Survey Of General Practitioners Research Articles

Do they cope or mope? A survey of GPs’ experiences with the changes in the Norwegian Cervical Cancer Screening Programme

Objective To explore Norwegian general practitioners’ (GPs) experiences with the changes in the cervical cancer screening programme and to uncover which aspects of the programme they find most challenging. Design We conducted an electronic cross-sectional survey. Setting Norwegian GPs were invited to participate in the survey between February and September in 2020. Subjects One hundred and fifty-five of 429 invited Norwegian GPs responded. Main outcome measures Self-reported measures were used to analyse GPs experiences and beliefs related to the screening programme. Results Most GPs did not find it particularly challenging to keep up with the changes in the screening programme, regardless of whether they came from areas with HPV-based or cytology-based cervical cancer screening implemented. Challenges concerning the follow-up of patients after an abnormal test were a frequently reported issue. We did not find any differences in how often GPs were uncertain of the follow-up of an abnormal test result in areas with HPV-based compared to cytology-based screening. Conclusions The implementation of HPV-based cervical cancer screening in women 34–69 years does not seem to have affected how challenging the GPs perceive the screening programme. Key Points How Norwegian general practitioners (GPs) keep up with changes in the Norwegian Cervical Cancer Screening Programme (NCCSP) has not been assessed previously. Most GPs did not find it particularly challenging to keep up with changes in the NCCSP regardless of whether they belonged to an area of HPV-based or cytology-based screening. The follow-up of patients with an abnormal test result was one of the main challenges reported by the GPs.

A GENDER-ORIENTED APPROACH TO MANAGEMENT OF EMOTIONAL BURNOUT AMONG DOCTORS AND NURSES IN WARTIME

The study of emotional burnout syndrome manifestations in doctors and nurses is a topical issue, both among scientists, practical psychologists and among medical branch managers of different levels, especially in times of crisis conditions. The research of this phenomenon is actual all over the world: the detection of signs of emotional burnout varies from 20 to 75%; the number of scientific publications on this topic is constantly growing, so in 2010 104 works were published, and in 2021 already 952 works were published; the rapid growth of scientific research is observed. The war in Ukraine, which had not previously been on such a scale, affects everyone's life and physical and emotional well-being. In addition to physical exertion, medical workers have an excessive emotional burnout, as the authors' research shows - the burnout rate among general practitioners is 63,7%, and among nurses 70%. Therefore, it is necessary to investigate this phenomenon in stressful conditions, so that it is possible to develop recommendations and render psychological help to medical workers. The purpose of this article is to systematize the information on emotional burnout, to determine further ways of development and to establish dynamics of emotional burnout of medical workers before and during martial law. Relevance of our study is stipulated by that the control of this phenomenon manifestation allows to improve mental health and continuation of professional activity of the specialists and as consequence to improve medical services. Materials and methods: the analysis of the scientific literature on the international scientometric databases, questionnaire survey of general practitioners of CF CPMC. The authors have compared the models of emotional burnout and described the phases of this process. Attention was paid to factors causing and accelerating this process, and also characteristics of these factors were described, degrees of influence on acceleration of professional burnout process of separate factors were defined. The carried out research allowed to reveal problems at management of medical workers emotions, to define the factors causing violation of awareness and the control of displays of emotions, to find out a role of a medical institution management, methods of influence on the factors causing or strengthening process of emotional burnout. The results of the study of determination of negative manifestations of emotional reactions of medical workers in conditions of a military condition are reflected in practical recommendations for development of mechanisms of management of this condition. Practical value of the research is of recommendatory character for work of heads of a medical establishment.

White-coat effect on orthostatic hypotension: a nationwide survey of Japanese general practitioners.

