General Practitioner Setting Research Articles

Integrating social work into general practice in Australia: protocol of an intervention study

PurposeThis study protocol provides an overview of research aimed to evidence social work contributions to general practitioner (GP) clinics and evaluating the value of social workers and students in such settings. The research will facilitate and evaluate 12 months service delivery by social workers and students who will be employed in North Queensland GP clinics.Design/methodology/approachThe study will be conducted in three phases. The first phase will involve developing partnerships and contractual arrangements to co-fund social workers to be employed in GP clinics. In the second phase, social workers and social work students will be practicing in GP settings and systematically recording basic demographics about their patients, areas of health and interventions. This data will be collated and correlated. Patient feedback surveys and a pre- and post-well-being scale will be applied to evaluate the outcomes of interventions. In the final phase, feedback about the value and contribution of social work in a GP setting will be sought from key GP practice stakeholders via an online survey tool to evaluate the research.FindingsFurther data is needed to evidence the contribution and outcomes of social work practice in Australia and elsewhere. It is important that social work and GPs work together to evidence and evaluate the outcomes and contribution of social work to develop sustainable funding pathways for embedding social work in GP clinics.Originality/valueThis is an innovative study design that will use various data sources to identify, quantify and evaluate the contribution of social work in general practice. It allows for stakeholders feedback that can contribute to policy review and the development of funding pathways to advance the inclusion of social work in integrated team care.

An Indicator of Treatment Quality in Ambulatory Care in Switzerland: Potential drug interaction in older people with polpharmacy in primary care

Background The Swiss Society of General Internal Medicine (SGAIM) has chosen the topic "Recognising drug interactions and preventing side effects" as a quality indicator in the primary care setting. Methodology Retrospectively, in a group practice of 6 general practitioners (GPs), all patients aged 65 and over who were prescribed ≥ 5 long-term medications were identified in the year 2022. These medications were systematically checked for interaction reports using the Compendium® software. Results The 226 patients were on average 77 years old and took an average of 7 different medications. In 188 (83.2 %) individuals with drug interaction signals, the severity of the drug interaction was classified as mild in 164 (87.3 %), moderate in 21 (11.1 %) and severe in 3 (1.6 %). Diuretics, antidiabetics and ACE-inhibitors/sartans were most frequently involved. In case of severe drug interaction reports, antidepressant agents and amiodarone were most frequently involved. In the multivariate analysis, no statistically significant associations were identified between the number of drug interaction reports and age, gender or type of residence. Conclusion In over 65-year-olds with polypharmacy (≥ 5 medications) in a GP setting, a software-supported systematic drug interaction check identified drug interactions of the prescribed medication in nine out of ten patients. The vast majority of drug interaction reports were minor and not clinically relevant. The number of drug interactions as an indicator of quality of care is limited, as patient-specific information other than their medication regimens is not taken into account. GPs' classification in the clinical context and the context and the assessment of the benefits and risks of (poly-)medication is indispensable.

Exploring the barriers, facilitators and needs to use patient outcomes in district nursing care: A multi-method qualitative study.

To provide an in-depth insight into the barriers, facilitators and needs of district nurses and nurse assistants on using patient outcomes in district nursing care. As healthcare demands grow, particularly in district nursing, there is a significant need to understand how to systematically measure and improve patient outcomes in this setting. Further investigation is needed to identify the barriers and facilitators for effective implementation. A multi-method qualitative study. Open-ended questions of a survey study (N = 132) were supplemented with in-depth online focus group interviews involving district nurses and nurse assistants (N = 26) in the Netherlands. Data were analysed using thematic analysis. Different barriers, facilitators and needs were identified and compiled into 16 preconditions for using outcomes in district nursing care. These preconditions were summarised into six overarching themes: follow the steps of a learning healthcare system; provide patient-centred care; promote the professional's autonomy, attitude, knowledge and skills; enhance shared responsibility and collaborations within and outside organisational boundaries; prioritise and invest in the use of outcomes; and boost the unity and appreciation for district nursing care. The preconditions identified in this study are crucial for nurses, care providers, policymakers and payers in implementing the use of patient outcomes in district nursing practice. Further exploration of appropriate strategies is necessary for a successful implementation. This study represents a significant step towards implementing the use of patient outcomes in district nursing care. While most research has focused on hospitals and general practitioner settings, this study focuses on the needs for district nursing care. By identifying 16 key preconditions across themes such as patient-centred care, professional autonomy and unity, the findings offer valuable guidance for integrating a learning healthcare system that prioritises the measurement and continuous improvement of patient outcomes in district nursing. Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. No patient or public contribution.

