General Practitioners In Relation Research Articles

Approach, Attitudes, and Knowledge of General Practitioners about Helicobacter pylori in the Doctor Soliman Fakeeh Hospital (DSFH) in Jeddah

Objectives: Helicobacter pylori (HP) is a gram-negative twisting molded microscopic organism, known to colonize, principally in the gastric mucosa of the antrum. This study was designed to investigate the approach, attitudes, and knowledge of general practitioners in relation to HP among healthcare providers in Doctor Suliman Fakeeh Hospital (DSFH) in Jeddah. Methods: This cross-sectional study was conducted in 2021 in DSFH in Jeddah, Saudi Arabia. An online self-administered questionnaire was distributed randomly for the period of July-September 2021, which was divided into 3 sections to gather information related to the consent, sociodemographic characteristics of the participants, and awareness of HP. Results: A total of 181 participants participated, 78% of participants were female. Among participants, it was revealed that the most prevalent reasons for the HP eradication therapy were peptic ulcer (48.4%), gastroesophageal reflux disease (41.8%), and dyspepsia (39.2%). There was a significant correlation between the knowledge of 181 healthcare respondents and which diagnostic test was used and when needed for HP confirmation was observed through statistical analysis and results showed data correlation to be statistically significant (p=0.30). There was a significant correlation between eradication treatment confirmation in suspected patients with infection and the experienced general practitioners of the DSFH analysis through statistical analysis and results showed data correlation to be statistically significant (p=0.20). Conclusion: The knowledge towards HP infection is still the most prevalent and persistent bacterial illness. There are numerous modalities for the diagnosing and eradication of HP.

Bulgarian General Practitioners' Communication Styles about Child Vaccinations, Mainly Focused on Parental Decision Making in the Context of a Mandatory Immunization Schedule.

The communication practices of general practitioners in relation with vaccines have not been a topic of wide scientific interest. In this article, we outline them in the context of Bulgaria. A representative, cross-sectional, quantitative, face-to-face survey was conducted among 358 Bulgarian general practitioners in 2022 using simple random sampling. We conducted an exploratory factor analysis using questions about the role of the GPs, which measure models of communication. Based on the factor analysis, we distinguished four communication styles. They were called: active communicator, restrictive communicator, informing communicator, and strained communicator. One-way ANOVA and the T-test were carried out to explore the connections between factor scores (communication styles) and other variables. One of the most important results in the study was that the informing physician (emphasizing the choice of the parents) was the most common model in Bulgaria. This is somewhat contradictory, because of the mandatory status of most vaccines. We found connections between the communication styles and other variables-such as the type of settlement, having a hesitant parent in the practice, recommendations of non-mandatory vaccines, and experience with vaccine-preventable diseases. On the basis of the factor analysis and analysis of relationships with other variables, we reached the conclusion that in Bulgaria, hesitant parents are not sufficiently involved in active, effective communication about vaccines by GPs.

Sickness Certification Behavior amongst Primary Care Physicians: A Descriptive Analysis of Indirect Measures Using the Theory of Planned Behavior.

BackgroundThe provision of sick leave to patients in general practice often entails a complex decision-making process. Commonly, general practitioners believe that the act of providing sick leave can become confrontational. We assessed the intention, attitude, subjective norm, and perceived behavioral control of general practitioners in relation to sick leave provision at public health clinics in Malaysia.MethodsA cross-sectional study design was implemented using data from 86 primary health care clinics in two states in Malaysia from February 2014 to March 2015. A questionnaire that comprised indirect measures were developed on the basis of the Theory of Planned Behavior. The questionnaire assessed several dimensions related to sickness certification provision viz., intention, attitude, subjective norm, and perceived behavioral control.ResultsThe mean scores in this study revealed that physicians acknowledged that patient factors such as clinical symptoms (6.59±0.04), debilitating signs and symptoms of diseases (6.45±0.06), importance of illness recovery (6.07±0.07), and approval of employers (5.35±0.09) played an important role in their decision to provide sick leave.ConclusionThe act of providing sickness certification to patients is a complex decision-making process. The findings of this study can be used to devise a targeted intervention to reduce the conflict that physicians face in issuing sick leaves.

