Age Of General Practitioners Research Articles

Is it worth trying? A cross-sectional study on the implementation of point-of-care ultrasound in Hungarian primary care

BackgroundAlthough the number of point-of-care ultrasound devices available in Hungarian primary care practices are increasing due to government funding, their use in day-to-day patient care is limited and unregulated. Our study aimed to evaluate the attitudes and needs of general practitioners (GPs) and patients in Hungary regarding the introduction of bedside ultrasonography in primary care practices.MethodsAs a part of a cross-sectional study, an anonymous, self-administered questionnaire was distributed to GPs and patients on a social media platform. Data collection was carried out from August 2023 to October 2023. Chi-square test was used to determine the associations between categorical variables.ResultsThe survey was completed by 415 GPs (mean age 53.8 ± 11.1 years, 54.9% female, mean 19.5 ± 11.9 years of practice) and 693 patients (mean age 45.5 ± 12.3 years, 95.2% female). There was a statistically significant increase in interest in PoCUS among young and middle-aged GPs (age 28–59; p = 0.02). In addition, this population of GPs was also more likely to undertake training in PoCUS than their older colleagues (p < 0.0001). An inverse relationship was found between the duration of practice and training willingness (p = 0.0011). Even with the government’s financial support, only 8.2% of GPs currently use PoCUS in a daily basis, and 59.5% of GPs are unfamiliar with the indications and the ways of using it. Patients would even pay to have the examination done in a primary care setting, even though only 45.9% of patients would pay a GP who is not certified in PoCUS, but the willingness to pay increased to 99.4% for those with formal training (p = 0.024).ConclusionOur findings indicate a significant interest in adapting PoCUS in primary care from both GPs and patients. Based on the fact that a significant proportion of Hungarian GPs are unaware of PoCUS and its indications, it is particularly important to develop educational frameworks, and practical guidelines for the effective incorporation of PoCUS in Hungary.

Relationships between the Structural Characteristics of General Medical Practices and the Socioeconomic Status of Patients with Diabetes-Related Performance Indicators in Primary Care.

The implementation of monitoring for general medical practice (GMP) can contribute to improving the quality of diabetes mellitus (DM) care. Our study aimed to describe the associations of DM care performance indicators with the structural characteristics of GMPs and the socioeconomic status (SES) of patients. Using data from 2018 covering the whole country, GMP-specific indicators standardized by patient age, sex, and eligibility for exemption certificates were computed for adults. Linear regression models were applied to evaluate the relationships between GMP-specific parameters (list size, residence type, geographical location, general practitioner (GP) vacancy and their age) and patient SES (education, employment, proportion of Roma adults, housing density) and DM care indicators. Patients received 58.64% of the required medical interventions. A lower level of education (hemoglobin A1c test: β = -0.108; ophthalmic examination: β = -0.100; serum creatinine test: β = -0.103; and serum lipid status test: β = -0.108) and large GMP size (hemoglobin A1c test: β = -0.068; ophthalmological examination β = -0.031; serum creatinine measurement β = -0.053; influenza immunization β = -0.040; and serum lipid status test β = -0.068) were associated with poor indicators. A GP age older than 65 years was associated with lower indicators (hemoglobin A1c test: β = -0.082; serum creatinine measurement: β = -0.086; serum lipid status test: β = -0.082; and influenza immunization: β = -0.032). Overall, the GMP-level DM care indicators were significantly influenced by GMP characteristics and patient SES. Therefore, proper diabetes care monitoring for the personal achievements of GPs should involve the application of adjusted performance indicators.

Current status and continuing medical education need for general practitioners in Tibet, China: a cross-sectional study

