Experiences Of General Practitioners Research Articles

Consensus on relevant point-of-care ultrasound skills in General Practice: a two-round French Delphi study

ContextPoint-of-Care Ultrasound (POCUS) has become an important tool in the clinical practice of many specialties, but its use and impact in General Practice in France remains to be explored.ObjectiveThe objective of this study is to obtain a consensus among experienced French general practitioners on a list of relevant POCUS skills in General Practice in 4 anatomical regions.MethodWe used a two-round Delphi method to obtain a consensus. An initial list of skills was drawn by conducting a literature review. To rate each skill, we used a nine-point Likert scale. An interactive meeting between experts took place between Delphi rounds. POCUS experts in General Practice were defined as general practitioners with theoretical training in ultrasound who regularly perform ultrasound, who have performed ultrasound for more than five years and/or are involved in providing ultrasound training.Results11 French general practitioners screened 83 skills in 4 anatomical regions: abdominal, urogenital, vascular, gynecology and obstetrics. An agreement was obtained for 36 POCUS skills as to their appropriateness in General Practice. There were 17 skills with a strong appropriate agreement (100% of “7–9” ratings) and 19 skills with a relative agreement (100% of “5–9” ratings).ConclusionThese skills could serve as a basis for guidelines on the use and curriculum of POCUS in General Practice in France as well as in other countries with similar healthcare systems.

General practitioners’ experiences of providing somatic care for patients with severe mental illness: a qualitative study

BackgroundPatients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties.MethodsWe conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group.ResultsGPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations.ConclusionThe GPs’ interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group.

How can primary care benefit from digital health applications? – a quantitative, explorative survey on attitudes and experiences of general practitioners in Germany

BackgroundSince 2020, physicians in Germany have the possibility of prescribing approved digital health applications (DHAs) with the costs covered by the health system – a step that was unique in the world at that time and still is. So far, there have been hardly any studies that shed light on the possible applications of DHAs in the context of primary care and take stock of the benefits and potential for optimization. In 2022, a quantitative survey was carried out. The aim was to determine what attitudes, experiences and expectations GPs have with regard to the use of DHAs, under what conditions they are willing to integrate them into health care, and what experience they have already gained.MethodsThe focus was on a large-scale survey of GPs. Between spring and summer 2022, all 18,914 GPs in the federal states of Baden-Württemberg, Hesse, Lower Saxony, Rhineland-Palatinate and Saarland were invited to an online survey. 5,868 questionnaires were included in the evaluation (response rate: 31%). A t-test on independent samples was used to determine significant differences between two groups.Results68% of those surveyed are positive about DHAs and consider them to be reliable (69%) and safe (63%) applications that can generate efficiency benefits for the doctor-patient relationship. 24% trust themselves to competently advise patients on DHAs. 14% have already prescribed DHAs, 13% plan to do so. 85% of doctors with DHA experience rate the prescribed applications as (very) useful. Observed health care effects relate primarily to the improvement in compliance (94%), mobility (93%), and education (93%), as well as weight reduction (83%). Among other things, a further optimization of usability (59%), systematic further training of doctors on DHAs (53%) and the expansion of gamification elements (49%) are suggested. GPs lack well-founded information with regard to DHAs (52%).ConclusionFor GPs, DHAs can be effective tools to encourage patients in their personal responsibility, compliance and motivation to behave in a health-conscious manner and to strengthen prevention in the primary care setting. Where DHAs have been used in a practical context so far, widespread positive health care effects are noticeable. Most respondents do not dare to give patients competent advice on available applications. Comprehensive training courses that provide information about the framework conditions, strategies and advantages of using DHAs appear to be important. There is also a need for more well-founded sources of information and research for doctors to select suitable applications in a targeted manner. GPs see significant added value in DHAs compared to conventional health apps. In order for DHAs to be effectively implemented in primary care, it is important to better inform GPs about the legal basis and possible applications as well as to address their concerns.

