Education Of General Practitioners Research Articles

Identifying factors explaining practice variation in secondary stroke prevention in primary care: a cohort study based on all patients with ischaemic stroke in the Stockholm region

ObjectivesThe aim of this study was to describe the practice variation in dispensation of secondary stroke preventive drugs among patients at different primary care centres (PCCs) in Stockholm region and...

P68 Identifying the Content and Context of Pain Within Education and Training of General Practitioners

P68 Identifying the Content and Context of Pain Within Education and Training of General Practitioners

Factors impacting the delay in diagnosis and treatment of testicular cancer: A review

Early diagnosis and management of testicular cancer can improve mortality and prognosis. This systematic review found extensive patient-, physician-, and system-related factors that increased the length of time to diagnosis. Future preventative strategies should target the modifiable factors such as lack of awareness, embarrassment, accessibility, general practitioner education, and clinical training and streamlined imaging processes.

The Complexity of Comorbidity in Patients with Severe Mental Disorders

Comorbidity of severe mental disorders and physical illness: issues arising Comorbidity of mental and physical illness is a major, perhaps main problem facing medicine in the years before us. In addition to shortening the life expectancy of people with mental illness comorbidity with physical illness comorbidity significantly and negatively affects the quality of life of the people who experience the mental and physical illnesses and their carers and increases the cost of health care. What makes the problem even more and challenging is that medicine is currently in the process of fragmentation into ever more narrow specialties which adds difficulty in the provision of care, Most of the solutions which have been proposed – collaborative care, in-service education of general practitioners and others did not turn out to be effective solutions in dealing with the problems of comorbidity. A significant revision of undergraduate and postgraduate training in medicine is most probably an essential component of the answer to the challenge of this type of comorbidity which will also require a reorganization of health services and their financing.DisclosureNo significant relationships.

A multimodal intervention to optimise antimicrobial use in residential aged care facilities (ENGAGEMENT): protocol for a stepped-wedge cluster randomised trial

BackgroundInappropriate antibiotic use can cause harm and promote antimicrobial resistance, which has been declared a major health challenge by the World Health Organization. In Australian residential aged care facilities (RACFs), the most common indications for antibiotic prescribing are for infections of the urinary tract, respiratory tract and skin and soft tissue. Studies indicate that a high proportion of these prescriptions are non-compliant with best prescribing guidelines. To date, a variety of interventions have been reported to address inappropriate prescribing and overuse of antibiotics but with mixed outcomes. This study aims to identify the impact of a set of sustainable, multimodal interventions in residential aged care targeting three common infection types.MethodsThis protocol details a 20-month stepped-wedge cluster-randomised trial conducted across 18 RACFs (as 18 clusters). A multimodal multi-disciplinary set of interventions, the ‘AMS ENGAGEMENT bundle’, will be tailored to meet the identified needs of participating RACFs. The key elements of the intervention bundle include education for nurses and general practitioners, telehealth support and formation of an antimicrobial stewardship team in each facility. Prior to the randomised sequential introduction of the intervention, each site will act as its own control in relation to usual care processes for antibiotic use and stewardship.The primary outcome for this study will be antibiotic consumption measured using defined daily doses (DDDs). Cluster-level rates will be calculated using total occupied bed numbers within each RACF during the observation period as the denominator. Results will be expressed as rates per 1000 occupied bed days. An economic analysis will be conducted to compare the costs associated with the intervention to that of usual care. A comprehensive process evaluation will be conducted using the REAIM Framework, to enable learnings from the trial to inform sustainable improvements in this field.DiscussionA structured AMS model of care, incorporating targeted interventions to optimise antimicrobial use in the RACF setting, is urgently needed and will be delivered by our trial. The trial will aim to empower clinicians, residents and families by providing a robust AMS programme to improve antibiotic-related health outcomes.Trial registrationUS National Library of Medicine Clinical Trials.gov (NCT04705259). Prospectively registered in 12th of January 2021.