BackgroundThe Tibetan area is one of China’s minority regions with a shortage of general practice personnel, which requires further training and staffing. This research helps to understand the current condition and demand for general practitioner (GP) training in Tibetan areas and to provide a reference for promoting GP education and training.MethodsWe conducted a cross-sectional survey using stratified sampling targeting 854 GPs in seven cities within the Tibetan Autonomous Region, utilizing an online questionnaire. Achieving a high response rate of 95.1%, 812 GPs provided invaluable insights. Our meticulously developed self-designed questionnaire, available in both Chinese and Tibetan versions, aimed to capture a wide array of data encompassing basic demographics, clinical skills, and specific training needs of GPs in the Tibetan areas. Prior to deployment, the questionnaire underwent rigorous development and refinement processes, including expert consultation and pilot testing, to ensure its content validity and reliability. In our analysis, we employed descriptive statistics to present the characteristics and current training needs of GPs in the Tibetan areas. Additionally, chi-square tests were utilized to examine discrepancies in training needs across various demographic groups, such as age, job positions, and educational backgrounds of the participating GPs.ResultsThe study was completed by 812 (812/854, 95.1%) GPs, of whom 62.4% (507/812) were female. The top three training needs were hypertension (81.4%, 661/812), pregnancy management (80.7%, 655/812), and treatment of related patient conditions and events (80.5%, 654/812). Further research shows that the training required by GPs of different ages in “puncturing, catheterization, and indwelling gastric tube use” (64.6% vs. 54.8%, p = 9.5 × 10− 6) varies statistically. GPs in various positions have different training needs in “community-based chronic disease prevention and management” (76.6% vs. 63.9%, p = 0.009). The training needs of GPs with different educational backgrounds in “debridement, suturing, and fracture fixation” (65.6% vs. 73.2%, p = 0.027) were also statistically significant.ConclusionsThis study suggests the need for targeted continuing medical education activities and for updating training topics and content. Course developers must consider the needs of GPs, as well as the age, job positions, and educational backgrounds of GPs practicing in the Tibetan Plateau region.Trial registrationNot applicable.

Patients and general practitioner knowledge and perception of testicular self-examination for cancer.

Testicular cancer (TC) predominantly affects young men and early detection enhances survival. However, uncertainty surrounds the impact of population-wide screening. Testicular self-examination (TSE) is a simple detection method but there is a gap in current practices that needs to be assessed. Our goal was to assess the perceptions and knowledge of male subjects in the general population (MP) and general practitioners (GPs) regarding TSE for TC. Two distinct surveys evaluating knowledge and perceptions of TSE for TC were administered to GPs and MP, aged 15‒45-years. Factors that could favour the realisation of TSE or improve the knowledge of TC were evaluated by multivariable logistic regression. Overall, 1048 GPs (mean (SD) age: 35.1 ± 10.3years) and 1032 MP (mean (SD) age: 27 ± 8.2years) answered the survey. Among the GPs, only 93 (8.9%) performed scrotal examination for TC screening. Although the majority (n = 993, 94.8%) were aware of the age of onset of TC, most (n = 768, 73.3%) did not know the overall survival rate from TC. GPs familiar with the guidelines were more likely to explain TSE to their patients (OR = 2.5 [95% CI 1.5‒4.1]; p < 0.01). Among the MP, 800 (77.5%) admitted that they did not know how to perform TSE and 486 (47.1%) did not know the main symptoms associated with TC. MP who had already undergone TC screening were more likely to be familiar with the main symptoms (OR = 2.1 [95% CI 1.6‒2.7]; p < 0.001) and MP who knew someone with TC or who had already undergone TC screening were more likely to be aware of the correct prevalence of TC (OR = 1.9 [95% CI 1.3‒2.7], p < 0.01; and OR = 1.6 [95% CI 1.2‒2.1], p < 0.01; respectively). The knowledge of both GPs and MP regarding TC could be improved. TSE screening and knowing someone close with TC improved the awareness of our subjects.

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

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

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

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

Measuring workload of Swiss general practice: a five-yearly questionnaire-based survey on general practitioners' self-reported working activities (2005-2020).

