Knowledge Of General Practitioners Research Articles

Knowledge, attitude and practice regarding enteric fever among doctors of Bangabandhu Sheikh Mujib Medical University

Background: Enteric fever remains a significant public health challenge, particularly in developing countries. Understanding the knowledge, attitudes, and practices of general practitioners regarding enteric fever is crucial for effective disease management and control. This study aims to assess these aspects among general practitioners, providing insights into current practices and identifying areas for improvement. Methods: This cross-sectional survey was conducted with 200 general practitioners. The questionnaire covered various aspects, including baseline characteristics, knowledge about enteric fever causative agents and symptoms, diagnostic practices, antibiotic preferences, and general attitudes towards management and prevention. Data were analyzed to determine the prevalence of specific knowledge and practices. Results: Majority of practitioners (74%) were residents, predominantly working indoors (61.5%). All respondents correctly identified Salmonella typhi and para typhi as causative agents and fever as a primary symptom. However, there was variability in recognizing other symptoms and diagnostic methods. Ceftriaxon was the most preferred antibiotic (67%), and blood culture correctly identified as gold standard for diagnosis by 71% of respondents. Attitudes and practices varied, with significant number not adhering to recommended diagnostic and treatment protocols. Conclusions: The study reveals a solid foundation of basic knowledge about enteric fever among general practitioners but also highlights significant gaps in the understanding of clinical symptoms, diagnostic practices, and treatment protocols. These findings underscore the need for enhanced educational initiatives and standardized guidelines to improve the management of enteric fever.

Needs and challenges among general practitioners in the management of actinic keratosis: a qualitative study

BackgroundBecause of the increasing incidence of actinic keratosis (AK), optimal use of limited healthcare resources is essential. Although most patients can be managed in primary care, dermatology referrals are common. More profound knowledge of general practitioners’ (GPs) considerations might assist in enhancing AK care.MethodsThe aim of the current study was to gain insight into AK management in primary care by exploring the needs and challenges among GPs in the Netherlands. A qualitative study was conducted based on semi-structured in-depth interviews with 15 conveniently sampled Dutch GPs, focusing on the needs and challenges in AK management. A literature-informed, predefined topic list guided the interviews, which were recorded, transcribed ad verbatim, and thematically analysed using the Framework Method.ResultsAll GPs reported AK to be a clinical diagnosis and most GPs indicated that most AK patients could be managed in primary care. Cryotherapy was preferred and experience with 5-FU therapy was limited. Most GPs applied cryotherapy without discussing other treatment options with patients. Reasons for dermatology referrals included an incomplete treatment response, extensive lesions, difficult-to-treat areas, and serious doubts about the diagnosis. GPs reported a need for more education, especially on 5-FU therapy. Their main challenges were dealing with diagnostic uncertainty, treating extensive lesions, managing treatment-related skin reactions, and reconciling patient misconceptions.ConclusionsThis study shows various AK management approaches among Dutch GPs with suboptimal guideline compliance due to diverse underlying barriers. It suggests that more education might contribute to a more standardised and uniform AK management and supports further transition of AK care from hospital to primary care.

Оцінка обізнаності щодо діагностики та менеджменту фарингіту в дітей серед лікарів загальної практики

