General Practitioners Characteristics Research Articles

The social, demographic and professional characteristics of general practitioners and district therapists of state and private sectors of health care

The article presents comparative analysis of demographic, social and professional characteristics of general practitioners and district therapists in state and private medical organizations. Sociological, statistical and analytical research methods were applied. The study was carried out on the basis of polyclinics of both Moscow Health Department and Moscow private health care sector. The sampling consisted of 399 questionnaires subjected to statistical processing. It is established that in state and private medical organizations, in this group of physicians prevail women 36-55 years old, born in the Russian Federation, in Moscow, married, having children and assessing one's income level as average. Most of them received their higher education in Moscow, graduated residency in therapy and have no medical category or academic degree. The professional experience consists 10 years or more. All physicians in state polyclinics hold more than one position and in private polyclinics 8.6% of physicians are underemployment. In the state sector, paternalistic model of communication with patient is preferable, in the private sector - a collegiate one. In the state sector, the collegiate management style of CEO is convenient and in the private sector - collegiate or dynamic one. In both sectors, adhocratic organizational culture is comfortable. Against the background of readiness to proceed working in current conditions, work in another sector is not excluded. The material factor is considered as main driver of professional motivation. The social, demographic and professional characteristics of general practitioners and district physicians in both sectors of health care in the main are similar, but have their own characteristics.

Where the joy comes from: a qualitative exploration of deep GP-patient relationships

BackgroundRelationship-based, whole person care is foundational to quality general practice. Previous research has identified several characteristics of deep General Practitioner (GP)-patient relationships and their association with improved patient concordance, satisfaction and perceived health outcomes. Psychological attachment theory has been used to understand therapeutic relationships, but has only been explored to a limited extent in the general practice context. Additionally, evolving changes in sociocultural and commercial practice contexts may threaten relationship-based care. In view of this, we aimed to explore the nature and experience of deep GP-patient relationships, as identified by patients, from GP and patient perspectives.MethodsSemi-structured interview design. An initial survey assessed patients’ perceived depth of their relationship with their GP, using the Health Care Provider Attachment Figure Survey and Patient-Doctor Depth of Relationship Scale. Patients who reported a deep relationship, and their GPs, were purposively selected for individual interviews exploring their experience of these relationships. A post-interview survey assessed interviewees’ attachment styles, using the Modified and Brief Experiences in Close Relationships Scale. Patient interviewees also rated the patient-centredness of their GP’s clinic using the Person-Centred Primary Care Measure. Transcripts were analysed using thematic analysis.ResultsThirteen patients and five GPs were interviewed. Four themes characterised deep relationships: the ‘professional’; human connection; trust; and ‘above and beyond’. Patient, GP and practice team all contributed to their cultivation.ConclusionsWe present a revised conceptual framework of deep GP-patient relationships. Deep relationships come to the fore in times of patient trouble. Like attachment relationships, they provide a sense of safety, caring and support for patients experiencing vulnerability. They can stretch GP boundaries and capacity for self-care, but also provide joy and vocational satisfaction. Patients may not always desire or need deep relationships with their GP. However, findings highlight the importance of enabling and cultivating these for times of patient hardship, and challenges of doing so within current healthcare climates.

Undermining support for COVID-19 public health policies: an analysis of the impact of subversive conspiracy narratives on Czech General Practitioners.

Limited knowledge exists regarding the impact of COVID-19 conspiracy theories on the professional practice of general practitioners (GPs). This study aimed to identify the basic characteristics of GPs who endorse COVID-19 conspiracy beliefs and compare their level of support for COVID-19 health policies with GPs who do not believe in conspiracies. Between January and February 2021, a representative online survey was conducted among 1163 GPs in the Czech Republic. The sample was designed to be representative of members of The Association of GPs of the Czech Republic. The survey revealed that nearly 14% of the GPs surveyed believed in one or more COVID-19 conspiracies. The average age of GPs who endorsed conspiracies was 58, which was higher than the rest of the sample (average age of 50). GPs who believed in conspiracies were less likely to support COVID-19 public health policies and therapy recommendations, including vaccination. Logistic and linear regression analyses indicated that doctors who believed in conspiracies were 2.62 times less likely to have received a COVID-19 vaccine. Mediation analysis showed that approximately one-quarter (23.21%) of the total effect of trust in government information on support for public health policies was indirectly mediated by the endorsement of COVID-19 conspiracy beliefs. The study findings suggest a concerning association between belief in COVID-19 conspiracies and a reduced level of support for public health policies among GPs. These results underscore the importance of incorporating the 'conspiracy agenda' into medical authorities' more effective public health communication strategies.

