Experiences Of General Practitioners Research Articles

General dental practitioners' and dental hygienists' perspectives on the guideline for periodontal screening, diagnostics, and treatment in general practice

In January 2021, the guideline 'Periodontal screening, diagnosis, and treatment in general practice' was introduced as a successor to the so-called paro protocol. Simultaneously, the Dutch Periodontal Screening Index was replaced by the Periodic Periodontal Screening. The experiences of general dental practitioners and dental hygienists with the new guideline were evaluated in the autumn of 2022. Random groups of 1,000 general dental practitioners and 400 dental hygienists were invited to answer an online questionnaire on this topic: 125 (12.5%) general dental practitioners and 102 (25.5%) dental hygienists responded. By the end of 2022, a large majority of both groups were using the Periodic Periodontal Screening. Both professional groups were satisfied with the new guideline. Dental hygienists used the Periodic Periodontal Screening in more cases than general dental practitioners and were also more frequently satisfied with the new guideline. Both oral healthcare professionals believed that the Periodic Periodontal Screening offers better opportunities to involve the patient in periodontal care compared to the Dutch Periodontal Screening Index.

Lyme disease in UK primary care: a knowledge, attitude and practice survey.

Lyme disease (LD) cases in the UK most commonly present within the primary care setting. Despite an upward trend of incidence, little is known regarding general practitioner (GP) experience with diagnosis and treatment. This study aims to describe baseline primary care clinician Knowledge, Attitude and Practice (KAP) in Scotland and England. Online KAP survey on Lyme disease for UK based practising GPs. An online KAP questionnaire was developed for use in UK primary care. The survey was distributed through UK based research networks, professional societies and via social media. 191 complete responses were analysed (England n=130, Scotland n=61). The Scotland-based respondent group had more relevant consultations in the previous 3 years. Respondents from Scotland demonstrated a greater awareness that erythema migrans (EM) is pathognomonic for Lyme disease and that serological testing of this patient group is not indicated. Less common cardiac and neurological symptoms were not as well associated with Lyme disease by both respondent groups for the former and England-based respondents for the latter. Prescribing according to the National institute for Health and Care Excellence (NICE) guidance was identified in 70% of Scotland and 42% of England-based GP responses. Targeted resources may improve clinician confidence on exposure risk, symptom recognition, testing limitations and treatment dose and duration. Scotland-based respondents' better survey performance potentially reflects greater clinical exposure and public awareness of the disease, due to high endemicity within the nation.

General practitioners' experiences delivering essential care services during the 2020 and 2021 COVID-19-related lockdowns.

The UK provided guidance for general practitioners (GPs) to deliver essential care services during the COVID-19 pandemic. Our objective was to describe local GP experiences and approaches to delivering care while similar formal guidance in Australia was unavailable. Two hundred and ninety-one GPs who practised during the March 2020 to December 2021 COVID-19 lockdowns in Melbourne and Sydney undertook an electronic survey exploring perceptions of essential care service delivery. The provision of care by Australian practices was compared to UK Royal College of General Practitioners' recommendations. Of 274 completed surveys, Australian GP practices were 60% concordant with UK guideline recommendations. There was a large shift towards telehealth service provision across the board, from diagnosis to follow-up. Most care continued if it was deliverable through telehealth or had urgent or time-sensitive need. Local guidance for delivery of essential care services should be developed for future calamities, informed by GPs' experience practising during the COVID 19 pandemic and considering Australian contextual factors.

General practice trainee, supervisor and educator perspectives on the transitions in postgraduate training: a scoping review

Transitions are a period and a process, through which there is a longitudinal adaptation in response to changing circumstances in clinical practice and responsibilities. While the experience of the transition...

Low-dose titrated amitriptyline as second-line treatment for adults with irritable bowel syndrome in primary care: the ATLANTIS RCT.