Sore throat and pharyngitis account for up to 5.0% of all medical visits to a general practitioner. The etiology of pharyngitis in both adults and children is dominated by viruses, but in 20.0-30.0% of children the cause may be bacteria, most often the Group A β-hemolytic streptococcus. Purpose - to assess the knowledge of general practitioners regarding the diagnosis and management of pharyngitis in children, to determine further ways to increase their level of awareness. Materials and methods. A survey of 60 general practitioners in the Ternopil region of Ukraine was conducted to determine their awareness of the diagnosis and management of pharyngitis in children. The questionnaire and statistical methods were used. Results. In total, 45.0% of general practitioners in individual cases prescribed bacteriological cultures from the oropharynx to patients with acute pharyngitis. However, they rarely (6.7%) used the Center or McIsaac criteria to choose a treatment strategy for acute pharyngitis. Antibiotic therapy for the treatment of pharyngitis was used in individual cases by 86.7% of respondents. Amoxicillin was chosen as a first-line antibiotic by 38.3% of respondents, while protected aminopenicillins were chosen by 36.6%. Only 10.0% of general practitioners indicated a 10-day course of antibiotic therapy. A little more than half of the correct answers were to questions related to the appointment of antibacterial therapy to healthy children in whom the Group A β-hemolytic streptococcus was detected during bacteriological examination or an increased level of antistreptolysin-O in the blood. Conclusions. The results of our study showed a different level of knowledge of general practitioners regarding some aspects of diagnosis and management of pharyngitis in children. Insufficient knowledge was demonstrated regarding the possibilities of diagnosing the streptococcal etiology of pharyngitis, in particular the use of both clinical and laboratory research methods. Despite good knowledge about prescribing antibacterial therapy, poor awareness about the duration of antibacterial therapy and incomplete knowledge about the choice of antibacterial agent are shown. Relatively satisfactory knowledge was demonstrated regarding the strategy of management of streptococcal carriage in healthy children. The presented data indicate the need to improve the awareness of general practitioners regarding the diagnosis and treatment of pharyngitis, taking into account the modern complications of streptococcal infection. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

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

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

The preparedness and knowledge of pharmacists and general practitioners in managing human monkeypox: a highly spreading infectious disease

BackgroundAfter the era of the COVID-19 pandemic, the role of pharmacists was emphasized in the battle against highly spreading and infectious diseases like human Monkeypox (hMPV).AimAssess the hMPV knowledge of the community, clinical pharmacists, and general practitioners (GPs) and raise their awareness about hMPV.MethodsA web-based questionnaire was distributed randomly to Egyptian community pharmacists, clinical pharmacists, and GPs from all governorates. The questionnaire was divided into two sections: one for demographic information and the other for hMPV knowledge (nature of the disease, incubation period, transmission, symptoms, Prophylaxis, Prevention, and management). The evidence-based answers were provided after completing the submission. Data were descriptively analyzed using IBM SPSS software.ResultsFrom a total of 753 respondents, only 710 participants were included in the final data analysis. The % of respondents who presented good total knowledge scores about hMPV was comparable between study groups (P = 0.826). There were no differences between groups identifying different disease clinical characteristics (P = 0.689) and hMPV management (P = 0.324). Community pharmacists had better knowledge scores than GPs in the prevention and prophylaxis domain (P = 0.037).ConclusionPharmacists and GPs have good and similar knowledge levels of hMPV. However, a gap exists in recognizing the right hMPV incubation period, prophylaxis, and omitting antibiotics from hMPV management. Pharmacists and GPs are the frontline health care providers (HCPs), so they would require more knowledge enhancement about such contagious diseases to offer the best possible patient care.

Gatekeepers in the health financing scheme: Assessment of knowledge, attitude, practices, and participation of Malaysian private general practitioners in the PeKa B40 scheme.

This is cross-sectional research done to assess the readiness of the private Malaysian general practitioners (GPs) for the implementation of the national health financing scheme. The study focused on their levels of knowledge and attitudes towards the types of health financing scheme, gatekeeper roles in the health financing scheme, and their participation in the PeKa B40 scheme. Their acceptance and level of participation in the national health financing scheme (NHFS) were also assessed. A set of self-designed and pre-tested questionnaires focusing on the aforementioned objectives were mailed to the respondents. The selection of respondents was done by stratified random sampling of the GPs in all 14 Malaysian states at both urban and rural levels. Out of a calculated number of 362 GPs targeted, 296 responses were received which represented a response rate of 81.7%. The respondents had a mean age of 50.7 years 165 (55.75%) were males and 131 (44.3%) were females. The rural respondents totalled 158 (53.4%) as compared to those from urban 138 (46.6%) areas. The outcomes observed were that GPs with PeKa B40 provider status, positive attitude towards health financing schemes, gatekeeper roles, and PeKa B40, were strongly associated with their acceptance and level of participation in the NHFS. The GPs possessed a positive attitude and were generally ready to participate in the NHFS, but the lower scores in knowledge levels would require definite education and training plans to further enhance their readiness. More incentives should be given to GPs to enrol as PeKa B40 providers. The results of this study should be strongly considered by the government in the efforts to engage the Malaysian private GPs in the forthcoming NHFS. Most importantly, the role of GPs as gatekeepers needed to be implemented, and the PeKa B40 scheme be greatly improved.

