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General practitioners' perspectives on lifestyle interventions for cognitive preservation in dementia prevention. 全科医生对预防痴呆症的认知保护生活方式干预措施的看法。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-14 DOI: 10.1186/s12875-024-02566-3
Josefine Kappe, Felix Wittmann, Melanie Luppa, Maria Isabel Cardona, Solveign Weise, Stephan Fuchs, Robert Philipp Kosilek, Linda Sanftenberg, Christian Brettschneider, Juliane Döhring, Catharina Escales, David Czock, Birgitt Wiese, Jochen René Thyrian, Wolfgang Hoffmann, Thomas Frese, Jochen Gensichen, Hans-Helmut König, Hanna Kaduszkiewicz, Steffi Gerlinde Riedel-Heller

Background: General practitioners (GPs) play a crucial role in identifying cognitive impairment and dementia and providing post-diagnostic care. This study investigates (1) how promising GP consider lifestyle changes to maintain cognitive performance in general, (2) GP beliefs about the power of modifiable health and lifestyle factors to maintain cognitive performance, and (3) whether those beliefs vary by GP age.

Methods: As part of the AgeWell.de trial, GPs (n = 72) completed a process evaluation questionnaire assessing their perspectives on lifestyle changes to preserve cognitive performance in elderly patients. In greater detail, their perceived efficacy of established risk and protective factors was investigated using a 5-point Likert scale. Descriptive statistical analyses were performed for research question (1) and (2). Spearman´s rank correlations and ordinal logistic regressions were used to answer research question (3). All results were interpreted exploratively.

Results: GPs rated the overall chance of lifestyle changes maintaining cognitive performance quite neutral with a median score of 3.0 (IQR = 2.0). They rated the efficacy of all the modifiable health and lifestyle factors high, with increase in physical and social activity ((Mdn = 5.0, IQR = 1.0) receiving the highest ratings with the narrowest range. Spearman's rank correlation indicated a significant positive relationship between age and the belief in "Optimization of nutrition" for preventing cognitive decline and dementia (ρ = .255, p = .041). However, ordinal logistic regressions showed no significant relationships between age and GP ratings of lifestyle change efficacy.

Conclusion: These findings highlight the positive perception of GPs on the efficacy of modifiable health and lifestyle factors for preventing cognitive decline and dementia.

Trial registration: The AgeWell.de trial is registered in the German Clinical Trials Register (DRKS; trial identifier: DRKS00013555, Registration Date 07 December 2017).

背景:全科医生(GP)在识别认知障碍和痴呆症以及提供诊断后护理方面发挥着至关重要的作用。本研究调查:(1)全科医生认为改变生活方式对维持一般认知能力有多大帮助;(2)全科医生对可改变的健康和生活方式因素对维持认知能力的作用的看法;(3)这些看法是否因全科医生的年龄而异:作为 AgeWell.de 试验的一部分,全科医生(n = 72)填写了一份过程评估问卷,评估他们对改变生活方式以保持老年患者认知能力的看法。更详细地说,他们使用 5 点李克特量表对既定风险和保护因素的功效进行了调查。对研究问题(1)和(2)进行了描述性统计分析。斯皮尔曼等级相关性和顺序逻辑回归用于回答研究问题(3)。所有结果均为探索性解释:全科医生对改变生活方式保持认知能力的总体可能性的评价为中性,中位数为 3.0(IQR = 2.0)。他们对所有可改变的健康和生活方式因素的有效性都给予了很高的评价,其中对增加体育和社交活动(中位数=5.0,IQR=1.0)的评价最高,范围最窄。斯皮尔曼等级相关性表明,年龄与 "优化营养 "预防认知能力下降和痴呆症的信念之间存在显著的正相关关系(ρ = .255,p = .041)。然而,序数逻辑回归显示,年龄与全科医生对改变生活方式效果的评价之间没有明显关系:这些发现凸显了全科医生对可改变的健康和生活方式因素在预防认知能力下降和痴呆症方面的功效的积极看法:AgeWell.de试验已在德国临床试验注册中心(DRKS;试验标识符:DRKS00013555,注册日期:2017年12月7日)注册。
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引用次数: 0
Expectations and needs of people with illicit substance use disorders in general practice: a qualitative study in Belgium. 全科医生对非法药物使用障碍患者的期望和需求:比利时的一项定性研究。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-14 DOI: 10.1186/s12875-024-02493-3
Lou Richelle, Nadine Kacenelenbogen, Charles Kornreich, Margaux Aron

Background: People who use illicit drugs cumulate medical and psychosocial vulnerabilities, justifying a rounded health approach. Both caregivers and patients can form barriers to accessing care, leading to inadequate care. This study aimed to identify the needs and expectations of such patients in general practice.