Irritable bowel syndrome, characterised by abdominal pain and a change in stool form or frequency, is most often managed in primary care. When first-line therapies are ineffective, National Institute for Health and Care Excellence guidelines suggest considering low-dose tricyclic antidepressants as second-line treatment, but their effectiveness in primary care is unknown and they are infrequently prescribed by general practitioners. To evaluate the clinical and cost-effectiveness of low-dose titrated amitriptyline as a second-line treatment for irritable bowel syndrome in primary care. A pragmatic, randomised, multicentre, two-arm, double-blind, placebo-controlled trial. A nested, qualitative study explored participant and general practitioner experiences of treatments and trial participation, and implications for wider use of amitriptyline for irritable bowel syndrome in primary care. Participants, clinicians, investigators and analysts were masked to allocation. Fifty-five general practices in three regions in England (Wessex, West of England, West Yorkshire). Patients aged ≥ 18 years meeting Rome IV criteria for irritable bowel syndrome with ongoing symptoms after trying first-line treatments and no contraindications to TCAs. Amitriptyline 10 mg once-daily, self-titrated by participants to a maximum of 30 mg once-daily or matched placebo for 6 months. Participants randomised 1 : 1 with most having the option to continue blinded treatment for a further 6 months. The primary participant-reported outcome was the effect of amitriptyline on global irritable bowel syndrome symptoms at 6 months, measured using the irritable bowel syndrome Severity Scoring System, with a 35-point between-group difference defined as the minimum clinically important difference. The key secondary outcome was the proportion of participants reporting subjective global assessment of relief at 6 months, defined as somewhat, considerable, or complete relief of symptoms. Other secondary outcomes included: effect on global symptoms, via the irritable bowel syndrome Severity Scoring System, and subjective global assessment of relief of irritable bowel syndrome symptoms at 3 and 12 months; effect on somatic symptom-reporting at 6 months; anxiety an-d depression scores; ability to work and participate in other activities at 3, 6 and 12 months; acceptability, tolerability and adherence to trial medication. Four hundred and sixty-three participants were randomised to amitriptyline (232) or placebo (231). An intention-to-treat analysis of the primary outcome showed a significant difference in favour of amitriptyline for irritable bowel syndrome Severity Scoring System score between arms at 6 months [-27.0, 95% confidence interval (CI) -46.9 to -7.10; p = 0.008]. For the key secondary outcome of subjective global assessment of relief of irritable bowel syndrome symptoms, amitriptyline was superior to placebo at 6 months (odds ratio 1.78, 95% CI 1.19 to 2.66; p = 0.005). Amitriptyline was superior to placebo across a range of other irritable bowel syndrome symptom measures but had no impact on somatoform symptom-reporting, anxiety, depression, or work and social adjustment scores. Adverse event trial withdrawals were more common with amitriptyline (12.9% vs. 8.7% for placebo) but most adverse events were mild. The qualitative study thematically analysed 77 semistructured interviews with 42 participants and 16 GPs. Most participants found the self-titration process acceptable and empowering. General practitioners should offer low-dose amitriptyline to patients with irritable bowel syndrome whose symptoms do not improve with first-line therapies. Guidance and resources should support GP-patient communication to distinguish amitriptyline for irritable bowel syndrome from use as an antidepressant and to support patients managing their own dose titration. This trial is registered as ISRCTN48075063. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/162/01) and is published in full in Health Technology Assessment Vol. 28, No. 66. See the NIHR Funding and Awards website for further award information.

Care needs of patients with the post-COVID syndrome in Dutch general practice: an interview study among patients and general practitioners