One and a Half Decades of Disease Management Programs - Status Quo From the Point of View of General Practitioners

In 2003, disease management programs (DMP) were established to improve the care of chronically ill outpatient patients. Since then, there has been a lot of controversy over the meaning and benefits of structured treatment programs, especially among primary care physicians. The present study examines the attitudes and experiences of general practitioners in relation to DMP, how they assess these one and a half decades after their introduction, and where DMP need to be improved. In the course of a written survey, a total of 752 general practitioners in Hesse were interviewed between April and June 2019. In addition to the descriptive analysis, a factor analysis was performed. 59 % of the interviewees assess the DMP as positive and consider it a useful contribution to primary care. 89 % are currently participating in one or more DMPs, with 52 % indicating that the treatment of patients included in DMP has benefited significantly. Respondents consider the provision of regular, structured patient care and the improvement of compliance to be particularly positive. It is also stated that the diagnostic and therapeutic knowledge could be extended by DMP participation. 58 % always follow the DMP therapy recommendations. Documentation requirements and frequent organizational changes to the programs are criticized. From the point of view of the respondents, a far-reaching rigidity of the DMP concept leads to an exaggerated narrowing of the scope for action and occasionally to complications in practice. The results show that the cooperation with specialist colleagues within DMP is often experienced as unsatisfactory. From a primary care point of view, a substantial improvement in DMP would mean a simplification of the documentation and administration effort, better regulated and smoother cooperation with other care levels, a greater degree of decision flexibility, a greater and more differentiated offer of compulsory training, and an increased involvement of primary care experience in the process of DMP development as well as a better reward.

Physical activity counselling in Ireland: a survey of doctors’ knowledge, attitudes and self-reported practice

ObjectivePhysical activity (PA) counselling has been shown to raise awareness of the importance of PA and to increase the rate of PA engagement among patients. While much attention has been...

Estudio psicométrico de un cuestionario sobre las actitudes de los médicos de atención primaria hacia la salud mental: Cuestionario MAPSAM-14.

<em>Background:</em><strong> </strong>The aim of this study is to adapt and analyze the psychometric properties of a questionnaire on the perceptions of general practitioners towards mental health.<strong> </strong><em>Method:</em><strong> </strong>This is a descriptive cross-sectional, observational study. A total of 145 general practitioners from the reference area of Malaga Regional Hospital answered this 25-item questionnaire; a factorial analysis was then conducted and its internal consistency reliability was tested.<strong> </strong><em>Results:</em><strong> </strong>The adequacy of sampling and sphericity were satisfactorily met. Three dimensions measured by 14 items were found in the factorial analysis explaining 55.1% of its variance: the MAPSAM-14 questionnaire.<strong> </strong><em>Conclusions:</em><strong> </strong>This questionnaire may be a proper tool with which to determine the satisfaction of general practitioners in relation to mental health services, their beliefs and stigma towards mental illness and their level of training in the field of schizophrenia and related disorders.

Approach, attitudes, and knowledge of general practitioners in relation to Helicobacter pylori is inadequate. There is much room for improvement!

BackgroundHelicobacter pylori (Hp) infection is one of the most common infections in humans. Due to its worldwide prevalence, a series of guidelines and recommendations has been developed for the appropriate screening, diagnosis, and management of patients with Hp infection. AimTo evaluate the approach, attitudes, and knowledge of a group of Mexican general practitioners in relation to Hp. Materials and methodsA cross-sectional study was conducted that evaluated the knowledge of Hp diagnosis and treatment through the application of a questionnaire. ResultsFrom the total of 430 questionnaires delivered, information was obtained from 411 (95% response rate). The most frequent indications for eradication treatment were peptic ulcer (48.4%), gastroesophageal reflux disease (41.8%), and dyspepsia (39.2%). Thirty-one percent of the physicians surveyed used more than one test to look for Hp, and serology was the most commonly employed method. The most widely used antibiotic regimen was clarithromycin plus amoxicillin (63.8%), followed by metronidazole plus tetracycline (16%). Ninety-two percent of the physicians confirmed eradication through endoscopy for the histologic analysis and only 23% utilized the breath test. ConclusionsOur results show the lack of knowledge about the established diagnostic and treatment recommendations for Hp infection. The implementation of workshops, courses, and conferences, or the formulation of practical guidelines should be directed at primary care physicians to strengthen the practice of medicine based on scientific evidence.