Methods: Qualitative research was conducted using semi-structured interviews with 23 people with illicit substance use disorder in Brussels in 2020. Multicentric recruitment was conducted to obtain a heterogeneous mix of sociodemographic profiles and care trajectories. Thematic analysis was performed using RQDA package software.

Results: Participants highlighted several vulnerabilities. These include the presence of significant self-stigmatization and guilt, sometimes to the extent of self-dehumanization, even after years of care, and overdoses masking suicide attempts and early memory disorders. Multiple substance use, smoking in almost all participants, and misuse of benzodiazepines were also noted. The majority of participants expressed the need for an open-minded, non-stigmatizing and empathic GP with a holistic approach that could guide them throughout their life course. The competencies of the GPs in the field of addiction seemed secondary to the participants. Knowledge and good collaboration with the mental health network were assets.

Conclusion: Participants expressed the need for GPs with good interpersonal skills, including a non-stigmatizing attitude. The care coordinator role of the GP was highlighted as a key element, as it was a holistic approach focusing on global health (including the social determinants of health) and not only on substance use disorders.

背景:使用非法药物的人在医疗和社会心理方面易受伤害,因此有必要采取综合保健方法。护理人员和患者都可能在获得护理方面形成障碍,导致护理不足。本研究旨在确定普通诊所中此类患者的需求和期望:方法:采用半结构式访谈法,对 2020 年布鲁塞尔的 23 名非法药物使用障碍患者进行了定性研究。研究人员进行了多中心招募,以获得不同的社会人口学特征和护理轨迹。使用 RQDA 软件包进行了专题分析:结果:参与者强调了几种脆弱性。其中包括严重的自我污名化和负罪感,有时甚至在多年的护理后还会出现自我非人化,以及用药过量掩盖自杀企图和早期记忆障碍。此外,还注意到多种药物的使用、几乎所有参与者都吸烟以及苯二氮卓类药物的滥用。大多数参与者表示,他们需要一名思想开放、无污名化、富有同情心的全科医生,以全面的方法指导他们的整个人生历程。对参与者来说,全科医生在戒毒领域的能力似乎是次要的。知识以及与心理健康网络的良好合作是他们的财富:参与者表示,全科医生需要具备良好的人际交往能力,包括非污名化的态度。与会者强调,全科医生的护理协调员角色是一个关键因素,因为这是一种注重全球健康(包括健康的社会决定因素)而不仅仅是药物使用障碍的整体方法。
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引用次数: 0
Factors influencing nurse practitioner panel size in team-based primary care: a qualitative case study. 以团队为基础的初级保健中影响执业护士小组规模的因素:一项定性案例研究。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-14 DOI: 10.1186/s12875-024-02547-6
Ruth Martin-Misener, Faith Donald, Jennifer Rayner, Nancy Carter, Kelley Kilpatrick, Erin Ziegler, Ivy Bourgeault, Denise Bryant-Lukosius

Background: Lack of access to health care is a worldwide public health crisis. In primary care it has led to increases in the implementation of nurse practitioners and heightened interest in their patient panel capacity. The aim of this study was to examine factors influencing nurse practitioner patient panel size in team-based primary care in Ontario, Canada.

Methods: We used a multiple case study design. Eight team-based primary care practices including rural and urban settings were purposively selected as cases. Each case had two or more nurse practitioners with a minimum of two years experience in the primary care setting. Interviews were conducted in-person, audio recorded, transcribed and analysed using content analysis.