General practitioners (GPs) play a key role in the delivery of health care in Switzerland. Assessing GPs' workload over time is essential to meet the population's health service demand and for future health care planning. The study involved four questionnaire-based cross-sectional studies among a representative sample of Swiss GPs on a five-yearly basis since 2005. Data on GPs' self-estimated workload and practice administration (face-to-face consultations, house calls, nursing home visits and clinical administrative work) were analysed in hours per week (h/week) or full-time equivalents (FTE; 100% = 55 h/week). The mean age of GPs (n = 2,037) in 2020 was 54.9 years, significantly higher than in 2005 (51.4 years, p <0.001, n = 1,780). The proportion of female GPs increased gradually from 16.5% in 2005 to 36.2% in 2020 (p <0.001). The GPs' workload significantly decreased over the last 15 years from 50.2 h/week to 43.4 h/week or from 90.9% FTE in 2005 to 78.9% FTE in 2020 (p <0.001). The decreased average workload across years was less pronounced in women (-4.4% FTE) than in men (-9.0% FTE, p = 0.015). Across all survey years, women worked on average 12.7 h/week or 23.2% FTE less than men (p <0.001). The time spent with patients gradually decreased, whereas the amount of time spent on clinical administrative work remained stable since 2005 (9 h/week). In 2020, GPs were working more frequently in group practices compared to 2005 (45.0% vs. 12.4%, p <0.001). This study demonstrates a decrease in GPs' overall workload from 2005 to 2020, indicating that the "new" generation of GPs prefers to work part-time. This decrease is at the expense of direct face-to-face encounters with patients. Over the last 15 years, a clear trend exists towards more women in the Swiss general practice, persisting over-ageing of GPs, replacement of single-handed practices by group practices, and increasing burden of administrative tasks, a risk factor for burnout and reduced job satisfaction. To maintain an efficient healthcare system in the future, substantial efforts are crucial to provide a positive and motivating insight into general practice to pre- and postgraduate students and improve the operational working conditions of GPs.

Relationship between training supervision and evolution of the density of GPs: a 3-year cohort study on French cities between 2018 and 2021

ContextThere is an uneven distribution of general practitioners (GPs) across territories of developed countries leading to inequalities in access to health care. Countries are implementing incentive or coercive policies depending on the characteristics of their health system. Several studies suggest that the location of practical training may influence the location of GPs’ practices. The objective of this study is to investigate the existence of a relationship between training supervision and evolution of the density of GPs in French municipalities between 2018 and 2021.MethodsThe evolution of the density of GPs in almost all French municipalities between 2018 and 2021 was followed up. A bivariate statistical analysis was carried out to look for a relationship between the evolution of the density of GPs and the number of training supervisors. Other bivariate analyses were carried out with other factors likely to influence the density of GPs, such as the existence of financial aid in the territory or the age of GPs. A multivariate analysis with all the significant variables in bivariate analysis was then carried out using the stepwise descending method.ResultsA total of 34 990 (99.9%) French municipalities were included in the follow-up. Among these, 9427 (26.9%) had a GP and 3866 (11%) had a GP involved in the training supervision. The density of GPs in French cities decreased on average by 2.17% between 2018 and 2021. Territories without training supervisors decreased by 4.63% while those with at least one increased by 1.36% (p < 0.01). This significant relationship was also found in multivariate analysis.ConclusionThe training supervision is associated with a better evolution of density of GPs in French municipalities. This association persisted when other factors were considered. The results of this 3-year follow-up may lead us to consider the training supervision as a factor to regulate the distribution of GPs.

Antibiotic treatment of community-acquired pneumonia: A questionnaire survey in Danish general practice.

Discrepancies exist in Danish guidelines for the treatment of bacterial community-acquired pneumonia (CAP). This study aimed to investigate how general practitioners (GPs) treat adults with CAP and explore associations between GP characteristics and treatment duration. In autumn 2020, GPs in the North Denmark Region were asked to complete an electronic questionnaire on antibiotic prescribing for CAP. Information about GP gender, age, experience and type of practice was obtained. Multivariable logistic regression was used to analyse the association between GP characteristics and treatment duration. A total of 298 GPs were invited to participate of whom 108 completed the survey. Penicillin V was used as first line treatment for CAP by all participants. Treatment duration varied from 5 (54.6%) to 10 days (8.3%). A 5-day course of penicillin was less likely to be prescribed by male GPs (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.13-0.94) and more likely to be prescribed by GPs with 5-9years of experience in general practice (OR 5.03, 95% CI 1.09-23.21) compared to those with 10-19 years of experience. Variation in antibiotic treatment of CAP emphasises the importance of generating solid evidence about the optimal duration regarding both effectiveness and safety.

Effects of GP characteristics on unplanned hospital admissions and patient safety. A 9-year follow-up of all Norwegian out-of-hours contacts.

