General Practice Research Articles

Utilizing a Geriatric Emergency Multi-disciplinary Service (GEMS) To Improve Care For Nursing Home (NH) Residents In The Emergency Department (ED)

Abstract Background The GEMS team provides an age attuned service for older adults living with frailty who present to the ED. Under the governance of a Geriatrician older adults living with frailty receive a Comprehensive Geriatric Assessment (CGA) and a collaborative plan of care. NH residents are often the most frail cohort of patients. They can sometimes be referred to the ED with needs that could be managed in the community. Moreover, transfer is associated with a higher risk of mortality (Lemoyne et al. 2019). To address this, all NH residents are classified as priority one by the GEMS Team. Pathways have been developed to the Community Integrated Hub for the Older Person (ICPOP), General Practitioners and Community Palliative Care Teams. The goals is to provide the right care, in the right place and at the right time. Methods Plan, Do, Study, Act (PDSA) Quality Improvement Methodology was utilized. Data was collected on all NH patients presenting to ED and interrogated over a 3-month period. Results 27 patients presented to ED from a nursing home during the collection period. (n=16) 60% of patients were discharged. 89% were living with severe frailty. 100% received a CGA, Advanced Care Planning and family liaison. (n=5) referred to ICPOP. (n=6) referred to Palliative Care through the GP. Conclusion The majority of patients reviewed were living with severe frailty and likely beginning the final journey of their lives. A CGA on presentation to ED ensures the goals of care are aligned with the persons will and preference. Alternative care pathways in the community enabled patients to be discharged back to the nursing home with appropriate follow-up supports. Reference 1. Lemoyne SE, Herbots HH, De Blick D, Remmen R, Monsieurs KG, Van Bogaert P. Appropriateness of transferring nursing home residents to emergency departments: a systematic review. BMC geriatrics. 2019 Dec; 19:1-9.

Competencies Required By All Hospital Doctors Caring for Older Adults: A Group Concept Mapping Study

Abstract Background The number of older adults accessing the healthcare service far exceeds the available geriatric specialist services. It is recognised that for the foreseeable future most hospital inpatient contacts with older adults will be completed by doctors not specifically trained in geriatric medicine. To ensure the provision of adequate healthcare, it is imperative that that all hospital doctors are trained in the minimum geriatric competencies. Allowing for the broad, complex, and multidisciplinary nature of geriatric medicine, we conducted a group concept mapping (GCM) study to permit multiple stakeholders with various expertise to convey their thoughts on the competencies required by all hospital doctors caring for older adults. Methods GCM is a mixed methods approach utilising six phases to generate expert group consensus, enabling participants to organise and represent their ideas. We invited healthcare professionals, patient advocacy groups and clinical educators to participate in GCM via an online platform. Hierarchical cluster analysis and multi-dimensional scaling were utilised to analyse participant input regarding competencies required by doctors caring for older adults. Results Forty-eight participants completed the brainstorming stage, generating eighty-eight statements, and twenty-two participants took part in the subsequent sorting stage. Participants included hospital doctors, general practitioners, allied health professionals and patient advocacy groups. Nine competency domains were identified as integral for all hospital doctors to care for older adults. Domains rated most important related to interpersonal communication skills, ethical and legal matters relating to older adults, recognition and management of delirium and medication management. Conclusion The twelve competency domains indicate the diverse skillset required by all doctors to provide comprehensive care to older adults within a hospital setting. This study identifies competencies that may serve as a foundational framework for ensuring quality healthcare for the ageing population. Future initiatives should consider incorporating these competencies to improve inpatient care provided by hospital doctors to older adults.

