Behaviour Of General Practitioners Research Articles

Using the behaviour change wheel to develop a tailored intervention to overcome general practitioners’ perceived barriers to referring insomnia patients to digital therapeutic sleepio

BackgroundDigital therapeutic Sleepio has proven effective in improving sleep quality and decreasing symptoms of anxiety. The National Institute for Health and Care Excellence (NICE) guidance recommends Sleepio as an alternative treatment to usual sleep hygiene education and hypnotic medications. General practitioners (GPs) play a critical role in the adoption of digital therapeutics in patient care. Previous interventions did not adopt theoretical frameworks to systematically understand GPs behaviour toward referring patients to digital therapeutics.ObjectivesThis study aimed to report the systematic and comprehensive development of an intervention to encourage GPs to refer insomnia patients to Sleepio, using the Behaviour Change Wheel (BCW).MethodsThe eight steps outlined in the BCW were followed to develop an intervention. The Capability Opportunity Motivation-Behaviour Self-Evaluation Questionnaire (COM-B-Qv1) was adopted to understand GPs perceived facilitators and barriers to refer insomnia patients to Sleepio. The Behaviour Change Technique Taxonomy Version 1 (BCTv1) was thereafter used to identify possible strategies that could be used to facilitate changes in GPs’ behaviour in relation to Sleepio.ResultsThe BCW design process resulted in the identification of five intervention functions, three policy categories and five behaviour change techniques (BCTs) as potential active components for an intervention. The intervention includes providing GPs with an orientation about using Sleepio to improve their knowledge and confidence, sending visual reminders to GPs to recommend Sleepio to their patients, providing ongoing technical support.ConclusionThe BCW can be successfully applied through a systematic process to understand the drivers of GPs’ behaviour and to develop an intervention that can encourage them to refer insomnia patients to Sleepio.

Time is money: general practitioners’ reflections on the fee-for-service system

BackgroundFee-for-service is a common payment model for remunerating general practitioners (GPs) in OECD countries. In Norway, GPs earn two-thirds of their income through fee-for-service, which is determined by the number of consultations and procedures they register as fees. In general, fee-for-service incentivises many and short consultations and is associated with high service provision. GPs act as gatekeepers for various treatments and interventions, such as addictive drugs, antibiotics, referrals, and sickness certification. This study aims to explore GPs’ reflections on and perceptions of the fee-for-service system, with a specific focus on its potential impact on gatekeeping decisions.MethodsWe conducted six focus group interviews with 33 GPs in 2022 in Norway. We analysed the data using thematic analysis.ResultsWe identified three main themes related to GPs’ reflections and perceptions of the fee-for-service system. First, the participants were aware of the profitability of different fees and described potential strategies to increase their income, such as having shorter consultations or performing routine procedures on all patients. Second, the participants acknowledged that the fees might influence GP behaviour. Two perspectives on the fees were present in the discussions: fees as incentives and fees as compensation. The participants reported that financial incentives were not directly decisive in gatekeeping decisions, but that rejecting requests required substantially more time compared to granting them. Consequently, time constraints may contribute to GPs' decisions to grant patient requests even when the requests are deemed unreasonable. Last, the participants reported challenges with remembering and interpreting fees, especially complex fees.ConclusionsGPs are aware of the profitability within the fee-for-service system, believe that fee-for-service may influence their decision-making, and face challenges with remembering and interpreting certain fees. Furthermore, the fee-for-service system can potentially affect GPs’ gatekeeping decisions by incentivising shorter consultations, which may result in increased consultations with inadequate time to reject unnecessary treatments.

Have interventions aimed at assisting general practitioners in facilitating earlier diagnosis of type 1 diabetes in children been successful? A systematic review protocol

BackgroundEarly diagnosis of type 1 diabetes in children is critical to prevent deterioration to diabetic ketoacidosis (DKA), a state where the body’s insulin levels are critically low resulting in the...