The relationship between the white-coat effect (WCE), defined as white-coat hypertension under treatment, and the frequency of orthostatic hypotension (OH) is not known. We conducted an orthostatic test in patients with WCE to determine the frequency of OH. This was a cross-sectional study of 5631 patients with hypertension visiting general practitioners nationwide, in which 4305 patients with hypertension recorded their home blood pressure (BP) and consented to the orthostatic test. Patients with hypertension were divided into four groups: controlled hypertension (CHT), masked hypertension (MHT), sustained hypertension (SHT), and WCE. The orthostatic test was performed, and BP and pulse rate were measured immediately and 1 min after orthostasis. The OH frequencies immediately after standing in CHT, WCE, SHT, and MHT patients were 7, 11.7, 12.1, and 6.6%, respectively, and those at 1 min after standing were 7.1, 13.1, 11.6 and 6.9%, respectively (Chi-square test, P < 0.01, respectively). Logistic regression analysis was performed to examine the relationship between WCE and the frequency of OH. The frequency of OH immediately after standing was significantly increased [adjusted odds ratio (AOR), 1.702; 95% confidence interval (CI), 1.246-2.326; P < 0.01]. The frequency of OH at 1 min after standing was also significantly higher (AOR, 1.897; 95% CI, 1.396-2.578; P < 0.01). When the standing test was performed for patients with WCE, the frequency of OH increased. Thus, it is important to recognize the possibility of OH in patients with WCE to avoid adverse events associated with excessive hypotension.

What Comes after the Trial? An Observational Study of the Real-World Uptake of an E-Mental Health Intervention by General Practitioners to Reduce Depressive Symptoms in Their Patients.

Unguided and free e-mental health platforms can offer a viable treatment and self-help option for depression. This study aims to investigate, from a public health perspective, the real-world uptake, benefits, barriers, and implementation support needed by general practitioners (GPs). The study presents data from a spin-off GP survey conducted 2.5 years subsequent to a cluster-randomized trial. A total of N = 68 GPs (intervention group (IG) GPs = 38, control group (CG) GPs = 30) participated in the survey (response rate 62.4%). Data were collected via postal questionnaires. Overall, 66.2% of the GPs were female. The average age was 51.6 years (SD = 9.4), and 48.5% of the GPs indicated that they continued (IG) or started recommending (CG) the e-mental health intervention under real-world conditions beyond the trial. A number of benefits could be identified, such as ease of integration and strengthening patient activation in disease management. Future implementation support should include providing appealing informational materials and including explainer videos. Workshops, conferences, and professional journals were identified as suitable for dissemination. Social media approaches were less appealing. Measures should be taken to make it easier for health care professionals to use an intervention after the trial and to integrate it into everyday practice.

Use of thromboprophylaxis guidelines and risk stratification tools in atrial fibrillation: A survey of general practitioners in Australia.

Rationale and ObjectivesClinical guidelines produced by cardiology societies (henceforth referred to simply as ‘clinical guidelines’) recommend thromboprophylaxis with oral anticoagulants (OACs) in patients with atrial fibrillation (AF) who have moderate‐to‐high stroke risk. However, deviations from these recommendations are observed, especially in the primary healthcare setting. The primary aims of this study were to evaluate the self‐reported use of AF clinical guidelines and risk stratification tools among Australian general practitioners (GPs), and their perceptions regarding the available resources.MethodWe conducted an online survey of Australian GPs. Descriptive statistics were used to summarise the findings.ResultsResponses from 115 GPs were included for analysis. Respondents reported various ways of accessing thromboprophylaxis‐related information (n = 113), including clinical guidelines (13.3%), ‘Therapeutic Guidelines©’ (37.2%) and Royal Australian College of General Practitioners websites (16.8%). Of those who reported reasons against accessing information from clinical guidelines (n = 97), the most frequent issues were: too many AF guidelines to choose from (34.0%; 33/97), different guidelines for different diseases (32.0%; 31/97), time‐consuming to read guidelines (21.6%; 21/97), disagreements between different guideline recommendations (20.0%; 19/97), conflict with criteria for government subsidy (17.5%; 17/97) and GPs' busy schedules (15.5%; 15/97). When assessing patients' risk of stroke (n = 112) and bleeding (n = 111), the majority of the respondents reported primarily relying on a formal stroke risk (67.0%) and bleeding risk (55.0%) assessment tools, respectively. Respondents reported using formal stroke and bleeding risk assessment tools mainly when newly initiating patients on therapy (72.4%; 76/105 and 65.3%; 65/101, respectively).ConclusionAmong our small sample of Australian GPs, most did not access thromboprophylaxis‐related information directly from AF‐specific clinical guidelines developed by cardiology societies. Although the majority reported using formal stroke and bleeding assessment tools, these were typically used on OAC initiation only. More focus is needed on formal risk reassessment as clinically indicated and at regular review.