BackgroundThe post-COVID syndrome (PCS) has a large impact on an individual’s daily life. The wide variety of symptoms in PCS patients and the fact that it is still relatively new makes it difficult for general practitioners (GPs) to recognize, diagnose and treat patients with PCS, leading to difficulties in assessing and fulfilling healthcare needs. It is largely unknown what the experiences of Dutch patients and GPs are with PCS and, therefore, we gained insight into the different aspects of living with PCS and the associated healthcare needs.MethodsSemi-structured interviews were performed with 13 self-reported PCS patients (varying in sex, age, education, and health literacy) and 6 GPs (varying in gender, age, and type of practice) between January-July 2022. Patients and GPs were most likely unrelated (not in the same practices). The data have been analysed using the Thematic Analysis method.ResultsExperiences appeared to vary between two types of PCS patients that emerged during the interviews: (1) individuals with good pre-existing health status (PEHS) who are severely affected by PCS and have difficulty recovering and (2) individuals with poorer PEHS whose health became even poorer after COVID-19 infection. The interviews with PCS patients and GPs revealed two main themes, in which the types of patients differed: (1) aspects of living with PCS; individuals with good PEHS mainly experience symptoms when overstimulated, while individuals with poorer PEHS generally feel exhausted continuously. (2) Healthcare experiences; GPs emphasized that individuals with good PEHS seem to benefit from support in distributing their energy by careful planning of daily activities, whereas individuals with poorer PEHS require support in activation. Patients and GPs emphasised the importance of taking patients seriously and acknowledging their symptoms. Finally, the patients interviewed indicated that some GPs doubted the existence of PCS, resulting in insufficient recognition.ConclusionAwareness of the differences in needs and experiences of the two types of PCS patients could contribute to more appropriate care. Acknowledgement of PCS by GPs as a real syndrome is important for patients and plays an important role in coping with or recovering from PCS. A multidisciplinary person-centred approach is important and can be coordinated by a GP.

“It’s that gut feeling isn’t it”: general practitioner experiences of safeguarding in care homes for older people

“It’s that gut feeling isn’t it”: general practitioner experiences of safeguarding in care homes for older people

Evaluation of utilization and consequences of CRP point-of-care-testing in primary care practices: qualitative interviews with general practitioners from Germany.

The use and advantages of point-of-care tests (POCTs) for C-reactive protein (CRP) in general practice, especially for upper respiratory tract infections (uRTIs), have been studied extensively. However, there is limited knowledge about test indications, prerequisites, and integration of these tests into everyday practice. This study aims to investigate the attitudes and experiences of general practitioners (GPs) in Germany regarding the use of semi-quantitative CRP-POCTs. The study places special emphasis on implementation in routine care, including testing procedures, feasibility, opportunities and barriers for specific consultation scenarios, as well as test indications and their impact on GP-patient communication. Qualitative interview study with 10 GPs (May/2023 to Aug/2023) METHOD: Ten German GPs who participated in an observational study on CRP-POCT use in general practices were interviewed using semi-structured interviews. Audio recordings were transcribed and content analysis was performed. Interviewed GPs stated that CRP-POCTs offer several advantages for various treatment cases. They improve diagnostic confidence and certainty of GPs' therapeutic decisions, and offer a broad spectrum of indications and application scenarios. Additionally, they have a positive impact on GP-patient communication, and their ease of use enables rapid implementation into existing workflows. On the other hand, CRP-POCT increase the time required for test performance and patient consultation. Due to the numerous benefits of semi-quantitative CRP-POCTs, interviewed GPs have a favourable attitude towards their regular integration into everyday practice. Implementation barriers include increased time and personnel expenses for testing and inadequate reimbursement by German statutory health insurance.

Using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in UK general practice: a qualitative exploration of the experiences of general practitioners, community-based nurses, care home staff, patients and their relatives

Using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in UK general practice: a qualitative exploration of the experiences of general practitioners, community-based nurses, care home staff, patients and their relatives

General practitioners’ knowledge and practice in consultations with (potential) torture victims: a qualitative pilot study from Norway

Background According to the UN Committee Against Torture, all state parties to the Torture Convention have a responsibility to meet the rehabilitation needs of torture victims who have sought asylum within their borders. General practitioners (GPs) can play a crucial role in identifying torture victims and securing rehabilitation when needed. There is a pressing knowledge gap on the knowledge and practices of GPs vis-à-vis potentially tortured patients, and an urgent need for research that investigates GPs’ practices of identification, referral, and rehabilitation – in Norway and beyond. This article presents an exploratory qualitative pilot study that investigates the experiences of GPs in Oslo vis-à-vis this patient group. Methods Semi-structured interviews with five experienced GPs in the greater Oslo area. Interview data was analyzed through thematic analysis and discussed within a theoretical framework seeing GPs as street-level bureaucrats. Results Issues that emerged in the pilot involve a consistent professional confidence and a particular concern for victims of sexual violence and sexualized torture. The pilot also found a troubling commonsensical reasoning about identification in the asylum process. The GPs asked for the re-establishment of specialist rehabilitation centers for refugees and torture victims to consult in case of need. Alas, the study also confirmed that GPs are a difficult profession to recruit for research. Conclusions This study indicates that GPs are important actors in terms of identifying torture victims after resettlement, but that there are shortcomings in their training and knowledge, in the overall organization of the healthcare system, and in specialized healthcare, that limit prospects for rehabilitation.