The advising behaviour of healthcare professionals; considerations of dieticians and general practitioners regarding dairy and probiotic interventions

Dairy and probiotics are examples of products that contain ingredients that provide health benefits beyond the basic nutritional components of the food itself. However, strong evidence based on randomised controlled trials is generally lacking, which in turn leads to weak guidelines and recommendations for clinical practice. Interestingly, despite the limited regulation of probiotics, for example, a significant proportion of healthcare professionals still recommend these products. We set out studying the advising behaviour of general practitioners (GPs) and dieticians and their underlying motivations whether to advise probiotics, a relatively new intervention, and dairy, an older intervention by conducting interviews and setting out a questionnaire. This study found that the vast majority of GPs and dieticians recommended dairy and probiotics. The proportion of dieticians that do not advise both dairy and probiotics was too small for statistical analysis, therefore, the results are mainly focused on GPs. Considerations that appeared to be associated with GP advising behaviour were related to compliance with protocols and guidelines in regard to both dairy and probiotics. For probiotics in particular, GPs' knowledge and patients' interest in using probiotics was related to advising behaviour of GPs. Considerations solely related to recommending dairy were related to GPs' perceptions about the amount of evidence of dairy efficacy and the recommendation of dairy in scientific journals. The study highlights the influence of authority-driven, expertise-driven and patient-driven considerations on whether or not to proceed with recommending an intervention. Insights into the drivers of GPs to advise, gives input to stakeholders in the nutrition innovation system to understand and allow to use appropriate tools to support GPs in making an informed decision to increase the quality of care provided.

A national media mass campaign improves beliefs and behaviours about low back pain in the general population and in general practitioners.

Previous international mass-media campaigns for low back pain (LBP) have had conflicting impacts on the general population. The objective was to evaluate the impact of a national back pain campaign conducted between 2017 and 2019 on beliefs and behaviours of general practitioners and the general population in France. Between 2017 and 2019, a mass-media campaign was used to disseminate positive messages about LBP using several media, along with a parallel campaign addressed to general practitioners. An email survey before the campaign and 6 and 18 months after the campaign started evaluated beliefs and behaviours among a representative sample of the 2 target populations (3500 people from the general population and 700 general practitioners before the campaign, and 2000 people and 300 general practitioners 6 and 18 months after). Overall, 56% of the general population respondents before the campaign and 74% and 75% at 6 and 18 months after adhered to the statement "One should maintain physical activity" when dealing with LBP. Conversely, the percentage adhering to the statement "The best treatment is resting" decreased significantly from 68% before the campaign to 45% at 6 and 18 months after. Physicians reported delivering more reassurance and giving more documentation to patients after the campaign. They prescribed less sick leave during the first consultation (65% before the campaign, 46% and 30% at 6 and 18 months after). A mass-media campaign aimed at the public and general practitioners in France significantly modified beliefs and behaviours about LBP.

S-16-3: ANTIHYPERTENSIVE TREATMENT PRESCRIBING BEHAVIOURS IN FRENCH GENERAL PRACTICE IN 2021

Hypertension (HT) is the leading reason for visits to general practitioners (GPs). Due to insufficient adherence and marked therapeutic inertia, there is room for improving blood pressure control in France. The objective of this study is to describe the antihypertensive treatment prescribing behaviours in French general practice. Method: Data from the IQVIA Longitudinal Patient Database (LPD) France were used. LPD France is a permanent observatory to which a nationally representative panel of physicians, including GPs (n = 1200), contribute anonymised electronic medical records (EMR). The analysis included all antihypertensive treatment prescriptions from July 2020 to June 2021, which were then extrapolated to the entire population. The following definitions were used to categorise the prescribing behaviours: INITIATION, for hypertensive patients already registered with the GP and who had been prescribed an antihypertensive treatment for the first time in 24 months; RENEWAL, for hypertensive patients whose therapeutic class had not changed, apart from dosage modifications, changes of molecule within the same class and titrations; CHANGE, for hypertensive patients for whom a therapeutic class had been added, withdrawn, and/or changed. Results: In 2021, a total of 11 557 545 hypertensive patients had received an antihypertensive treatment prescription following consultation with a GP. These were distributed as follows (see figure). Conclusion: These findings provide informative data on the prescribing behaviours of GPs, primarily marked by a renewal rate that does not appear to reflect the reality of blood pressure control in France. Prescription modifications are in the minority, and essentially consist of class rotations. This observation requires urgent reflection when it comes to the training of prescribers and the value placed on blood pressure control under the French public health objectives pay-for-performance scheme (ROSP).∗IQVIA EMR LPD Médecins Généralistes “. EMR = Electronic Medical Records, LPD = Longitudinal Patient Data