Migrant GPs and patients: a cross-sectional study of practice characteristics, patient experiences and migration concordance

Objective To investigate practice type and location of native and immigrant general practitioners (GPs); effects of migration status concordance between GPs and patients on experiences of patients in key areas of primary care quality and discrimination. Design and setting Secondary analysis of GP and patient survey data from QUALICOPC (Quality and Costs of Primary Care), a cross-sectional study of GPs and their patients in 34 countries, performed between 2011 and 2013. Main outcome measures We explored practice type and location of native and immigrant GPs and the experiences of native patients and patients with a migration background of communication, continuity, comprehensiveness, accessibility, and discrimination, using multilevel analysis. Concordance was modelled as a cross-level interaction between migration status of GPs and patients. Results Percentages of immigrant GPs varied widely. In Europe, this was highest in England and Luxemburg (40% of GPs born abroad) and lowest in Bulgaria and Romania (1%). The practice population of immigrant GPs more often included an above average proportion of people from ethnic minorities. There were no differences in main effects of patient experiences following a visit to an immigrant or native GP, in four core areas of primary care or in discrimination. However, people from first-generation migrant background more often experienced discrimination, in particular when visiting a native GP. Conclusion Patient experiences did not vary with GPs’ migration status. Although experience of discrimination was uncommon, first-generation migrant patients experienced more discrimination. Primary care should provide non-discriminatory care, through GP awareness of unconscious bias and training to address this. Key messages There were large differences in percentage of migrant GPs between countries. Migrant GPs’ practices had an above average proportion of people from ethnic minorities. In general, patients’ experienced discrimination from GPs and practice staff was low, but first-generation migrant patients more often experienced discrimination. First-generation migrant patients more often experienced discrimination when they visited a native GP.

Work pressure and job dissatisfaction: Challenges in Danish general practice

A main objective of the Nordic healthcare systems is to deliver timely and equal access to high-quality healthcare to the entire population. Health care providers, such as general practitioners (GPs), may therefore experience pressure to deliver care from both the health authorities and patients. However, if GPs’ gains do not outweigh their costs of providing the demanded care, it may lead to job dissatisfaction and thereby potentially to poorer quality of care. This study contributes to the literature by estimating the association between different sources of experienced work pressure and job dissatisfaction among GPs. We use data from a nation-wide survey of Danish GPs distributed in 2019. The study includes six items covering GPs’ experienced work pressure, which we categorise based on the degree to which they are related to demands from either patients or health authorities. Using a series of ordered logit models with a rich set of explanatory variables, we estimate the association between the pressure measures and GP job dissatisfaction. We find that GPs reporting high or considerable work pressure have an increased likelihood of also reporting job dissatisfaction. However, we find considerable heterogeneity in this relationship across different sources of work pressure as well as across GP, practice, and area characteristics. For example, the relationship between pressure from patients’ demands for consultations and job dissatisfaction is stronger among GPs practicing in areas with an undersupply of GPs. Solo practitioners, who cannot share their administrative burdens with colleagues, experience a stronger association between pressure from the health authorities and job dissatisfaction. Policymakers should consider this heterogeneity when implementing new schemes and organisational structures affecting GPs’ work pressure. Published: Online January 2022.

Impact of targeted wording on response rates to a survey of general practitioners on referral processes for suspected head and neck cancer: an embedded randomised controlled trial.

Introduction Low response rates to surveys can lead to non-response bias, limiting generalisability of findings. When survey topics pertain to uncommon conditions, the decision of general practitioners (GPs) to complete a questionnaire may be swayed by the perceived relevance of the questionnaire content to their practice. Aim To explore whether targeted wording of a questionnaire for GPs about head and neck cancer referral patterns affects response rates. Methods A randomised controlled trial was embedded into a larger survey on referral practices for head and neck cancer among GPs in New South Wales, Australia. GPs were randomly allocated to receive versions of the study material with explanatory text written using either a 'symptom-frame' or a 'cancer-frame'; however, the questions and responses were the same in both groups. Results The overall response rate was 10.9% (196/1803). The response rate to the 'cancer-frame' version was 10.6% and 11.1% for the 'symptom-frame' version. After adjusting for practice location and GP gender, the difference in response rate based on wording was not significant (difference 0.5% [95%CI: -2.4, 3.4%]). A sub-analysis showed that GPs practicing in regional New South Wales were more likely to respond to the survey compared to those practicing in metropolitan New South Wales, independent of the intervention group or participant sex (AOR 1.61 [95%CI: 1.12, 2.31]; P = 0.01). Discussion The wording 'frame' of the survey did not appear to impact response rates in a survey of referral practices for suspected head and neck cancer; however, the significantly higher response rate from regional GPs warrants further investigation as to whether the content was considered more salient to their practice.