Results: Forty participants, including 19 nurse practitioners, 16 administrators (inclusive of executives, managers, and receptionists), and 5 physicians were interviewed. Patient, provider, organizational, and system factors influenced nurse practitioner patient panel size. There were eight sub-factors: complexity of patients' health and social needs; holistic nursing model of care; nurse practitioner experience and confidence; composition and functioning of the multidisciplinary team; clerical and administrative supports, and nurse practitioner activities and expectations. All participants found it difficult to identify the panel size of nurse practitioners, calling it- "a grey area." Establishing and maintaining a longitudinal relationship that responded holistically to patients' needs was fundamental to how nurse practitioners provided care. Social factors such as gender, poverty, mental health concerns, historical trauma, marginalisation and literacy contributed to the complexity of patients' needs. Participants indicated NPs tried to address all of a patient's concerns at each visit.

Conclusions: Nurse practitioners have a holistic approach that incorporates attention to the social determinants of health as well as acute and chronic comorbidities. This approach compels them to try to address all of the needs a patient is experiencing at each visit and reduces their panel size. Multidisciplinary teams have an opportunity to be deliberate when structuring their services across providers to meet more of the health and social needs of empanelled patients. This could enable increases in nurse practitioner panel size.

背景:无法获得医疗服务是世界性的公共卫生危机。在初级医疗保健领域,这导致执业护士的使用率上升,人们对执业护士的病人数量也更加关注。本研究旨在探讨影响加拿大安大略省以团队为基础的初级保健中执业护士病人小组规模的因素:我们采用了多重案例研究设计。我们有目的地选择了八个以团队为基础的初级医疗实践作为案例,其中包括农村和城市环境。每个案例都有两名或两名以上的执业护士,且在初级医疗机构至少有两年的工作经验。访谈以面谈形式进行,采用内容分析法进行录音、转录和分析:40 名参与者接受了访谈,其中包括 19 名执业护士、16 名管理人员(包括行政人员、经理和接待员)以及 5 名医生。患者、医疗服务提供者、组织和系统因素影响了执业护士患者小组的规模。共有八个子因素:患者健康和社会需求的复杂性;整体护理模式;执业护士的经验和信心;多学科团队的组成和运作;文书和行政支持,以及执业护士的活动和期望。所有与会者都认为很难确定执业护士小组的规模,称其为 "灰色地带"。建立和保持纵向关系,全面满足患者需求,是执业护士提供护理的根本。性别、贫困、心理健康问题、历史创伤、边缘化和文化程度等社会因素导致了患者需求的复杂性。参与者表示,护士在每次就诊时都会努力解决患者的所有问题:执业护师采用综合方法,关注健康的社会决定因素以及急性和慢性并发症。这种方法迫使他们在每次就诊时尽量满足患者的所有需求,并减少了他们的小组人数。多学科团队有机会在跨医疗服务提供者构建服务时深思熟虑,以满足授权病人的更多健康和社会需求。这可以增加执业护士小组的规模。
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引用次数: 0
Social disparities in access and quality of consultation in outpatient care in Germany. 德国门诊病人就诊机会和就诊质量的社会差异。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-14 DOI: 10.1186/s12875-024-02552-9
Olaf von dem Knesebeck, Daniel Lüdecke, Jens Klein

Background: Overall, research on social determinants of access and quality of outpatient care in Germany is scarce. Therefore, social disparities (according to sex, age, income, migration background, and health insurance) in perceived access and quality of consultation in outpatient care (primary care physicians and specialists) in Germany were explored in this study.

Methods: Analyses made use of a cross-sectional online survey. An adult population sample was randomly drawn from a panel which was recruited offline (N = 2,201). Perceived access was assessed by waiting time for an appointment (in days) and travel time to the practice (in minutes), while quality of consultation was measured by consultation time (in minutes) and quality of communication (scale of four items, Cronbach's Alpha 0.89).

Results: In terms of primary care, perceived access and quality of consultation was worse among women compared to men. Estimated consultation time was shorter among people with statutory health insurance compared to privately insured respondents. Regarding specialist care, people aged 60 years and older reported shorter waiting times and better quality of communication. Lower income groups reported lower quality of communication, while perceived access and quality of consultation was worse among respondents with a statutory health insurance. Variances explained by the social characteristics ranged between 1% and 4% for perceived access and between 3% and 7% for quality of consultation.

Conclusion: We found social disparities in perceived access and quality of consultation in outpatient care in Germany. Such disparities in access may indicate structural discrimination, while disparities in quality of consultation may point to interpersonal discrimination in health care.