Low adherence to the guideline for the acute treatment of migraine

The real-world use of triptans in the treatment of migraine is disappointing. Only 12% of the Danish migraine population purchased a triptan between 2014 and 2019, and only 43% repurchased a triptan after first prescription. The aim of the present study was to assess whether physicians and patients adhere to the therapeutic guideline on acute migraine treatment. We interviewed 299 triptan experienced participants with migraine and 101 triptan naïve participants with migraine from the Danish Migraine Population Cohort, using a semi-structured questionnaire. Descriptive statistical analyses were used to study the association with triptan use and the assessed factors. Among triptan naïve participants with migraine, 64% had consulted their general practitioner about their migraine, of whom only 23% received information about the possibility of triptan treatment. Among triptan experienced participants, 77% had only tried one type of triptan. Only 12% could recall they had been informed by their general practitioner to try each triptan three times before giving up. Twenty percent were informed to try three different triptans in total, if the first did not work. In disagreement with the guideline, participants who reported a low pain reduction by a triptan had only tried one type of triptan. Our study shows a low adherence to therapeutic guideline for the attack treatment of migraine. There is a need for better education of general practitioners regarding treatment of migraine. Future campaigns should aim to inform both the public and the general practitioner about antimigraine treatments.

An Overview of the Level of Knowledge of Medical Student of Universitas Sumatera Utara about Risky Pregnancies

Background. One indicator of a country's health status is the Maternal Mortality Rate (MMR). Every pregnant woman has potential dangers during pregnancy, childbirth, and puerperium. Until now, in all parts of the world, risky pregnancies, especially high-risk pregnancies, are still a problem in health services, especially in developing countries. In Indonesia, MMR decreased during the period 1991-2015 from 390 to 305 per 100,000 live births. However, this is still far from the MDGs target goal, which is 102 per 100,000 live births. Many women are still pregnant or giving birth at a risky age. This condition leads to many complications (especially high-risk pregnancies) such as miscarriage, premature birth, genetic disorders, and even death. This may occur due to the lack of knowledge and education of general practitioners who serve pregnant women, especially in peripheral areas. Objective. This study aims to determine the knowledge level of Medical students of Universitas Sumatera Utara about risky pregnancy. Methods. This research was conducted in a quantitative descriptive study with a cross-sectional design. This research was conducted at the Faculty of Medicine, Universitas Sumatera Utara. The samples of this study were students of the Faculty of Medicine, Universitas Sumatera Utara, which were taken by proportionate stratified. Primary data was collected using a questionnaire containing 21 true and false questions. Result. It was found that the knowledge of students from the Faculty of Medicine, Universitas Sumatera Utara class 2018 and 2019 regarding risky pregnancies was good (85.7%). Conclusion. Students of the Faculty of Medicine, Universitas Sumatera Utara, class of 2019 have better knowledge than students of class 2018.

What do general practitioners want from specialist alcohol and other drug services? A qualitative study of New South Wales metropolitan general practitioners.

Alcohol and other drug (AOD) use is common in Australia with significant health and community impacts. General practitioners (GP) often see people with AOD use; however, there is little research to understand how specialist AOD services could assist GPs in the management of patients with AOD issues. Thirty-five GPs working in general practice in a metropolitan area in Sydney in New South Wales, Australia, participated in one of three focus groups. The groups were recorded, transcribed and thematically analysed. The five themes raised by participants were: GP personal agency and interest in AOD issues; GP education and training gaps; improving pathways between GP and specialist AOD services; easier access to AOD specialist advice; and improving access to collaborative care for patients with complex AOD presentations. Participants requested education on screening, assessing, managing AOD issues, focused on alcohol, stimulants and high-risk prescription medicines. They suggested better referral processes, discharge summaries and care planning for complex presentations. Participants wanted easy access to specialist advice and suggested collaborative care assisted by experienced AOD liaison nurses. Australia has several existing programs; online referral pathways and specialist phone advice, that address some of the issues raised. Unfortunately, many participants were not aware of these. GP education must be supported by multiple processes, including durable referral pathways, ready access to local specialist advice, clear communication (including patient attendance and a treatment plan), care planning and written summaries.