BackgroundThere are substantial differences in hospital referrals between general practitioners (GPs); however, there is little research on the consequences for patient safety and further healthcare use.ObjectiveTo investigate associations between out-of-hours GP characteristics, unplanned hospital admissions, and patient safety.MethodsThis cohort study included all Norwegian out-of-hours services contacts from 2008 to 2016, linked to registry data on patient characteristics, healthcare use and death, and GP age, sex, specialist status, out-of-hours service experience, and prior admission proportion. We estimated the impact from GP characteristics on (i) immediate unplanned hospital admissions for “all conditions,” (ii) immediate unplanned hospital admissions for “critical conditions,” (iii) 30-day unplanned hospital admissions, (iv) 30-day hospital costs, and (v) 30-day risk of death. To limit confounding, we matched patients in groups by age, time, and location, with an assumption of random assignment of GPs to patients with this design.ResultsPatients under the care of older and male GPs had fewer immediate unplanned hospital admissions, but the effects on cumulative 30-day unplanned hospital admissions and costs were small. The GPs’ prior admission proportion was strongly associated with both immediate and 30-day unplanned hospital admissions. Higher prior admission proportion was also associated with admitting more patients with critical conditions. There was little evidence of any associations between GP characteristics and 30-day risk of death.ConclusionsGPs’ prior admission proportion was strongly associated with unplanned hospital admissions. We found little effects on 30-day mortality, but more restrictive referral practices may threaten patient safety through missing out on critical cases.

Wide variability in colorectal cancer screening uptake by general practitioner: Cross-sectional study.

Despite several interventions, colorectal cancer (CRC) screening uptake remains below acceptable levels in Italy. Among the potential determinants of screening uptake, only a few studies analysed the role of general practitioners (GPs). The aim was to evaluate the variation in screening uptake of the clusters of subjects assisted by single GPs. Ancona province, Central Italy. Cross-sectional study, including all residents aged 50-69 years, who were offered the public screening programme with biannual faecal immunochemical tests. Demographic (of all GPs) and screening data (of all eligible residents) for years 2018-2019 were collected from the official electronic datasets of the Ancona Local Health Unit. The potential predictors of acceptable screening uptake, including GP's gender, age, and number of registered subjects, were evaluated using random-effect logistic regression, with geographical area as the cluster unit. The final sample consisted of 332 GP clusters, including 120,178 eligible subjects. The overall province uptake was 38.0% ± 10.7%. The uptake was lower than 30% in one-fifth of the GP clusters, and higher than 45% in another fifth. At multivariable analysis, the significant predictors of uptake were younger GP age (p = 0.010) and lower number of registered subjects (p < 0.001). None of the GP clusters with 500 subjects or more showed an uptake ≥45%. The wide variation across GPs suggests they might substantially influence screening uptake, highlighting a potential need to increase their commitment to CRC screening. Further research is needed to confirm the role of the number of registered subjects.

Characteristic-specific rates of rheumatoid arthritis and its management in Australian general practice.

A 2006-16 study investigated rheumatoid arthritis (RA) management by Australian general practitioners (GPs). The aim of this study was to examine: GP-patient encounters for RA management over the decade, treatments provided for RA management (new and continuing), characteristics of patients managed and ofGPs providing management, and differences across regional areas and areas of socioeconomic advantage/disadvantage, compared with Australian guidelines. GP self-reported data collected through the Bettering theEvaluation And Care of Health (BEACH) program were analysed for patient and GP characteristics and management actions (medications, referrals, investigations, procedures) nationally, regionally and bysocioeconomic advantage/disadvantage levels. Proportions of RA management encounters: remained static across the decade, were higher for female patients, increased with patient and GP age, increased with socioeconomic disadvantage in major cities, were higher for patients from English-speaking backgrounds, and were higher in regional/remote areas. GP behaviour indicates equity and uniformity in RA management nationally. The results suggest adherence to current guidelines for total and new RA contacts.