General practitioners' representation of early-stage CKD is a barrier to adequate management and patient empowerment: a phenomenological study.

In high-income countries, chronic kidney disease (CKD) affects over 10% of the population. Identifying these patients early is a priority, especially as new treatments are available to reduce the risk of cardiovascular and renal morbidity. We aimed at understanding the management and care pathway of patients with early-to-moderate CKD defined as an estimated glomerular filtration rate (eGFR) ≥ 45mL/min/1.73m2 (CKD-EPI), by analyzing the experience of general practitioners in a region in France. This qualitative semiopragmatic phenomenological study analyzed in-depth interviews held with a purposive sample (age, gender, training, type of practice, rural/urban context) of 24 general practitioners, with triangulation of research until data saturation. From diagnostic, etiological and prognostic viewpoints, the general practitioners enrolledin our study perceived CKD as a complex, poorly-defined clinical entity in asymptomatic and multimorbid patients. They distinguished it from a rare condition they considered as 'mainly renal'. The fact that they did not perceive early-stage CKD as a disease was a hindrance to patient care, which should protect the kidneys with a preventive approach. Indeed, general practitioners perceived CKD patient management as a pathway requiring a personalized, integrative model, common to all chronic diseases, without necessarily involving a nephrologist, at least in the early stages. This study shows how the general practitioners' representations influence their attitudes and interventions. Clarifying the concept of early-stage CKD by taking factors like age and etiology into account would facilitate personalized management of this heterogeneous, often multimorbid, population. Finally, organizational models to support patient empowerment in an integrative care pathway must be established andvalidated.

General practitioners' user experience of the nationwide digital decision support system in primary care.

The aim of the study is to describe the user experiences of a nationwide digital decision support system (DDSS). DDSSs have the potential to improve the quality and safety of healthcare services by supporting clinical decision-making with evidence-based recommendations. Due to a lack of knowledge, it is difficult to assess whether DDSSs are fulfilling their purpose. In Estonia, a nationwide DDSS for general practitioners (GPs) was implemented in 2020. To understand the impact of DDSS on the quality of care in the Estonian context and meet the demands of healthcare, it is necessary to gather information about the experiences of the users. This is the first study that examines the experiences of GPs on the use of DDSS nationwide. A qualitative descriptive study was conducted based on snowball sampling. Semi-structured interviews were performed in February-March 2022 with nine GPs. Data were analyzed by thematic analysis. A total of six themes and 16 subthemes emerged from the data. A total of six themes and 16 subthemes emerged from the data. The following themes were identified: user-friendliness, DDSS use in clinical practice, benefits of the DDSS, and the impact of the DDSS on GPs' work, barriers to using the DDSS, and suggestions for improving the user experience. The results of the study are important, as they address and contribute to the relevant aspects of digital health in primary care. GPs shared their individual user experiences, including user-perceived barriers and enabling factors that influence the implementation and use of a decision support system in primary care settings. It is revealed that GPs have different benefits and barriers depending on the topic discussed. Future research should evaluate the functioning of the DDSS and the quality of the decisions it provides by observing and evaluating patient records. Systematic user experiences need to be collected and examined to ensure the usability and sustainability of the DDSS.

Diagnosis and management of acute infections during telehealth consultations in Australian general practice: a qualitative study.