Health and economic impact of dapagliflozin for type 2 diabetes patients who had or were at risk for atherosclerotic cardiovascular disease in the Italian general practitioners setting: a budget impact analysis

AimIn 2022, in Italy, general practitioners (GPs) have been allowed to prescribe SGLT2i in Type 2 Diabetes (T2D) under National Health Service (NHS) reimbursement. In the pivotal clinical trial named DECLARE-TIMI 58, dapagliflozin reduced the risk of hospitalization for heart failure, CV death and kidney disease progression compared to placebo in a population of T2D patients. This study evaluated the health and economic impact of dapagliflozin for T2D patients who had or were at risk for atherosclerotic cardiovascular disease in the Italian GPs setting.MethodsA budget impact model was developed to assess the health and economic impact of introducing dapagliflozin in GPs setting. The analysis was conducted by adopting the Italian NHS perspective and a 3-year time horizon. The model estimated and compared the health outcomes and direct medical costs associated with a scenario with dapagliflozin and other antidiabetic therapies available for GPs prescription (scenario B) and a scenario where only other antidiabetic therapies are available (scenario A). Rates of occurrence of cardiovascular and renal complications as well as adverse events were captured from DECLARE-TIMI 58 trial and the literature, while cost data were retrieved from the Italian tariff and the literature. One-way sensitivity analyses were conducted to test the impact of model parameters on the budget impact.ResultsThe model estimated around 442.000 patients eligible for the treatment with dapagliflozin in the GPs setting for each simulated year. The scenario B compared to scenario A was associated with a reduction in the occurrence of cardiovascular and renal complication (−1.83%) over the 3 years simulated. Furthermore, the scenario A allowed for an overall cost saving of 102,692,305€: 14,521,464€ in the first year, 33,007,064€ in the second and 55,163,777€ in the third. The cost of cost of drug acquisition, the probability of cardiovascular events and the percentage of patients potentially eligible to the treatment were the factor with largest impact on the results.ConclusionsThe use of dapagliflozin in GPs setting reduce the number of CVD events, kidney disease progression and healthcare costs in Italy. These data should be considered to optimize the value produced for the T2D patients who had or were at risk for atherosclerotic cardiovascular disease.

Transition of patients with recently diagnosed Dementia from inpatient to outpatient setting– a scoping review

IntroductionAfter being diagnosed with dementia, patients need a medical professional to empathetically address their fears and get initial questions answered. This scoping review therefore addresses how patients newly diagnosed with dementia are cared for in the general practitioner (GP) setting and how the communication between different healthcare professionals and the GP is handled.MethodsThe scoping review was conducted based on the PRISMA Extension for Scoping Reviews checklist. After developing a search algorithm, literature searches were performed in PubMed, Scopus, Web of Science, Cochrane Library, PsychInfo, GeroLit and Cinahl using defined search criteria, such as a focus on qualitative study designs. After the removal of duplicates, title/abstract and full text screening was carried out.ResultsFinal data extraction included 10 articles out of 12,633 records. Strategies regarding the post-acute care of newly diagnosed patients included providing clarity and comfort to the patients and giving support and information both pre- and post-diagnosis. Care efforts were focused on advanced care planning and deprescribing. Involving people with dementia and their caregivers in further care was seen as crucial to provide them with the support needed. GPs emphasised the importance of listening to concerns, as well as ensuring wishes are respected, and autonomy is maintained. All studies found communication between the GP setting and other healthcare professionals regarding post-acute care to be inadequate. Lack of information sharing, clinical notes and recommendations for the GP setting resulted in inefficient provision of support, as GPs feel limited in their ability to act.DiscussionSharing necessary information with the GP setting could promote patient-centred care for people living with dementia and facilitate appropriate and timely resource allocation and effective healthcare collaboration between the settings, for example, by defining clear care pathways and clarifying roles and expectations.