General practitioners' views and experiences of postpartum contraception counselling and provision: a qualitative-descriptive study.

To explore Australian general practitioners' views and experiences of undertaking postpartum contraception counselling and provision during the 6-8-week postnatal check. Qualitative-descriptive study; semi-structured online interviews. General practitioners who provide postnatal care in Australian primary health care, recruited using purposive, convenience, and snowball methods, 16 June - 6 July 2023. Views and experiences of postpartum contraception counselling and provision. Twenty-three general practitioners from six states were interviewed; the mean interview time was 30 minutes (range, 21-47 minutes), twenty-two participants were women, and twenty-one worked in metropolitan areas. All participants provide postnatal checks and had the training and facilities needed for providing contraceptive implant insertions. Twelve participants had training in intrauterine device (IUD) insertion, and twenty-one worked in practices with facilities for IUD insertions. Three themes were constructed: views and preferences regarding postnatal contraception counselling; postpartum provision of long-acting reversible contraception (LARC); and opportunities for improving postpartum contraception care in general practice. While most participants recommended LARC methods at postnatal checks, only twelve were trained to insert IUDs. Time constraints, limited access to training, limited financial support, and the lack of guidelines for postnatal checks and contraception care were seen as impeding postpartum contraception counselling. Participants highlighted the importance of access to education and training, appropriate remuneration for general practitioners, multidisciplinary collaboration among health professionals, the inclusion of practice nurses, and raising awareness among mothers of the importance of postnatal checks and postpartum contraception care. General practitioners are well placed to facilitate discussions about contraception with women who have recently given birth. Postpartum contraception care in general practice could be improved by better access to contraception training, appropriate remuneration for contraception procedures, greater multidisciplinary collaboration, and national postnatal check and postpartum contraception guidelines.

General practitioner support needs to implement cardiovascular disease risk assessment and management guidelines: Qualitative interviews.

Previous research identified numerous barriers to general practitioner (GP) use of cardiovascular disease (CVD) risk guidelines, and it is unclear whether these issues have been resolved. This study explored recent GP experiences. Interviews with 18 GPs in an Australian state with relatively few COVID-19 cases in 2021 were transcribed and coded using a framework analysis approach, with data mapped to five previously identified CVD risk assessment strategies: absolute risk focused, absolute risk adjusted, clinical judgement, passive disregard and active disregard. GPs used various CVD risk calculators to inform clinical decision making, but there were concerns about accuracy, the role of extra risk factors and less 'personalised' assessment. GPs addressed these concerns by requesting additional tests, subjectively adjusting the CVD risk assessment to account for extra risk factors and focusing on individual risk factors. Many barriers to CVD risk assessment guidelines remain. GP support is needed to implement revised guidelines.

Early-career general practitioners’ career intentions in Estonia: A qualitative study

Background The shortage of general practitioners (GPs) is a worsening problem in many countries and poses a threat to the services provided by primary care and by extension for the entire healthcare system. Issues with GP workforce recruitment and retention can be reasons for this shortage. Objectives To describe GP trainees and newly qualified GPs experiences and perceptions on how their training and early experiences of work influence their career intentions in primary care in Estonia. Methods A qualitative study with GP trainees (n = 12) and newly qualified GPs (n = 13) using semi-structured group interviews (n = 6) was conducted. Interviews were conducted from October until November 2020. Data were analysed using thematic analysis with NVivo Software. Results Although early-career GPs in Estonia envision their future roles as GP practice owners with patient list, this is often postponed due to various reasons. Early-career GPs expressed a sense of unpreparedness to fill all the roles of GPs’ and found the process of establishing a GP practice and taking on a patient lists very complicated. They value work-life balance and prefer workplaces, which offer flexible working conditions. Conclusion Potential strategies were identified to enhance the willingness of early-career GPs to continue their career as GP practice owners with patient list: improving the GP training program by placing more emphasis on managing skills and making the process of establishing GP practice and taking on a patient list less bureaucratic and more accessible.