GPs in UK: From Health Gatekeepers in Primary Care to Health Agents in Primary Health Care.

After 75 years of reformed practice, general practitioners (GPs) in the UK have transformed from health gatekeepers who simply provide medical decision-making such as diagnostic and treatment services and referral services, to health agents who proactively provide more relevant health services such as immunizations, health monitoring and health management, etc. In order to discuss this transformation of the role of the general practitioner and the conditions for the evolution of the role, this study chose the documentary analysis method to provide a comprehensive overview of the legal and normative documents related to the general practitioner. Furthermore, this study uses a comparative analysis method to conclude the definition and role characteristics of GPs as health agents. This study summarises the general pattern of evolution of GPs into health agents. The transformation into a health agent relies on the interpersonal trust and rigorous institutional of society on the general practitioner system. The expansion of GPs' clientele and range of services, together with the motivation to proactively provide services, have combined to push for a "qualitative change" in the GP's role as health agent. The transformation of the role of the general practitioner to a health agent is a historical necessity. It responds to the evolution of society's understanding of health and the need for higher levels of health. Therefore, recognizing the role of GPs as health agents is important for optimizing the use of health care resources and improving the health of society by taking advantage of this role.

Anxiety management in Australian general practice: an analysis of encounters from 2006 – 2016

BackgroundAnxiety disorders are highly prevalent mental health conditions managed predominantly by general practitioners (GPs). This study aimed to examine the management of anxiety by Australian GPs since the introduction of the Better Access to Psychiatrists, Psychologists and General Practitioners initiative in 2006.MethodsWe conducted secondary analysis of Bettering the Evaluation and Care of Health data on GP encounters for anxiety from 2006 to 2016 (N = 28,784). We calculated point estimates and used multivariate logistic regression to explore the effect of GP and patient characteristics on rates and types of management.ResultsThe management rate of anxiety increased from 2.3% of GP encounters in 2006 to 3.2% in 2016. Over the 10-year period, increases were seen in referrals to psychologists (AOR = 1.09, 95%CI = 1.07–1.11, p < .0001) and selective serotonin / serotonin-noradrenalin reuptake inhibitors (AOR = 1.05, 95%CI = 1.03–1.06, p < .0001), and benzodiazepines decreased (AOR = 0.94, 95%CI = 0.92–0.95, p < .0001). Systematic differences in management were found for patient and GP characteristics, including high rates of benzodiazepines in certain groups.ConclusionsAnxiety is accounting for more of the GP workload, year on year. GP management of anxiety has become more closely aligned with practice guidelines since 2006. However, high rates of benzodiazepine prescribing in certain groups remains a concern. Further research is needed into GP treatment decision making for anxiety.

Practitioner characteristics, diagnostic accuracy metrics and discovering-individual with respect to 637 melanomas documented by 27 general practitioners on the Skin Cancer Audit Research Database.

Knowledge of accuracy for melanoma diagnosis and melanoma discovering-individual in primary care is limited. We describe general practitioner (GP) characteristics and analyse defined diagnostic accuracy metrics for GPs in the current study comparing this with a previous study for GPs common to both, and we analyse the individual first discovering each melanoma as a lesion of concern. The characteristics and diagnostic accuracy of 27 Australasian GPs documenting 637 melanomas on the Skin Cancer Audit Research Database (SCARD) in 2013 were described and analysed. The number needed to treat (NNT) and percentage of melanomas that were in situ (percentage in situ) were analysed as surrogates for specificity and sensitivity, respectively. The discovering-individual was analysed according to patient age and sex and lesion Breslow thickness. The average NNT and percentage in situ were 5.73% and 65.07%, respectively. For 21 GPs in both a 2008-2010 study and the current study, the NNT was 10.78 and 5.56, respectively (p = 0.0037). A consistent trend of decreasing NNT and increasing percentage in situ through increasingly subspecialised GP categories did not reach statistical significance. NNT trended high at ages and sites for which melanoma was rare. While the patient or family member was more likely to discover thick melanomas and melanomas in patients under 40 years, GPs discovered 73.9% of the melanomas as lesions of concern. GPs were the discovering-individuals for the majority of melanomas in the current study and their accuracy metrics compared favourably with published figures for dermatologists and GPs.