How general practitioners in France are coping with increased healthcare demand and physician shortages. A panel data survey and hierarchical clustering

BackgroundGeneral practitioners (GPs) face quantitative and qualitative changes in patient demand and doctor shortages. ObjectivesTo investigate how GPs cope with doctor shortage issues. Materials and methodsTwo cross-sectional surveys of a representative panel of 1530 GPs in 2019 and 2022 about their perceptions of physician shortages, working hours worked (WHW), and adaptive behaviors. Hierarchical clustering enabled identification of profiles with different adaptation patterns. Multiple Poisson or logistic regression models studied associations between GPs’ profiles and professional characteristics. Results87.4 % of GPs applied at least one adaptation to control patients’ healthcare demand. 24 % adopted task-shifting while their average WHW decreased by 3.6 h between 2019 and 2022. Four GP profiles were identified. “Low adapters/low workload” and “Low adapters/high workload” (25 % of the sample each) reported 2.4 adaptive measures: 75.5 % refused to be new patients' preferred doctor in the former group (vs 5.1 %). “High adapters/unchanged consultations” (30.7 %) and “High adapters/shortened consultations” (18.9 %) reported 4.8 and 6.1 adaptations, respectively. They were more likely to practice in medically underserved areas. ConclusionThese results call into question GPs’ gatekeeper role in the French healthcare system. Moreover, the marked reduction in WHW in underserved areas is likely to exacerbate their uneven distribution nationwide. Encouraging vertical integration between HCPs while enhancing cooperation and task-shifting is probably a pathway toward improving the relative GP shortage.

Implementation Of A Novel And Integrated Community Flexible Endoscopic Evaluation Of Swallowing (FEES) Service Model For Older Persons

Abstract Background FEES is a gold standard Speech & Language Therapy (SLT) led diagnostic instrument that facilitates evidence-based dysphagia care. A novel community-based FEES service for older persons’ services was recently established in Ireland's Mid-West. New pathways, integrated across divisions, were designed and implemented to complement existing dysphagia pathways within Integrated Care Programme for Older Persons (ICPOP), inpatient rehabilitation for older persons and primary care. An integrated pathway was also established with acute services (Otolaryngology). The aim of this abstract is to describe the implementation process for this novel community FEES service. Methods An SLT-led FEES team engaged with a range of community- and acute-based stakeholders across policy and practice: SLTs, Otolaryngologists, management teams, ICPOP teams, Gerontology Consultants, General Practitioners, Infection Prevention and Control (IPC) teams. Normalisation Process Theory (NPT), an empirically tested and theoretically-sound implementation science framework, scaffolded discussion across a range of implementation and consultation activities including co-design workshops and educational presentations and training, using Health Service Executive (HSE) Change Management tools. Results Stakeholders co-developed a shared understanding of current and new pathways to identify and enact implementation strategies at individual, discipline and system-levels. The project involved stakeholder mapping, communication/engagement planning, risk management, resource planning, and large-scale targeted education/training across settings and disciplines. A FEES working group was formed to coordinate, sustain, monitor, and futureproof implementation activities. Conclusion This collaborative project generated interdisciplinary vision and action to enact an innovative dysphagia care pathway for older people in the community. Articulated through an NPT lens, the project provides insights into the collaboration needed to implement truly integrated care and to identify enablers at individual, disciplinary, and organisational levels. Such knowledge is essential for enhancing integrated care and enacting change and innovation in the Irish health service.

A Systematic Review Of Medication Knowledge In Older Adults

Abstract Background Medication knowledge, as defined by six aspects, is the person's awareness of their medication name, dose, purpose, adverse drug reaction (ADR), administration schedule and special instructions, is essential in the older patient's treatment journey. This review aimed to assess medication knowledge in older adults. Methods A systematic search of six electronic databases, grey literature and citation indexes included studies conducted in any setting or any country on those 65 or older, published over the last ten years, reporting primary data with full-text access, and assessing patients' six aspects of medication knowledge. Joanna Briggs Institute Critical appraisal tool was used to evaluate quality of studies. Results Of the 67871 articles searched, only 10 cross-sectional studies were included. Medication knowledge data was collected from pharmacies, community, general practices and outpatient clinics. Surveys used face-to-face interviews and electronic, written, and mail questionnaires. Five studies assessed knowledge on single medications. None assessed all six aspects of medication knowledge. One study assessed five aspects, while the rest assessed fewer aspects. The percentage of those who knew their medication names ranged from 41.9% to 97%, dose 19.4%, purpose 15% to 90%, administration schedule 65% to 92.6%, ADR 42% to 80% and special instructions 32.4% to 94.8%. Data lacked the source of medication knowledge or evidence of a patient-centred care approach. There were repeated calls for further education and research. Conclusion Research indicates that older adults have a mixed knowledge of their medications, with some areas well grasped and others lacking. Additionally, it appears that medication knowledge is not thoroughly evaluated initially. Despite ongoing advice to employ all six aspects of medication knowledge for assessment and education enhancement, no progress is seen in older adults' medication knowledge. Therefore, there's a need for better research that anticipates the application of these six aspects, concentrating on education for older adults or their caregivers through patient-centred methods.