Dutch GPs' perspectives on addressing obesity: a qualitative study.

Early diagnosis and treatment of obesity in primary care may help to tackle the obesity pandemic. Nonetheless, GPs frequently fail to address obesity and demonstrate limited adherence to guidelines. To explore Dutch GPs' perspectives on addressing obesity regarding the following three target behaviours: discussing weight; diagnosing; and referring patients with obesity. A qualitative focus group study with Dutch GPs. Six focus groups were conducted with a purposive sample of 21 GPs. Thematic analysis was performed using deductive coding, according to the Theoretical Domains Framework (TDF). For discussing weight, the main barriers identified were a presented complaint unrelated to obesity (environmental context and resources), concerns about a negative response from the patient (beliefs about consequences), and worries about obesity being a sensitive subject to discuss (emotions). A long-term trustworthy relationship (social influences) facilitated discussing weight. For diagnosing patients with obesity, the main barriers were related to resources; for example, lack of (appropriate) measuring equipment and time (environmental context and resources). For referring patients with obesity, the main barriers were no referral options nearby (environmental context and resources), and doubts about the positive effects of the referral on weight change (beliefs about consequences). Different barriers for discussing weight, diagnosing, and referring patients with obesity were identified, underscoring the importance for tailored interventions to these specific behaviours. Improving knowledge and skills of GPs seems insufficient as this study showed that particular attention should be paid to establishing long-term relationships, addressing GPs' beliefs about consequences, and creating a supportive environment with sufficient time and resources.

Evaluation of Knowledge, Attitude and Practice of General Practitioners regarding Oral Cancer in Tehran

Background: General practitioners (GPs) are the primary examiners of patients suspected of oral cavity cancer. The present study aims to determine the knowledge, attitude, and practice of general practitioners regarding oral cancer in Tehran.
 Methods: A 17-item questionnaire was applied to evaluate the knowledge, attitude, and practice of general practitioners in this cross-sectional, descriptive-analytical study, in 2019. The questionnaires were completed by 154 GPs participating in different medical congresses. Data were analyzed with a linear regression model using SPSS-25. P-value < 0.05 was considered statistically significant.
 Results: Of 154 GPs, 44.8% were female with a mean age of 44.5 ± 13.3, mean clinical experience of 14.6 ± 11.6 years, and mean time of 16.9 ± 12.1 years elapsed from graduation. Age, sex, and marital status had no significant association with knowledge, attitude, and practice; however, the time elapsed from graduation had a significant indirect association with knowledge (p = 0.04), and mean clinical experience had a significant direct association with attitude towards oral cancer (p = 0.04).
 Conclusion: Educational interventions are required to improve the GPs’ knowledge and practice to improve the early diagnosis and prevention of oral cancer.

Knowledge, attitudes and practices of general practitioners and paediatricians towards Group A beta-haemolytic streptococcal tonsillopharyngitis: A cross-sectional study from Türkiye.

General practitioners (GPs) and paediatricians are very important in the management of sore throat in terms of providing correct diagnosis and treatment. The aim of this study was to evaluate the knowledge, attitudes and practices of GPs and paediatricians towards Group A beta-haemolytic streptococcal (GABHS) tonsillopharyngitis. Three vignettes/case studies, in which the causative agents were GABHS, Epstein-Barr virus (EBV) and non-EBV viral infection, were presented as part of a questionnaire sent to paediatricians and GPs to elicit information regarding their diagnosis and treatment of tonsillopharyngitis. In all, 236 physicians responded to the questionnaire (126 paediatricians, 106 GPs). GPs registered more accurate diagnoses of GABHS tonsillopharyngitis and tended to administer more symptomatic treatment in the case of non-EBV tonsillopharyngitis than paediatricians. Paediatricians requested more tests in the diagnosis of GABHS tonsillopharyngitis than GPs. Most GPs and paediatricians possess adequate knowledge regarding GABHS diagnosis and the differential diagnosis of patients. Differences between the hospital and general practice settings may have affected the approach to symptomatic treatment and requesting tests.

