The assessing medical professionals' knowledge of autism spectrum disorders.

In 1978, Primary Health Care (PHC) was formally recognised, in the Declaration of Alma-Ata, as the key to achieving the World Health Organisation's goal of 'Health For All by the Year 2000' (HFA). PHC was seen as the solution to the inadequate illness management systems that had developed throughout the world. It was hoped that PHC would address some of the major inequalities in health observed both within and between countries by its balanced system of treatment and disease prevention. The WHO envisaged that PHC would take place as close as possible to where people live and work and be the first element of a continuing health care process. Additionally, health service collaboration and multi-professional partnerships were expected to replace professional boundaries and competition. Shortly after the Declaration of Alma-Ata, the World Health Organisation, supported by national and international nursing bodies, proposed that nurses would be the driving force behind the HFA movement as active partners in inter-professional teams, leaders in health care and resources to people rather than resources to other health professionals. In the ensuing years, although community health nurses were acknowledged by the government and the nursing profession as key players in PHC in Australia, practice nurses (nurses who are employed in general medical practices) were not identified within this group. Hence, it appeared as though these practice nurses were 'invisible', not considered important to PHC in Australia, or simply overlooked as a major influence on population health. The purpose of this study was to describe the current role of these nurses and to identify and analyse the factors that influenced their scope of practice and hence their contribution to PHC. The research was conducted as a case study of practice nurses in one Division of General Practice in southeast Queensland. The study was influenced by the constructivist paradigm of inquiry and utilised a complementary sequence of quantitative methods followed by qualitative investigation. The first stage of the study comprised a telephone followed by mail survey of general practitioners and practice nurses employed within the Division. This was followed by a second stage, which involved group and individual interviews of key informants and was supported by document review and observation. The study revealed that the practice nurse role is essentially one of assistant to the general practitioner wherein the nurse undertakes basic assessment procedures to aid the medical diagnosis, carries out delegated therapeutic procedures, and contributes to the administrative functioning of the practice. Autonomous nursing initiatives, which appear to be largely opportunistic and incidental to delegated activities, include physical and emotional support of patients, clarification and reinforcement of medical instructions, and the provision of health education. The practice nurse's role, and hence contribution to PHC, was found to be constrained by a number of factors. These factors include the current funding arrangements for general practice, the view that practice nurses are an option rather than a necessity, the general practitioners' control of the practice setting, the appropriation of nursing work to medical receptionists, the lack of professional development opportunities, and the practice nurses' passive acceptance of their circumstances. However, both general practitioners and practice nurses appreciate the value of nursing services in general practice and GPs would sanction the employment of more nurses, if given financial incentives, especially for the purpose of preventive care. The majority of practice nurses believe their role should be expanded to include autonomous functioning while most of the GPs were amenable to some extension of nursing practice but reticent or opposed to any independent interventions. There appears a need in Queensland for courses to prepare practice nurses for advanced practice if they want to expand their role in PHC beyond that of assistants to GPs. It would also seem to be in the nurses' interests to initiate a professional association of practice nurses as a vehicle to explore other issues relevant to their professional development. In addition, if PNs want to expand their role they will need to demonstrate improved patient outcomes and cost effectiveness.

BackgroundThe demand for and provision of health care is in constant change. People live longer and have more complex health requirements, challenging the functioning of the health care system in...

Nurse Practitioners, Practice Nurses and Nurse Specialists: what's in a name?

Family Physicians' Experiences With Community Mental Health Centers: A Multilevel Analysis