Introduction of A Proforma to Improve Communication to General Practitioners from an Acute Orthogeriatric Service

Abstract Background The National Office of Clinical Audit Irish Hip Fracture Standards 5 and 6 advise “patients with hip fracture should have their bone health assessed to determine their need for therapy to prevent future osteoporotic fractures” and “hip fracture patients should receive a specialist falls assessment and intervention to prevent further falls”. Ideally, these assessments should be communicated clearly via discharge summaries to avoid omission or duplication of treatment. Methods An admission proforma for an acute orthogeriatric service assessing inpatients with fragility fractures was developed. We retrospectively audited orthogeriatric patients’ discharge summaries prior and post introduction of the proforma. Patients who had atraumatic fractures were appropriately excluded from audit on their falls assessment. Results The total number of patients was 98. There were 70 patients in the pre-orthogeriatric proforma group and 28 patients in the post-orthogeriatric proforma group. The average age was 80.34 (SD 8.78). There were 55 females. The average length of stay was 18.08 days (SD 10.49). In the pre-orthogeriatric proforma group a falls assessment was reported in the discharge summary for 85.29% (n=58), bone protection; 60% (n=42). In the post-orthogeriatric proforma group a falls assessment was reported in the discharge summary for; 96.15% (n=25), bone protection; 61% (n=17). 100% of patients included had a bone protection plan: IV Zoledronic acid for 56 patients, denosumab for 26 patients, DEXA for 4 patients, virtual follow-up for 8 patients, onward specialty referral for 2. One patient was from overseas and for follow-up locally. Conclusion An orthogeriatric proforma may improve communication of falls assessment and bone protection plans in discharge summaries. Despite 100% of patients having a bone protection plan, there was a discrepancy of this in the discharge summaries. A dedicated orthogeriatric intern would ensure communication is accurate. This could avoid potential duplication or omission of prescribing of anti-resorptive treatment.

The Prevalence of Frailty Among People Experiencing Homelessness Attending a Primary Care Clinic: A Service Evaluation and Quality Improvement Initiative

Abstract Background Frailty is traditionally considered a geriatric syndrome though can present at a younger chronological age among people experiencing homelessness (PEH) due to risk factors such as poor nutrition, addiction and loneliness. Our walk-in primary care clinic for PEH has not previously recorded frailty status or prevalence among attendees, which would provide an opportunity to offer effective, evidence-based interventions. As part of a quality improvement initiative (QI), we evaluated frailty prevalence to improve our service to PEH. Methods The frailty status of adults presenting consecutively to a general practitioner at an urban, walk-in primary care clinic in Ireland dedicated to PEH was measured each Monday during a service evaluation in the first two months of 2024. Frail Scale (criteria: fatigue, resistance, ambulation, illness and weight loss; 0=robust, 1-2=pre-frail, 3-5=frail)) and the Clinical Frailty Scale (CFS) were used. Results 73 adults presented (median age 41.5), 21 female (28.8%)). 24 were frail on the Frail Scale (32.9% of total presenting), of which 4 were female (19.0% of females presenting) and 20 were male (38.5% of males presenting). 43 were pre-frail on the Frail Scale (58.9% of total presenting), of which 15 were female (71.4% of females presenting) and 28 were male (53.8% of males presenting). The median CFS was 4 (vulnerable). The most common frailty indicators were fatigue (68.5%) and weight loss (64.4%). Conclusion Frailty and pre-frailty were highly prevalent among PEH at our primary care clinic. A third were frail and over half pre-frail. The prevalence of this reversible syndrome had not previously been evaluated. Our findings underline the opportunity to improve our service by screening for frailty among PEH and offer appropriate interventions to reverse frailty and build resilience. Service evaluation and QI initiatives can enable application of research evidence and improvement of real-world clinical care.