The use of telehealth has increased dramatically since the beginning of the COVID-19 pandemic. Little is known about how GPs manage acute infections during telehealth, and the potential impact on antimicrobial stewardship. To explore the experiences and perceptions of GP trainees' and supervisors' use of telehealth, and how it influences their management of acute infections. Australian GP registrars (trainees) and supervisors were recruited via email through their training organisations. Semi-structured interviews with 18 participants were conducted between July and August 2022. Interviews were transcribed verbatim and analysed using a reflexive thematic approach. We identified six overall themes. 1. Participants experienced impaired diagnostic capacity during telehealth consultations. 2. Attempts to improve diagnostic acuity included various methods, such as having patients self-examine. 3. The management of clinical uncertainty frequently entailed referring patients for in-person assessment, overinvestigating, or overtreating. 4. Antibiotic prescribing decisions during telehealth were informed by less information than were in-person consults, with varying impact. 5. Participants believed that other GPs improperly prescribed antibiotics during telehealth. 6. Supervisors believed that registrars hadn't developed the knowledge or skills to determine when conditions could be managed appropriately via telehealth. Telehealth has potential for reducing transmission of acute infections and increasing access to healthcare. However, the implications of GPs, especially less experienced GPs, making diagnoses with less certainty, and consequently compromising antimicrobial stewardship, are a concern. Patient self-assessment tools may improve outcomes of telehealth consultations for acute infections.

General practitioner perceptions and experiences of managing perinatal mental health: a scoping review

BackgroundGeneral Practitioners (GPs) are involved in preconception, pregnancy, and postnatal care. Overall, mental health remains a significant contributor to disease burden affecting 1 in 4 pregnant women. Psychotropic medication prescribing occurs in almost 1 in 12 pregnancies, and appears to be increasing, along with the prevalence of mental health disorders in women of reproductive age. Perinatal mental health management is therefore not an unlikely scenario within their clinical practice. This scoping review aims to map current research related to GPs perceptions and experiences of managing perinatal mental health.MethodA comprehensive search strategy using nine electronic databases, and grey literature was undertaken between December 2021 and February 2023. Relevant studies were sourced from peer review databases using key terms related to perinatal mental health and general practitioners. Search results were screened on title, abstract and full text to assess those meeting inclusion criteria and relevance to the research question.ResultsAfter screening, 16 articles were included in the scoping review. The majority focused on perinatal depression. Findings support that GPs express confidence with diagnosing perinatal depression but report issues of stigma navigating a diagnosis. Over the last two decades, prescribing confidence in perinatal mental health remains variable with concerns for the safety profile of medication, low level of confidence in providing information and a strong reliance on personal experience. Despite the establishment of perinatal guidelines by countries, the utilisation of these and other existing resources by GPs appears from current literature to be infrequent. Many challenges exist for GPs around time pressures, a lack of information and resources, and difficulty accessing referral to services.ConclusionRecommendations following this scoping review include targeted perinatal education programs specific for GPs and embedded within training programs and the development of practice guidelines and resources specific to general practice that recognises time, services, and funding limitations. To achieve this future research is first needed on how guidelines and resources can be developed and best delivered to optimise GP engagement to improve knowledge and enhance patient care.

Returning-to-work after mental health-associated sick leave: a qualitative interview study exploring the experiences of general practitioners in Germany

Background and aimPsychiatric disorders are increasing globally. Especially when these disorders affect working people, this places a financial burden on society due to long-term sick leave, the incapacity to work and the inability to earn and pay taxes. General practitioners (GPs) are often the first health professionals to be consulted by those suffering from mental health disorders.This study investigated the experiences of GPs regarding their patients with mental health disorders and identified factors that are important for a successful return to work.MethodsThis qualitative study used semi-structured interviews to explore the opinions of GPs (n = 12) working in Munich, Germany, or its metropolitan area. The interviews were audio-recorded, transcribed, and analyzed using the reflexive thematic analysis method.ResultsGPs think of themselves as important players in the rehabilitation process of patients with mental health disorders. In their daily routine, they face many obstacles to ensure the best treatment and outcome for their patients. They also suffer from poor collaboration with other stakeholders, such as psychiatric hospitals, therapists or employers.They indicate that the mental health disorder of each patient is unique, including the barriers to and possibilities of a successful return to work. Additionally, the workplace appears to play a crucial role in the success rate of re-entry into work. It can exacerbate the course of mental health disorders or support recovery. Fear, shame and stigmatization of the patients are personal factors responsible for prolonged sick leave.ConclusionWe conclude that GPs believe that they can have a major impact on the rehabilitation of patients with mental health disorders. As such, special focus should be placed on supporting them in this context.