Service change and innovation in community end-of-life care during the COVID-19 pandemic: Qualitative analysis of a nationwide primary care survey

Background: Primary healthcare teams (general practice and community nursing services) within the United Kingdom provided the majority of community end-of-life care during COVID-19, alongside specialist palliative care services. As international healthcare systems move to a period of restoration following the first phases of the pandemic, the impact of rapidly-implemented service changes and innovations across primary and specialist palliative care services must be understood. Aim: To provide detailed insights and understanding into service changes and innovation that occurred in UK primary care to deliver end-of-life care during the first phase of the COVID-19 pandemic. Design: Cross-sectional online survey. Responses were analysed using descriptive statistics and thematic analysis. Setting/participants: United Kingdom survey of general practitioners and community nurses, circulated via regional and national professional networks. Results: A total of 559 valid responses were received from 387 community nurses, 156 general practitioners and 16 ‘other’. Over a third of respondents (n = 224; 40.8%) experienced changes in the organisation of their team in order to provide end-of-life care in response to the COVID-19 pandemic. Three qualitative themes were identified: COVID-19 as a catalyst for change in primary palliative care; new opportunities for more responsive and technological ways of working; and pandemic factors that improved and strengthened interprofessional collaboration. Conclusion: Opportunity has arisen to incorporate cross-boundary service changes and innovations, implemented rapidly at the time of crisis, into future service delivery. Future research should focus on which service changes and innovations provide the most benefits, who for and how, within the context of increased patient need and complexity.

General practitioner management for chronic sensorineural hearing loss in older adults

Introduction. The article is devoted to the special role of the primary care physician - therapist, geriatrician, general practitioner, in assisting the elderly and senile in taking appropriate and timely measures in identifying people with chronic sensorineural hearing loss (SNL), consulting them at the stage of primary health care.Aim of the study. Understand the intended role of general practitioners and therapist in identifying and counseling patients with hearing loss in primary health care.Materials and methods. A survey of general practitioners and therapist was conducted in the form of 88 statements, collected in six concepts, in response to the question “What should be the role of a general practitioner in the treatment of chronic sensorineural hearing loss in persons of an older age group?” in the format of a Google-questionnaire.Results. The results showed a sufficient awareness of general practitioners and therapist about the predisposition of their elderly patients to hearing loss and the significance of the associated consequences on the quality of life. As a result of the data obtained, the highest percentage of statements was noted in Concept 1 “Determine - Diagnose - Discuss” and varied on individual issues from 27.8% to 55.6%, the lowest - in Concept 5 “Educate - Strategise - Encourage” and ranged from 16.7% to 44.4%.Discussion. Strengthening collaboration between therapists and otorhinolaryngologists, otorhinolaryngologists, and audiologists is the most effective strategy for reducing individuals with untreated SNL. The importance of the role of the primary care physician in multidisciplinary care and its coordination is especially emphasized in the concept of “Know - Refer - Coordinate”.Conclusions. The authors conclude that the priority concept of modern health care, which makes it possible to significantly improve the quality of life of patients in the older age group and reduce the psychosocial consequences of hearing loss.

Otitis externa: what is the problem with getting it right? A mixed-methods study in primary and secondary care.

Otitis externa accounts for 1.1-1.3 per cent of patient presentations in primary care and 25 per cent of urgent referrals to ENT. This study aimed to explore otitis externa clinical decision-making at the primary-secondary care interface, otitis externa prevalence and recent trends in antimicrobial resistance in otitis externa related bacterial isolates and ototopical prescribing. This is a mixed-methods study drawing on data from primary and secondary care and open National Health Service sources. A total of 101 general practitioner survey respondents reported frequently prescribing oral antibiotics for otitis externa. General practitioner consultations for otitis externa increased 25 per cent over 15 years. General practitioner ototopical preparations cost the National Health Service £7 410 440 in 2006 and £11 325 241 in 2016. A total of 162 consecutive hospital otitis externa-related bacterial isolates yielded 128 pseudomonas species, with 18 that were resistant to gentamicin and 7 that were resistant to ciprofloxacin. Ten guidelines reviewed showed systematic inconsistencies. General practitioners reported regularly prescribing oral antibiotics for otitis externa. Antimicrobial drug resistance is common in otitis externa. The available guidance is suboptimal.