背景:总体而言,有关德国门诊就医机会和质量的社会决定因素的研究很少。因此,本研究探讨了德国门诊(初级保健医生和专科医生)就诊机会和就诊质量方面的社会差异(根据性别、年龄、收入、移民背景和医疗保险):方法:采用横断面在线调查进行分析。成人样本从线下招募的小组中随机抽取(N = 2,201)。通过预约等候时间(以天为单位)和前往诊所的旅行时间(以分钟为单位)来评估对就诊的感知,而通过就诊时间(以分钟为单位)和沟通质量(四个项目的量表,Cronbach's Alpha 0.89)来衡量就诊质量:结果:就初级保健而言,女性对就诊机会和就诊质量的感知比男性差。与参加私人保险的受访者相比,参加法定医疗保险的受访者预计就诊时间更短。在专科医疗方面,60 岁及以上人群的候诊时间更短,沟通质量更高。低收入群体的沟通质量较低,而拥有法定医疗保险的受访者认为就诊机会和就诊质量较差。社会特征对就医感受的解释差异在 1%-4%之间,对就医质量的解释差异在 3%-7%之间:结论:我们发现,在德国门诊就医的可及性和就诊质量方面存在社会差异。这种就医机会上的差异可能表明存在结构性歧视,而就诊质量上的差异则可能表明存在医疗保健方面的人际歧视。
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引用次数: 0
Integrated behavioral health implementation and chronic disease management inequities: an exploratory study of statewide data. 综合行为健康实施与慢性病管理不平等:对全州数据的探索性研究。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-14 DOI: 10.1186/s12875-024-02483-5
Gretchen J R Buchanan, Jerica M Berge, Timothy F Piehler

Background: People with diabetes, vascular disease, and asthma often struggle to maintain stability in their chronic health conditions, particularly those in rural areas, living in poverty, or racially or ethnically minoritized populations. These groups can experience inequities in healthcare, where one group of people has fewer or lower-quality resources than others. Integrating behavioral healthcare services into primary care holds promise in helping the primary care team better manage patients' conditions, but it involves changing the way care is delivered in a clinic in multiple ways. Some clinics are more successful than others in fully integrating behavioral health models as shown by previous research conducted by our team identifying four patterns of implementation: Low, Structural, Partial, and Strong. Little is known about how this variation in integration may be related to chronic disease management and if IBH could be a strategy to reduce healthcare inequities. This study explores potential relationships between IBH implementation variation and chronic disease management in the context of healthcare inequities.

Methods: Building on a previously published latent class analysis of 102 primary care clinics in Minnesota, we used multiple regression to establish relationships between IBH latent class and healthcare inequities in chronic disease management, and then structural equation modeling to examine how IBH latent class may moderate those healthcare inequities.

Results: Contrary to our hypotheses, and demonstrating the complexity of the research question, clinics with better chronic disease management were more likely to be Low IBH rather than any other level of integration. Strong and Structural IBH clinics demonstrated better chronic disease management as race in the clinic's location became more White.

Conclusions: IBH may result in improved care, though it may not be sufficient to resolve healthcare inequities; it appears that IBH may be more effective when fewer social determinants of health are present. Clinics with Low IBH may not be motivated to engage in this practice change for chronic disease management and may need to be provided other reasons to do so. Larger systemic and policy changes are likely required that specifically target the mechanisms of healthcare inequities.