Improving the Format, Content, and Writing Process of Outpatient Clinic Letters Within a Musculoskeletal Therapy Department.

Outpatient clinic letters are recognized as an important component of patient care. This project aimed to coproduce clinic letters that have meaning and relevance for key stakeholders. This health care improvement project was conducted in one musculoskeletal therapy (physiotherapy and osteopathy) department in southern England using a Lean Six Sigma Define, Measure, Analyze, Improve, and Control-inspired framework. The views and experiences of key stakeholders, including therapists, general practitioners, and patients, were explored using surveys and group meeting methods. New letter designs were coproduced with stakeholders, including patient partners and personalized care lead staff, and were refined through a pilot phase. Qualitative data were analyzed thematically, and quantitative data were analyzed descriptively. Overall, patients and therapists found the clinic letters an important and meaningful part of care. However, therapists reported that they often did not write the letters, and time was identified as the main barrier. The main theme identified from patient feedback was that patients wanted to write the letters in collaboration with the clinician. The pilot phase demonstrated that, on average, the new letters took less time to write. This project has coproduced new clinic letters and operational processes centered on the needs of key stakeholders. This article will help other outpatient departments reflect on their own clinic letters and consider their meaning and relevance for their stakeholders.

Participant and GP perspectives and experiences of screening for undiagnosed type 2 diabetes in community pharmacy during the Pharmacy Diabetes Screening Trial

BackgroundThe Pharmacy Diabetes Screening Trial (PDST) evaluated three approaches to screening for undiagnosed type 2 diabetes mellitus (T2DM) in community pharmacy: (1) paper-based risk assessment (AUSDRISK) alone; and AUSDRISK followed by a point of care test if AUSDRISK ≥ 12; with either (2) HbA1c; or (3) small capillary blood glucose Test (scBGT). This paper reports the perspectives and experiences of the pharmacy screening service of two key stakeholder groups: screening participants and general practitioners (GPs).MethodsAll referred participants (n = 2242) received an online survey to determine the outcome of the referral, as well as their level of satisfaction with the service. In addition, a random sample of 2,989 (20%) of non-referred participants were surveyed to determine their overall experience and level of satisfaction with the service. GPs to whom participants were referred were contacted to establish if, since the date of the screening service, their patient had (1) been to see them; (2) had further tests performed (FBG, RBG, OGTT, HbA1c); or (3) been diagnosed with diabetes or prediabetes. Descriptive statistics were reported for quantitative data. Factors associated with visiting the GP following screening were assessed using multivariable logistic regression. Qualitative data were analysed using content analysis.ResultsResponse rates 16% (n = 369) and 17% (n = 520) were achieved for the three-month referred and non-referred participant surveys, respectively. Over 90% of respondents were very positive about the screening service (n = 784/853) and would recommend it to a family member or friend (n = 784/853). Participants also reported making significant improvements in diet and exercise, because of the screening. Among referred respondents, those who received a POC test were twice as likely to visit their GP compared to those who received a risk assessment only (OR 2.11 95% CI 1.46–3.06). GPs (15.8% response rate, n = 57/361) indicated that the referral worked well and that recommendations for follow-up care by the pharmacist were appropriate.ConclusionOpportunistic screening of individuals during routine encounters with the community pharmacy in a previously undiagnosed population has been shown to foster positive engagement with consumers and GPs, which may assist in reducing the burden of T2DM on the individual and the community.

General Practitioner's Experience of Public-Private Partnerships to Develop Team-Based Care: A Qualitative Study.