General practitioners’ and women’s experiences of perimenopause consultations: A qualitative evidence synthesis protocol

Background Perimenopause precedes menopause and can cause a myriad of symptoms for women. General practitioners (GPs) are frequently the first contact for perimenopausal women with symptoms. However, women express feeling dissatisfied with the consultations they have with their GPs for perimenopausal symptoms. Moreover, diagnostic difficulties can make these consultations challenging for GPs. Despite these challenges, research to date has focused on menopause, not the transition to menopause. To date, no evidence synthesis has examined how women experience perimenopause consultations, nor how GPs experience providing care to these women. Objective To systematically search, collate, and appraise the qualitative literature to understand general practitioners' and women's experiences of perimenopause consultations and examine how treatment decisions are made during consultations. Methods A meta-ethnography will be conducted following Sattar et al. (2021) guidelines for conducting a meta-ethnography as developed by Noblit and Hare (1988). Seven databases will be systematically searched. To be included, studies must report on the experiences of either general practitioners and/or perimenopausal women and published since 2014 to capture the most up-to-date evidence. Quality assessment will be conducted using CASP (Critical Appraisal Skills Programme) tools. A GRADE-CERqual (Confidence in the Evidence from Reviews of Qualitative research) will be conducted to assess the confidence of the findings. PROSPERO registration number CRD42024520537. Discussion Findings will provide new and useful insight into how GPs and women experience consultations for perimenopause and how decisions are made during these consultations.

A mixed methods investigation into GP attitudes and experiences of using social prescribing in their practice

Abstract Aim Social prescribing (SP) enables clinicians to signpost patients to non-medical services in the community in order to support their psycho-social needs. SP has been promoted as a positive service delivery model for primary and community care; however, there are few data on the views of doctors working in this area on the effectiveness of SP and its implementation. Subject and methods This study used a mixed methods approach to examine attitudes and experiences of general practitioners (GPs) on their use of SP. GPs completed an online survey (n = 102), provided narrative written responses (n = 55) and took part in semi-structured interviews on the topic (n = 8). Results Principal component analysis (PCA) showed that 90% of respondents use SP in their practice, with significant factor loadings on six separate components. Thematic analysis revealed three main themes, which were then combined with the PCA components to derive overarching themes that underpin effective implementation of SP: (1) perceptions of effectiveness and efficacy of SP, (2) training and awareness, and (3) structure and operational delivery. Conclusion This study is one of the first to explore attitudes of doctors to SP. Whilst data shows that most respondents are supportive of SP in principle, the analysis also reveals that there are specific barriers that need to be overcome to enable effective implementation.

Exploring the impact of pharmacist-supported medication reviews in dementia care: experiences of general practitioners and nurses

BackgroundDementia is a major global public health challenge, and with the growing elderly population, its prevalence is expected to increase in the coming years. In Sweden, municipalities are responsible for providing special housing for the elderly (SÄBO), which offers services and care for older individuals needing specific support. SÄBO is both the person´s home and a care environment and workplace. Polypharmacy in patients with dementia is common and increases the risk of medication interactions. Involving clinical pharmacists in medication reviews has been shown to enhance medication safety and improve prescribing practices. However, the views of the standard care team involved in medication prescribing, administration, monitoring and documentation on integrating pharmacist services have received less attention. Thus, this study aims to explore how pharmacists’ contributions can enhance medication safety, improve patient care efficiency, and potentially alleviate the workload of general practitioners for people with dementia living in special housing.MethodsThis study has a descriptive qualitative study design using semi-structured interviews and qualitative content analysis. The study was conducted in a southern Swedish special housing and included nurses, assistant nurses, general practitioners (GPs), and a pharmacist. Due to the COVID-19 pandemic, interviews were conducted over the phone. The Swedish Ethical Review Authority approved the study.ResultsThe analysis revealed three main categories, and eleven subcategories.: (1) Integrating multidisciplinary approaches for holistic dementia care, (2) Strengthening dementia care through effective medication management and (3) Advancing dementia care through pharmacist integration and role expansion. Nurses focused on non-pharmacological treatments, while GPs emphasized the importance of medication reviews in assessing the benefits and side-effects of prescribed medication. Pharmacists were valued for their reliable medication expertise, appreciated by GPs for saving time and providing recommendations prior to consultations with individuals with dementia and their next-of-kin. Although medication reviews were considered beneficial, there was skepticism about their ability to solve all medication-related problems associated with dementia care.ConclusionsThis study highlights the critical role pharmacists play in enhancing medication safety and patient care efficiency in special housing for individuals with dementia. Despite the value of their contributions, communication barriers within healthcare teams pose significant challenges. Recognising potential pharmacist role expansion is essential to alleviate the workload of GPs and ensure effective collaborative practices for better patient outcomes.