背景:糖尿病、血管疾病和哮喘患者通常都在努力维持其慢性健康状况的稳定,尤其是那些居住在农村地区、生活贫困或种族或民族上属于少数群体的人。这些群体在医疗保健方面可能会遇到不公平的情况,即一个群体比其他群体拥有更少或更低质量的资源。将行为医疗保健服务纳入初级保健有望帮助初级保健团队更好地管理患者的病情,但这涉及到以多种方式改变诊所提供医疗服务的方式。一些诊所在全面整合行为医疗模式方面比其他诊所更成功,这一点从我们团队之前开展的研究中可以看出,我们确定了四种实施模式:低度实施、结构性实施、部分实施和强力实施。对于这种整合差异与慢性病管理的关系,以及 IBH 能否成为减少医疗保健不平等的策略,我们知之甚少。本研究探讨了在医疗保健不平等的背景下,IBH 实施差异与慢性病管理之间的潜在关系:在之前发表的对明尼苏达州 102 家初级保健诊所进行的潜类分析的基础上,我们使用多元回归建立了 IBH 潜类与慢性病管理中的医疗不平等之间的关系,然后使用结构方程模型研究了 IBH 潜类如何缓和这些医疗不平等:结果:与我们的假设相反,同时也说明了研究问题的复杂性,慢性病管理较好的诊所更有可能是低 IBH 诊所,而不是任何其他整合水平的诊所。随着诊所所在地的白种人越来越多,强IBH诊所和结构性IBH诊所的慢性病管理效果也越来越好:IBH可能会改善医疗服务,但可能不足以解决医疗服务不公平的问题;当健康的社会决定因素较少时,IBH似乎更有效。IBH较低的诊所可能没有动力为慢性病管理进行这种实践变革,可能需要为其提供其他理由。可能需要进行更大规模的系统和政策变革,专门针对医疗保健不公平的机制。
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引用次数: 0
Antibiotic prescription pattern among Primary Healthcare General Practitioners in the South Batinah Governorate of Oman, 2019. 阿曼南巴蒂纳省初级保健全科医生的抗生素处方模式,2019 年。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-10 DOI: 10.1186/s12875-024-02488-0
Sami M Al Mujaini, Zayid K Almayahi, Noura A Abouammoh, Sumaiya Al Amri

Background: Misuse and overuse of antibiotics comprise leading causes of antimicrobial resistance. The study aims to assess the pattern of antibiotic prescription among primary healthcare general practitioners in the South Batinah Governorate of Oman.

Method: A cross-sectional study of 600 antibiotic prescriptions issued in the South Batinah Governorate in 2019 was conducted to verify the triggering diagnoses and determine the appropriateness of the prescribed antibiotic. Logistic regression analysis was used to determine the association between predictors and inappropriate use.

Results: Respiratory infections accounted for 62% of antibiotic prescriptions, of which 92.2% were inappropriately prescribed. Extended-spectrum antibiotics were inappropriately prescribed in 33.3% of cystitis cases, while 14.3% of gastroenteritis received incorrect spectrum of antibiotics. Amoxicillin represented 46.2% of antibiotic prescriptions, of which 84.4% were unnecessarily prescribed. Lower inappropriate antibiotic prescribing rate was linked to patients ≥ 18 years (OR = 0.46, 95% CI: [0.26, 0.82]), those who underwent laboratory tests (OR = 0.22, 95% CI: [0.12, 0.39]), and consultations at health centers (OR = 0.44, 95% CI: [0.24, 0.79]). Arabic-speaking physicians were more likely to prescribe antibiotics inappropriately.

Conclusion: Inappropriate antibiotic prescription was frequently observed in mild respiratory infections and associated with specific patient and physician characteristics. Appropriateness of antibiotic prescriptions issued can be improved through enhanced testing capacities as well as implementation of physician and community awareness campaigns.

背景:滥用和过度使用抗生素是导致抗菌药耐药性的主要原因。本研究旨在评估阿曼南巴蒂纳省初级保健全科医生的抗生素处方模式:方法:对南巴蒂纳省 2019 年开具的 600 份抗生素处方进行横断面研究,以核实触发诊断并确定处方抗生素的适当性。采用逻辑回归分析确定预测因素与不当使用之间的关联:呼吸道感染占抗生素处方的62%,其中92.2%的处方不合理。33.3%的膀胱炎病例不恰当地使用了广谱抗生素,14.3%的肠胃炎病例使用了不正确的广谱抗生素。阿莫西林占抗生素处方的 46.2%,其中 84.4%为不必要处方。抗生素处方不当率较低与患者年龄≥ 18 岁(OR = 0.46,95% CI:[0.26, 0.82])、接受实验室检查(OR = 0.22,95% CI:[0.12, 0.39])和在医疗中心就诊(OR = 0.44,95% CI:[0.24, 0.79])有关。讲阿拉伯语的医生更有可能开出不当的抗生素处方:结论:轻度呼吸道感染中经常出现抗生素处方不当的情况,这与患者和医生的具体特征有关。通过提高检测能力以及开展提高医生和社区意识的活动,可以改善抗生素处方的合理性。
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引用次数: 0
Frequency, persistence and relation of disease symptoms, psychosomatic comorbidity and daily life impairment after COVID-19: a cohort study in general practice. COVID-19 后疾病症状、心身并发症和日常生活障碍的频率、持续性及其关系:全科医生队列研究。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-10 DOI: 10.1186/s12875-024-02551-w
Alexander Hapfelmeier, Jan Donhauser, Clara Teusen, Stefanie Eck, Antonius Schneider