This paper reports an integrative review of the literature on nursing competency standards for nurses working in primary health care and, in particular, general practice. Internationally, there is growing emphasis on building a strong primary health care nursing workforce to meet the challenges of rising chronic and complex disease. However, there has been limited emphasis on examining the nursing workforce in this setting. Integrative review. A comprehensive search of relevant electronic databases using keywords (e.g. 'competencies', 'competen*' and 'primary health care', 'general practice' and 'nurs*') was combined with searching of the Internet using the Google scholar search engine. Experts were approached to identify relevant grey literature. Key websites were also searched and the reference lists of retrieved sources were followed up. The search focussed on English language literature published since 2000. Limited published literature reports on competency standards for nurses working in general practice and primary health care. Of the literature that is available, there are differences in the reporting of how the competency standards were developed. A number of common themes were identified across the included competency standards, including clinical practice, communication, professionalism and health promotion. Many competency standards also included teamwork, education, research/evaluation, information technology and the primary health care environment. Given the potential value of competency standards, further work is required to develop and test robust standards that can communicate the skills and knowledge required of nurses working in primary health care settings to policy makers, employers, other health professionals and consumers. Competency standards are important tools for communicating the role of nurses to consumers and other health professionals, as well as defining this role for employers, policy makers and educators. Understanding the content of competency standards internationally is an important step to understanding this growing workforce.

There are various Medical Subject Headings (MeSH) terms used to index general practice research, without consistency. To understand how general practice-related research is indexed in the main general practice journals between 2011 and 2021, and to analyse the factors that influenced the choice of the general practice-related MeSH. This was a quantitative bibliometric study conducted on MEDLINE. MeSH were selected according to the international definition of General Practice/Family Medicine: 'General Practice', 'Primary Health Care', 'Family Practice', 'General Practitioners', 'Physicians, Primary Care', and 'Physicians, Family'. Their use was studied from 2011 to 2021 on MEDLINE, reviewing the 20 general practice journals with the highest impact factors. A descriptive and analytical approach was used; the association of the country, journal, and year with the choice of general practice-related MeSH terms was analysed. A total of 8514 of 150 286 articles (5.7%) were using one of the general practice-related MeSH terms. The most used were 'Primary Health Care' (4648/9984, 46.6%) and 'General Practice' (2841/9984, 28.5%). A total of 80.0% (6172/7723) of the articles were related to the UK or US and 71.0% (6055/8514) of the articles came from four journals (BJGP, BMJ, Journal of General Internal Medicine, and Annals of Family Medicine). Two main country clusters emerged from the use of general practice-related MeSH: a British cluster mainly using 'General Practice' and an American cluster using 'Primary Health Care'. The journals also mainly differed in their used of these two MeSH terms. Important variations in the indexation of general practice research were found. Researchers should consider combining 'Primary Health Care' and 'General Practice' in their PubMed searches to access all the general practice research, regardless of their country of origin.

Improving patient outcomes by coaching primary health general practitioners and practice nurses in evidence based wound management at on-site wound clinics

Objective. Although health professionals are increasingly undertaking qualitative interviews with professional peers, there is little literature regarding the methodological implications of this process. The aim of the study was to elicit from informants their views on being interviewed by a fellow health professional. Design. Semi-structured interviews with nine general practitioners (GPs), three rheumatologists, and three physical therapists, with a substantive focus on perceptions of osteoarthritis. The interviewer was a GP, and informants were asked for their reactions to being interviewed by a fellow professional. Data were analysed by hand, using a thematic approach. Setting. Primary care clinics and practices in the UK. Results. Although reassured to the contrary, many informants viewed the interview as a test of their professional knowledge. The interview was also seen by some GPs as serving an educational process, with the interviewer as an authoritative source of clinical information. There were some indications of professional vulnerability among informants in relation to possible scrutiny of their practice or knowledge, though none reported a negative experience of the interview. Notions of professional identity appeared central to many of the issues that emerged. Conclusion. The nature of the relationship in interviews involving professional peers creates specific methodological issues, which have important implications for qualitative research in primary healthcare. There are both advantages and disadvantages to interviewing professional peers, which should be considered in the light of the objectives of a particular study.

Prevalence of Generalized Anxiety Disorder in General Practice in Denmark, Finland, Norway, and Sweden

Changing the health care workforce: lessons from foundation-sponsored programs.