Sicherstellung der hausärztlichen Versorgung in Deutschland – Befunde einer quantitativen Befragung von Allgemeinmediziner*innen

ZusammenfassungHintergrundAngesichts der Gefahr einer Verknappung niedergelassener Allgemeinmediziner*innen stellt sich die Frage, welche Konzepte wirksame Beiträge leisten können, um eine drohende Mangelversorgung abzuwenden. Bis dato fehlt es an Studien, die beleuchten, wie Hausärzt*innen aus ihrer beruflichen Erfahrung zu verschiedenen Ansätzen zur langfristigen Sicherstellung der Primärversorgung stehen.Ziel der ArbeitZiel der Studie war es, Positionen, Haltungen und Erfahrungswerte von Hausärzt*innen mit Blick auf eine Sicherstellung der allgemeinmedizinischen Breitenversorgung zu ermitteln.MethodenIm Zuge einer Online-Befragung wurden zwischen Februar und Juni 2023 insgesamt 4176 Hausärzt*innen befragt. Über die deskriptive Analyse hinaus erfolgte zur Ermittlung von signifikanten Unterschieden zwischen 2 Gruppen ein t‑Test bei unabhängigen Stichproben.Ergebnisse42 % beobachten im Umfeld einen merklichen Schwund allgemeinärztlicher Praxen. 53 % bescheinigen der Hausarztmedizin eine sinkende Attraktivität für den ärztlichen Nachwuchs, was 3 Problembereichen zugeordnet wird: 1) Stellung der hausärztlichen Versorgung im Gesundheitswesen, 2) Voraussetzungen in Aus- und Weiterbildung, 3) Arbeitsbedingungen. Zur Sicherung der Hausarztmedizin sprechen sich die Befragten v. a. für folgende Ansatzpunkte aus: Einrichtung eines Primärarztsystems (85 %), vermehrte Förderung von Interesse und Berührungspunkten in Aus- und Weiterbildung (80 %), Stärkung multiprofessioneller ambulanter Versorgungszentren (64 %), Restrukturierung von Curricula (56 %) und Zulassungskriterien zum Medizinstudium (50 %), Reform der allgemeinmedizinischen Weiterbildung (53 %).DiskussionHausärzt*innen haben eigene Vorschläge und Präferenzen, die Expertisen und Sachverständige ergänzen. Bei der Planung, Implementierung und Evaluation von Maßnahmen zur Stabilisierung der hausärztlichen Versorgung sollten Allgemeinmediziner*innen konsequenter als bislang involviert werden.

Family Doctors Facing Break-Point Decision: A Cross-Sectional Study

Health professionals, especially working physicians, experience terrible psychological effects from their work since they see patients' conditions worsen till they pass away. Gaining a thorough grasp of the experiences of general practitioners working in Ostergotland County, Sweden, was one of the primary goals of the current study. To gather information from study participants, a cross-sectional study was carried out. This survey comprised 121 health professionals in total. Participants were given a 19-question questionnaire. The results of the study indicated that the majority of doctors have more than 20 years of experience, more than half of the sample said that making a break-point decision is difficult, and the majority of doctors (n=46, 79%) said they felt more confident in their ability to make decisions when multiple doctors were involved in the process. About 79% of the sample had graduations from within the European Union, with 65% of those degrees coming from Sweden. About 50% of the doctors who made decisions did so based on their own experiences, while the majority of doctors (67%) think that patient relatives' input is important when making decisions. Together, these factors make break-point decision-making for physicians a challenging and intricate undertaking, even with their vast medical knowledge. Involving patients and consulting with colleagues can boost trust in the decision-making process.