Hereditary angioedema: Patient journey approach in Mexico.

Objective: To understand the patient’s journey with HAE from symptom initiation to diagnosis, treatment allocation, follow-up, and the impact of the disease on their quality of life in Mexico. Methods: A survey was administered to the patients with HAE. Participants completed a questionnaire covering five domains: patient journey; effects on productivity, school performance and daily activities; quality of life; anxiety and depression. Responses were analyzed using descriptive statistics. Results: A total of 17 surveys were analyzed (15 women and 2 men, age range: 23-67 years). Type I HAE was most common (71%), normal C1 inhibitor HAE was 12% and 18% did not know their HAE type. The average disease evolution was 13.7 years and the time from symptom initiation to diagnosis was 20 years. 59% of patients knew of one or two treatments available, 12% knew 3 treatments and 18% were aware of 4 or more, 12% were not aware of any treatments. 53% had a job, 18% referred a severely anxious state, 41% were depressed and all patients referred some social impact due to HAE. Conclusions: There is a need to reinforce the knowledge of general practitioners on HAE to promote an earlier diagnosis and awareness of rare diseases and their impact on quality of life among the general population and promote the removal of barriers to treatment.

Knowledge, Attitudes and Practices of General Practitioners in Lahore with Regard to Excess Weight and Obesity

The number of people suffering from overweight has equaled the number of undernourished people. Objective: To determine knowledge, attitude and practice of resident’s general physician’s related to obesity. Methods: A KAP study was conducted among male and female physician having age between 30-60 years. Participants were asked about their knowledge, attitude and practice and scored according to their responses. The Sample size was 100. It was a questionnaire-based study. The questionnaire was divided into four parts professional and personal characteristics, including training related to obesity; knowledge of current recommendations regarding physical activity; attitudes towards obesity and patients with obesity and reported practices. Data were entered and analyzed using SPSS version 23.0. Results: Showed that Majority of General Practitioners (GP’s) (55%) know the prevalence of obesity and 52% know the body mass index ranges. (73%) think that obese patients are not comfortable discussing their weight. 28% GP’s measured weight and calculated BMI (66%). 54% of GP’s calculate their own body mass index. Conclusions: From this study it is observed that majority of the respondents know about prevalence of obesity and concept of BMI. It also sheds light on the fact that neither patients nor doctors are comfortable in discussing their weight specially when they are obese. General Practitioners involved in study know much about the weight related issues and their treatment as well. This highlights the need for improved communication and sensitivity when addressing excess weight related issues.

Decision making of the endodontic-periodontal interrelation

This present work was aimed at evaluating the clinical knowledge of general practitioners (GPs), attending a specialization course on Endodontics in the cities of Recife - Brazil and João Pessoa - Brazil, as regards the endo-perio lesions, owing to the difficulties, noticed when stablishing their diagnosis and, therefore, when performing the therapeutic decision. On this purpose, a questionnaire with three case-reports, concerned with those lesions, was answered by a sample of 54 GPs. During the interviews, they were inquired on their possible diagnosis and treatment, by means of digitalized radiographies and case decriptions. The results revealed a great range of variation, even higher than what was expected, in reference to the diagnosis and proposed therapies, associated to a low frequency related to the right decision-making. In conclusion, the majority of the interviewed students does not retain the required scientific knowledge towards the studied subject.

Activities of the Japan Council for Implementation of the Maternal Emergency Life Support System reduced direct causes of maternal deaths in Japan.