500 General practitioners’ views on the electronic transfer of prescriptions to pharmacies in Ireland: a qualitative interview study

Abstract Introduction The use of electronic systems to transfer prescriptions continues to grow in healthcare systems worldwide. In response to the COVID-19 pandemic, legislation was implemented in Ireland in April 2020 to permit the electronic transfer of prescriptions (ETP) from prescribers to pharmacies using a national secure email system (Healthmail). This has resulted in a significant increase in the volume of prescriptions transmitted via Healthmail from general practitioners (GPs) to pharmacies in Ireland. Aim With a clear need to evaluate how stakeholders have been affected by this initiative and to guide the future delivery of patient care, the primary aim of this study was to investigate GPs’ views on the ETP to pharmacies in Ireland via Healthmail and how it has affected their practice. Methods Semi-structured interviews were conducted via video-conference with GPs in Ireland. GPs were identified using convenience and snowball sampling, purposively ensuring variety in age/years of experience, gender, and practice location. Interviews were audio-recorded and transcribed verbatim. Interview transcripts underwent thematic analysis (1). Results Twelve audio-recorded interviews were conducted with GPs between May 2021 and July 2021. The participants had a median of 16 years’ experience as a GP. Four main themes were generated: 1)Efficiencies with prescribing and easing GP workload: even with limited training, GPs felt that Healthmail’s ETP has been easy to use and seamlessly integrated into their practice. Time has been saved and overall workload decreased due to less prescription printing and delegating more to administrative staff with prescription ordering. 2) New GP-pharmacist communication pathways: GPs found asynchronous communication regarding prescription queries less disruptive to their workflow, and particularly useful for less urgent matters. Some GPs were not aware of some Healthmail functions that facilitated additional notes between GPs and pharmacists, whilst others were concerned they had no evidence if pharmacists saw these notes. 3) Security, transparency, and documentation: whilst acknowledging their lack of technological expertise, GPs perceived that Healthmail prescriptions had security advantages over physical ones overall; the increased transparency of the prescription journey minimises the risk of prescriptions being mislaid, damaged, or fraudulently altered, as well as creating an audit trail. 4) Implications for patients: ETP via Healthmail has reduced footfall to practices, reduces multiple pharmacy use, and most patients have adapted well to it. GPs were mostly reluctant to engage routinely in any hypothetical bidirectional communication with patients via Healthmail. Conclusion This study provides strong evidence for continuing the ETP to pharmacies in Ireland as GPs found this initiative easy to use, time-saving, and enhancing both GP-pharmacist communication and GP workflow. However, this study has highlighted stakeholders’ lack of awareness with some functions of Healthmail, so any future systems utilised for the ETP should come with best-practice guidance for all users. While the purposive sampling facilitated GP heterogeneity, snowball sampling may have somewhat reduced the diversity in views; a future survey would be useful in identifying if any GPs characteristics significantly influencing GPs’ views, as well as identifying other issues experienced and novel ideas to improve the ETP process going forward.

Skin cancer-related conditions managed in general practice in Australia, 2000–2016: a nationally representative, cross-sectional survey

ObjectiveSkin cancer is Australia’s most common and costly cancer. We examined the frequency of Australian general practice consultations for skin cancer-related conditions, by patient and general practitioner (GP) characteristics and...