Background: Long-lasting symptoms with a possible relation to psychosomatic comorbidity have been described following COVID-19. However, data is sparse in general practice. The trial's objective was to investigate the time-dependent frequency of disease symptoms and relation to psychosomatic comorbidity and daily life impairment (DLI).

Methods: Comparative cohort study of patients reporting a previous SARS-CoV-2 infection and uninfected controls in general practice. Participants were recruited in 14 general practices in the greater Munich area. Data collection was questionnaire based with a 12 months follow-up. Descriptive statistics, multivariable regression and bivariate correlations were used for analysis.

Results: A total of n = 204 cases infected up to 42 months ago (n = 141 Omicron, n = 63 earlier variants), and n = 119 controls were included. Disease symptoms were substantially more prevalent in cases (55-79% vs. 43% within one year of infection). This difference also appeared in the multivariable analysis adjusting for socio-demographics and psychosomatic comorbidity with odds ratios (OR) of 4.15 (p < 0.001) and 3.51 (p = 0.054) for the cohorts with Omicron or earlier variants infection (vs. controls), respectively. It was persistent with earlier variants (OR 1.00 per month, p = 0.903), while a decreasing trend was observed for Omicron (OR 0.89 per month, p < 0.001). DLI was especially correlated with fatigue (r = 0.628).

Conclusion: DLI, psychosomatic comorbidity and independently increased disease symptoms require holistic treatment of the patient in general practice according to the bio-psycho-social model. A key role in restoring the daily life capability may be attributed to the symptom fatigue.

背景:据描述,COVID-19 后出现的长期症状可能与心身疾病有关。然而,普通实践中的数据却很少。该试验的目的是调查疾病症状随时间变化的频率以及与心身并发症和日常生活障碍(DLI)的关系:方法:对报告既往感染过 SARS-CoV-2 的患者和全科医生中未受感染的对照者进行队列比较研究。参与者在大慕尼黑地区的 14 家全科诊所中招募。数据收集以问卷调查为基础,随访 12 个月。分析方法包括描述性统计、多变量回归和双变量相关性:共有 n = 204 个 42 个月前感染的病例(n = 141 个 Omicron 型,n = 63 个早期变种)和 n = 119 个对照组。病例中出现疾病症状的比例要高得多(感染后一年内出现疾病症状的比例为 55-79% 对 43%)。这一差异也出现在调整了社会人口统计学和心身合并症的多变量分析中,其几率比(OR)为 4.15(P 结论:病例和心身合并症的几率比为 4.15):DLI、心身疾病合并症和独立增加的疾病症状要求全科医生根据生物-心理-社会模式对患者进行综合治疗。症状疲劳可能是恢复日常生活能力的关键因素。
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引用次数: 0
Regional variation in health care substitution for intrauterine device insertion: a retrospective cohort study. 放置宫内节育器的医疗保健替代品的地区差异:一项回顾性队列研究。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-10 DOI: 10.1186/s12875-024-02546-7
Maarten D Vink, France R Portrait, Tim van Wezep, Xander Koolman, Ben W Mol, Eric J van der Hijden

Background: Rising health care costs are a major concern in most Western countries. The substitution of healthcare stands as a strategic approach aimed at mitigating costs while offering medical services in proximity to patients' residences. An illustrative instance involves the migration of outpatient hospital care to primary care settings. Notably, the insertion of intrauterine devices (IUDs) can be safely executed within primary care contexts. In order to establish a pragmatic objective for the rate of IUD substitution, we conducted an evaluation of regional disparities in healthcare substitution pertaining to the insertion of intrauterine devices. Furthermore, we investigated disparities in the follow-up ultrasound and reinsertion of IUDs between primary and secondary healthcare environments.