Knowledge of end-of-life law: A cross-sectional survey of general practitioners working in aged care.

To describe the knowledge of end-of-life law and experiences in practice at the end of life amongst Australian general practitioners (GPs). A cross-sectional online survey of GPs practising in aged care settings in Queensland (QLD), New South Wales (NSW) and Victoria (VIC). From 521 potential GPs, 160 (response rate 30.7%) were included in the final sample. Most participants (62%) reported experience with six key end-of-life areas at least 'a few times', including 74% administering medication for pain and symptom relief, and 67% facilitating advance care planning 'several' or 'many times' and perceiving they had 'some' knowledge of end-of-life law (53%, n=84). However, low-to-moderate actual levels of end-of-life legal knowledge were identified (mean correct response of 5.24 out of 9). Australian GPs working in aged care may have low-to-moderate knowledge about end-of-life law despite frequently making end-of-life decisions in clinical practice.

Referral of patients with chronic obstructive pulmonary disease to pulmonary rehabilitation from primary care: A local survey of GPs and practice nurses

Aim To gain an understanding of the referral practices of local general practitioners (GPs) and practice nurses (PNs) to a local pulmonary rehabilitation (PR) programme in order to improve referral rates of patients with chronic obstructive pulmonary disease (COPD). Methods The study involved a cross-sectional survey of local GP and PNs from 16 GP practices within a local health and social care trust. The survey was distributed electronically and in hard copy form to GP practices and a 1-month period was provided to complete the survey. Inclusion/exclusion criteria GPs and PNs who review patients with COPD were eligible to complete the survey. Outcome measures The study reports on descriptive statistics for perceived referral rates to PR, knowledge of PR referral process within the local area, service user barriers, referral barriers and strategies to improve referral. Inferential statistics were used to determine if differences existed between GPs and PNs with regards MRC questioning and PR education. Results The survey was distributed to a total of 70 people, with responses received from 13 general practitioners (GPs) and 11 practice nurses. The overall response rate for the survey was 34%, with a GP response rate of 23% versus a PN response rate of 79%. 83% percent (n = 20) of respondents estimated they referred &lt;50% and 17% (n = 4) did not refer any COPD patients to PR. The number of PNs who reported that they question service-users around exertional breathlessness and educate around the benefits of PR was significantly higher than participating GPs (p &lt;0.05). 63% (n = 15) of respondents felt that the principal barrier to PR referral was patient unwillingness/refusal to attend. 29% (n = 7) of respondents felt that information leaflets/posters would improve referral rates to PR. Conclusions In this local survey referral from primary care to PR in the COPD population was underutilised by clinicians. PNs reported that they were more likely than GPs to explore patient’s exertional breathlessness and to educate patients regarding the benefits of PR. Respondents perceived that patient unwillingness to attend PR was the primary barrier however practitioner referral barriers in the form of time constraints were also cited. Respondents also cited a perceived lack of patient understanding of the benefits of PR as a factor affecting PR attendance.

Not All STEMI Patients Receive Timely Reperfusion: Considerations for Rural Emergency Departments.

Early reperfusion for ST-elevation myocardial infarction (STEMI) is well known to improve patient outcomes. A review of patient records in one rural health service in New South Wales, Australia, suggested that not all STEMI patients were receiving timely reperfusion. Consequently, the aim of this study was to further investigate factors influencing clinical decision making by primary care providers in relation to rural STEMI patients. This cross-sectional observational study was in two phases, a retrospective audit of patient records and a survey of rural general practitioners (GPs). In the first phase, patients with STEMI who were referred from small rural hospitals to a regional hospital emergency department (ED) were identified through the local health district database. In phase two, information from the database informed questions for a survey distributed to the GP visiting medical officers (VMOs) at small rural hospitals in the region. The survey was designed to ascertain factors that may contribute to delays in the care of STEMI patients. Of the STEMI patients identified (n = 139), 15% (21) who were eligible for medical reperfusion were not administered thrombolysis within 4 hours of triage. Auditing of this group's records found that ECGs were inaccurately interpreted for 76% of the missed STEMI patients. In the survey, about 55% of the GP respondents said they “very much agree” with the statement that they felt competent in STEMI management. Only 64% of the GP VMOs agreed they felt competent in diagnosis and management of a failed thrombolysis and not all respondents were aware of the relevant clinical guideline. Patients with missed STEMI are at higher risk of morbidity and mortality and increased length of stay, adding burden to the patient, carer and health service. Without addressing gaps in service provision and better adherence to clinical guidelines, unacceptable delays in STEMI management in rural health services are likely to continue.