Adherence to COPD management guidelines in general practice? A review of the literature

Chronic obstructive pulmonary disease (COPD) is a progressive illness that is mostly managed in the general practice setting. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines are the international gold standard, and it is important to understand how these are being applied in general practice. This review aimed to assess the current level of adherence to international best practice guidelines among general practitioners in relation to COPD. PubMed and EMBASE searches (from 2012 to 2016) were performed and used the search terms guidelines, COPD, general practitioners, and primary care. Papers were excluded if they were not primary sources, were published before 2012, or did not pertain to a general practice setting. After applying set inclusion and exclusion criteria, 11 studies were retrieved. These papers were grouped under three categories: diagnosis, pharmacological, and non-pharmacological management, based on the GOLD guidelines. Current studies show significant variability in adherence to the GOLD guidelines. Barriers identified include lack of clarity, unfamiliarity with recommendations, and lack of familiarity with the guidelines. If general practice is expected to manage COPD and other chronic diseases, health service investment is needed to provide appropriate focused guidelines, to support their dissemination and resources to implement them in practice.

Representations of their own sexuality and aging body by old people: phenomenological and psychodynamic approach.

The sexuality of the elderly is rarely mentioned in general medicine although it holds an important place in many old people's life, and sexual well-being is a part of the global well-being according to the World Health Organization. To explore the representations of their own sexuality and aging body by the elderly. Qualitative study using semi-structured interviews in 15 healthy elderly people over 65 years of age, living at home. In-depth interviews were transcribed and submitted to qualitative content using a phenomenological and a psychodynamic analysis. The phenomenological approach allows to explore the meaning and significance of the sexuality of older people (their representations and individual experience). The psychodynamic approach allows an analysis of defense mechanisms in verbal and nonverbal behavior. Some elderly maintain a view of their sexuality in accordance with the societal standards existing before the sexual liberalization following the events of May 68 in France. For these people, sexuality is tabooed and only linked to procreation, no longer part of the aging body, and perceived as degraded, then difficult to be approached by general practitioners in relation with defense mechanisms. Other elderly people have managed to free themselves from those previous societal standards. The notion of pleasure is still present in these people and their aging body is perceived as an altered body, difficult to be accepted on account of the pressure for conformity due to actual societal standards. These standards reserve sexuality to young people and convey a picture of a sexuality that would be improper for the elderly. Understanding the representations of their sexuality by the elderly allows GPs a better approach for helping older patients to improve their sexual well-being.

The importance of gender of patients and general practitioners in relation to treatment practices for overweight.

BackgroundSeveral studies suggest that men and women are treated differently for similar disease including diabetes and cardiovascular disease. Differences in attitudes and treatment practices towards men and women with obesity are not well recognized.ObjectiveTo investigate the attitudes and treatment practices among Danish general practitioners (GPs), in relation to treatment of overweight, while taking gender of both the patients and practitioners into account.DesignQuestionnaire inventory covertly examining attitudes and practices among Danish general practitioners towards treatment of overweight. All 3.637 general practitioners from the Danish Medical Association register were invited to participate in the survey. In total 1.136 participated.ResultsThe GPs found weight loss to be more important for overweight male than overweight female patients. They also treated complications to overweight more rigorously among male than female patients, and recommended lipid lowering medicine more often to male than female overweight patients. In addition, the younger female GPs and older male GPs more often said that they would treat an overweight patient with lipid lowering medicine.ConclusionAmong general practitioners in Denmark, treatment for weight loss is more often practiced for overweight male than overweight female patients presenting with same symptoms. In addition, hyperlipidemia among overweight males is also more often treated with lipid lowering medicine than hyperlipidemia among overweight females.

Awareness of antibiotic resistance and antibiotic prescribing in UTI treatment: A qualitative study among primary care physicians in Sweden

Objectives. To improve education and information for general practitioners in relation to rational antibiotic prescribing for urinary tract infection (UTI), it is important to be aware of GPs’ views of resistance and how it influences their choice of UTI treatment. The aim of this study was to explore variations in views of resistance and UTI treatment decisions among general practitioners (GPs) in a county in Sweden. Design. Qualitative, semi-structured interviews were analysed with a phenomenographic approach and content analysis. Setting. Primary care in Kronoberg, a county in southern Sweden. Subjects. A purposeful sample of 20 GPs from 15 of 25 health centres in the county. Main outcome measures. The variation of perceptions of antibiotic resistance in UTI treatment. How UTIs were treated according to the GPs. Results. Three different ways of viewing resistance in UTI treatment were identified. These were: (A) No problem, I have never seen resistance, (B) The problem is bigger somewhere else, and (C) The development of antibiotic resistance is serious and we must be careful. Moreover, GPs’ perceptions of antibiotic resistance were mirrored in how they reported their treatment of UTIs in practice. Conclusion. There was a hierarchal scale of how GPs viewed resistance as an issue in UTI treatment. Only GPs who expressed concerns about resistance followed prescribing guidelines completely. This offers valuable insights into the planning and most likely the outcome of awareness or educational activities aimed at changed antibiotic prescribing behaviour.