Evaluation of deep learning-based depression detection using medical claims data

Human accuracy in diagnosing psychiatric disorders is still low. Even though digitizing health care leads to more and more data, the successful adoption of AI-based digital decision support (DDSS) is rare. One reason is that AI algorithms are often not evaluated based on large, real-world data. This research shows the potential of using deep learning on the medical claims data of 812,853 people between 2018 and 2022, with 26,973,943 ICD-10-coded diseases, to predict depression (F32 and F33 ICD-10 codes). The dataset used represents almost the entire adult population of Estonia. Based on these data, to show the critical importance of the underlying temporal properties of the data for the detection of depression, we evaluate the performance of non-sequential models (LR, FNN), sequential models (LSTM, CNN-LSTM) and the sequential model with a decay factor (GRU-Δt, GRU-decay). Furthermore, since explainability is necessary for the medical domain, we combine a self-attention model with the GRU decay and evaluate its performance. We named this combination Att-GRU-decay. After extensive empirical experimentation, our model (Att-GRU-decay), with an AUC score of 0.990, an AUPRC score of 0.974, a specificity of 0.999 and a sensitivity of 0.944, proved to be the most accurate. The results of our novel Att-GRU-decay model outperform the current state of the art, demonstrating the potential usefulness of deep learning algorithms for DDSS development. We further expand this by describing a possible application scenario of the proposed algorithm for depression screening in a general practitioner (GP) setting—not only to decrease healthcare costs, but also to improve the quality of care and ultimately decrease people’s suffering.

Monitoring and reporting of adverse effects of testosterone prescribing for gender affirmation at general practice clinics - Data from the PUSH! Audit

Introduction Prescribing testosterone for gender affirming hormone therapy (GAHT) has been increasing in Australia with much of this practice done by general practitioners (GPs) and there are current AusPATH guidelines on how this can be done appropriately. There has been limited data collected from GPs about how well these patients are monitored and the adverse effects (AEs) that are experienced by this population of patients. Objectives The primary objective of this study was to collect data about monitoring and adverse effects of GAHT provided in GP settings. Methods The PUSH! Audit was a cross-sectional study that collected data from 9 GP Clinics across 5 Australian cities who provided GAHT with testosterone. Data was also collected about cisgender men who were prescribed testosterone for testosterone deficiency (TD) as a comparison group (n = 209). Results The patients in the GAHT group (n = 277) tended to be younger (29.8 vs 54.9), with significant prevalence of smoking (21.8%) and anxiety/depression (37.2%) although this was not significantly higher that the comparison group. Most of the GAHT group had a testosterone level recorded in their file (90.6%) and the most common route of administration of testosterone was by intra-muscular injection (89.9%). The testosterone levels were mainly in the target range for males (75.7%) with only a small percentage registering levels above the target range (5.6%). Of the measured AEs, whilst there were significant prevalence of liver abnormalities and hypercholesterolemia, this was not significantly different to the TD group. The hypertension prevalence was lower in the GAHT group. Of the reported AEs, acne (10.1%) and balding (4.7%) were the only two AEs that were significantly reported. Conclusion This study shows that GAHT with testosterone can be provided effectively in general practice with high levels of success and very low levels of AEs.

The added value of text from Dutch general practitioner notes in predictive modeling.

This work aims to explore the value of Dutch unstructured data, in combination with structured data, for the development of prognostic prediction models in a general practitioner (GP) setting. We trained and validated prediction models for 4 common clinical prediction problems using various sparse text representations, common prediction algorithms, and observational GP electronic health record (EHR) data. We trained and validated 84 models internally and externally on data from different EHR systems. On average, over all the different text representations and prediction algorithms, models only using text data performed better or similar to models using structured data alone in 2 prediction tasks. Additionally, in these 2 tasks, the combination of structured and text data outperformed models using structured or text data alone. No large performance differences were found between the different text representations and prediction algorithms. Our findings indicate that the use of unstructured data alone can result in well-performing prediction models for some clinical prediction problems. Furthermore, the performance improvement achieved by combining structured and text data highlights the added value. Additionally, we demonstrate the significance of clinical natural language processing research in languages other than English and the possibility of validating text-based prediction models across various EHR systems. Our study highlights the potential benefits of incorporating unstructured data in clinical prediction models in a GP setting. Although the added value of unstructured data may vary depending on the specific prediction task, our findings suggest that it has the potential to enhance patient care.