Infertility is an important health issue in Australia affecting one in six couples. Increasingly these couples are being referred from general practice to assisted reproductive technology clinics for tertiary level care. Whilst there is general agreement that some infertility can be prevented by addressing modifiable lifestyles and other risk factors, limited research has examined women’s understanding of the fertile period of the menstrual cycle as a possible risk factor for infertility. The aim of this study was to inform the development of a new model care to improve the fertility-awareness of sub-fertile women in primary health care. It was hypothesised that most women who are seeking assisted reproductive technology treatment cannot correctly identify the fertile window of the menstrual cycle, and whilst most general practitioners and practice nurses do not provide fertility-awareness education because of a lack of education and training, practice nurses will show greater interest than general practitioners in delivering fertility-awareness education for sub-fertile women. The study used a mixed methods design and had two phases. Phase 1 measured fertility-awareness knowledge, attitudes and practices of women attending general practice (n = 328) and infertile women on admission to assisted reproductive technology clinics (n = 204). Phase 2 entailed three stages, and included a review of guidelines concerning their recommendations on fertility-awareness education in the primary care of infertile women, measured fertility-awareness knowledge, attitudes and practices of general practitioners’ (n = 278) and practice nurses’ (n = 473) when women first report trouble conceiving, and interviews with general practitioners (n = 11 and focus groups with practice nurses (n = 20) exploring the barriers and enablers, if any, and how best to deliver FA education in general practice. The study found that few women attending general practice (2.1%) and assisted reproductive technology clinics (12.7%) correctly identify the fertile period of the menstrual cycle. Conversely, a high degree of agreement exists between these women groups (92.2% and 94.5%, respectively) and general practitioners’ and practice nurses’ (89.2%) that women should receive fertility-awareness education when first reporting trouble conceiving. These findings strengthen the research evidence that poor fertility-awareness is a modifiable risk factor for infertility, and suggest that general practice is an appropriate setting for an intervention promoting couples’ fertile potential though a better understanding of the fertile time of the menstrual cycle. There was general agreement among general practitioners and practice nurses that greater use of specially trained nurses and midwives in a collaborative team care arrangement with general practitioners would improve both the quality and accessibility of fertility-awareness education in general practice. The study also identified that patient educational materials are needed to guide the delivery of fertility-awareness education in general practice.

Background Stroke can affect a person’s ability to drive a motor vehicle. In Australia, there is a 4-week restriction in driving after stroke and a 2-week restriction after transient ischemic attack. Concerns exist as to whether people discharged home from the acute setting receive education about these driving restrictions. Objectives This study sought to investigate health professionals’ knowledge about, and responsibilities for patients return-to-driving (RTD) education after stroke and TIA. Methods A cross-sectional online survey was designed and included questions about health professional demographic characteristics and knowledge and opinions of RTD guidelines. An open-ended question at the end of the survey enabled respondents to provide additional, free text information. Descriptive analyses were used to describe respondents’ demography and characteristics. Chi-square analysis was used to compare responses across the different professional groups. Significance was tested using a p-value of 0.05. Data obtained from the free text question were analyzed through an inductive thematic approach. Results A total of 455 health professionals responded to the survey, with 45% being occupational therapists. Only 22% of health professionals correctly selected the 4-week restriction period after stroke and 27% selected the 2-week restriction period for those with TIA. Occupational therapists were identified by 85% of respondents as the profession responsible for providing RTD education, followed by doctors (72%). Health professionals lack clarity in RTD guidelines and often defer the responsibility of managing RTD to others. Conclusions Education of health professionals in RTD guidelines is recommended to improve the processes of care after stroke.

Aim: This study was conducted to evaluate the knowledge, attitude, and practice of the general health practitioners toward diabetic retinopathy (DR), Kingdom of Saudi Arabia (KSA). Materials and Methods: This was a cross-sectional descriptive study. Responses were obtained using a structured multi-point questionnaire. It included closed-ended questions that were arranged in a Likert's scale. Informed consent and ethical approval were obtained. Data were analyzed using SPSS version 16 statistical software. Results: Of the 180 general practitioners (GPs) who participated in the study, 56.7% were males and 43.3% were females. Of those, 51.1% were practicing in rural areas, and 41.1% had postgraduate training. Participants had good knowledge about the prevalence of diabetes mellitus in KSA (97.2%). The majority (92.8%) agreed that early detection and treatment of DR plays a critical role in the prevention of permanent visual loss. However, participants had good attitude toward screening for DR. However, the practice of fundus examination was poorly mastered by 43.9% of the GPs. Conclusion: This study displays the need for hands-on training of GPs about detection of DR by direct use of ophthalmoscopes. Barriers for ophthalmoscope examination, as perceived, need to be further addressed and evaluated. Furthermore, It is of great importance to improve the screening facilities at the primary health care setting.