Methods: All women who underwent IUD insertion in Dutch primary care (by general practitioners and midwives) and secondary care (by hospital physicians) between January 1, 2016, and December 31, 2020 were included. The main outcome measures were the case-mix adjusted IUD insertion rates at the regional level by care setting and the proportions requiring follow-up ultrasound and IUD reinsertion within three months.

Results: Of the 840,766 IUD placements, 74% were inserted in primary care and 26% in secondary care. The proportion inserted in primary care increased from 70% in 2016 to 77% in 2020. The observed substitution rate ranged from 58 to 82% between regions. Compared with health care professionals in primary care, those in secondary care performed more ultrasounds to verify IUD placement (23% vs. 3%; p-value < 0.01) and more IUD reinsertions within three months (6% vs. 2%; p-value < 0.01).

Conclusions: IUDs are increasingly being inserted in Dutch primary care, with peak regional IUD insertion care substitution rates at ≥ 80%. IUD insertion care substitution to primary care appears to be associated with significantly fewer women having follow-up ultrasound or IUD reinsertion within three months.

背景:在大多数西方国家,医疗费用不断上涨是一个主要问题。医疗保健替代是一种战略方法,旨在降低成本,同时在患者住所附近提供医疗服务。一个典型的例子是将医院门诊护理转移到初级保健机构。值得注意的是,放置宫内节育器(IUD)可以在基层医疗机构安全进行。为了确定宫内节育器替代率的实用目标,我们对与放置宫内节育器相关的医疗保健替代方面的地区差异进行了评估。此外,我们还调查了初级和中级医疗环境中宫内节育器后续超声检查和重新植入的差异:所有在 2016 年 1 月 1 日至 2020 年 12 月 31 日期间在荷兰初级医疗机构(由全科医生和助产士实施)和二级医疗机构(由医院医生实施)接受宫内节育器置入手术的女性均被纳入研究范围。主要结果指标是按医疗机构进行病例组合调整后的地区宫内节育器置入率,以及三个月内需要随访超声检查和宫内节育器重新置入的比例:在 840 766 例放置宫内节育器的案例中,74% 在初级医疗机构放置,26% 在二级医疗机构放置。在初级医疗机构放置宫内节育器的比例从 2016 年的 70% 增加到 2020 年的 77%。各地区观察到的替代率从 58% 到 82% 不等。与初级医疗机构的医护人员相比,二级医疗机构的医护人员进行了更多的超声波检查以核实宫内节育器的放置情况(23% 对 3%;P 值 结论:越来越多的宫内节育器是在荷兰初级医疗机构置入的,地区宫内节育器置入护理替代率峰值≥ 80%。将宫内节育器置入护理改为初级保健似乎与三个月内进行超声随访或宫内节育器再置入的妇女人数明显减少有关。
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引用次数: 0
Factors affecting the essential medicine prescribing behavior among general practitioners in Beijing, China: a cross-sectional study with structural equation model. 影响中国北京全科医生基本药物处方行为的因素:一项采用结构方程模型的横断面研究。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-10 DOI: 10.1186/s12875-024-02556-5
Xiaolei Chen, Zhengwen Feng, Qi Luo, Hui Li, Shuang Shao, Juan Du

Background: The aim of this study is to explore the influence of GPs'information, motivation and behavior skills on EM prescribing behavior in urban and suburban districts.

Method: A cross-sectional study was conducted from June to November 2022 cross 3 urban districts and 4 suburban districts in Beijing. The structural equation model was used to analyze the factors influencing the essential medicine prescription behavior among general practitioners in urban and suburban districts.

Results: A total of 511 valid questionnaires were collected. There was a statistically significant difference in mean scores for personal motivation and behavioral skills between urban GPs and suburban GPs. For urban GPs, the path analysis revealed that the social motivation had a direct effect on the essential medicine prescribing behavior (β = 0.225, p < 0.05). In contrast, for suburban GPs, both social motivation and personal motivation had a direct effect on the essential medicine prescribing behavior, respectively (β = 0.175, p < 0.05; β = 0.193, p < 0.01).