The Australian Frailty Network: Development of a consumer-focussed national response to frailty.

Frailty is an important concept in the care of older adults. Over the past two decades, significant advances have been made in measuring frailty. While it is now well-recognised that frailty status is an important determinant of outcomes from medical illnesses or surgical interventions, frailty measurement is not currently routinely integrated into clinical practice. In the community setting, it is uncommon for general practitioners to deliver frailty-optimised care. In hospitals, there is substantial variability in how people living with frailty are managed. This variability is notable between and even within disciplines. Furthermore, gains from understanding frailty mechanisms and risk factors are not yet applied/implemented at scale to delay the progression of frailty in community-dwellers. The Australian Frailty Network (AFN) is a national collaborative group of researchers, clinicians, non-government organisations, consumers and policymakers, in which the engagement and active involvement of consumers has been embedded from the outset. The AFN aims to generate new knowledge to improve health outcomes, to ensure evidence-based management is translated into clinical practice and to build capacity in multidisciplinary and translational frailty research. Here, we describe the development of the AFN, highlighting important milestones: (i) securing funding for the network and flagship elements; (ii) an inaugural summit to establish the strategic vision, values and scope with end-users; (iii) sabbatical visits to learn from international examples; and (iv) developing the governance structure and an actionable plan encompassing consumer engagement, research, education and policy and practice to maximise impact.

Community Specialist Team for Older Adults - Who Do You Think We Are? Co-Design Of A Patient Information Leaflet

Abstract Background Navigating care pathways can be challenging and confusing for patients and caregivers. With the emergence of several new clinical specialist teams, we identified the need for accurate, clear and relevant information, provided as a printed leaflet and available at referral stage for both older adults and referring practitioners. Methods A draft Patient Information Leaflet (PIL) was developed with contributions from all members of the Community Specialist Team for Older Adults (CSTOA) explaining the purpose of the service. A review of referral sources was undertaken to identify those key stakeholders from whom feedback should be sought to ensure content validity. The draft PIL and a feedback questionnaire were distributed to patients and their caregivers who have had intervention from the CSTOA in addition to General Practitioners and Community Health Network colleagues. Results There were 27/35 responses to the questionnaire. Data was collated and analysed. All respondents reported that from reading the PIL, they understood clearly what the service provides, and all agreed that the leaflet accurately describes the service. Details such as what to expect from intervention of the team and advice to bring a family member to the initial appointment were mentioned as particularly useful content. Supplementary feedback commended the co-location and accessibility of the service compared to a hospital setting. It was suggested that other services should be included in the CSTOA. Based on survey responses, minor edits were made to the PIL to meet stakeholder satisfaction. Conclusion Feedback from this survey helped endorse the provision of a printed PIL to be provided at referral stage. Additional commentary gathered, re-enforces the need for continuous interaction and information sharing with service stakeholders. Next steps include making this PIL available electronically to allow for real time updates and translating to other languages to ensure inclusivity.

