efficient screening tools that comprehensively assess mental illness. Therefore, the aim of this systematic review was to identify screening tools that either take a multiple-mental disorder or a transdiagnostic approach. As primary and secondary outcomes, diagnostic accuracy and time efficiency were investigated.

Methods: The data bases MEDLINE, Embase, Cochrane Library, Psyndex and PsycINFO were searched. Studies reporting on multiple-mental disorder or transdiagnostic screening tools used in primary care with adult patients were included. Sensitivity, specificity, positive and negative predictive value served as measures of diagnostic accuracy. Time efficiency was evaluated by the number of items of a screening tool and the time required for its completion and evaluation.

Results: Eleven studies met the inclusion criteria. The majority of screening tools assessed multiple mental disorders separately. A sub-group of screening tools took a transdiagnostic approach by examining the spectrum of mood, anxiety and stress-related disorders. One screening tool used internalised, cognitive/somatic and externalised dysfunction as transdiagnostic domains of mental illness. Mostly, a sufficient sensitivity and specificity was reported. All screening tools were found to be time efficient.

Conclusion: The eleven identified screening tools can support general practitioners to identify patients with mental health problems. However, there was great heterogeneity concerning their diagnostic scope of psychopathology. Further screening tools for primary care are needed that target broad constructs of mental illness, such as transdiagnostic factors or personality dysfunction.

Objective: To explore how it feels to be a burnt out GP in the NHS.

Design: In depth qualitative interviews with 16 UK GPs with self-declared 'lived experience' of burnout.

Setting: United Kingdom Primary Care.

Results: Seven male and nine female GPs described their experiences of burnout to a peer researcher. Themes identified were exhaustion and depersonalisation, mental and physical illness, identity and existential crises, and finally tenacity and resilience. Participants were self-reflective and described distress, shame, stigma, and guilt, including times of suicidal behaviour and isolation due to their burnout.

Conclusions: Burnout threatens a GP's sense of identity, purpose, and functioning in their lives, and ultimately can be life-threatening. Active listening to GP distress and a system wide approach to managing distress and burnout is urgently required.