Here, we aimed to provide an overview of Japan Council for the Implementation of the Maternal Emergency Life-Saving System (J-CIMELS) and its simulation program, which has reduced maternal mortality due to direct causes in Japan. The Japan Association of Obstetricians and Gynecologists (JAOG), Japan Association of Obstetricians and Gynecologists, and Maternal Death Exploratory Committee (JMDEC) launched the Maternal Death Reporting Project in 2010. The project analyzed obstetricians' tendency to delay their initial response to sudden maternal deterioration. Obstetricians can predict small changes before deterioration by monitoring vital signs. In 2015, the J-CIMELS was established to provide practical education. J-CIMELS developed a simulation program (J-MELS; Japan Maternal Emergency Life Support) to ensure that the obstetricians acquire the latest knowledge of emergency physicians, anesthesiologists, and other general practitioners and apply it in clinical situations. In the last 7 years, the J-MELS basic course has been conducted 1000 times with a total attendance of 19 890 people. As a result, the incidence of obstetric hemorrhage progressively decreased from 29% in 2010 to 7% in 2020. We believe that the activities of J-CIMELS are improving obstetric care providers' medical practices in Japan.

General Practitioners' Knowledge, Attitudes, and Practices of Dietary Advice for Weight Control in Their Overweight Patients: A Scoping Review.

This scoping review assessed the knowledge, attitudes, and practices of general practitioners (GPs) regarding dietary advice for weight management. A systematic search of PubMed, EMBASE, CINAHL, and MEDLINE was conducted for any qualitative, quantitative, and mixed-methods studies published in the past five years that informed GPs' dietary advice for weight control. Thirteen studies were included in the analysis after screening 881 papers. These studies tended to focus mostly on GPs' practices rather than their knowledge and attitudes. The most frequently mentioned dietary advice was to reduce calorie intake; however, 32 different types of dietary advice were identified in the literature, including approaches such as intermittent fasting and a ketogenic diet that are not recommended in current guidelines. GPs showed varying levels of knowledge and attitudes regarding the best dietary advice for patients. Further research is needed to better understand GP perspectives, with efforts to assist GPs in providing tailored advice based on the latest evidence to improve patient outcomes required.

Factors affecting communication between transgender and non-binary individuals and general practitioners: Recommendations for inclusive interactions

Research shows that transgender and non-binary (TNB) individuals frequently experience discrimination and mistreatment in health care settings. These negative experiences cause TNB people to underutilize health care and, when they do utilize it, may affect communication of health information. Moving from social cognitive theory (SCT) and theory of planned behavior (TPB), this study investigated what factors influence pre-, during, and post physician visit communication between TNB individuals and general practitioners (GPs) in The Netherlands. Between March and May 2022, fifteen TNB individuals and ten GPs participated in semi-structured interviews and focus groups about their experiences with GP-TNB interactions. The findings suggest that GPs addressing TNB people, GP knowledge and education, GP office procedures and environment, and social environment (in)directly facilitate or hamper communication. These findings support previous ideas about the influence of factors such as knowledge and social environment on one's behavior, as previously described in SCT and TPB. They also add and specify how pre-determined and novel factors affect whether TNB people feel welcome and comfortable at GP offices and if GPs feel equipped to provide TNB people with quality care. More specifically, to facilitate appropriate health communication, GPs are advised to ask patients about their pronouns, adjust intake forms, and put up TNB-specific posters or a Pride flag in their offices. TNB people are advised to make an introductory appointment to discuss their gender identity. Lastly, TNB topics should be included in medical curricula and online GP resources.

Knowledge, attitudes and practice of female genital mutilation and cutting: An observational cross-sectional study in primary care (FGM/C Study).

Female genital mutilation and cutting (FGM/C) describes procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Increasing migration means many communities living in the UK originate from countries where FGM/C is practiced. Consequently, clinicians in the UK are increasingly exposed to women and children who have experienced FGM/C. To explore the knowledge, attitudes and practice of primary care general practitioners and practice nurses about FGM/C. An observational cross-sectional study with general practitioners (GPs) and practice nurses (PNs) working in primary care in the West Midlands, United Kingdom. An online survey was circulated to GPs and PNs between September 2019 and December 2019. 137 survey responses were received. Study participants were predominantly female (81.8%) and general practitioners (59.9%) with a mean age of 47.3 (SD =9.1). 19.7% of responders reported seeing more than one patient with FGM/C in the last 12 months. 91% of responders had received some form of FGM/C training; however the format and frequency of training varied and 34.3% felt they had received inadequate training to manage treatment of FGM/C. Results suggest varying degrees of competence and confidence associated with recognising and managing patients with FGM/C in primary care in the West Midlands. Given that FGM/C patients typically present in primary care it is important that clinicians can provide appropriate support underpinned by up-to-date training.