Conclusion: Social motivation of urban GPs were positively and significantly associated with essential medicine prescribing behavior. Social motivation and personal motivation of suburban GPs were positively and significantly associated with essential medicine prescribing behavior. Therefore, various corresponding policies and measures should be developed to promote the National Essential Medicines Policy in China.

研究背景本研究旨在探讨城市和郊区全科医生的信息、动机和行为技能对电磁处方行为的影响:方法:于 2022 年 6 月至 11 月在北京市 3 个城区和 4 个郊区进行了横断面研究。采用结构方程模型分析影响城区和郊区全科医生基本药物处方行为的因素:共回收有效问卷 511 份。城市全科医生和郊区全科医生在个人动机和行为技能方面的平均得分差异有统计学意义。城市全科医生的社会动机与基本药物处方行为呈显著正相关。郊区全科医生的社会动机和个人动机与基本药物处方行为呈显著正相关。因此,中国应制定各种相应的政策和措施来促进国家基本药物政策的实施。
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引用次数: 0
The effect of family physician team processes on chronic disease management performance from a structural network perspective. 从结构网络角度看家庭医生团队流程对慢性病管理绩效的影响。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-10 DOI: 10.1186/s12875-024-02550-x
Yixiang Chen, Ziyang Zhang, En Yang, Hua Qing, Yilin Wei, Shangfeng Tang

Objective: The family physician team has become the core carrier for delivery primary health care in China. This study aimed to measure the effect of the network structural characteristics of family physician team processes on health performance. Strategic recommendations for optimizing the family physician team processes with a view to improving performance were presented.

Methods: A cross-sectional survey was conducted from October to December 2021 in Qianjiang in Hubei Province and Changsha in Hunan Province. Task performance, contextual performance, social networks, and sociodemographic characteristics were collected. Social network analysis was conducted to calculate density and centralization, then hierarchical linear regression analysis was employed to explore the relationship between the network structural characteristics of family physician team processes and performance.

Results: In total, 88 family physician teams attended in this investigation. The transition processes of family physician team showed a distinctive low density (0.272 ± 0.112), high centralization (0.866 ± 0.197) network structure. For family physician team, the density of action processes significantly and positively affected task performance (B = 0.600, P < 0.05); the centralization of action processes positively affected task performance (B = 0.604, P < 0.01); the density of action processes positively affected contextual performance (B = 0.545, P < 0.01); the density of interpersonal processes significantly and positively affected contextual performance (B = 0.326, P < 0.05).

Conclusion: The network density and centralization of family physician team processes have positive effects on chronic disease management performance. The results from this study help to enhance our conceptual understanding of social network and its implications for team-dynamics. Optimizing family physician team processes is an effective way to strengthen the construction of family physician team and promote the quality and efficiency of family physician-contracted service. It is recommended to strengthen the management of team processes, enhance the internal collaboration mechanism, and optimize the centralized network structure of family physician team.

目的:家庭医生团队已成为中国基层医疗卫生服务的核心载体。本研究旨在测量家庭医生团队流程的网络结构特征对健康绩效的影响,并提出优化家庭医生团队流程以提高绩效的战略建议。方法:本研究于 2008 年 7 月至 2009 年 12 月进行了一项横断面调查:方法:2021 年 10 月至 12 月在湖北省潜江市和湖南省长沙市进行了横断面调查。收集了任务绩效、情境绩效、社会网络和社会人口特征。通过社会网络分析计算密度和集中度,然后采用层次线性回归分析探讨家庭医生团队过程的网络结构特征与绩效之间的关系:共有 88 个家庭医生团队参与了本次调查。家庭医生团队的过渡流程呈现出明显的低密度(0.272±0.112)、高集中化(0.866±0.197)的网络结构。对于家庭医生团队而言,行动过程的密度对任务绩效有显著的正向影响(B = 0.600,P 结论:家庭医生团队的行动过程密度和集中度对任务绩效有显著的正向影响:家庭医生团队流程的网络密度和集中度对慢性病管理绩效有积极影响。本研究的结果有助于加深我们对社会网络及其对团队动力影响的概念性理解。优化家庭医生团队流程是加强家庭医生团队建设、促进家庭医生签约服务提质增效的有效途径。建议加强团队流程管理,强化内部协作机制,优化家庭医生团队集中式网络结构。
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引用次数: 0
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BMC primary care
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