Integration of theoretical principals of psychosomatic medicine and practice of Balint supervision in physicians in the promotion of effective professional communication

The review of the Russian and foreign literature on the relationships of psychosomatic medicine and Balint supervision of physicians was conducted. We selected and analyzed articles from MEDLINE / PubMed Elibrary.ru, Scopus databases during from 1990 till 2020, international medical journals and collections of scientific papers as well as relevant references in the bibliography of the analyzed articles. The search was carried out with the usage of search queries of various combinations of the specified key words.The “philosophy” of psychosomatic medicine and the theory of Balint supervision have the evident common historical grounds. Psychosomatic medicine and Balint supervision are united by the conception that the patient’s perceptions about his/her illness, related to it experiences and behavior as well as their relationships to his/her unconscious are very important in the therapy process. That means that the experiences and behavior of a physician related to the complicated communication with the patient are important as well. The patient has to be no more a passive object of the care so the process of therapy obtains the character of interpersonal communication and the mutual influence between the patient and the physician. This point is what Balint supervision is focused at. The technology of Balint group work helps physicians to shift an emphasis in the clinical practice from the disease-centered to the patient-centered approach. The analysis of Balint groups effectiveness provided during more than fifty years brought an evidence that Michael Balint presented very efficient method which helped physicians in different medical fields and psychologists reduce their emotional arousal in the treatment of “difficult” patients who are patients with psychosomatic disorders very frequently. The integrative relationships between basic approaches of psychosomatic medicine and Balint supervision in physicians and psychologists are described. The history of the relations and common principles related to the attention to the complexed issues of physician-patient communication and the therapy in psychosomatic disorders which becomes more successful due to the impact of analytical Balint supervision, are analyzed. The significance of Balint groups work in the training of the health care professionals, who are treating patients with psychosomatic disorders, difficulties and perspectives of implementation of Balint group method into the system of education and training of general practitioners, psychiatrists and psychotherapists are presented.

The impact of COVID-19 on the well-being, education and clinical practice of general practice trainees and trainers: a national cross-sectional study

BackgroundCOVID-19 has changed General Practice (GP) education as well as GP clinical activities. These changes have had an impact on the well-being of medical trainees and the role of GP plays in the society. We have therefore aimed to investigate the impact that COVID-19 has had on GP trainees and trainers in four domains: education, workload, practice organization and the role of GP in society.Design: a cross-sectional study design was used.MethodsThe Interuniversity Centre for the Education of General Practitioners sent an online survey with close-ended and open-ended questions to all GP trainees and trainers in Flanders, active in the period March – September 2020. Descriptive statistics were performed to analyze the quantitative data and thematic analysis for the qualitative data.Results216 (response 25%) GP trainees and 311 (response 26%) trainers participated. GP trainees (63%, N = 136) and trainers (76%, N = 236) reported new learning opportunities since the COVID-19 pandemic. The introduction of telehealth consulting and changing guidelines required new communication and organizational skills. Most of the GP trainees (75%, n = 162) and trainers (71%, n = 221) experienced more stress at work and an overload of administrative work. The unfamiliarity with a new infectious disease and the fact that COVID-19 care compromised general GP clinical activities, created insecurity among GP trainers and trainees. Moreover, GP trainees felt that general GP activities were insufficiently covered during the COVID-19 pandemic for their training in GP. GP trainers and trainees experienced mutual support, and secondary support came from other direct colleagues. Measures such as reducing the writing of medical certificates and financial support for administrative and (para) medical support can help to reprioritize the core of GP care.COVID-19 has enhanced the use of digital learning over peer-to-peer learning and lectures. However, GP trainees and trainers preferred blended learning educational activities.ConclusionsCOVID-19 has created learning opportunities such as telehealth consulting and a flexible organization structure. To ensure quality GP education during the pandemic and beyond, regular GP care should remain the core activity of GP trainees and trainers and a balance between all different learning methods should be found.

Analysis of the stress level of resident physician education program specialist in Obstetrics and Gynecology Andalas University in 2020