Ensuring Patient Care Continuity: An Audit of Discharge Letter Completeness in Accordance with National Standards

Abstract Background Discharge letters serve as a crucial communication tool to convey essential patient's healthcare information from hospital teams to general practitioners and step-down institutions. In 2013, the Health Information and Quality Authority (HIQA) introduced the National Standard for Patient Discharge Summary Information guideline. Reference 1. Health Information and Quality Authority. (2013). National Standard for Patient Discharge Summary Information. Retrieved from https://www.hiqa.ie/hiqa-news-updates/hiqa-publishes-national-standard-patient-discharge-summary-information. Methods This audit reviewed the completeness of discharge letters of patients admitted under the geriatric service of a tertiary hospital, covering the period between 1st September and 31st December 2023. Twenty-five variables were selected from the HIQA standards. The discharge letters were audited for completeness based on the inclusion of these recommended variables. An acceptable completeness rate of 80% for each variable was established. Results Of the total 89 discharge letters meeting the inclusion criteria, the average age of patients was 80.75 [SD12.95] years, with males comprising 60%. Seventeen out of 25 selected variables were 100% complete as they were automatically included by the electronic software. All discharge letters also invariably included diagnosis and hospital course information. Over 80% of the discharge letters met the acceptable threshold of including the items: discharge medication and future actions/follow-up. However, documentation of allergic status and inclusion radiological and blood investigations were only found in 27% and 49% of the letters, respectively. Conclusion The audited discharge letters had acceptable rates of completeness regarding inclusion of important items, while documentation of allergic status and inclusion of blood and radiological investigations fell below the acceptable standard. Of note, those that were automatized achieved 100% compliance. Regular auditing of discharge letters should become standard practice to improve completeness and ensure patient care continuity and safety. Consideration should be given to automatization of inclusion of reports of investigations.

Loneliness in the Republic of Srpska: advocating for social prescribing.

This study explores the potential implementation of social prescribing in the Republic of Srpska, Bosnia and Herzegovina, where the approach is non-existent, and supporting structures are underdeveloped despite a recognized need for intervention. As social prescribing gains global recognition for improving health, the study investigates its feasibility in an uncharted area. The research assesses the necessity for social prescribing by examining loneliness rates and healthcare utilization in the Republic of Srpska, a region seldom studied in public health literature. Data from 1231 individuals aged 16-86 were collected in May 2021, marking the first initiative to gather information on loneliness and healthcare usage in the country. Loneliness rates in the Republic of Srpska were comparable to the UK. Using a negative binomial model, the study establishes significant links between loneliness, chronic health conditions, age, and healthcare service utilization. Loneliness, chronic health conditions, and age predict the use of general practitioner services. In the 44-54 and 65+ age groups, loneliness predicts accident and emergency service use. Specialist healthcare services are positively predicted by loneliness, having one chronic health condition, and being above 44 years of age. Notably, a COVID-19 diagnosis negatively predicts the use of all healthcare services. Gender and place of residence do not significantly impact healthcare service utilization. The study concludes that observed loneliness rates and correlated healthcare usage patterns in the Republic of Srpska indicate a need for social prescribing. The paper discusses the feasibility of implementing social prescribing in this particular case.

An Audit of the Fifth Irish Hip Fracture Standard in patients >=70 years following hip fracture

Abstract Background Hip fractures are a significant cause of morbidity and mortality in older adults. Bone health assessment is key in the reduction of future fracture risk. The aim of our study was to examine the adherence to the fifth Irish Hip Fracture Standard in patients >=70 years presenting to Letterkenny University Hospital (LUH) with a hip fracture and to examine the number of patients who were commenced on bone protection. Methods We included patients >=70 years who were admitted under the Orthopaedic service following a hip fracture between January and June 2023 in LUH and were identified the database maintained by the using Fracture Liaison Nurse. Data collected included age, month in which hip fracture occurred, patient resident in Ireland, patient alive/deceased, patient on bone protection prior to fracture, patient commenced on bone protection or patient declined treatment. Data was recorded in a Microsoft excel spreadsheet and was analysed by the clinical audit facilitator. We measured our data against the British Geriatric Society guideline on the use of IV zoledronate following hip fracture. Results 76 patients were admitted to LUH with a hip fracture >=70 years between January and June 2023. 100% of patients were reviewed by the fracture liaison service and following this it was recommended that 46 patients (60%) be commenced on bone protection. A letter was sent to each patient’s General Practitioner outlining the recommendation for bone protection. On follow up only 7/46 (15.2%) had been started on treatment. Conclusion The fracture liaison service is appropriately identifying patients who require treatment, despite this, patients are not starting the necessary bone protection in the community. This has prompted our service to establish an IV zoledronate clinic for patients following hip fracture and to generate a plan for ongoing treatment of this patient cohort.