Objectives: A tripartite public-private partnership was established between GPs' practices, public health authorities and a university department of family medicine, to develop multidisciplinary teams and integrate nurses into GPs' practices. The present paper describes the points of view of the GPs involved in this collaboration. Methods: We conducted a qualitative study, with data coming from eight interviews with GPs, one from each practice. We also used the facilitator's project diary to complete the discussion. Results: The principal issue discussed was the financial aspects of the collaboration. GPs are generally satisfied, but time spent coordinating with nurses and transferring activities made them fear financial losses. Secondly, the partnership with public health authorities was well appreciated, but not clear enough. Some aspects of the partnership, such as referring patient to the nurse should have been better defined et controlled. The last aspect was the academic support. It allowed reducing GPs' workload in training nurses and supporting the project implementation within the GPs' practice. Conclusion: GPs have a positive point of view of such public-private partnership and saw an opportunity to be involved in developing public health policies.

1.D. Workshop: Long COVID: A Myth or a reality?

Abstract COVID-19 has been a pandemic since 2020 and to date has resulted in a substantial global burden through both morbidity and mortality. Long term symptoms impacting the mental, social, and physical well-being among COVID-19 survivors started to be noted from early pandemic. This phenomenon was reported as Long COVID, and the World Health Organization (WHO) has now defined it as “a condition that occurs in those with probable or confirmed COVID-19 infection where symptoms last for at least two months from the onset of the infection”. Yet, the paucity of longitudinal cohort studies and clinical trials on Long COVID presents the scientific, clinical, and public health ecosystems with limited understanding pertaining to this new condition as well as presents uncertainty on whether “Long COVID is a myth or a reality?” Additionally, on a country level, the level of preparedness to deal with Long COVID at a population level and through healthcare services are not established. With over 60% of Europeans reported to suffer from Long COVID, this timely workshop is set to bring forward a pan-European expert consensus on the existence and the deterrent effects attributed to Long COVID, with recommendations for the way forward. The workshop will start off by presenting the overall impact of COVID on the well-being of middle-aged and older adults residing in 27 European countries as well as explores whether having Long COVID further deteriorate their well-being. The symptoms of Long COVID will be explored along with their effect on the health-related quality of life (HRQoL), fatigue, mental well-being, while investigating the determinants that diminish HRQoL. This will provide an all-rounded approach to the direct effects of Long COVID. It is known that Long COVID individuals will seek their first medical care contact at primary healthcare. Therefore, the workshop will explore the general practitioner's knowledge, perceptions, and experience on Long COVID's diagnosis and management across two European countries. This will provide an insight whether primary healthcare practitioners are equipped with dealing with this emerging syndrome. The workshop then focuses on Italy's perspective, at a country level, in managing Long COVID through Good Clinical Practice and access to national services. Finally, a European overview of the Long-COVID-19 situation from a population health perspective will be provided and it will offer unique insights on the development of different tools, strategies and structures in national healthcare systems and their fight against long-COVID. Key messages • Long COVID is causing deterrent effects and impact the physical, mental, social and economic status of the populations. • We need better tools (e.g., registries or targeted Health Examination Surveys) to assess the situation and to customise health care provision for the current patients and avoid the further spread.

Obstacles and practical perspectives of the consultation in general medicine of migrants with psychological disorders. Qualitative study among French general practitioners

The aim of this study is to understand the problems of managing psychological disorders in migrant populations, based on the experience of general practitioners. A qualitative study was carried out with general practitioners interviewed in a semi-directive mode. We chose the continuous comparison method and Peirce's pragmatic phenomenological approach to explore the lived experience. Thirteen interviews revealed four phenomenological categories: (1) Immigration was an experience of mental suffering from beginning to end at the source of psychological disorder migrant population (PDMPs) with the need for specialized follow-up. (2) Inadequate support on arrival, with complicated administrative procedures and insecure societal and environmental conditions, exacerbated the precariousness of migrants, making follow-up difficult. (3) Immigration was a transcultural journey in which the language, attitudes and perceptions of each individual blurred understanding of symptoms and care, and thus professional communication. (4) Unprepared general practitioners found counselling migrants to be difficult, time-consuming and complex. They pointed to the need for a coordinated system with comprehensive multidisciplinary care.Data saturation was reached. Three researchers were brought together. This study highlights the difficulties encountered by general practitioner (GPs) dealing with migrant patients in France. They feel helpless in the face of the nature of the disorders encountered and experience a disparity between the connections that are difficult to establish and those in their usual practice, even when professional experience with this population is acquired. They point to the need for coordinated models of care, financed by public policy.