Classical Borrelia Serology Does Not Aid in the Diagnosis of Persistent Symptoms Attributed to Lyme Borreliosis: A Retrospective Cohort Study.

The diagnosis of Lyme borreliosis is based on two-tier testing using an ELISA and Western blot. About 5-10% of patients report persistent symptoms of unknown etiology after treatment, resulting in substantial difficulties in further diagnostic workup. This paper presents a study aimed at determining whether serology can differentiate between patients with persistent symptoms attributed to Lyme and other patients with Lyme borreliosis. A retrospective cohort study included 162 samples from four subgroups: patients with persistent symptoms of Lyme (PSL), early Lyme borreliosis with erythema migrans (EM), patients tested in a general practitioner setting (GP), and healthy controls (HC). ELISA, Western blots, and multiplex assays from different manufacturers were used to determine inter-test variations in PSL and to compare reactivity against Borrelia-specific antigens among the groups. In comparing the IgG and IgM reactivity by Western blot, IgG was more often positive in the PSL group than in the GP group. The individual antigen reactivity was similar between the PSL and EM or GP groups. Inter-test agreement among the manufacturers was variable, and agreement was higher for IgG testing compared to IgM. Serological testing is unable to define the subgroup of patients with persistent symptoms attributed to Lyme borreliosis. Additionally, the current two-tier testing protocol shows a large variance among different manufacturers in these patients.

Personality traits among major depressive disorder in southern Thailand: a hospital-based case–control study

BackgroundResidual depression can cause functional impairment. This study aimed to assess personality traits among individuals with depression, to compare the results with personality traits found in outpatients without psychiatric disorders recruited from general practitioner settings, and to study the association between personality traits and the age-onset of depression, duration of treatment, and the presence of depressive residual symptoms.MethodsA case–control study surveyed Thai individuals with depression and outpatients without psychiatric disorders recruited from general practitioner settings at an outpatient clinic of Songklanagarind hospital, in 2022. The questionnaires were: (1) demographic data, (2) the PHQ-9 Thai version, and (3) the International Personality Item Pool-NEO (IPIP-NEO) Thai version. The difference between personality traits and the assigned clinical group were analyzed using the Student’s t-test and the Wilcoxon rank sum test. A generalized linear model was performed to examine differences of personality traits between the assigned clinical group (case–control), and the presence of depressive residual symptoms. The association between personality traits and treatment profiles was assessed by using an analysis of the variance test and the Kruskal–Wallis test.ResultsIn regards to 73 individuals with depression in the case group, and 73 gender-and age-matched outpatients without psychiatric disorders recruited from general practitioner settings in the control group; 78.1% of cases and 82.2% of controls were female. Thirty-eight (52.1%) cases had depressive residual symptoms. Regarding the IPIP-NEO Thai version, there was a statistically significant difference in Neuroticism, Extraversion, and Conscientiousness domains between the case and the control groups. In comparison to the control group, the case group scored higher on the Neuroticism domain, and lower on the Extraversion and Conscientiousness domains. Every 0.18-point reduction in the Neuroticism score and every 0.09-point increment in regards to the Openness score were associated with a 1-year increment of age-onset of depression. This study found an association between a higher score of Neuroticism and a lower score of Conscientiousness with the presence of depressive residual symptoms.ConclusionDifferent personality profiles were found between individuals with depression and outpatients without psychiatric disorders recruited from general practitioner settings. Individuals with depressive residual symptoms featured a higher score of Neuroticism and a lower score of Conscientiousness. A higher score of Neuroticism and a lower score of Openness were associated with age-onset of depression, but no personality traits were associated with treatment duration.