Community Flexible Endoscopic Evaluation Of Swallowing (FEES): A Prospective Cohort Study Of Clinical, Process And Patient-Reported Outcomes

Abstract Background Dysphagia prevalence increases with age, impacts on quality of life and increases healthcare utilisation and cost (Atrill 2018). Instrumental swallowing assessment is essential for accurate diagnosis and treatment of dysphagia but can be difficult to access in the community. FEES is a gold-standard instrumental assessment delivered by speech and language therapists (SLTs). The aim of this abstract is to report clinical, process and patient-reported outcomes of participants who had a community FEES over a 6-month period. Methods A prospective cohort study recruiting adults who accessed community FEES in Ireland's Mid-West. Baseline assessment data (demographics, a range of validated tools and process data) were recorded at index visit. A structured phone interview was completed at six months. The primary outcome was the rate of medical complications potentially caused by dysphagia at follow-up. Secondary outcomes included healthcare utilisation, dysphagia severity, functional status and quality of life. Results 62 participants were recruited: mean age: 70.98 (SD=15.01), 55.4% were female. At follow-up, 27.42% reported medical complications potentially attributable to dysphagia, 27.4% had attended general practice, 3.23% attended medical assessment units, 6.45% attended emergency departments. 82.26% were diagnosed with dysphagia or modified independence: Dysphagia Outcome Severity Scale (DOSS) ≤6, (M=5.2, SD=1.53). Changes to dysphagia care plans were recommended in 60.94% of cases. There was significant difference in Functional Oral Index Scale (FOIS) scores across time, F (1.75, 106.78) = 5.38, p = 0.008. FOIS scores at 6 months (M=5.92, SD=1.50) were significantly higher than pre-FEES (M=6.42, SD=1.37). Significant differences in quality of life (EQ5D5L-VAS) scores p<0.001 were detected: higher scores at 6-months (M=69.35; SD=20.42) compared to index visit (M=64.52; SD=19.44). Conclusion Access to community FEES for older persons may improve outcomes by reducing the frequency of dysphagia-related complications and healthcare utilisation, improving functional swallowing status, enhancing quality of life and contribute to evidence-based dysphagia diagnosis and care planning.

The Prevalence of Potentially Inappropriate Medications (PIMs) Among Frail Older Participants of The Irish Longitudinal Study on Ageing (TILDA)

Abstract Background This study aimed to assess PIMsprevalence among frail older participants of The Irish Longitudinal Study on Ageing (TILDA), using a newly developed OPTI-3S criteria (criteria for OPTImising medicines by Stopping, Stepping down, or Switching to safer alternatives). Methods All TILDA participants with polypharmacy (i.e. ≥5 medicines) and frailty based on Clinical Frailty Scale (CFS) ≥4 were included. PIMswere assessed based on the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail v2) [1], Poudel et al. algorithm [1], the Norwegian General Practice--Nursing Home criteria (NORGEP-NH) [1], and OPTI-3S. The prevalence of PIMsidentified by each tool was assessed across all frailty levels (CFS ≥4). Poisson regression assessed associations between PIM prevalence and covariates (e.g. medications). Results Most of the study cohort (86.5%, n=504) had at least one PIM identified by any of the four tools. OPTI-3S identified at least one PIM in 62.6% of participants, followed by Poudel’s algorithm (53.9%) and NORGEP-NH (40.5%). OPTI-3S could identify at least one PIM in 97.8% of participants with CFS ≥7, followed by STOPPFrail (88.9%). Overall, 34.8% of prescribed medications were considered to be PIMsThe OPTI-3S list detected more PIMsthan any other tool for all frailty levels (e.g. OPTI-3S, 78.4% vs STOPPFrail, 40.2% in CFS ≥7). Deprescribing all OPTI-3S-defined PIMswould reduce polypharmacy by 20.6% compared to NORGEP-NH (13.3%) and Poudel’s algorithm (12.0%). The most prevalent PIMswere aspirin, benzodiazepines and z-drugs, and antihypertensive medications. The number of medications, anticholinergic burden, and being on specific medications (e.g. aspirin, NSAIDs, benzodiazepines, antidepressants) were significantly associated with increased PIMs. Conclusion OPTI-3S is a useful PIM screening tool in community-dwelling frail older adults, pending further testing in the hospital setting. Reference 1. Anlay, D.Z et al. Br J Clin Pharmacol. 2024;90(1):12-106.