Introduction:The Specialist Doctor Education Program (PPDS) is one of the academic education of general practitioners and is known as a resident doctor to become a specialist and is at the forefront ofhealth services. Resident doctors are expected to be flexible clinicians, educators, researchers, andadministrators by the end of their residency training. It often requires stressful hard work, and is oftenreported as a cause of burnout, anxiety, depression, anger, irritability, anxiety, sleep deprivation,fatigue, substance abuse, and psychosocial problems. One of the problems that often occurs with residents is long working hours. Based on the working hours regulation adopted in the UK since 1998, namely the European Working Time Directive (EWTD) and a policy change in 2007 and 2009 called The New Deal, the working hours of resident doctors to achieve optimal performance is 56 hours per week. In the initial survey of 10 PPDS Obgin Unand residents, network station residents still had to carry out their duties 24 hours a day for 1 month in the hospital. Except for applying for certain permits. If you add up, the average working hours in 1 week is more than 60 working hours. Objective: This study aims to determine the stress level of resident doctors in the Education Program of Obstetric and Gynecology Specialist, Andalas University in 2020Methods: This research is a quantitative study followed by qualitative method using an explanatory design. Data was taken using the triangulation method. The data was taken from questionnaires, Focus Group Discussion (FGD), and document review from Obstetric and Gynecology residents of all semester at Andalas University.Results: The highest stress level in the Obstetric and Gynecology residents of Andalas University in 2020 was 60.3% at moderate level, there was a relationship between stress levels with graduation and semester. The highest stress domain is ARS (Academic Related Stressor) and SRS (Social Related Stressor).Conclusion: the stress level in the Obstetric and Gynecology residents of Andalas University in 2020 is at a moderate level, and the highest stress domain is ARS (Academic Related Stressor) and SRS (Social Related Stressor).Keywords: Resident Doctor; Obstetric and Gynecology; stress

Q fever prevention: Perspectives from university animal science and veterinary students and livestock farmers.

To explore animal science and veterinary students' and livestock farmers' perceptions concerning Q fever prevention. An online survey with an open-ended question seeking knowledge and perceptions about Q fever prevention was distributed among participants during March-September 2019. We applied thematic analysis to identify emerging themes. Animal science and veterinary students enrolled at the University of Adelaide and members of Livestock South Australia representing cattle, sheep and goat farmers in South Australia. A total of56 animal science and veterinary students and 154 livestock farmers responded to the open-ended question. Not applicable. Perceived challenges and opportunities for a coordinated Q fever prevention approach including human vaccination reported by the participants. Two major themes arose in each group. Students and farmers viewed Q fever vaccination as important. However, excessive cost for students was a barrier and for farmers, it was general practitioners' lack of knowledge of Q fever and access to an accredited immunisation provider. Similarly, both groups highlighted the need for education and increasing public and community awareness of Q fever. Our findings underscore that a sector-wide approach involving community awareness programmes, education and training for general practitioners, and subsidised vaccination as well as commitment from government and industry partners may contribute to reducing the burden of Q fever among at-risk populations.

General practitioners' knowledge, attitude, and practices regarding optional immunization in urban area of Sangli District: A cross sectional study.

Immunization is one of the most effective, safest, and efficient public health interventions. Thousands of children are still dying from vaccine-preventable diseases every year. Administration of optional vaccines such as Hib, Inactivated polio vaccine (IPV), typhoid, hepatitis A, chickenpox, and rotavirus at appropriate age helps them in protecting from various diseases in under 18 population. Also, the attitude and practices of general practitioners have an important role in preventing modern diseases in children. This study was undertaken to assess the level of knowledge, attitude, and practices regarding optional vaccines among the general practitioners. Study type: Cross-sectional. Study setting: Sangli-Miraj-Kupwad corporation area. Study subject: Practicing General Practitioners willing to participate. Study period: July 2018-Sep 2019. Study tools: predesigned, pretested questionnaire. Statistical analysis: by using Microsoft Excel and SPSS 22.0 version software. Out of 162 general practitioners, 105 were males and 57 were females. A total of 83 (51.23%) general practitioners had good knowledge about optional vaccines in their practice. Good knowledge was found to be highest among MBBS practitioners 38 (55.9%). A total of 118 (72.84%) general practitioners were counseling the parents regarding optional vaccines. There is a need to create training programs and continuing medical education (CMEs) for general practitioners (GPs) on optional vaccination practices to improve knowledge.

Unmasking and Managing Hypercalcaemia-In Clinical Settings!