PS-P06-3: TREATMENT SEEKING BEHAVIOUR AND TRIGGERS AMONG PATIENTS WITH CHRONIC ILLNESSES DURING COVID-19 PANDEMIC: A QUALITATIVE STUDY

Background: Public health strategies, many of which required restricting movement of people, such as lock-downs and social-distancing measures had to be resorted to world-wide, to reduce the incidence and transmission of COVID-19, leading to a decline in healthcare utilization by non-COVI-19 patients, which is detrimental to people suffering from chronic-illnesses. This study aimed to assess treatment-seeking behavior among patients with chronic illnesses during the pandemic and the new normal. Methods: This qualitative study involved in-depth interviews with sixteen patients aged 30 -55 years with chronic diseases. Three focus group sessions were also held. The indepth interviews and focus group discussions were conducted until saturation point was achieved. Purposive sampling was used, and data were analyzed thematically. The study centers were two public hospitals and one general practitioner setting in Sri Lanka. Findings: Three main themes were identified. Namely, change of treatment seeking behaviour, difficulties in healthcare access and adherence and high out of pocket expenditure. Majority had diabetes, hypertension or both. Trigger factors for changing the healthcare setting during the pandemic were long waiting times, lack of staff to conduct the clinic, lack of drugs and investigations, and fear and anxiety associated with the pandemic. Treatment access and adherence were found difficult due to lack of high expenditure on transportation, prolonged waiting times, difficulties in buying the drugs, and spending on laboratory investigations. The reasons for high cut-off pocket expenditures were mostly for transportation, drugs, consultations and investigation. Some mentioned that due to difficulties in obtaining the treatment, they resort to adopting a healthy lifestyle, taking indigenous medication, and taking the drugs in a different frequency and regime. Very few agreed that they received the drugs via the postal service but stated that this was not regular, and that not all the drugs were available. Conclusion: Healthcare system-related and patient-related factors lead people to change their treatment-seeking behavior. Any health intervention to promote people's treatment-seeking behavior and to continue acess and adherence, especially for a chronic illness, should consider these complex trigger factors of individual needs, goals, and issues.

Health Literacy as a Mediator of the Relationship Between Socioeconomic Position and Pre-Exposure Prophylaxis Uptake Among Men Who Have Sex with Men Living in France.

In recent decades, several research studies have mentioned a potential mediating effect of health literacy (HL) on the relationship between socioeconomic position and health prevention behaviors. However, no study to date has investigated this hypothesis on HIV prevention behaviors. The present study aimed to evaluate whether HL mediates the relationship between socioeconomic status (SES) and pre-exposure prophylaxis (PrEP) uptake in men who have sex with men (MSM). The study is based on data collected in the Enquête Rapport au Sexe [report to sex] 2019 survey, an anonymous, self-administered online cross-sectional survey in France conducted between February 16, 2019 and March 31, 2019. Data on education level and perceived financial situation were used as measures of SES, whereas HL was assessed from the Health Literacy Questionnaire's "ability to actively engage with health care providers" scale. Mediation analyses were performed with a model-based causal moderated mediation analysis package in R software. Analyses were adjusted for age, place of residence, marital status, and social support. The study sample included 13,629 MSM. Median age was 32 years. The majority had an education level higher than upper secondary school (78%) and an adequate HL level (73%). Almost two-thirds perceived their financial situation as comfortable (62%). Overall, PrEP uptake was low (9.5%). The analyses did not show a mediating effect of HL on the relationship between education and PrEP uptake. However, a total mediation effect of HL was observed on the relationship between perceived financial situation and uptake. In the context of PrEP uptake, MSM ability to actively engage with health care providers may offset the effect of a difficult financial situation. In the current French context, where PrEP is now also available in general practitioner settings, this result could inform the development of training and support policies for health professionals and the way in which sexual health issues are addressed in consultations. [HLRP: Health Literacy Research and Practice. 2023;7(1):e61-e70.].

Primary care for people with a newly diagnosed dementia in hospital after discharge

AbstractBackgroundOlder people with cognitive impairment usually live at home. Possible deficits can be compensated there, often with the help of relatives. Therefore, the diagnosis of dementia is often delayed. It can lead to a first dementia diagnosis being made during an acute hospital stay. As a result, hospital discharge and subsequent care pose challenges for those involved. The aim of this study was to assess existing barriers and facilitating factors in the care of patients with a newly diagnosed dementia after hospitalization in the general practitioner (GP) setting. The study is funded by the German Alzheimer Society.MethodSixteen semi‐structured interviews with GPs from Germany were conducted from July to December 2021. Data were analysed according to the qualitative content analysis from Kuckartz.ResultTheoretical saturation regarding the research question was reached within the qualitative interviews. The analysis showed that GPs identify communication deficits on the part of the hospitals as a barrier to provide adequate care for their patients. A conversation is rarely initiated with the GPs to ensure continued outpatient care.GPs use different strategies to provide care for their patients. Special importance is given to the communication with people with dementia and their relatives in a first consultation after hospital discharge to obtain detailed information, e.g., about the hospital stay or third‐party anamnesis. This first consultation is focused on organizing the care of patients in their own homes. Managing medication from the hospital is a critical issue for GPs, as patients are often prescribed many new medications.ConclusionSince the acute reason for hospitalization is not dementia, there is usually no comprehensive assessment. It is therefore important for those affected that the diagnosis is verified after discharge and that appropriate measures are initiated. Based on the study results, practice‐oriented recommendations for the GP setting are going to be developed, which, for example, highlight the sensitive communication with those involved. For better initial care of their patients, GPs need adequate communication from the side of the hospital. Here, additional professional groups (e.g., care managers) and better digital networking can have a positive impact on care.