Essential components of health assessment for older people in primary care: a cross‐sectional survey of Australian general practitioners

ObjectiveTo examine general practitioners’ views about how health assessments for older people should be conducted. MethodsGeneral practitioners were randomly sampled from a national database of medical practitioners and invited to complete a survey. Survey items explored general practitioners’ views about essential components of a 75+ Health Assessment and who should assess each component, consultation time, use of standardised templates and tools, and home visits. ResultsOverall, 185 (19.2%) general practitioners participated. Of 61 items presented, 24 were rated ‘essential’ by ≥70% of practitioners, with an average estimated consultation time of 65 minutes. Of the 24 essential items, it was perceived that 21 could be assessed by either a general practitioner or clinic nurse. Most practitioners indicated a standardised template (86%) and standardised tools for complex issues (79%) should be used, and home visits conducted (75%). ConclusionsGeneral practitioners agreed on 24 items as essential for every health assessment, with assessments estimated to take more than one hour. Implications for public healthIncreases to remuneration for prolonged assessments or mechanisms for improving efficiency and quality of assessments are needed. Acceptable mechanisms may include standardised patient‐reported tools, standardised templates and the use of non‐medical staff to assist with assessments.

Influencing factors for mental health of general practitioners in Hebei Province under the outbreak of COVID-19: A cross-sectional study.

ObjectiveThis study aimed to understand the mental health status of general practitioners (GPs) in Hebei Province during the outbreak of coronavirus disease 2019, analyse influencing factors, and establish and evaluate the risk prediction model.MethodsDuring February 25‐29, 2020, a self‐designed questionnaire was used to conduct an online survey of GPs in Hebei Province. The survey included a questionnaire on GPs' basic information, a questionnaire on GPs' working hardware and software facilities, and a questionnaire on GPs' mental health condition. A total of 1040 participants returned the completely filled valid questionnaire, and the answers were analyzed using the χ 2 test, Wilcoxon rank‐sum test and logistic regression with SPSS 20.0 software. Based on the results of binary logistic regression analysis, a risk prediction model was established, and the receiver operating characteristic curve was used to evaluate the model.ResultsThe results showed that 44.2% (460/1040) of GPs expressed anxiety after the outbreak. Absence of prescreening clinics, fever clinics or isolated observation rooms in primary medical institutions; persons in the administrative area required to be isolated; low sleep quality of GPs and less than 6 hours of sleep per day of GPs were risk factors affecting the mental health status of GPs. Also, epidemic‐related training and adequate protective equipment were the protective factors for the mental health status of GPs.ConclusionThe government should strengthen the infrastructure construction of community institutions, equip them with sufficient epidemic protection equipment, ensure the rest time of GPs and strengthen mental health training to ensure the mental and physical health of GPs.

Attitudes to and experience of disease management programs in primary care-an exploratory survey of general practitioners in Germany.