Attitudes and treatment practice of general practitioners towards patients with obesity in primary care

BackgroundObesity is one of the most common and relevant health problems in need of urgent action in Germany. General practitioners (GPs) are the initial contact and thus one of the most important starting points for the successful treatment of overweight and obesity. The aim of the study was to assess the treatment practice and attitudes towards patients with obesity in primary health care in Germany.MethodsAnalyses were based on baseline data of the INTERACT trial of 47 GPs in central Germany. Stigmatizing attitudes were identified using the Fat Phobia Scale (FPS). In addition, questionnaires including sociodemographic information, attribution of causes of obesity, referral behavior and clinical activities were completed. Statistical investigations include descriptive analysis, principal component analysis, inference statistics and linear regression models.ResultsGPs rated the quality of medical care for patients with obesity in Germany as below average. The FPS score revealed a value of 3.70, showing that GPs’ attitudes towards patients with obesity are stigmatizing. Younger GP age, male gender and a lower number of referrals to specialists were associated with higher levels of stigmatizing attitudes.ConclusionWeight-related stigmatization has an impact on medical treatment. Obesity management guides would help to increase knowledge and reduce weight-related stigmatization in primary care, thereby improving medical care for obese and overweight patients.

Geographical Variation in Medication Prescriptions: A Multiregional Drug-Utilization Study.

BackgroundStudies have emphasized the importance of geographical factors and general practitioner (GP) characteristics in influencing drug prescriptions.ObjectivesTo: (i) ascertain the prevalence rate (PR) of use of drugs in six therapeutic categories used for chronic conditions; (ii) assess how geographical characteristics and GP characteristics may influence drug prescribing.MethodsThis study is part of the EDU.RE.DRUG Project, a national collaborative project founded by Italian Medicine Agency (AIFA). Cross-sectional analyses were undertaken employing the pharmacy-claim databases of four local health units (LHUs) located in two Italian regions: Lombardy and Campania. Six drug categories were evaluated: proton-pump inhibitors; antibiotics; respiratory-system drugs; statins; agents acting on the renin−angiotensin system; psychoanaleptic drugs. The PR was estimated according to drug categories at the LHU level. A linear multivariate regression analysis was undertaken to evaluate the association between the PR and geographical area, age and sex of GPs, number of patients, and percentage of patients aged >65 per GP.ResultsLHUs in Campania showed a PR that was significantly higher than that in Lombardy. Antibiotics showed the highest PR in all the LHUs assessed, ranging from 32.5% in Lecco (Lombardy) to 59.7% in Naples-2 (Campania). Multivariate linear regression analysis confirmed the association of the PR with geographical area for all drug categories. Being located in Campania increased the possibility of receiving a drug prescription from the categories considered, with estimates more marked for antibiotics, proton-pump-inhibitors, and respiratory-system drugs.ConclusionsThis study provides information about the PR of medications used for treating common and costly conditions in Italy and highlighted a significant geographical variation. These insights could help to develop area-specific strategies to optimize prescribing behavior.

Contemporary Trends in the Level of Staffing by General Practitioners in Krasnodar Krai

Aim. To evaluate the level of staffing by general practitioners (GP) in medical organizations in Krasnodar Krai.Materials and methods. Indicators characterizing the level of staffing by GPs in Krasnodar Krai hospitals were analysed using data from the state statistical observation form No. 30 “Information about a medical organization” for the 2009–2019 period. According to the data derived from the Krasnodar Krai Patient Register as of 01.01.2020, all GPs were divided into groups in terms of the ratio of the number of served population and the recommended values. Using the data of the Regional Register of Medical Workers as of 01.01.2020, the age composition of GPs was analysed.Results. As of 01.01.2020, Krasnodar Krai featured 228 medical organizations subordinate to the Krasnodar Krai Ministry of Healthcare. Of these, 58 have full-time GP positions. The overall number of GP positions comprises 294, which are currently taken by 198 specialists (1.1% of the total number of doctors and 1.9% of doctors providing medical care on an outpatient basis). Over the studied period, stable indicators of the provision of the Krasnodar Krai population by GPs were noted; however, the level of staffing by GPs in hospitals was decreasing. This indicates a growing trend in the lack of GPs. An analysis of the actual load of 198 GPs showed that, on average, 1 GP serves 1219 people. For 26.8% of GPs, the number of served population increased the recommended values by 1.5 times or more. As a result, over 100,000 adults in the region are served under the conditions of excessive workload on GPs. The average age of GP is 50.1 ± 0.9 years. Currently, more than 25% of GPs are working retirees by age. In the medium term, this value may exceed 50%. Considering specialists who are about to retire, the estimated need for GPs is 146 doctors.Conclusion. In order to provide affordable and high-quality primary health care to the population in Krasnodar Krai, the number of GPs should be increased. In addition, measures should be taken to raise the attractiveness of work in Krasnodar Krai hospitals.