Knowledge, attitude and behaviour of general practitioners in Shanghai during the pandemic of COVID-19: a cross-sectional study

ObjectivesTo understand the knowledge, attitude and behaviour of general practitioners (GPs) towards COVID-19 and to provide evidence for improved prevention and control measures against the pandemic.Study designA cross-sectional study was...

Combining default choices and an encounter decision aid to improve tobacco cessation in primary care patients: protocol for a cluster-randomized trial

BackgroundWhile quitting smoking dramatically decreases overall mortality, general practitioners (GPs) are less likely to prescribe medications for smoking cessation than other cardiovascular risk factors. Guidelines recommend providers first assess patients’ “readiness” to quit, an “opt-in” strategy, but only a minority of tobacco users are ready to quit on a given day. An “opt-out” strategy offering treatment as the default choice increased quit attempts in hospital and with pregnant women, but has not been tested in primary care. We will assess the efficacy of training GPs to offer treatment as the default choice using an encounter decision aid with current smokers seen in primary care.MethodsThis is a pragmatic cluster-randomized controlled superiority trial with block randomization at the GP level in private practice in French-speaking Switzerland. GPs will be blinded to the arm allocation. The intervention is a half-day training course teaching an ‘opt-out’ approach to smoking cessation using an encounter decision aid (paper or electronic). GPs in the enhanced usual care group receives a brief refresher training about smoking cessation without changing their behaviour. GPs in both arms will recruit 23 patients each prior to routine primary care visits. The primary outcome is the effect of consulting a GP who received the intervention on the 7-day, point prevalence, smoking abstinence 6 months after the baseline appointment. Secondary outcomes include continuous abstinence; number of quit attempts; use of smoking cessation aids; patient-perceived involvement in discussions; and changes in GP behaviour. Patient outcomes will be collected using paper and telephone questionnaires. Assuming 15% drop-out, recruiting 46 GPs with 23 patients each will give us 80% power to detect an increase in smoking cessation from 4% (control) to 10.5% (intervention), with an alpha < 0.05.DiscussionGP visits are an opportunity to administer proven smoking cessation treatments. We hypothesize GPs offering smoking cessation treatment as the default choice using an encounter decision aid will increase the number of patients who quit. This study could significantly change our approach to smoking cessation in primary care. Default choices and the electronic decision aid are low-cost, easily diffusible interventions.Trial registrationClinicalTrials.gov Identifier: NCT04868474, First Posted May 3, 2021, Last Update Posted October 6, 2021.

Illness behaviour and influencing aspects of general practitioners in Germany and their use of the health care system: a qualitative study.

ObjectivesThe aim of this study was to explore aspects that play a role when general practitioners (GPs) become ill and thus gain a more comprehensive understanding of the overall illness behaviour of GPs and their use of the healthcare system.SettingPrimary care practices in Thuringia, Germany.ParticipantsConvenience sample of 16 GPs.DesignQualitative study design with semistructured interviews and content analysis.ResultsUsing our approach of having participants report their own episodes of illness, we found that self-treatment was practised and accepted by all 16 participants. The widespread use of naturopathy and complementary methods seems to be a special feature of German GPs. Formal use of the healthcare system mainly took place through direct consultation with specialists.Our study revealed various aspects influencing the illness behaviour of the GPs and their use of the healthcare system. Some aspects also apply to lay patients, but it became clear how strongly illness behaviour is influenced by participants’ activities as physicians. Noteworthy and less described aspects are especially the influence of patients and practice staff, the influence of biographical and professional imprint and the attitudes and values of the physicians.Complex inter-relationships were found between illness behaviour and influencing aspects; these are subjected to a dynamic and recursive process.ConclusionsThe illness behaviour of German GPs seems to be comprehensively influenced by their activities as responsible healthcare providers. The ability to perceive and reflect in this regards should already be actively promoted in studies and further education. Further research is needed for a better understanding of the inter-relationships.