Fragmentation of care between intensive and primary care settings and opportunities for improvement

PurposeTo explore the gaps in care provided across the transitions from the intensive care unit (ICU) to primary care, in order to improve post-ICU care.MethodsSemistructured interviews with three participant groups:...

Supporting GPs and people with hypertension to maximise medication use to control blood pressure: Protocol for a pilot cluster RCT of the MIAMI intervention.

Background: Hypertension is one of the most important risk factors for stroke and heart disease. Recent international guidelines have stated that 'poor adherence to treatment - in addition to physician inertia - is the most important cause of poor blood pressure control'. The MaxImising Adherence, Minimising Inertia (MIAMI) intervention, which has been developed using a systematic, theoretical, user-centred approach, aims to support general practitioners (GPs) and people with hypertension to maximise medication use, through the facilitation of adequate information exchange within consultations about long-term antihypertensive medication use and adherence skill development. The aim of the MIAMI pilot cluster randomised controlled trial (RCT) is to gather and analyse feasibility data to allow us to (1) refine the intervention, and (2) determine the feasibility of a definitive RCT. Methods: GP practices (n = 6) will be recruited and randomised to the intervention arm (n = 3) or usual care control arm (n = 3). Each practice will recruit 10 patient participants. For a patient to be eligible they must have a diagnosis of hypertension, be on two or more anti-hypertensive medications, must not be achieving recommended blood pressure levels, and be over the age of 65 years. Participants in the intervention arm will meet their GP and receive the MIAMI intervention twice over three months. Quantitative data collection will take place at baseline and three month follow up. A pilot health economic analysis and a qualitative sub-study will also be incorporated into the study. Discussion: This pilot cluster RCT of the MIAMI intervention will allow us to gather valuable acceptability and feasibility data to further refine the intervention so it optimally designed for both GP and patient use. In particular, the qualitative component will provide an insight into GP and patient experiences of using the intervention.

General practitioners’ perspectives regarding early developmental surveillance for autism within the australian primary healthcare setting: a qualitative study

BackgroundSignificant challenges remain in the early identification of child developmental disabilities in the community. Implementing supports and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental disabilities, including autism. As part of a cluster randomised controlled trial, this study seeks to examine and compare the perspectives and experiences of Australian general practitioners (GPs) in relation to a digital developmental surveillance program for autism and usual care pathway, in general practice clinics.MethodsA qualitative research methodology with semi-structured interviews and thematic inductive analysis underpinned by grounded theory was utilised. All GPs from South Western Sydney (NSW) and Melbourne (Victoria) who participated in the main program (“GP Surveillance for Autism”) were invited to the interview. GPs who provided consent were interviewed either over online or in-person meeting. Interviews were audio-recorded, transcribed, and coded using NVivo12 software. Inductive interpretive approach was adopted and data were analysed thematically.ResultsTwenty-three GPs across the two sites (NSW: n = 11; Victoria: n = 12) agreed to be interviewed; data saturation had reached following this number of participants. Inductive thematic coding and analysis yielded eight major themes and highlighted common enablers such as the role of GPs in early identification and subsequent supports, enhanced communication between clinicians/professionals, relationship-building with patients, and having standardised screening tools. Specific facilitators to the feasibility and acceptability of a digital screening program for the early identification of developmental disabilities, including the early signs of autism, and encouraging research and education for GPs. However, several practical and socioeconomic barriers were identified, in addition to limited knowledge and uptake of child developmental screening tools as well as COVID-19 lockdown impacts. Common and specific recommendations involve supporting GPs in developmental/paediatrics training, streamlined screening process, and funding and resources in the primary healthcare services.ConclusionsThe study highlighted the need for practice and policy changes, including further training of GPs alongside sufficient time to complete developmental checks and appropriate financial remuneration through a Medicare billing item. Further research is needed on implementation and scale up of a national surveillance program for early identification of developmental disabilities, including autism.