Overruling of Procalcitonin-Guided Antibiotics for Lower Respiratory Tract Infections in Primary Care: Ancillary Study of a Randomized Controlled Trial

Lower respiratory tract infections (LRTIs) in primary care are a promising target for antibiotic stewardship. A clinical trial in Switzerland showed a large decrease in antibiotic prescriptions with procalcitonin guidance (cut-off < 0.25 µg/L) compared with usual care. However, one-third of patients with low procalcitonin at baseline received antibiotics by day 28. To explore the factors associated with the overruling of initial procalcitonin guidance. Secondary analysis of a cluster randomized trial in which patients with an LRTI were included. Using the characteristics of patients, their disease, and general practitioners (GPs), we conducted a multivariate logistic regression, adjusted for clustering. Ninety-five out of 301 (32%) patients with low procalcitonin received antibiotics by day 28. Factors associated with an overruling of procalcitonin guidance were: a history of chest pain (adjusted OR [aOR] 1.81, 95% confidence interval 1.03-3.17); a prescription of chest X-ray by the GP (aOR 4.65, 2.32-9.34); a C-reactive protein measured retrospectively above 100 mg/L (aOR 7.48, 2.34-23.93, reference ≤ 20 mg/L); the location of the GP practice in an urban setting (aOR 2.27, 1.18-4.37); and the GP's number of years of experience (aOR per year 1.05, 1.01-1.09). Overruling of procalcitonin guidance was associated with GPs' socio-demographic characteristics, pointing to the general behavioral problem of overprescription by physicians. Continuous medical education and communication training might support the successful implementation of procalcitonin point-of-care tests aimed at antibiotic stewardship.

Prescriptions of antihypertensive drugs are influenced by the characteristics of general practitioners and their patients: a cross-sectional study in Normandy, France.

Hypertension is associated with significant cardio-vascular morbi-mortality. However, hypertension control is low, especially in France. The reasons influencing general practitioners' (GPs) prescription of antihypertensive drugs (ADs) remains unclear. This study aimed at assessing the influence of GP and patient characteristics on AD prescriptions. A cross-sectional study based on a sample of 2165 GPs was realized in Normandy (France) in 2019. The ration of AD prescription to overall prescription volume was calculated for each GP and allowed the definition of a 'low or high AD prescriber'. Associations of this AD prescription ratio with GP's age, gender, practice location, number of years of practice, number of consultations, number and age of registered patients, patients' income and number of patients with a chronic condition were assessed using univariate and multivariate analysis. Low prescriber GPs were 51.3±11.2 years-old and were mainly women (56%). In the multivariate analysis, low prescribers were associated with urban practice (OR: 1.47, 95%CI: 1.14-1.88), GP's younger age (OR: 1.87, 95%CI: 1.42-2.44), patient's younger age (OR: 3.39, 95%CI: 2.77-4.15), more patient consultations (OR: 1.33, 95%CI: 1.11-1.61), lower income patients (OR: 1.44, 95%CI: 1.17-1.76) and fewer diabetes mellitus patients (OR: 0.72, 95%CI: 0.59-0.88). Prescriptions of ADs are influenced by the characteristics of GPs and their patients. In future work, a more detailed assessment of all components of the consultation (in particular home blood pressure monitoring use) is necessary to explain AD prescription in general practice.

PS-BPP05-4: PRESCRIPTIONS OF ANTIHYPERTENSIVE DRUGS ARE INFLUENCED BY THE CHARACTERISTICS OF GENERAL PRACTITIONERS AND THEIR PATIENTS

Background: Hypertension is associated with significant cardiovascular morbimortality. However, hypertension control is low, especially in France. The reasons influencing general practitioners (GP) prescription of antihypertensive drugs (AD) remains unclear. This study aimed at assessing the influence of GP and patient characteristics on AD prescriptions. Methods: A cross-sectional study based on a sample of 2,165 GPs working with French national health insurance was realized in Normandy (region of France) in 2019. Only GPs meeting the criteria for full-time GP practice were included. The ration of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP and permited the low-high AD prescriber definition. Associations of this AD prescription ratio with GP age, gender, practice location, number of years of practice, number of home visits and consultations, number and age of registered patients, patient income and number of patient with a chronic condition were assessed using univariate and multivariate analysis. Results: The low prescribers GPs were 51.3 ± 11.2 year-old and were mainly women (56%) and practiced in urban context (53%). They prescribed less antihypertensives drugs (4% vs 8%, p &lt; 0.001) and had more low-income patients (6% vs 4%, p &lt; 0.001). In the multivariate analysis, low prescribers were associated to urban practice (OR: 1.47, 95%CI: 1.14;1.88), GP younger age (OR: 1.87, 95%CI:1.42;2.44), patients younger age (OR: 3.39, 95%CI: 2.77;4.15), more patients consultations (OR: 1.33,95%CI: 1.11;1.61), more low-income patients (OR: 1.44, 95%CI: 1.17;1.76) and less diabetes mellitus patients (OR: 0.72, 95%CI:0.59;0.88). Conclusions: Our study described a profile of the typical low er AD prescriber GP. In future work, a more detailed assessment of all components of the consultation (in particular home blood pressure monitoring use) is necessary to explain AD prescription in general practice.