ANTIHYPERTENSIVE TREATMENT INITIATION IN FRANCE: WHAT DID GENERAL PRACTITIONERS PRESCRIBE IN 2021?

Objective: Hypertension (HT) is the leading reason for visits to general practitioners (GPs). The diagnosis of HT and the decision to initiate drug treatment form an integral part of their natural field of practice. The recent national and international guidelines have made proposals that are specifically dedicated to this sequence of care. The objective of this study is to analyse the prescribing behaviours of GPs when initiating treatment for patients newly diagnosed with hypertension. Design and method: Data from the IQVIA Longitudinal Patient Database (LPD) France were used. LPD France is a permanent observatory to which a nationally representative panel of physicians – including GPs (n = 1200) – contribute anonymised electronic medical records (EMR). This analysis included all antihypertensive drug prescriptions made by the GPs from July 2020 to June 2021, which were then extrapolated to the entire population of mainland France. Initiation was defined by the establishment of an antihypertensive treatment for a patient already registered with the GP and who was receiving antihypertensive treatment for the first time in 24 months. Results: Over the 12-month period analysed, 869 283 patients had received an initial antihypertensive drug prescription following consultation with a GP. Monotherapy was prescribed in 71.5% of cases (versus 67.3% the previous year) and dual therapy in 21.5% of cases (versus 23.2% the previous year). Fixed-dose combinations accounted for 62% of the dual therapies. The therapeu tic classes of the prescribed monotherapies were distributed as follows: Conclusions: These findings reveal prescriptions that appeared to be consistent with the latest guidelines in which the first-line use of renin-angiotensin system blockers and calcium channel blockers is preferred. It is also interesting to note that treatment initiation with dual therapies was much less common, with a use rate of fixed-dose combinations slightly higher than that of the free-dose combinations. *IQVIA EMR LPD Médecins Généralistes / Cardiologues Libéraux’. EMR = Electronic Medical Records, LPD = Longitudinal Patient Data

ANTIHYPERTENSIVE TREATMENT PRESCRIBING BEHAVIOURS IN FRENCH GENERAL PRACTICE IN 2021

Objective: Hypertension (HT) is the leading reason for visits to general practitioners (GPs). Due to insufficient adherence and marked therapeutic inertia, there is room for improving blood pressure control in France. The objective of this study is to describe the antihypertensive treatment prescribing behaviours in French general practice. Design and method: Data from the IQVIA Longitudinal Patient Database (LPD) France were used. LPD France is a permanent observatory to which a nationally representative panel of physicians – including GPs (n=1200) – contribute anonymised electronic medical records (EMR). The analysis included all antihypertensive treatment prescriptions from July 2020 to June 2021, which were then extrapolated to the entire population. The following definitions were used to categorise the prescribing behaviours: INITIATION - for hypertensive patients already registered with the GP and who had been prescribed an antihypertensive treatment for the first time in 24 months; RENEWAL - for hypertensive patients whose therapeutic class had not changed, apart from dosage modifications, changes of molecule within the same class and titrations; CHANGE - for hypertensive patients for whom a therapeutic class had been added, withdrawn, and/or changed. Results: In 2021, a total of 11 557 545 hypertensive patients had received an antihypertensive treatment prescription following consultation with a GP. These were distributed as follows: Conclusions: These findings provide informative data on the prescribing behaviours of GPs, primarily marked by a renewal rate that does not appear to reflect the reality of blood pressure control in France. Prescription modifications are in the minority, and essentially consist of class rotations. This observation requires urgent reflection when it comes to the training of prescribers and the value placed on blood pressure control under the French public health objectives pay-for-performance scheme. *IQVIA EMR LPD Médecins Généralistes ‘. EMR = Electronic Medical Records, LPD = Longitudinal Patient Data