Effect of an Intervention in General Practice to Increase the Participation of Immigrants in Cervical Cancer Screening

Immigrant women have lower participation in cervical cancer screening (CCS) programs. At the same time, some groups of immigrants have higher prevalence of cervical cancer. Targeted interventions are therefore necessary. To determine whether an intervention among general practitioners (GPs) could influence immigrant women's participation in the Norwegian CCS program. Cluster-randomized clinical trial using the 20 subdistricts of the Bergen, Norway, municipality as clusters. The clusters were matched in 10 pairs according to the number of immigrant women living in them and randomized thereafter. The intervention was implemented between January and June 2017 among urban, primary care, general practices in Bergen. Follow-up ended in January 2018. General practices belonging to the control areas continued treatment as usual. A total of 10 360 women who attended 73 general practices in the 20 subdistricts were included as participants. The intervention consisted of 3 elements: an educational session for GPs at lunch describing the importance of CCS among immigrants and giving advice about how to invite them to participate, a mouse pad as a reminder, and a poster placed in waiting rooms. In the educational session, we elaborated the need for GPs to ask every immigrant woman about CCS, regardless of their reason for contacting their GP. The main outcome, screening status of immigrant women by January 1, 2018, was obtained from the Norwegian Cancer Registry. The effect of the intervention was measured as odds ratio (OR) for CCS status as of January 1, 2018, for the intervention group vs the control group, with 3 levels of adjustments: baseline CCS status at January 1, 2017 (model 1), additional adjustment for women's age, marital status, income level, and region of origin (model 2), and further adjustment for the GP's sex, age, and region of origin (model 3). Two subgroup analyses, screening status at baseline and women's country of origin, were conducted to assess whether these factors had any influence on the effect of the intervention. Data were analyzed as intention to treat. A total of 10 360 immigrant women, 5227 (50.4%; mean [SD] age, 44.0 [12.0] years) in the intervention group and 5133 (49.6%; mean [SD] age, 44.5 [11.6] years) in the control group, belonging to 39 general practices in the intervention area and 34 in the control area, were included in the study. The proportion of immigrant women screened increased by 2.6% in the intervention group and 0.6% in the control group. After adjustment for screening status at baseline, women in the intervention group were more likely to have participated in CCS (OR, 1.24 [95% CI, 1.11-1.38]). This statistically significant effect remained unchanged after adjustment for women's characteristics (OR, 1.24 [95% CI, 1.11-1.38]) and was reduced, but still significant, after further adjustment for GP characteristics (OR, 1.19 [95% CI, 1.06-1.34]). In subgroup analyses, the intervention particularly increased participation among women who were not previously screened at baseline (OR, 1.35 [95% CI, 1.16-1.56]), and those from Poland, Pakistan, and Somalia (OR, 1.74 [95% CI, 1.17-2.61]) when adjusting for baseline screening status. Our intervention targeting general practices significantly increased CCS participation among immigrants, although the absolute effect size of 2% in the fully adjusted model was small. Engaging other primary health professionals such as midwives to perform CCS could further contribute to increasing participation. ClinicalTrials.gov Identifier: NCT03155581.

Prevalence of burnout and associated factors among general practitioners in Hubei, China: a cross-sectional study

BackgroundHigh occupational burnout among general practitioners (GPs) is an important challenge to China’s efforts to strengthen its primary healthcare delivery; however, data to help understand this issue are unavailable. This study aimed to investigate the prevalence of burnout and associated factors among GPs.MethodsA cross-sectional design was used to collect data from December 12, 2014, to March 10, 2015, with a self-administered structured questionnaire from 1015 GPs (response rate, 85.6%) in Hubei Province, Central China. Burnout was measured using a 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS). MBI-HSS scores and frequency were analyzed by the three dimensions of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Factors associated with burnout among GPs were estimated using a multiple linear regression model.ResultsOf the respondents, 2.46% had a high level of burnout in all three dimensions, 24.83% reported high levels of EE, 6.21% scored high on DP, and 33.99% were at high risk of PA. GPs who were unmarried, had lower levels of job satisfaction, and had been exposed to workplace violence experienced higher levels of burnout. Intriguingly, no statistically significant associations were found between burnout and the duration of GP practice, age, sex, income, practice setting, and professional level.ConclusionThis is the first study of occupational burnout in Chinese general practice. Burnout is prevalent among GPs in Hubei, China. Interventions aimed at increasing job satisfaction, improving doctor-patient relationships and providing safer workplace environments may be promising strategies to reduce burnout among GPs in Hubei, China.