Topical Steroids: Awareness and Misuse Among General Medical Practitioners

Introduction: Topical steroids (TS) contributed in the management of several inflammatory, tumoral or allergic dermatoses. However, their misuse may lead to serious or even irreversible adverse effects. This study aimed to evaluate the knowledge and attitudes of general medical practitioners in Morocco regarding topical steroids use and misuse. Materials and Methods: Cross-sectional national survey over a 4-month period from 01/09/2022 to 30/12/2022. The data was collected by a Google Forms questionnaire which was shared on different professional groups on the social networks. The target population was Moroccan general practitioners. Data analysis was performed by Excel software. Results: A total of 200 general medical practitioners answered the questionnaire, of which 133(66.5%) practiced in the public sector and 67(33.5%) in the private sector. 11% had rated their frequency of prescription as high, 56% as medium and 33% as minimal or rare; the indications were dominated by eczema, atopic dermatitis and psoriasis. The prescription of topical corticosteroids started from the age of 1 year in 32.5% of general practitioners while the majority prescribed them at any age. Sixty (30%) were aware of the pharmacological effects of topical corticosteroids. The most frequently prescribed galenic form was cream in 95% of cases followed by gels, lotions and finally preparations. One hundred and thirty-three (66%) had answered correctly to the indications of topical corticosteroids and 106(53%) prescribed them in short cures. Few doctors (1%) had been able to identify all side effects. One hundred and fifty (75%) of the general medical practitioners had already seen patients presenting adverse effects dominated by skin atrophy, delayed healing, depigmentation, fungal or bacterial infection; their response consisted of degression in 75% of cases or switching to a lower class, while 11.5% had wrongly suggested an abrupt discontinuation. Conclusion: The high frequency of topical steroids side effects is an increasing problem encountered by dermatologists. Lack of some general practitioners and patient awareness are also important underlying factors. To our knowledge, this is the first Moroccan study that aimed to evaluate the knowledge, attitudes, and behavior regarding topical corticosteroids by general medical practitioners.

Assessment of the Current Knowledge and Practice of General Practitioners Towards Laryngopharyngeal Reflux in Saudi Arabia.

Background General practitioners (GPs) have a significant role in the diagnosis of patients with laryngopharyngeal reflux (LPR). Some published data revealed a lack of knowledge among GPs about the disease, consequently, this lack of knowledge impacted their performance. This survey aims to assess the current knowledge and practice of general practitioners regarding laryngopharyngeal reflux in Saudi Arabia. Methodology This survey study was conducted to assess the current knowledge and practice of general practitioners regarding laryngopharyngeal reflux in Saudi Arabia using an online questionnaire. The questionnaire was distributed and collected from the five regions in Saudi Arabia, which are The Central Region (Riyadh, Qassim), Eastern Region (Dammam, Al-Kharj, Al-Ahasa), Western Region (Makkah, Madinah, Jeddah), Southern Region (Asir, Najran, Jizan), and Northern Region (Tabuk, Jouf, Hail). Results In the current study, we collected data from 387 general practitioners, 61.8% of whom were aged between 21-30 years old, and 57.4% of the participants were males. Moreover, 40.6% of the participants thought that both LPR and gastroesophageal reflux disease (GERD) share pathophysiology, however, they are two different diseases considering their clinical presentation. Moreover, it was found that heartburn was the most known symptom of LPR among the participants (Mean score 2.14 (SD=1.31), where a lower score indicated more relation). Considering the treatment of LPR, 40.6% and 40.3% of the participants reported using proton pump inhibitors once or twice daily respectively. In contrast, antihistamine/H2 blockers, alginate, and magaldrate were used to a lesser extent as reported by 27.1%, 21.7%, and 12.1%. Conclusion The current study showed limited knowledge among general practitioners considering LPR with a higher rate of referring patients to other departments depending on symptoms which may increase the pressure on other departments of mild cases.