What are patients’ first-time experiences with video consulting? A qualitative interview study in Danish general practice in times of COVID-19

ObjectiveTo explore the experiences of Danish patients using video consultation (VC) to consult their general practitioner (GP) during COVID-19 lockdown and their attitudes towards continued use beyond COVID-19.DesignA qualitative design...

An exploration of primary care healthcare professionals\u2019 understanding of pain and pain management following a brief pain science education

BackgroundPersistent pain is a leading cause of disability worldwide yet implementation of clinical guidelines that recommend a biopsychosocial approach remains a challenge in clinical practise. Limited pain understanding amongst clinicians may be partly responsible for this.Purpose of the study1) Qualitatively explore the experience of receiving PSE, understanding of PSE and operationalisation of PSE-related principles in routine clinical practice. 2) Quantitatively explore pain knowledge, attitudes, and behaviours of general practitioners (GPs) and nurse practitioners (NPs) before and after pain science education (PSE).MethodsAn exploratory, single-site, mixed-methods study in north-east England. Fifteen NPs/GPs completed questionnaires and a case-vignette before and after a 70-min face-to-face PSE lecture. Qualitative data were thematically analysed from two focus groups after the intervention.ResultsClinicians’ relatively high prior levels of knowledge, attitudes, and behaviour were similar after PSE. Qualitative themes described facilitation of self-reflection on pain management behaviours, and difficulties in operationalising PSE principles in practise including: limited patient rapport; short appointment times; patients’ passive and often oppositional biomedical treatment expectations; and clinicians’ lack of readily understandable language to communicate with patients.ConclusionThe findings highlight the value of PSE perceived by these clinicians who were already favourably inclined towards biopsychosocial pain management. They sought more resources for their personal learning and for communication with patients. Even with such favourable disposition, the practicalities and environment of clinical practice impeded the operationalisation of PSE-related principles.Trial registrationThis study was prospectively registered at ClinicalTrials.Gov (NCT04587596) in October 2020.

Effect of a price display intervention on laboratory test ordering behavior of general practitioners

BackgroundRedundant use of diagnostic tests in primary care has shown to be a contributor to rising Dutch healthcare costs. A price display in the test ordering system of the electronic health records (EHRs) could potentially be a low-cost and easy to implement intervention to a decrease in test ordering rate in the primary care setting by creating more cost-awareness among general practitioners (GPs). The aim of this study was to assess the effect of a price display for diagnostic laboratory tests in the EHR on laboratory test ordering behavior of GPs in the Westelijke Mijnstreek region in the Netherlands.MethodsA pre-post intervention study among 154 GPs working in 57 general practices was conducted from September 2019, until March 2020, in the Netherlands. The intervention consisted of displaying the costs of 22 laboratory tests at the time of ordering. The primary outcome was the mean test ordering rate per 1.000 patients per month, per general practice.ResultsTest ordering rates were on average rising prior to the intervention. The total mean monthly test order volume showed a non-statistically significant interruption in this rising trend after the intervention, with the mean monthly test ordering rate levelling out from 322.4 to 322.2 (P = 0.86). A subgroup analysis for solely individually priced tests showed a statistically significant decrease in mean monthly test ordering rate after implementation of the price display for the sum of all tests from 67.2 to 63.3 (P = 0.01), as well as for some of these tests individually (i.e. thrombocytes, ALAT, TSH, folic acid). Leucocytes, ESR, vitamin B12, anti-CCP and NT-proBNP also showed a decrease, albeit not statistically significant (P > 0.05).ConclusionsOur study suggests that a price display intervention is a simple tool that can alter physicians order behavior and constrain the expanding use of laboratory tests. Future research might consider alternative study designs and a longer follow-up period. Furthermore, in future studies, the combination with a multitude of interventions, like educational programs and feedback strategies, should be studied, while potentially adverse events caused by reduced testing should also be taken into consideration.