Workforce crisis in primary healthcare worldwide: Hungarian example in a longitudinal follow-up study

ObjectiveThe study was designed to explore the development of the general practitioner (GP) shortage in primary care and its characteristics in Hungary.DesignLongitudinal follow-up study over the decade 2007–2016.MethodsAnalyses were performed...

Prevalence of persons contacting general practice for psychological stress in Denmark

Objective: The prevalence of psychological stress has previously been estimated based on self-reported questionnaires. This study aimed to investigate the prevalence of persons who contact the general practitioner (GP) for psychological stress and to explore associations between psychological stress and characteristics relating to the patient, the GP, and area-specific socioeconomic factors.Design: Cross-sectional computer assisted journal audit.Setting: General practice in the Region of Southern Denmark.Subjects: Patients aged 18–65 years with a consultation during a six-month period that was classified with a stress-related diagnosis code.Main outcome measures: Six months prevalence of GP-assessed psychological stress and characteristics relating to the patient, the GP, and area-specific socioeconomic factors.Results: Fifty-six GPs (7% of the invited) identified 1066 patients considered to have psychological stress among 51,422 listed patients. Accordingly, a 2.1% six months prevalence of psychological stress was estimated; 69% of cases were women. High prevalence of psychological stress was associated with female sex, age 35–54 years, high education level and low population density in the municipality, but not with unemployment in the municipality or household income in the postal district. GP female sex and age <50 years, few GPs in the practice and few patients per GP were also associated with a higher prevalence of psychological stress.Conclusions: A total of 2% of the working-age population contacted the GP during a six-month period for psychological stress. The prevalence of psychological stress varies with age, sex and characteristics of both the regional area and the GP.Key points Psychological stress is a leading cause of days on sick leave, but its prevalence has been based on population surveys rather than on assessment by health care professionals. • This study found that during six months 2.1% of all working-age persons have at least one contact with the GP regarding psychological stress. • The six months prevalence of psychological stress was associated with patient age and sex, GP age and sex, practices’ number of GPs and patients per GP, and area education and urbanization level.

Age-related differences in working hours among male and female GPs: an SMS-based time use study

BackgroundIn several countries, the number of hours worked by general practitioners (GPs) has decreased, raising concern about current and impending workforce shortages. This shorter working week has been ascribed both to the feminisation of the workforce and to a younger generation of GPs who prefer more flexible working arrangements. There is, however, limited insight into how the impact of these determinants interact. We investigated the relative importance of differences in GPs’ working hours in relation to gender, age, and employment position.MethodsAn analysis was performed on real-time monitoring data collected by sending SMS text messages to 1051 Dutch GPs, who participated during a 1-week time use study. We used descriptive statistics, independent sample t-tests, and one-way ANOVA analysis to compare the working time of different GP groups. A path analysis was conducted to examine the difference in working time by gender, age, employment position, and their combinations.ResultsFemale GPs worked significantly fewer hours than their male peers. GPs in their 50s worked the highest number of hours, followed by GPs age 60 and older. GPs younger than 40 worked the lowest number of hours. This relationship between working hours and age was not significantly different for women and men. As shown by path analysis, female GPs consistently worked fewer hours than their male counterparts, regardless of their age and employment position. The relationship between age and working hours was largely influenced by gender and employment position.ConclusionsThe variation in working hours among GPs can be explained by the combination of gender, age, and employment position. Gender appears to be the most important predictor as the largest part of the variation in working hours is explained by a direct effect of this variable. It has previously been reported that the difference in working hours between male and female GPs had decreased over time. However, our findings suggest that gender remains a critical factor for variation in time use and for policy instruments such as health workforce planning.