Primary health care utilization and hospital readmission in children with asthma: a multi-site linked data cohort study

Objectives To (1) describe primary health care utilization and (2) estimate the effect of primary care early follow-up, continuity, regularity, frequency, and long consultations on asthma hospital readmission, including secondary outcomes of emergency (ED) presentations, asthma preventer adherence, and use of rescue oral corticosteroids within 12 months. Methods An Australian multi-site cohort study of 767 children aged 3–18 years admitted with asthma between 2017 and 2018, followed up for at least 12 months with outcome and primary care exposure data obtained through linked administrative datasets. We estimated the effect of primary care utilization through a modified Poisson regression adjusting for child age, asthma severity, socioeconomic status and self-reported GP characteristics. Results The median number of general practitioner (GP) consultations, unique GPs and clinics visited was 9, 5, and 4, respectively. GP care was irregular and lacked continuity, only 152 (19.8%) children visited their usual GP on more than 60% of occasions. After adjusting for confounders, there was overall weak indication of effects due to any of the exposures. Increased frequency of GP visits was associated with reduced readmissions (4–14 visits associated with risk ratio of 0.71, 95% CI 0.50–1.00, p = 0.05) and ED presentations (>14 visits associated risk ratio 0.62, 95% CI 0.42–0.91, p = 0.02). Conclusions Our study demonstrates that primary care use by children with asthma is often irregular and lacking in continuity. This highlights the importance of improving accessibility, consistency in care, and streamlining discharge communication from acute health services.

The gender and age characteristics of general practitioners in Moscow

The feminization and middle age decreasing in general practitioner profession is a worldwide trend.Purpose of the study is to explore gender and age structure, professional characteristics of general practitioners in Moscow.The retrospective analysis of personal records of students of the Chair of General Medical Practice of the Institute of Professional Education of the The I. M. Sechenov First Moscow State Medical University trained from 2016 to 2020 (n = 400).It is established that women made 80.5% out of them. The average age was 50.7 ± 0.7 years; average general professional experience - 28.8 ± 0.8 years, in general medical practice - 9.7 ± 0.3 years. The internship/residency in therapy was graduated by 84.2% of students. Up to 96.3% worked in state medical organizations. The majority (97.0%) had no academic degree. Indicators with positive dynamics: share of women, physicians with internship/residency in therapy, employees of state medical organizations, without an academic degree. Indicators with negative dynamics: age, professional experience. Differences between men and women were established for residency and professional experience in general medical practice.The average social and professional portrait of general practitioner in Moscow: woman 50 years old graduated internship/residency in therapy, professional experience of more than 20 years, with professional retraining about 10 years ago, working in state medical organization, no academic degree.The activities were proposed considering gender and age specifics, professional characteristics of general practitioners, directed to increasing efficiency and comfort of training.

Exploring behaviour change in general practice consultations: A realist approach.

While general practice involves supporting patients to modify their behaviour, General Practitioners (GPs) vary in their approach to behaviour change during consultations. We aimed to identify mechanisms supporting GPs to undertake successful behaviour change in consultations for people with T2DM by exploring (a) the role of GPs in behaviour change, (b) what happens in GP consultations that supports or impedes behaviour change and (c) how context moderates the behaviour change consultation. Semi-structured interviews with academic clinicians (n = 13), GPs (n = 7) and patients with T2DM (n = 16) across Australia. Data were analysed thematically using a realist evaluation approach. Perspectives about the role of GPs were highly variable, ranging from the provision of test results and information to a relational approach towards shared goals. A GP-patient relationship that includes collaboration, continuity and patient-driven care may contribute to a sense of successful change. Different patient and GP characteristics were perceived to moderate the effectiveness and experience of behaviour change consultations. When patient factors are recognised in consultations, a relational approach becomes possible and priorities around behaviour change, that might be missed in a transactional approach, can be identified. Therefore, GP skills for engaging patients are linked to a person-centred approach.