Discrimination between migrants and non-migrants in depression’s management by General Practitioners

Abstract Background In Europe, migrants have a higher prevalence of depression compared to the native population and, more often, they face unmet medical needs, including less frequent referral to mental health services. According to social psychology, general practitioners (GPs) may undertreat migrants due to unconscious stereotypical bias that could lead to and sustain discrimination in primary health care. The central question in this research is whether patients' migration background influences GPs' attitudes and decisions regarding treatment and referral in mental health. Methods In 2021, an experimental design was delivered to GPs with two video vignettes staging a depressed native and a Belgo-Moroccan patient, respectively. The randomly assigned vignette was followed by an online questionnaire regarding treatment and referral decisions. We recruited a national sample of Belgian GPs' (n = 700). T-tests and chi-square were used for analyses. Results The preliminary results are based on the first 224 respondents. Overall, there was no significant difference in the management of depression between a Belgian patient and a Belgo-Moroccan patient. Nevertheless, severity of symptoms was rated lower in the Belgo-Moroccan as compared to the Belgo-Moroccan (t = 2.37, p = .019). Conclusions In summary, these results indicate that general practitioners seem to treat migrants fairly in comparison with non-migrants. However, underestimation of the severity of the symptoms could lead to a different medical decision. This hypothesis will be investigated in the coming months. Key messages These findings may help us to further understand the role of general practitioner behaviour in mental health care discrimination. This research shed light on current management of migrants’ mental health by the primary health care providers in Belgium.

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.

Determinants of Mental Health and Practice Behaviors of General Practitioners During COVID-19 Pandemic in Bali, Indonesia: A Cross-sectional Study.

PurposeWe aim to study the level of mental health distress and COVID-19 prevention in practice behaviors among general practitioners (GPs) in Bali, Indonesia, as well as their determinants.MethodsWe conducted a cross-sectional online survey. Survey recruitment material was disseminated by purposive snowballing through regional professional association as well as research team’s personal acquaintances. The survey measured mental health status by DASS-21 questionnaire and practice behavior by a questionnaire based on WHO recommendations for hand hygiene and PPE use during the COVID-19 pandemic. We conducted multivariate analyses to identify independent determinants for mental health and practice behavior.ResultsAnalyses included 635 (41.75%) of GPs in Bali. Mental health status was relatively good with prevalence of depression, anxiety, and stress of 13.2%, 19.7%, and 11% respectively, lower than previous studies in Indonesia and elsewhere. Practice behavior, however, was not considerably lower with only 65.4% and 32.1% reported consistent hand hygiene and recommended PPE use respectively. Routine optional PPE use was reported by 23.6% of respondents. Long working hours and fear of COVID-19 was identified as detrimental to mental health while consistent hand hygiene improved it. Meanwhile, workplace, work setting, and fear of COVID-19, were identified as determinants for PPE use. GPs working in primary health centers and private hospitals were also found to have less adherence to hand hygiene protocols.ConclusionOur results showed relatively good mental health status along with inadequate infection prevention in practice behavior of GPs in Bali, Indonesia. Intervention should be made to improve practice behavior. Determinants of practice behavior identified in this study could help to pinpoint intervention targets.

Prescribing Behavior of General Practitioners for Generic Drugs.