Contexts and mechanisms relevant to General Practitioner (GP) based interventions to reduce adverse drug events (ADE) in community dwelling older adults: a rapid realist review

Background: Older adults in Ireland are at increased risk of adverse drug events (ADE) due, in part, to increasing rates of polypharmacy. Interventions to reduce ADE in community dwelling older adults (CDOA) have had limited success, therefore, new approaches are required. A realist review uses a different lens to examine why and how interventions were supposed to work rather than if, they worked. A rapid realist review (RRR) is a more focused and accelerated version. The aim of this RRR is to identify and examine the contexts and mechanisms that play a role in the outcomes relevant to reducing ADE in CDOA in the GP setting that could inform the development of interventions in Ireland. Methods: Six candidate theories (CT) were developed, based on knowledge of the field and recent literature, in relation to how interventions are expected to work. These formed the search strategy. Eighty full texts from 633 abstracts were reviewed, of which 27 were included. Snowballing added a further five articles, relevant policy documents increased the total number to 45. Data were extracted relevant to the theories under iteratively developed sub-themes using NVivo software. Results: Of the six theories, three theories, relating to GP engagement in interventions, relevance of health policy documents for older adults, and shared decision-making, provided data to guide future interventions to reduce ADEs for CDOA in an Irish setting. There was insufficient data for two theories, a third was rejected as existing barriers in the Irish setting made it impractical to use. Conclusions: To improve the success of Irish GP based interventions to reduce ADEs for CDOA, interventions must be relevant and easily applied in practice, supported by national policy and be adequately resourced. Future research is required to test our theories within a newly developed intervention.

Learning objectives of Belgian general practitioner trainees regarding their hospital training: A qualitative study

Background In Europe, hospital training is integrated in the postgraduate curriculum of General Practitioners (GPs) according to the European Directives. However, little is known about the specific learning objectives of GP trainees during this training. Objectives This exploratory study investigated GP trainees’ expected learning objectives for their hospital training and the factors influencing the learning process. Methods Semi-structured interviews were conducted in three focus groups consisting of first-year GP trainees before their hospital training. Data were coded thematically and analysed in NVivo. Results A total of 22 Belgian GP trainees (55% females, average age of 26.2 years) were interviewed. Three major themes emerged: learning objectives, factors influencing learning and organisational aspects. GP trainees mainly wanted to improve their knowledge of common conditions by conducting consultations and follow certain patients’ hospitalisation trajectory. Emergency medicine or internal medicine was the preferred specialty. Other GP trainees wanted to learn more about some specific conditions. Conversely, an overloaded work schedule was dreaded to hinder effective learning. Regular meetings and supervision from their hospital trainer were deemed crucial to strengthen GP trainees’ learning trajectory. Conclusion GP trainees wanted to learn more about both common conditions and some specific conditions. Their previous year in a GP setting strengthened their confidence and facilitated purposeful learning. Relieving GP trainees from administrative tasks when working as supplementary doctors could strike a better balance between the continuity of the clinical department and their personal learning objectives.

The impact of smoking status on anticipated stigma and experience of care among smokers and ex-smokers with chronic illness in general practice.