Barriers to assessing vulnerability in pregnant women. A cross-sectional survey in Danish general practice.

Undetected vulnerability in pregnancy contributes to inequality in maternal and perinatal health and is associated with negative birth outcomes and adverse child outcomes. Nationwide reports indicate important barriers to assessing vulnerability among Danish general practitioners. To explore general practitioners perceived barriers to vulnerability assessment in pregnant women and whether the barriers are associated with practice organization of antenatal care, general practitioner, and practice characteristics. The questionnaire was sent to all Danish general practitioners (N = 3,465). Descriptive statistics described the barriers to assessing vulnerability in pregnant women. Analytical statistics with ordered logistic regression models were used to describe the association between selected barriers to vulnerability assessment and antenatal care organization, and general practitioner and practice characteristics. 760 general practitioners (22%) answered. Barriers to vulnerability assessment were related to lacking routines for addressing vulnerability, lacking attention to and record-keeping on vulnerability indicators, an insufficient overview of vulnerable pregnant women, and perceived insufficient remuneration for antenatal care consultations. Not prioritizing extra time when caring for vulnerable pregnant women was associated with experiencing more barriers. Always prioritizing continuity of care was associated with experiencing fewer barriers. General practitioners of either young age, male gender, or who did not prioritize extra time to care for vulnerable pregnant women experienced more barriers. Barriers to vulnerability assessment among pregnant women do exist in general practice and are associated with organizational characteristics such as lacking prioritization of extra time and continuity in antenatal care consultations. Also, general practitioner characteristics like male gender and relatively young age are associated with barriers to vulnerability assessment.

Rates of psychotropic medicine prescribing in paediatric populations in Australian general practice from 2000-2016

General practitioner (GP) prescribing of psychotropic medicines to paediatric patients is increasing across countries, sparking the need for additional research into this field. We examined prescribing rates, GP and patient characteristics and indications associated with prescribing psychotropic medicines to paediatric patients in Australian general practice, using data from the Bettering the Evaluation and Care of Health (BEACH) program. We extracted all encounters with children aged 3 to 17 from 2000 to 2016. Psychotropic medicines were defined as those in the ATC codes N05 (Psycholeptics) and N06 (Psychoanaleptics). Of the 144,397 encounters, GPs prescribed 1829 psychotropic medicines to paediatric patients at an average rate of 1.16 prescriptions per 100 encounters (95% confidence interval 1.09-1.23). We found that the rate of psychotropic medicines prescribed to paediatric patients in Australian general practice increased. Patients who were adolescent, female, socio-economically disadvantaged or from an English-speaking background were significantly more likely to be prescribed a psychotropic medicine. GP practices in remote or regional areas and Australian graduate GPs were more likely to prescribe psychotropic medicines to paediatric patients. Depression, attention deficit hyperactivity disorder, anxiety and autism were the most common psychiatric indications managed with psychotropic medicines. Antidepressants, psychostimulants, benzodiazepines, antipsychotics and other psychotropic medicines were prescribed, signifying a high rate of off-label use. Sertraline was the most common psychotropic medicine prescribed, followed by fluoxetine and methylphenidate. Future studies involving data from other prescribers, e.g. paediatricians and psychiatrists, and studies linking prescribed medicines to their indications may widen our understanding of psychotropic medicine prescribing in Australian paediatric patients.

Foot, ankle, and leg problems in Australian primary care: consultation patterns, management practices, and costs.