Implementation of a quality care management system for patients with arthritis of the hip and knee

The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery.

Medicine use of elderly Chinese and Vietnamese immigrants and attitudes to home medicines review

There is a paucity of research into the perceptions of elderly Australian ethnic minorities towards public health services related to quality use of medicines. Among the six fastest growing ethnic groups in Australia, the Mandarin-speaking Chinese and Vietnamese constitute the largest elderly populations with poor English skills. This paper investigates the relationships of elderly Chinese and Vietnamese migrants with medicines, general practitioners and pharmacists, and how these relationships influence their awareness and attitudes of the home medicines review (HMR) program. Two semi-structured focus groups were held with a total of 17 HMR-eligible patients who have never received a HMR, one with Chinese and one with Vietnamese respondents, each in the respective community language. Confusion about medications and an intention to have a HMR were pronounced among all participants although none of them had heard of the program before participating in the focus groups. Respondents reported difficulties locating a pharmacist who spoke their native language, which contributed to an increased unmet need for medicine information. The Chinese group additionally complained about a lack of support from their general practitioners in relation to their medicine concerns and was adamant that they would prefer to have a HMR without the involvement of their general practitioner. Our results indicate a distinct HMR need but not use among elderly Chinese and Vietnamese eligible patients with poor English skills. Home medicines review service use and perceived medication problems are likely to improve with an increasing availability of bilingual and culturally sensitive health care providers.

LESSONS FROM THE ONGOING UK INJECTABLE DIAMORPHINE SHORTAGE

LESSONS FROM THE ONGOING UK INJECTABLE DIAMORPHINE SHORTAGE

Dutch practice guidelines for managing adjustment disorders in occupational and primary health care.

Stress-related disorders, especially adjustment disorders, are widespread among working populations and are responsible for high costs in terms of suffering, sick leave, disability, and economic losses. Despite their high prevalence, there has been relatively little research on the effectiveness of treatments in an occupational health care setting. Guidelines for occupational physicians and general practitioners in relation to mental health problems were recently developed in The Netherlands and are discussed in this article. The guidelines provide a classification based on terms that are already used in the profession and are consistent with the diagnosis "adjustment disorder". They give recommendations for guidance and treatment on the basis of existing evidence, experience in adjacent fields, and consensus procedures. They are based on cognitive behavioral principles, mainly stress inoculation training and graded activity, and aim to enhance the problem-solving capacity of patients in relation to the work environment. The aim of this paper is to contribute to the exchange of and a discussion on methods and good practices in primary and occupational health care.

Health problems and psychosocial work environment as predictors of long term sickness absence in employees who visited the occupational physician and/or general practitioner in relation to work: a prospective study

Aims: To determine whether psychosocial work environment and indicators of health problems are prospectively related to incident long term sickness absence in employees who visited the occupational physician (OP) and/or...

Straightforward consultation or complicated condition?

Background: Low back pain is a common condition in general practice and represents a significant part of a general practitioner's workload. However, despite guidelines, back pain still presents considerable challenges to clinicians.Objective: To explore the perceptions and declared behaviour of UK general practitioners in relation to patients with low back pain.Method: A qualitative design was used, involving semi-structured interviews with 17 GPs in the North of England. Interviews were transcribed verbatim and analysed using qualitative thematic analysis.Results: Two major themes emerged from the data relating to approaches to and perceptions of low back pain. A dichotomy emerged, where GPs describe their approach to what they know to be a straightforward consultation where most patients recover, and the frustration they experience when patients do not. Although GPs are using a simple bio-mechanistic approach to low back pain, they also operate a method of categorising patients, which involves identifying real and pseudo patients. When confronted with ‘challenging' cases, that is those who do not recover, most GPs feel isolated and poorly prepared.Conclusion: GPs adopt a bio-mechanistic approach to LBP which appears to work well for the majority of patients, as the natural history of low back pain dictates that most patients will recover. However, this approach to low back pain fails at the margins and this is evident by the significant minority of persistent sufferers and the GP's reaction to them. Expanding patient-centredness to explore psychological and social dimensions in relation to low back pain presents an ongoing challenge in general practice.