General practitioner experiences in delivering early medical abortion services to women from culturally and linguistically diverse backgrounds: A qualitative-descriptive study.

General practitioners (GPs) are ideally placed to deliver early medical abortion (EMA), yet little is known about how GPs deliver this care to women from culturally and linguistically diverse (CALD) backgrounds. We explored GP experiences in providing EMA to women from CALDbackgrounds and their recommendations for service improvements. This was a qualitative study involving telephone interviews with 18 Australian GPs who provide EMA to women from CALD backgrounds. Data were thematically analysed using the Capability, Opportunity and Motivation Behaviour model. GPs experienced challenges in communication and cultural competency when delivering EMA to women from CALD backgrounds due to insufficient training, lackof multilingual resources and difficulties accessing interpreters. In addition, the stigma surrounding abortion and concerns around reproductive coercion made engaging these women challenging. Upskilling GPs in culturally competent care, improving access to multilingual resources and enabling efficient interpreter use can optimise EMA delivery to women from CALD backgrounds.

Assessing feasibility of targeted primary care referrals for patients with clinical suspicion of interstitial lung disease using lung ultrasound: a prospective case finding study. The potential benefits of LUS utilization.

In Primary Health Care (PHC) many interstitial lung disease (ILD) cases may remain at diagnostic delay, due to their challenging presentation and the limited experience of general practitioners (GPs) in recognizing their early symptoms. We have designed a feasibility study to investigate early ILD case-finding competency between PHC and tertiary care. A cross-sectional prospective case-finding study was launched at two private health care centers of Heraklion, Crete, Greece, during nine months (2021-2022). After clinical assessment by GP, PHC attenders, who agreed to participate in the study, were referred to the Respiratory Medicine Department, University Hospital of Heraklion, Crete, underwent Lung Ultrasound (LUS) and those with an overall suspicion for ILDs underwent high resolution computed tomography (HRCT) scan. Descriptive statistics and chi-square tests were used. Multiple Poisson regression analysis was performed to explain positive LUS and HRCT decision with selected variables. One hundred and nine patients out of 183 were finally included (54.1% females; mean age 61, SD: 8.3 years). Thirty-five (32.1%) were current smokers. Overall, two out of ten cases were assessed to need HRCT due to a moderate or high suspicion (19.3%; 95%CI 12.7, 27.4). However, in those who had dyspnea in relation to counterparts, a significantly higher percentage of patients with LUS findings (57.9% vs. 34.0%, p=0.013) was found, as in those who had crackles (100.0% vs. 44.2%, p= 0.005). Detected possible ILD provisional labelling cases were 6, and most importantly, 5 of those cases were considered highly suspicious for further evaluation based on LUS findings. This is a feasibility study exploring potentials by combining data of medical history, basic auscultation skills, as crackles detection, and inexpensive and radiation-free imaging technique, such as LUS. Cases of ILD labeling may be hidden within PHC, sometimes, much before any clinical manifestation.

Veterinary Clinician's Opinions and Experiences with the Feline Ovarian Pedicle Tie