To compare self-reported levels of 'anticipated' stigma and experience of care in general practice between current and ex-smokers living with COPD, other chronic illnesses, or those with no chronic conditions. Participants completed an online survey, advertised through social media, about their experience of care from general practitioners (GPs) in the past 12 months. Respondents self-reported doctor-diagnosed chronic illnesses. Experience of care and anticipated stigma was assessed using validated questions. Multi-nominal regressions were used to determine independent effect of smoking status on anticipated stigma and other indicators of patient experience in primary care. Patients with COPD (n = 161) reported significantly higher anticipated stigma scores compared to those with other chronic conditions (n = 225) and this was strongly related to delayed or avoidance in seeking help from a GP when needed. This relationship remained irrespective of current smoking status. There was no difference between groups for relational components of experience of care. Primary care patients living with COPD reported worse experience of care across several domains and were more likely to anticipate experiencing stigma in the GP setting irrespective of their current smoking status compared to those with other chronic illnesses or no chronic illnesses.

Removal of rubber earphonecover inside nose after 2 years in a general practitioner setting during covid-19 pandemic

Inserted a big size of rubber ear phone cover into the nose is a rare case.Foreign body regarding children is common and need to be seriously considered.Nowadays, using an earphone for music players and games isverycommon among children that need to be more cautious.In general practitioner’s practice, several limitations seen with no fully equipped and emergency trolley, no general anaesthetic set up and no X ray. In this case report, we reported a 10-year-old child with bad smelling breath for 2 years with on and off pain and difficulty in breathing. It has become worsened until the child informshis mother regarding this incidence last weeks. Last 2 weeks, the child was examined in dental clinic for this bad smelling breath and no dental problem identify. The parents were refused to bring the child to the hospital because of this Covid-19 situation worsening in this state currently. They decided to cometo nearby general practitioner where the smelly and soaked with pus in this ear was removed without any complication in that clinic without any anaesthesia using blunt crocodile forceps. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 467-469

Фитотерапия инфекционно-воспалительных заболеваний верхних дыхательных путей в амбулаторной терапевтической и общей врачебной практике

Acute respiratory infections (ARIs) are the most common reason of outpatient visits for internal medicine ambulatory care. As a rule, ARIs are induced by various serotypes of respiratory viruses that cause diseases with very similar clinical symptoms and, thus, it is impossible to make an accurate etiological diagnosis. At the same time, the therapeutic approaches are usually the same and include impact on different pathogenetic components of the inflammation process which, among other things, can be achieved by using herbal medicinal products known for a wide range of effects — immunomodulatory, antiseptic, antibacterial, antiviral and anti-inflammatory. The review is focused on the use of herbal medicines for the treatment of infectious & inflammatory upper airway diseases. The evidence-based medicine data have proven the efficacy and safety of phytomedicines, and therefore they can be administered for the treatment of acute rhinosinusitis and tonsillopharyngitis associated with acute viral respiratory tract infections, as well as within the combined therapy of recurrent and chronic diseases of the nose and paranasal sinuses. As shown, their use reduces the severity and duration of symptoms in patients with acute rhinosinusitis and tonsillopharyngitis. It is emphasized that herbal medications may have beneficial effects on microbiota composition of the pharynx, decreasing the pharyngeal mucosa contamination with true and opportunistic pathogens KEYWORDS: acute respiratory infections, upper airways, mucociliary clearance, tonsillopharyngitis, rhinosinusitis, phytotherapy. FOR CITATION: Stremoukhov A.A., Zaplatnikov A.L., Vlasova N.L., Smirnova M.A. Phytotherapy of infectious & inflammatory upper airway diseases in outpatient care and general practitioner settings. Russian Medical Inquiry. 2022;6(8):419–426 (in Russ.). DOI: 10.32364/2587- 6821-2022-6-8-419-426.

Peer navigators' role in supporting people living with human immunodeficiency virus in Australia: Qualitative exploration of general practitioners' perspectives