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.

Attitudes of anabolic steroid users and non-users towards general practitioners in the United Kingdom

BackgroundResearch from past decades has suggested that anabolic-androgenic steroid (AAS) users are often sceptical of their physicians’ level of knowledge regarding AAS. We questioned whether contemporary British AAS users and non-AAS-using weightlifters would display similar distrust of their general practitioners. MethodsWe distributed anonymous questionnaires to 61 AAS-using and 106 non-AAS-using male British weightlifters at gymnasiums and via online social media sites. Respondents rated their general practitioners’ knowledge regarding health- and drug-related topics, using 10-point Likert scales from 0 (worst) to 10 (best). AAS users also rated their degree of trust in various sources of information about AAS, using similar scales, and were asked whether they had disclosed their AAS use to various categories of individuals. We then compared our findings with the results from a 2004 American study that had used virtually identical methodology. ResultsBoth AAS-using and non-using weightlifters rated their general practitioners favourably on knowledge of general health and disease, cigarette smoking, and alcohol, with mean scores ranging from 6.8 to 8.7. However, respondents scored their general practitioners significantly lower on knowledge of AAS, with mean ratings of 4.3 to 4.9 from AAS non-users and only 2.4 to 2.9 from users. Among various sources of information about AAS, users trusted their doctors significantly less than “underground” guides or Internet sites. Only 22 (36 %) of the AAS users had ever disclosed their use of these drugs to any physician. These findings closely resembled those of the earlier American study, with contemporary British men reporting even greater mistrust of their physicians on weightlifting- and AAS-related topics than their American counterparts. ConclusionDespite increasing AAS use worldwide and mounting evidence of the long-term dangers of these drugs, contemporary British weightlifters in general and AAS users in particular appear to remain distrustful of their physicians’ knowledge of fitness sports, performance-enhancing supplements, and especially AAS.

Health professionals’ and caregivers’ perspectives on improving paramedics’ provision of palliative care in Australian communities: a qualitative study

ObjectivesParamedics have the potential to make a substantial contribution to community-based palliative care provision. However, they are hindered by a lack of policy and institutional support, as well as targeted...

Urologist communication is a primary factor leading to erectile dysfunction treatment postprostatectomy.

Studies have shown insufficient utilization of care for patients with erectile dysfunction (ED) after radical prostatectomy (RP). The aim of this study was to evaluate variables associated with barriers to seeking and receiving ED treatment. In this multicenter prospective cross-sectional study, the functional outcomes of 936 patients were assessed 10 to 15years after RP. A total of 525 patients with ED or incontinence were asked about their treatment experiences or lack thereof. The data were analyzed using the chi-square test, t test, and multivariate logistic analyses. Patients answered validated questionnaires regarding information sources, communication with their partner and urologist, and barriers to ED treatment. Of the 525 patients, 80 were not available to survey. A total of 304 patients answered the survey (response: 68.0%). A total of 246 patients had ED and were included in this study. The mean age at surgery was 64.4 ± 6.1years, and the mean age at the time of this survey was 77.1 ± 6.2years. The mean follow-up duration was 12.7 ± 1.5years. Forty-six percent (n = 114 of 246) of the patients had never received ED treatment. The most important conversation partners regarding the ED were the partner (69% [n = 169 of 246]) and the urologist (48% [n = 118 of 246]). Patients who never received ED treatment were less likely to have conversations with their urologist (34% vs 60%; P < .001), had less support (51% vs 68%; P = .01), and had less interest in sex from their partner (20% vs 40%; P = .001). Communication with other groups (general practitioners, other physicians, family, friends, and the Internet) had no influence on ED treatment utilization. The most relevant barrier to receiving ED treatment was the belief that treatment would not help (65%). No interest in sex from their partner (odds ratio, 3.9) and no conversation with their urologist about ED (odds ratio, 2.9) were found to be independent predictors of not receiving ED treatment. Urologists should have enhanced awareness of how to approach patients directly about their ED and actively offer them treatment options. These results should be further validated in a multicenter, prospective study. Response bias may have affected the results. Furthermore, the current cohort was relatively old. This study revealed that no interest in sex from one's partner and insufficient communication with a urologist were relevant barriers to insufficient utilization of ED treatment after RP.