Ligation of the feline ovarian pedicle is commonly performed by autoligation, also known as the pedicle tie. This technique is faster than double ligation with suture, has a very low risk of hemorrhage-related complications, and has been suggested as an acceptable standard in all practice settings. However, although it has been demonstrated to be appropriate for novice surgeons under supervision, fewer institutions teach autoligation than double ligation. This study aimed to determine the opinions and experiences of general practitioners regarding the feline ovarian pedicle tie. An anonymous 23-question online survey entitled “Veterinary Clinician's Opinions and Experiences with Surgical Spay/Neuter Techniques” was advertised to veterinarians performing feline ovariohysterectomies via social media posts that also encouraged sharing and cross-posting. The survey questions, most of which presented non-exclusive answer options resulting in percentages summing to greater than 100%, probed the opinions and experiences of veterinarians regarding the technique. There were 142 respondents, with 77 indicating the use of the pedicle tie and 65 indicating no use. Of those who used the pedicle tie, most reported learning from either a dedicated high-quality high volume (HQHV) educational setting (32%) or a colleague/mentor (32%). Nearly half used it in all cases, although 20% did not use it for pregnant cats. They had used it for a median of 5 (IQ 3-8) years, and 99% were comfortable teaching the technique to others. Of those who did not use the pedicle tie, 60% reported that it meets the standard of care (SOC), 14% reported that it does not, and 26% that it sometimes meets SOC. Most veterinarians not performing the pedicle tie thought it was appropriate for unowned cats or cats in HQHV programs (77-82%), but only 55% thought it was appropriate for owned cats in general practice. The most common reasons given for not using the technique were that they had not learned it in vet school (51%), followed by the fact that they had not seen it used before (34%) and that while they had seen it done, they were nervous to try (28%). Seventy-four percent of those who did not use autoligation of the feline ovarian pedicle used autoligation of the testicular pedicle, either the pedicle tie (40%) or figure 8 (34%). Of those who believed that the pedicle tie does not meet SOC, 78% indicated it was because they had not seen it used, and 67% because it was not taught in vet school. However, 89% reported that an expensive commercially available device with similar positive attributes, specifically reduced procedure time, met SOC. Veterinarians using the pedicle tie graduated more recently (P = 0.040), with the median year of graduation in 2011 (IQR 2004-2016) as compared to 2007 (IQR 1998-2014). The greatest barrier to performing the technique or considering it SOC is a lack of familiarity with the method and the fact that it is not taught routinely in veterinary school. There is an encouraging trend, with more recent graduates being more likely to perform the technique; however, there remains an opportunity to increase use.

Barriers to obesity health care in general practice from rural Waikato GP perspectives: A qualitative study.

Over 34% of New Zealand (NZ) adults are classed as obese, which reduces quality of life for many individuals. Those living in rural areas, high-deprivation communities, and indigenous Māori populations are more likely to experience obesity and related co-morbidities than other cohorts. General practice is positioned as most suitable to deliver effective weight management health care; however, little is understood about the rural general practitioner (GP) experience in NZ, despite having the majority of patients at high risk of developing obesity. The aim of this study was to investigate rural GP perspectives on barriers to delivering weight management. Qualitative descriptive design guided by Braun and Clarke (2006) using semi-structured interviews and analysed using deductive reflexive thematic approach. Rural Waikato general practice which has significant rural, Māori and high-deprivation communities. Six rural Waikato GPs. Three significant themes were identified: communication barriers, rural health care barriers, and social and cultural barriers. GPs reported not wanting to jeopardise the doctor-patient relationship by discussing weight. GPs felt unsupported by the health system through lack of rurally appropriate obesity intervention options, funding and resources. The unique rural lifestyle and health needs were reportedly not understood at the wider health system level, making the role of a rural GP working in high-deprivation communities more difficult. Additional barriers to delivering effective weight management included factors outside the clinical practice such as obesity stigma, an obesogenic environment and sociocultural factors shaping rural patients' lives. Rural GPs have a lack of weight management referral options that are considered effective for their patients, as the options available reportedly do not cater for their patients' unique rural health needs. GPs position addressing the individualised and complex weight management health issue as challenging. Navigating stigma, wider sociocultural issues, and limited intervention options were difficult and found to be questionable to achieve in a short 15-min consult. There is a need for rural health support in the form of funding, staff (indigenous and non-indigenous), and rurally feasible resources to improve health outcomes and reduce inequity. Effective primary care weight management strategies need to be appropriate for high-deprivation rural communities, including tailored, affordable and reliable interventions that GPs can offer patients if future weight management efforts are to be successful in this space.