The GP's role in maternity care

In an Editorial in this issue, Westin and Bakketeig bring up the important question of whether uncritical use of ultrasound scanning in pregnancy can imply potential harm to the foetus. The Editorial evoked discussion among the national editors of this journal concerning the role of general practitioner in relation to maternity care. In the Nordic countries, as well as widely elsewhere, the care for healthy, pregnant women is generally organised within a primary health care setting. There are three main professions responsible for these preventive activities: general practitioners, midwives and gynaecologists. In Sweden, pregnancy care is usually organised in separate maternity units staffed mainly by midwives. Other countries organise primary clinical care and preventive care more or less under the same roof, served by a team of different professions. Primary care professionals are usually responsible for referring expectant women to routine ultrasound screening. In some instances, there is also ultrasound equipment at the local health care centre. In Iceland, where there is no referral system, a large number of pregnant women choose to consult a privately practising gynaecologist, often as early as in gestational weeks 7/9. These gynaecologists usually have ultrasound instruments in their office and will thus perform a scan to certify the presence of a vital embryo. This opportunity to experience ‘‘a first encounter’’ with the child-to-be could readily become part of the culture surrounding pregnancy. Why wait for weeks in uncertainty when a scan can tell immediately whether the foetus looks alive and well? During this first appointment, an Icelandic gynaecologist is likely to inform the pregnant women about the possibility to have a next ultrasound examination in pregnancy weeks 11/14 (early ultrasound screening). This is a scan designed to detect chromosomal aberrations and certain other foetal anomalies. It usually does not replace ultrasound screening in weeks 18/20, which has been a routine in many countries for 15/20 years. In a recent Editorial in SJPHC (1), Getz stated that primary health care personnel should not regard ultrasound in pregnancy as a specialist topic belonging solely within the sphere of obstetricians. As GPs, we want the health care system to deliver optimal care for pregnant women and their unborn children. When applying medical technology on a large scale in a preventive setting, it is paramount to ascertain that it does not entail the potential for unintended damage. Primum non nocere / first if all, do no harm.

Health and psychosocial work characteristics of employees who did or did not consult the general practitioner in relation to work.

To examine how health problems and psychosocial work characteristics are associated with having visited or not having visited the general practitioner (GP) in relation to work. Baseline self-reported data of the Maastricht Cohort Study about fatigue at work were used to gather information about fatigue (Checklist Individual Strength), presence of at least one long-term disease, likelihood of having a mental illness (General Health Questionnaire), and psychosocial work characteristics (psychological job demands, decision latitude and social support at work, as measured with the Job Content Questionnaire). The cohort participants indicated having visited (VISITORS) or not having visited (NON-VISITORS) the GP in relation to work. Differences between these groups were measured by multiple logistic regression analyses. When compared with VISITORS and taking into account the influence of sociodemographic characteristics and mutual associations between reported health problems and psychosocial work characteristics, a lower percentage of NON-VISITORS reported at least one long-term disease and NON-VISITORS presented lower levels of fatigue and psychological job demands, and higher levels of decision latitude and social support at work. The results of this study indicate that NON-VISITORS reported fewer health problems and a more positive perception of their work environment than VISITORS did. Interrelationships between psychosocial work characteristics and health variables should be taken into consideration when studying their associations with visiting the GP in relation to work.

Uncomfortable prescribing decisions: a critical incident study.

To explore the discomfort experienced by general practitioners in relation to decisions about whether or not to prescribe. Focused interviews of general practitioners about prescribing decisions that made them uncomfortable. Analysis based on the critical incident technique. One family practitioner committee area in the north of England. 69 principals and five trainee general practitioners. Drugs and clinical problems associated with prescribing discomfort. Reasons given by doctors for making the prescribing decisions they did and reasons for feeling uncomfortable. Antibiotics, tranquillisers, hypnotics, and symptomatic remedies were most often associated with discomfort, but any prescribable item could be associated with discomfort. Respiratory diseases, musculoskeletal problems, and anxiety were most often associated with discomfort, but again any condition could be associated. The main reasons given for the decisions made were patient expectation, clinical appropriateness, factors related to the doctor-patient relationship, and precedents. The main reasons given for feeling uncomfortable were concern about drug toxicity, failure to live up to the general practitioner's own expectations, concern about the appropriateness of treatment, and ignorance or uncertainty. Many considerations, including medical, social, and logistic ones, influence the decision to prescribe in general practice. The final action taken depends on a complex interaction of these disparate influences.