The factors influencing General Practitioners’ (GPs) prescribing behavior are diverse in terms of health care policies and regulations, GPs’ education and experience, demographic trends and disease profiles. Thus, it can be useful to analyze the specific local patterns, as they affect the quality of healthcare and the stability of the healthcare market. The aim of the present longitudinal retrospective study is to investigate the prescription of generic drugs in a database of about 4.6 million prescriptions from a sample of 38 GPs practicing in Salerno, Italy, within a timeframe of 15 years, from 2001 to 2015. The GPs in our study show a general tendency to increase prescriptions of generic drugs during the studied time span, to fulfill regulatory obligations and with some differences in prescription behavior according to age, gender and experience. The generics prescription depends also on the different diagnoses, with some diagnostic areas showing a greater generic drug prescription rate. Expanding this research to larger datasets would allow deepening the knowledge of the patterns of GPs’ prescribing decisions, to provide evidence to be used in comparison between different national settings.

Australia's national zoster vaccination program: Knowledge, attitudes and behaviour of general practitioners.

To assess knowledge, attitudes and behaviour of Australian general practitioners (GPs) regarding herpes zoster vaccination under the National Immunisation Program (NIP) from 2016 for adults aged 70-79 years. National cross-sectional online survey of GPs, October-November 2017. Knowledge, attitudes and behaviour regarding zoster vaccination, including challenges experienced and recommendations for improvement. Of the 1026 GPs who responded (response rate 7.9%), 98.5% were aware that zoster vaccine is NIP-funded for adults aged 70-79 years and 85.4% that it is recommended for age 60-69 years; however, 51.3% incorrectly thought it is routinely recommended for age 50-59 years. A minority (4.6%) incorrectly believed that being immunocompromised is not a contraindication to zoster vaccination and 16.0% that it cannot be co-administered with influenza or pneumococcal vaccine. Almost half (48.9%) rarely or never reported zoster vaccination data to the Australian Immunisation Register (AIR). Challenges perceived included lack of adequate information on vaccine contraindications; efficacy and safety concerns; and difficulty applying age criteria for NIP eligibility in general practice. Respondents indicated a desire for program expansion to include younger and older adult age groups. This Australian GP survey, conducted one year after the introduction of the national zoster vaccination program, identified some knowledge gaps. A repeat survey of GPs is warranted to determine whether these issues persist, particularly regarding contraindication to vaccination for immunocompromised individuals. We encourage all GPs to offer zoster vaccination in line with current Australian evidence-based guidelines, particularly for the NIP-funded 70-79 years cohort; ensuring compliance with relevant contraindications; and reporting to AIR.

Avoiding acute kidney injury in primary care: attitudes and behaviours of general practitioners and community pharmacists in Hawke's Bay.

INTRODUCTION Awareness of the effect of acute kidney injury on patient outcomes and health systems is growing internationally. New Zealand's approach focuses on stopping consumption of 'at-risk' medicines when acute kidney injury has been established and raising awareness of the risks associated with the Triple Whammy drug combination. AIM To explore current practices and views of Hawke's Bay general practitioners (GPs) and community pharmacists regarding patient education about medicines with potential for contributing to community-acquired acute kidney injury, with a focus on community pharmacists providing patient education regarding when to temporarily withhold 'at-risk' medicines during acute dehydrating illnesses. METHODS Two tailored cross-sectional online anonymous surveys of GPs and community pharmacists working in Hawke's Bay were administered between 2015 and 2016. Descriptive statistics were generated from the closed-question responses and manifest content analysis was applied to the free-text responses. RESULTS Twenty-two percent (37/167) of GPs and 34% (32/95) of pharmacists responded. Most respondents, GPs (34/37) and pharmacists (25/32), self-reported expertise to educate patients on temporarily withholding 'at-risk' medicines during acute dehydrating illnesses. Twenty-nine (78%) GPs had confidence in pharmacists providing this patient education and 20 (54%) welcomed pharmacist contact regarding a Triple Whammy prescription. However, for a variety of reasons, pharmacists did not routinely provide this education or contact GPs. DISCUSSION Both GPs and community pharmacists reported they had expertise to provide useful patient education about 'at-risk' medicine use during acute dehydrating illnesses. Dialogue to clarify the role of the two groups would be beneficial to achieve a more coordinated approach to patient care. Relevant strategies and frameworks already exist, but national interprofessional leadership and local application would be beneficial.