Objective: In this article I present 2 cases of hypercalcaemia identified and managed in 2021 in smaller settings and review of literature of such cases in bigger facilities India with an objective of alerting private practitioners’ role in managing such cases efficiently. Hypercalcaemia is not a disease but just a biomarker of a total serum calcium concentration > 10.4 mg/dL (> 2.60 mmol/L) or ionized serum calcium > 5.2 mg/dL (> 1.30 mmol/L). Principal causes include Primary hyperparathyroidism, vitamin D toxicity, and cancer. The serum Calcium and Phosphorous (Ca/P) ratio is a most valuable tool for the diagnosis of Primary hyperparathyroidism, better than serum Calcium alone. Locations of cases reported: Kalimpong in West Bengal and Chikkaballapur near Bengaluru Participants: i) A - 66-year-old Kamala Pradhan, a known diabetic, my patient in Delhi for last 5 years presenting with pruritus, muscle weakness, lack of appetite and weight lost for 3 months and accidentally diagnosed after a Blood test as moderate hypercalcaemic due to over consumption of Vit. D (weekly 60 K units for 3 years) and ii) the second case of a rural 45 year’s old women from Bengaluru in May 2021 diagnosed as Cancer Cervix stage 3 at a private cancer hospital in Bangalore who succumbed in about 3 week’s time Measurements: i) In the first a serum test indicated serum Calcium level 20 mg/dl and Vitamin D 150ng/ml in first test and after management for a months’ time Calcium levels came down to 10mg/dl and Vitamin D levels to 50ng/ml. ii) Second case had calcium level of 120 mg/dl indicating Calcium crisis. Results: The first case of moderate hypercalcemia due to Vit D intoxication improved, the Calcium level came down to 10mg/dl and D Vitamin came down to 50ng/ml with clinical improvements in 12 weeks’ time. The Calcaemic crisis was not monitored as the patient died within 3 weeks of starting treatment. Conclusion: A case of successful management of moderate due to Vitamin D intoxication and another case of calcinemia crisis due to advanced cervical cancer, with serious complications, and death are reported for education of general practitioners. Material & Methods: The author a family physician for 54 years and a Public Health practitioner for 45 years, have used 2 cases of hypercalcaemia followed in 2021 and review some other published cases, along with a few retrospective studies in India and abroad, that lead to hypercalcaemia and current recommendations for the management of elevated serum calcium levels.

Qualitative study of GPs’ views and experiences of population-based preconception expanded carrier screening in the Netherlands: bioethical perspectives

ObjectiveBetween 2016 and 2017, a population-based preconception expanded carrier screening (PECS) test was developed in the Netherlands during a pilot study. It was subsequently made possible in mid-2018 for couples...

TP6.2.16General practitioner compliance with Scottish cancer referral guideline for Oesophago-gastric cancer

Abstract Aims The outcome of oesophago-gastric cancer is often poor. Timely referral of suspected cancer is essential for early diagnosis and optimal outcome. This study aims to audit the General Practitioners (GPs) compliance with the Scottish referral guidelines for suspected oesophago-gastric cancer. Methods A retrospective cohort study of all newly diagnosed oesophago-gastric cancers who were referred from the primary care and discussed in a single regional MDT was performed between October 2019 and September 2020. Electronic records were interrogated and symptomatology audited against the Scottish cancer referral guidelines. Results Of the 349 patients, 227 (65.0%) were referred from the primary care. 150 (66.1%) were male and the mean age was 69.5 ± 10.9 years. Mean Scottish Index of Multiple Deprivation was 5 ± 3. 149 (65.6%) had dysphagia and/or odynophagia and 181 (79.7%) were oesophageal cancers. 67 (29.5%) were T4 disease and 87 (38.3%) were metastatic at presentation. Urgency of referral was: 25 (11.0%) routine, 54 (23.7%) urgent and 148 (65.2%) Urgent Suspicion of Cancer (USOC). 192 (84.6%) patients qualified to be referred as USOC, of these 138 (71.9%) were actually referred as USOC. Of the 35 (15.4%) patients who did not qualify for the USOC referral, 10 (28.6%) patients were referred as USOC. The sensitivity was 71.9% and specificity 71.4%. Conclusions GP compliance with the adherence with the National guidelines remains a barrier in the USOC in oesophago-gastric cancer. Further GP education and awareness is required to improve their compliance.

Deprescribing intervention activities mapped to guiding principles for use in general practice: a scoping review

ObjectiveTo identify and characterise activities for deprescribing used in general practice and to map the identified activities to pioneering principles of deprescribing.SettingPrimary care.Data sourcesMedline, EMBASE (Ovid), CINAHL, Australian New Zealand...