To explore consultation patterns, management practices, and costs of foot, ankle, and leg problems in Australian primary care. We analyzed data from the Bettering the Evaluation and Care of Health program, April 2000 to March 2016. Foot, ankle, and leg problems were identified using the International Classification of Primary Care, Version 2 PLUS terminology. Data were summarized using descriptive statistics examining general practitioner (GP) and patient characteristics associated with a foot, ankle, or leg problem being managed. Cost to government was estimated by extracting fees for GP consultations, diagnostic imaging, and pathology services from the Medicare Benefits Schedule (MBS) database. Costs for prescription-only medicines were extracted from the Pharmaceutical Benefits Schedule and for nonprescribed medications, large banner discount pharmacy prices were used. GPs recorded 1,568,100 patient encounters, at which 50,877 foot, ankle, or leg problems were managed at a rate of 3.24 (95% confidence intervals [CIs] 3.21-3.28) per 100 encounters. The management rate of foot, ankle, or leg problems was higher for certain patient characteristics (older, having a health care card, socioeconomically disadvantaged, non-Indigenous, and being English speaking) and GP characteristics (male sex, older age, and Australian graduate). The most frequently used management practice was the use of medications. The average cost (Australian dollars) per encounter was A$52, with the total annual cost estimated at A$256m. Foot, ankle, and leg problems are frequently managed by GPs, and the costs associated with their management represent a substantial economic impact in Australian primary care.

Prescription of benzodiazepines and Z-drugs among older patients in primary care: a French, national, cohort study.

In France, general practitioners (GPs) prescribe benzodiazepines and Z-drugs (BZD/ZDs) widely, and especially to older adults. Several characteristics of patients and/or GPs linked to BZD/ZD overprescription have been described in the general population but not among older patients in primary care. To estimate the proportion of GP consultations by patients aged 65 and over that resulted in a BZD/ZD prescription, and determine whether any GP-related factors predicted BZD/ZD overprescription in this setting. We analyzed sociodemographic and practice-related GP characteristics, and aggregated data on consultations recorded prospectively by 117 GPs in a database between 2000 and 2010. Next, we used logistic regression models to look for factors potentially associated with BZD/ZD overprescription (defined as an above-median prescription rate). The GPs' mean age at inclusion was 47.4 (7.1), and 87.9% were male. During the study period, the median (95% confidence interval) proportion of consultations with patients aged 65 and over resulting in a BZD/ZD prescription was 21.8% (18.1-26.1) (range per GP: 5-34.1%). In a multivariable analysis, a greater number of chronic disease (OR [95% CI] = 2.10 [1.22-3.64]), a greater number of drugs prescribed per consultation (5.29 [2.72-10.28]), and shorter study participation were independently associated with BZD/ZD overprescription. BZD/ZD overprescription was associated with a greater chronic disease burden and the number of drugs prescribed per consultation but not with any sociodemographic or practice-related GP characteristics. Targeted actions are needed to help GPs limit their prescription of BZD/ZDs to older patients with multiple comorbidities and polypharmacy.

General practitioner gender and use of diagnostic procedures: a French cross-sectional study in training practices

ObjectivesThe acceleration in the number of female doctors has led to questions about differences in how men and women practice medicine. The aim of this study was to assess the...

Talking about Climate Change and Environmental Degradation with Patients in Primary Care: A Cross-Sectional Survey on Knowledge, Potential Domains of Action and Points of View of General Practitioners.

Purpose: General practitioners (GPs) could play a role in mitigating climate change by raising awareness of its impact on human health and implementing changes to improve population health and decreasing environmental footprints. The aim of this study was to assess GPs’ knowledge and perspectives about the health impacts of climate change. Method: A questionnaire was sent to 1972 GPs in the French-speaking part of Switzerland. Knowledge of the impact of environmental degradations and climate change on health and willingness to address climate change with patients, to be exemplary and to act as role models were surveyed as well as demographic characteristics of GPs. Results: Respondents (N = 497) expressed a high level of self-reported knowledge regarding climate change, although it was lower for more specific topics, such as planetary health or health–environment co-benefits. Participants mostly agreed that it is necessary to adapt clinical practice to the health impacts of climate change and that they have a role in providing information on climate change and its links to human health. Conclusion: Most of the GPs were concerned about environmental and climate degradation. However, this study revealed a gap between the willingness of GPs to integrate the impact of climate change on health into their clinical activities and their lack of overall knowledge and scientific evidence on effective interventions. A promising way forward may be to develop co-benefit interventions adapted to the clinical setting on diet, active mobility and connecting with nature.