THU0642-HPR Better Arthritis Care: What Training Do Community Based Health Professionals Need To Better Care for People with Arthritis?

Актуальність. В Україні, як і у всьому світі, більшість людей, які стикаються з захворюваннями, що загрожують або обмежують життя та потребують паліативної допомоги, перебувають вдома [1]. За оцінками, паліативна допомога необхідна в 40–60% усіх випадків захворювань, що призводять до смерті [2]. За даними Державної служби статистики України, у 2020 р. смертність становила 616 840 осіб [3], відповідно, надання паліативної допомоги в Україні потребували орієнтовно від 250 до 370 тисяч пацієнтів. Ведення пацієнтів впродовж прогресування/розвитку хвороби та заключної фази життя покладається на лікарів, які найбільш наближені до пацієнта – лікарів загальної практики – сімейних лікарів. Головною метою надання паліативної допомоги є забезпечення найбільш досяжної якості життя пацієнтів. При цьому лікар повинен вчасно визначити, коли обсяг надання паліативної допомоги виключно лікарем загальної практики – сімейним лікарем є недостатнім, та своєчасно залучити спеціалізовані служби паліативної допомоги. Мета роботи: розробити алгоритм надання паліативної допомоги лікарями загальної практики – сімейними лікарями з визначенням пацієнтів, для яких обсяг надання паліативної допомоги виходить за межі первинної медичної допомоги. Матеріали та методи. Чинна нормативно-правова база, яка регламентує надання паліативної допомоги лікарями загальної практики – сімейними лікарями, наукова література, опитувальники соціологічного дослідження пацієнтів (п=25). Використали методи системного аналізу, синтезу, абстрагування, соціологічний та медико-статистичний методи. Результати. Вивчено чинні накази МОЗ України та галузеві стандарти надання медичної допомоги, якими керуються лікарі загальної практики – сімейні лікарі при наданні паліативної допомоги, та виявлено відсутність послідовності виконання норм, визначених різними нормативами. Встановлено, що використання засобів для визначення рівня якості життя (ЯЖ), як основної мети паліативної допомоги, не запропоновано. Обов'язком лікаря загальної практики – сімейного лікаря є своєчасне залучення до надання паліативної допомоги спеціалізованих служб. При цьому, певний показник або критерій, що може свідчити про недостатність обсягу надання паліативної допомоги на рівні надання первинної медичної допомоги, відсутній. Запропоновано опитувальники для визначення ЯЖ пацієнтів (EORTC QLQ-C30) та самооцінки депресії (PHQ-9). Показано, що показники менше 50 балів за функціональними шкалами опитувальника EORTC QLQ-C30 та/або 10 або більше балів за шкалою депресії PHQ-9 є свідченням про необхідність супроводу пацієнта психологом, священнослужителем та соціальним працівником, тобто підставою залучення мультидисциплінарної команди мобільної паліативної допомоги. Розроблено уніфікований алгоритм дій надання паліативної допомоги лікарями загальної практики – сімейними лікарями. Висновки. Для забезпечення виконання норм та правил, визначених для лікарів загальної практики – сімейних лікарів різними нормативними документами, інструкціями та галузевими стандартами, необхідне впровадження Уніфікованого алгоритму (уніфікованої схеми) дій лікаря при наданні паліативної допомоги. Тому лікарям загальної практики – сімейним лікарям необхідно вчасно застосовувати алгоритм визначення пацієнтів, для яких обсяг надання паліативної допомоги виключно лікарями загальної практики – сімейними лікарями є недостатнім та налагоджувати взаємодію з мультидисциплінарними мобільними паліативними службами.