Family medicine and international cooperation in the North: A step ahead

International cooperation contributed to the development of family medicine in the North of Russia, it was characterized by a system approach and interdisciplinary interaction. The article presents the results of Russian-Norwegian projects that were developed with the active participation of the Department of Family Medicine of NSMU (Arkhangelsk), as well as the main aspects of the projects: significance for practical health care, research, and educational components.
 Several complementary projects aimed at the development of primary health care, such as Reform of Arkhangelsk Region Health Care System with a special emphasis on primary care, System approach to NCD prevention and Suicide prevention in the Arkhangelsk region were implemented together with the Norwegian Directorate of Health. The POMOR Program specialist training in general practice in Northern Russia project (together with the University of Troms The Arctic University of Norway, Norwegian Medical Association, and Norwegian Centre for Rural Medicine) facilitated the development of tutorship in family medicine in the Arkhangelsk and Murmansk regions. Better interaction between psychiatrists and general practitioners in the mental health sphere became an essential area of international collaboration (Integrating mental health into primary care in the Arkhangelsk County, Russia: the Pomor model in psychiatry project together with the University of Troms The Arctic University of Norway and University Hospital of North Norway, Troms). The education component of the projects got a sequel in the continued medical education system of NSMU while the scientific one was continued in the form of publications in international and Russian journals, and masters thesis defense of public health degrees. The project's results were consistently presented at the international and Russian forums. General practitioners education is a cross-cutting theme for the cooperation on the path from a beginner to an expert and plays a special role in support of GPs during the COVID-19 pandemic.

Conceptual approaches to the development of continuing medical education for general practitioners in Moscow

The article is devoted to the current state of continuing medical education for general practitioners in the city of Moscow and is based on a survey of general practitioners working in Moscow. Results demonstrate a lack of satisfaction with the organisation and content of training in its previous format, the absence of significant changes in the learning objectives following education reform and an ambiguous attitude towards this reform. The minimum continuing education requirements for general practitioners working in the city of Moscow were shown to consist of day release, short-term training, theoretical and practical orientation and the application of contemporary educational technologies. Conceptual approaches to the development of continuing medical education in the field of general medical practice in Moscow were formulated. These comprised organisation of training, setting of learning objectives, selection of forms and methods of training, determination of interactive training content, application of a competency-based approach and individualisation of the educational path.

Deprescribing in older patients by early-career general practitioners: Prevalence and associations.

Deprescribing is the health-professional-supervised process of withdrawal of an inappropriate medication to manage polypharmacy and improve patient outcomes. Given the harms of polypharmacy and associated inappropriate medicines, practitioners, especially general practitioners (GPs), are encouraged to take a proactive role in deprescribing in older patients. While trial evidence for benefits of deprescribing is accumulating, there is currently little epidemiologic evidence of clinicians' (including GPs') deprescribing behaviours. We aimed to establish the prevalence and explore associations of deprescribing of inappropriate medicines by early-career GPs. A cross-sectional analysis of the ReCEnT study of GP registrars' in-consultation experience, 2016-18. Participants recorded 60 consecutive consultations, three times at 6-month intervals, including medicines ceased (our measure of deprescribing). The outcome was deprescribing of an inappropriate medicine (defined by a synthesis of three accepted classification systems) in patients 65years or older. Logistic regression determined the associations of deprescribing inappropriate medicines. One thousand one hundred and thirteen registrars reported 19581 consultations with patients 65years and older. Inappropriate medicines were deprescribed in 2.6% (95% CIs 2.4%-2.9%) of consultations. Of deprescribed medicines, 43% had been prescribed for three months or longer. Most commonly deprescribed were opioids (19%), proton pump inhibitors (9.2%), anti-inflammatory drugs (9.0%), statins (7.8%), and antidepressants (6.6%). The most common reason for deprescribing was: "no longer indicated" (38%). Significant adjusted associations of deprescribing included patients identifying as Aboriginal or Torres Strait Islander (OR 2.86); continuity-of-care (ORs 0.71 and 0.20 for the patient being new to practice and to the registrar, respectively); inner-regional compared to major-city location (OR 1.33); the problem/diagnosis being chronic (OR 1.90); and longer consultations (OR 1.03 per minute increase in duration). These findings will have important implications for the education of GPs in deprescribing as a clinical skill.