Developing a Questionnaire Evaluating Knowledge, Attitudes and Behaviors on Audit & Feedback among General Practitioners: A Mixed Methods Study.

Audit and Feedback (A&F) is one of the most common strategies used to improve quality in healthcare. However, there is still lack of awareness regarding the enabling factors and barriers that could influence its effectiveness. The aim of this study was to develop a questionnaire to measure the knowledge, attitudes and behaviors of general practitioners (GPs) regarding A&F. The study was performed in the context of the EASY-NET program (project code NET-2016-02364191). The survey was developed according to two steps. Firstly, a scoping review was performed in order to map the literature on the existing similar instruments with the aim of identifying the sub-domains and possible items to include in a preliminary version of the questionnaire. In the second phase, the questionnaire was reviewed by a multidisciplinary group of experts and administrated to a convenience sample in a pilot survey. Ten papers were included in the scoping review. The survey target and development methodology were heterogenous among the studies. The knowledge, attitudes and behaviors domains were assessed in six, nine and seven studies, respectively. In the first step, 126 pertinent items were extracted and categorized as follows: 8 investigated knowledge, 93 investigated attitudes, and 25 investigated behaviors. Then, 2 sub-domains were identified for knowledge, 14 for attitudes and 7 for behavior. Based on these results, a first version of the survey was developed via consensus among two authors and then revised by the multidisciplinary group of experts in the field of A&F. The final version of the survey included 36 items: 8 in the knowledge domain, 19 in the attitudes domain and 9 in the behaviors domain. The results of the pilot study among 15 GPs suggested a good acceptability and item relevance and accuracy, with positive answers totaling 100% and 93.3% in the proposed questions. The methodology used has shown to be a good strategy for the development of the survey. The survey will be administrated before and after the implementation of an A&F intervention to assess both baseline characteristics and changes after the intervention.

E091 Improving recognition and referrals for axial spondyloarthritis in primary care

Abstract Background/Aims It is estimated there is an 8.5-year delay from onset of symptoms to diagnosis of axial spondyloarthritis. The condition is poorly recognised in the United Kingdom. An audit of a general practice with 7,500 patients revealed only 7 patients living with the diagnosis, of which only 2 were diagnosed before the age of 45. Estimates suggest this figure should be closer to 35 to 40. In the 12 months prior to the audit, only 2 referrals were sent to rheumatology suspecting axial spondyloarthritis. The short-term aim of this study was to improve the recognition and referrals for axial spondyloarthritis in primary care from 2 per year to 15. The long-term goal is to increase the number of patients living with the diagnosis from 7 to 37. Methods EMIS alerts and pop-ups were created for patients, aged 20-45, presenting with “low back pain” or a similar coding to increase clinicians' clinical suspicion index. The alerts and pops included a hyperlink to the SPADE tool to facilitate reasoning. This was consolidated with an education webinar to refresh General Practitioners and Advanced Nurse Practitioners on the diagnostic criteria for axial spondyloarthritis. Results Following implementation of alerts and hyperlinks to the SPADE tool, general practitioners' confidence and knowledge of knowing when to suspect, assess and refer axial spondyloarthritis increased from 1.9, 1.7 and 2 to 4.8, 4.4 and 4.2 on a 5 point self-rated Likert scale. In the 12 months following the intervention, number of referrals had increased from 2 per year to 11. Conclusion This study has highlighted various findings. It has highlighted an insufficient number of referrals to rheumatology suspecting axial spondyloarthritis in order to maintain the suspected population of a general practice. This is likely linked to poor awareness and screening of the condition. It has also highlighted that clinicians in primary care respond positively to training for knowing when to suspect, assess and refer on for axial spondyloarthritis. However, this only measured a short-term change in knowledge and further testing is required to assess long term change. Furthermore, combined with education and the use of pop up and alerts has increased the awareness and referrals for axial spondyloarthritis from primary to secondary care. Future audits are required in the long term to assess for success in the long term goal. Disclosure D. Hamilton: None.