The redefining of human immunodeficiency virus (HIV) from an acute disease to a manageable chronic illness has reshaped the focus of care, emphasising clinical outcomes and sidelining the complex social barriers many people living with HIV (PLHIV) still face. This parallels changes in the location of HIV care in Australia, with many PLHIV seeking care from private general practitioners whose ability to address complex social issues is constrained by limitations of time and resources. In response, peer navigation has emerged as a model of care implemented by some HIV-based community health organisations seeking to support PLHIV's biomedical and psychosocial needs. However, there is limited understanding of how peer navigation operates in community settings or of the way these programmes integrate with primary care. This paper is the first to explore peer navigation from the perspective of general practitioners (GPs), with experience in treating PLHIV, to understand the role they see for peer navigators (PNs) in supporting PLHIV. Semi-structured in-depth interviews were conducted with six GPs (11.5% of specialty HIV GPs in Queensland, Australia) to examine their views and experiences of peer navigation in the context of HIV care. GPs highlighted the complexities of care for PLHIV and the need for additional resources and supports for psychosocial care. GPs valued peer navigation as part of a patient support network and bridge to health and social care systems. PNs normalised HIV, alleviating fear and stigma, educating and translating clinical information for patients. However, a key challenge was the absence of direct communication pathways with PNs. Peer navigation has clear potential in supporting the care of PLHIV, to alleviate constraints in GP settings and expand HIV care beyond the clinic.

A digital behaviour change intervention to increase booking and attendance at Stop Smoking Services: the MyWay feasibility RCT

Background Smoking remains a leading cause of illness and preventable death. NHS Stop Smoking Services increase quitting, but, as access is in decline, cost-effective interventions are needed that promote these services. StopApp™ (Coventry University, Coventry, UK) is designed to increase booking and attendance at Stop Smoking Services. Design A two-arm feasibility randomised controlled trial of StopApp (intervention) compared with standard promotion and referral to Stop Smoking Services (control) was conducted to assess recruitment, attrition and health equity of the design, alongside health economic and qualitative process evaluations. Setting Smokers recruited via general practitioners, community settings and social media. Participants Smokers aged ≥ 16 years were recruited in one local authority. Participants had to live or work within the local authority area, and there was a recruitment target of 120 participants. Interventions StopApp to increase booking and attendance at Stop Smoking Services. Main outcome measures Participants completed baseline measures and follow-up at 2 months post randomisation entirely online. Objective data on the use of Stop Smoking Services were collected from participating Stop Smoking Services, and age groups, sex, ethnicity and socioeconomic status in baseline recruits and follow-up completers/non-completers were assessed for equity. Results Eligible participants (n = 123) were recruited over 116 days, with good representation of lower socioeconomic status groups; black, Asian and minority ethnic groups; and all age groups. Demographic profiles of follow-up completers and non-completers were broadly similar. The attrition rate was 51.2%, with loss to follow-up lowest in the social media setting (n = 24/61; 39.3%) and highest in the general practitioner setting (n = 21/26; 80.8%). Most measures had < 5% missing data. Social media represented the most effective and cost-efficient recruitment method. In a future, definitive, multisite trial with recruitment driven by social media, our data suggest that recruiting ≥ 1500 smokers over 12 months is feasible. Service data showed that five bookings for the Stop Smoking Services were scheduled using StopApp, of which two did not attend. Challenges with data access were identified. A further five participants in the intervention arm self-reported booking and accessing Stop Smoking Services outside StopApp compared with two control arm participants. Event rate calculations for the intervention were 8% (Stop Smoking Services data), 17% (including self-reports) and 3.5% from control arm self-reports. A conservative effect size of 6% is estimated for a definitive full trial. A sample size of 840 participants would be required to detect an effect for the primary outcome measure of booking a Stop Smoking Services appointment in a full randomised controlled trial. The process evaluation found that participants were satisfied with the research team contact, study methods and provision of e-vouchers. Staff interviews revealed positive and negative experiences of the trial and suggestions for improvements, including encouraging smokers to take part. Conclusion This feasibility randomised controlled trial found that, with recruitment driven wholly or mainly by social media, it is possible to recruit and retain sufficient smokers to assess the effectiveness and cost-effectiveness of StopApp. The study methods and measures were found to be acceptable and equitable, but accessing Stop Smoking Services data about booking, attendance and quit dates was a challenge. A full trial may be feasible if service data are accessible. This will require careful planning with data controllers and a targeted social media campaign for recruitment. Changes to some study measures are needed to avoid missing data, including implementation of a more intensive follow-up data collection process. Future work We plan a full, definitive randomised controlled trial if the concerns around data access can be resolved, with adaptations to the recruitment and retention strategy. Limitations Our trial had high attrition and problems with collecting Stop Smoking Services data, which resulted in a reliance on self-reporting. Trial registration Research Registry: 3995. The trial was registered on 18 April 2018. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.