Understanding exercise referrals in primary care: a qualitative study of General Practitioners and Physiotherapists

BackgroundPhysical inactivity is estimated to cost the UK National Health Service over £7.4 billion per year. Healthcare practitioners have a key role in supporting increases in physical activity (PA) levels, including referring to exercise referral schemes. To date, there has been little research into practitioner perspectives on referrals to exercise schemes. ObjectivesTo explore the views and experiences of General Practitioners (GPs) and physiotherapists in relation to factors which influence referral and adherence to exercise referral schemes. Design setting and participantsQualitative study of primary care-based practitioners in Glasgow, UK. MethodsSemi-structured interviews were conducted with 14 practitioners (seven GPs and seven physiotherapists). Interviews were recorded and analysed thematically. ResultsFour themes are presented. Firstly, all people, including healthcare practitioners, bring inherent biases which are influenced by their background, experiences and worldviews to a consultation which impact their approach to PA promotion. Secondly, clinical time pressures are a major barrier to effective PA promotion. Thirdly, patient-led, compassionate care which seeks to fully understand a patient is the most vital component of behaviour change, with suggestions that promoting peer support and the use of personal anecdotes to normalise vulnerabilities might be helpful. Lastly, providing ongoing support for change was felt to be beneficial to PA promotion. This is often accessed through exercise referral schemes and improved by better collaboration between exercise providers and referring practitioners. ConclusionPractitioners believed exercise referrals could be improved with more targeted training in behaviour change facilitation, support for multidisciplinary working, and enhanced communication between the programmes and referrers. Additionally, supporting behaviour change requires time for compassionate care and fully understanding patients’ motivations and beliefs. Lack of time was felt to be the greatest current barrier to effective PA promotion. Contribution of the Paper•Previous physical activity promotion research has focussed on overcoming barriers to physical activity.•Few studies have considered the effect of the therapeutic interaction on successful exercise referrals.•In this qualitative study, primary care-based practitioners (GPs and physiotherapists) reported inherent biases which affected referrals, as well as time pressures.•Targeted training, support for multidisciplinary working, and enhanced communication between the programmes and referrers, would improve referrals.

A Dutch Survey on Medication Adjustments after Metabolic and Bariatric Surgery: Experiences of Bariatric Surgeons, Internists, Pharmacists, and General Practitioners

BackgroundAs metabolic and bariatric surgery (MBS) can alter the pharmacokinetics of drugs, post-bariatric surgery patients may require medication adjustments and monitoring. To improve pharmacotherapy in these patients, we aimed to understand the beliefs, attitudes, knowledge, and concerns of healthcare professionals who treat these patients.MethodsA survey by means of an online questionnaire was divided into six sections. It was sent to bariatric surgeons, internists, pharmacists, and general practitioners in the Netherlands.ResultsOut of 229 returned surveys, 222 were included. Virtually all respondents (98%) expected MBS to influence the effect of medication. Both reduced efficacy (23%) and more adverse events or medication-related complications (21%) were recognized. Two-thirds of the respondents felt competent to prescribe or to provide advice regarding medication in post-bariatric surgery patients.Most of the respondents (95%) believed that other healthcare professionals should be aware of the contraindication “bariatric surgery”. Of the respondents, 37% indicated that they were not aware of the medication advice incorporated in the electronic health record systems. Almost half of the respondents (48%) indicated that they documented changes in drug effects. Most respondents answered that these ought to be registered in the pharmacovigilance database or national registry.ConclusionsThe majority of prescribers and pharmacists believe that patients will receive better pharmacotherapy if healthcare professionals take MBS into account. However, not all prescribers think they are competent to act adequately. To improve this, information on changed drug effects after MBS should be more widely shared among healthcare professionals via resources that are easily accessible.Graphical