BackgroundDisease management programs (DMPs) were set up in Germany in 2003 to improve outpatient care of chronically ill patients. The present study looks at the attitudes and experiences of general practitioners (GPs) in relation to DMPs, how they rate them almost 20 years after their introduction and where they see a need for improvement.MethodsA total of 1504 GPs in the Federal States of Rhineland Palatinate, Saarland and Hesse were surveyed between December 2019 and March 2020 using a written questionnaire.ResultsIn total, 58% of respondents rate DMPs positively and regard them as making a useful contribution to primary care. The guarantee of regular, structured patient care and greater compliance are regarded as particularly positive aspects. It was also established that diagnostic and therapeutic knowledge was expanded through participation in DMPs. 57% essentially follow the DMP recommendations for (drug) treatment. Despite positive experiences of DMPs in patient care, the GPs surveyed mention various challenges (documentation requirements, frequent changes to the programmes, inflexibility). Univariant linear regression analysis revealed factors influencing the satisfaction with DMPs, such as improvement of compliance and clearly defined procedures in medical care.ConclusionMost of the GPs surveyed consider the combination of continuous patient care and evidence-based diagnosis and treatment to be a great advantage. To better adapt DMPs to the conditions of primary care, it makes sense to simplify the documentation requirements, to regulate cooperation with other healthcare levels more clearly and to give GPs more decision-making flexibility. Increased inclusion of GP experience in the process of developing and refining DMPs can be helpful.Supplementary InformationThe online version of this article (10.1007/s10354-021-00867-1) contains supplementary material, which is available to authorized users.

Chronic Illness, Subjective Wellbeing, and Health Services Availability: A Study of Older Adults in Australia.

Chronic illness is prevalent in older adults. While current scholarship has examined how various factors may be associated with the onset of chronic illnesses, fewer scholars have examined the role of health services availability. Drawing on a sample of older adults aged 50 and above from wave 16 of the Household, Income, and Labour Dynamics in Australia survey and geo-coded information of general practitioners (GPs) from the Australian Medical Directory, 2016, we investigated whether living in areas with a greater number of GPs is related to reports of living with a chronic illness. Contrary to our hypothesis, we did not find an association between the availability of health services and reports of chronic illnesses, though factors such as better socioeconomic status and better subjective wellbeing are related to lower likelihoods of reporting a chronic illness. We concluded that, while easy access to local health services may be important for the diagnosis and treatment of chronic illnesses, it is less persuasive to attribute the availability of health services to the likelihood of older adults reporting chronic illnesses without knowing how much or how often they use the services.

Conceptual approaches to the development of continuing medical education for general practitioners in Moscow

The article is devoted to the current state of continuing medical education for general practitioners in the city of Moscow and is based on a survey of general practitioners working in Moscow. Results demonstrate a lack of satisfaction with the organisation and content of training in its previous format, the absence of significant changes in the learning objectives following education reform and an ambiguous attitude towards this reform. The minimum continuing education requirements for general practitioners working in the city of Moscow were shown to consist of day release, short-term training, theoretical and practical orientation and the application of contemporary educational technologies. Conceptual approaches to the development of continuing medical education in the field of general medical practice in Moscow were formulated. These comprised organisation of training, setting of learning objectives, selection of forms and methods of training, determination of interactive training content, application of a competency-based approach and individualisation of the educational path.

Australia-wide cross-sectional survey of general practitioners' knowledge and practice of lung cancer screening.

Low-dose computed tomography (LDCT) screening can reduce lung cancer deaths in high-risk individuals, yet current Australian guidelines do not recommend screening. Little is known about current screening practices in Australia. To evaluate the proportion of general practitioners who report ordering lung cancer screening for their patients, identify factors associated with ordering lung cancer screening and assess general practitioners (GP) rationale for recommending screening and preference of composition of any future national targeted screening programme. A survey was distributed to a nationally representative sample of 4000 Australian GP. The questionnaire included respondent demographics, self-reported screening practices, knowledge of screening recommendations, recent screening education, preference for recruitment methodologies for potential screening programmes and potential factors influencing the screening practices of GP. Two logistic regression models identified factors associated with self-reported chest X-ray (CXR) and LDCT screening within the past 12 months. A total of 323 GP completed the survey (participation rate 8.1%). Participants were mostly females (50.6%), from collective/group (79.1%) and metropolitan-based practices (73.5%). Despite the majority of responders understanding that screening is not recommended by Australian professional societies (71.2%), a substantial proportion of participants requested a CXR or LDCT screening (46.4% and 20.8% respectively). A variety of shared (GP reassurance, affordability of screening, believing screening is funded) and unique practice, educational and cognitive factors were associated with self-reported LDCT and CXR screening, with the strongest association being recent education about screening from radiology practices (odds ratio (aOR) for LDCT screening 10.4, P < 0.001). In Australia, lung cancer screening occurs outside a coordinated programme, and there is discordance between practice and national recommendations. This highlights an urgent need for clearer guidance from national and professional bodies.