Sources and processes of social influence on health-related choices: A systematic review based on a social-interdependent choice paradigm

BackgroundMost choices in healthcare are not made in social isolation. However, current econometric models treat patients' preferences as the sole determinants of their choices.Through the lens of sociology and medical sociology theories, this paper presents a systematic literature review of identifiable social influences on patients’ choices, serving as a first step in developing a social-interdependent choice paradigm. MethodsFollowing the PRISMA guideline and using nine databases, we identified the individual agents or groups involved in health-related choices, the functional content through which social relationships influence patients, and the choice constructs affected by these processes. From 9036 screened articles, we selected 208 to develop an analytical framework connecting social relationships with choice constructs. ResultsSocial influences predominantly come from family, friends, specialized physicians, and general practitioners. We decomposed the functional content of social relationships into functions and contents. Dyadic interactions and expert knowledge were prominent functions, followed by social control. Prescriptive and informational contents were prevalent, followed by instrumental and emotional ones. Expert knowledge and social norms aligned with prescriptive and informational signals, while dyadic interactions provide emotional and instrumental signals. Reference points for social norms included friends, coworkers, and patients. Social relationships primarily impact which alternatives are evaluated, followed by alternative evaluation strategies and goal selection. Distinctions between medical domains and dimensions emerged, highlighting how the medical area conditions the social influence process. ConclusionThis systematic review presents a comprehensive framework that elucidates the social influence process in healthcare patient decision-making. By detailing the functional content of social relationships into functions and contents and linking these components to the elements of the choice process, we created a structured approach to understanding how social relationships impact patient choices. This will facilitate the systematic integration of social relationships into econometric models of patient choice.

Improving antibiotic prescribing – Recommendations for funding and pricing policies to enhance use of point-of-care tests

IntroductionDiagnostics can contribute to the improved quality of antibiotic prescribing. However, there is potential to enhance the use of point-of-care tests (POCTs) in general practice. This paper presents fit-for-purpose policy recommendations related to funding and pricing for POCTs applied for community-acquired acute respiratory tract infections (CA-ARTIs). MethodsThe development of the recommendations was informed by an analysis of the current status of funding and pricing policy frameworks for CA-ARTI POCTs in European countries, and an identification of barriers and facilitators for their uptake. Draft recommendations were developed and subsequently revised based on written and verbal feedback from meetings with experts. ResultsThe proposal includes four recommendations for policy interventions related to funding and three recommendations regarding pricing policies. Two of the funding policy-related recommendations concern physicians’ remuneration, and two relate to product-specific reimbursement (public coverage) of the CA-ARTI POCTs. The pricing-related recommendations include a proposal to explore the introduction of price regulation, to pilot subscription-fee procurement models and to enhance more strategic approaches in public procurement of CA-ARTI POCTs. ConclusionsOptimised pricing and funding policies could make a difference in enhancing uptake of CA-ARTI POCTs. It is crucial for the successful implementation of policies to consider country settings. Additionally, supportive policy action is recommended, including the systematic use of health technology assessment, stakeholder communication, and monitoring and evaluation.