General Practice Research Articles

Analysis of radiation oncology integration within general practitioners’ daily patient care: a cross-sectional survey in Germany

Abstract Purpose General practitioners (GPs) play a crucial role in providing interdisciplinary care for radiation oncology patients. This study aims to understand the specific needs and challenges faced by general practitioners in Germany when treating oncology patients. Methods A comprehensive web-based questionnaire with 24 items was disseminated to GPs in Germany via email using survio.com. The survey collected data on demographics, qualifications, clinical experiences, decision-making involvement, and symptom recognition. It specifically examined post-radiotherapy care and the use of specialized palliative homecare networks (SAPV). Statistical analyses were descriptive. The survey was open from July 4 to August 9, 2023. Results A notable majority of general practitioners displayed confidence in their understanding of cancer-related symptoms, with over half (54.6%) rating their knowledge with 4 out of 5. This level of self-assessed expertise extended to their capacity to address the needs of cancer patients (53.8%), although 67% express a need for further education in specifically radiotherapeutic side effects. Satisfaction with SAPV networks was high, and 72.3% of respondents were actively involved in palliative care, compared to only 45.6% in managing radiation therapy. Notable challenges included inadequate communication with specialists, insufficient staffing, and under-recognition of GPs’ roles in oncology care. Conclusion The study highlights a paradox where GPs show high engagement in palliative care but limited involvement in radiation therapy management due to communication gaps and professional development needs. Addressing these disparities through targeted initiatives and fostering a collaborative care model is essential to amplify the important role of GPs, ensuring more integrated and effective patient care.

Treatment of patients with tumor/treatment-related hypothalamic obesity in the first two years following surgical treatment or radiotherapy

Survivors of sellar/suprasellar tumors involving hypothalamic structures face a risk of impaired quality of life, including tumor- and/or treatment-related hypothalamic obesity (TTR-HO) defined as abnormal weight gain resulting in severe persistent obesity due to physical, tumor- and/or treatment related damage of the hypothalamus. We analyze German claims data to better understand treatment pathways for patients living TTR-HO during the two years following the index surgical treatment. A database algorithm identified patients with TTR-HO in a representative German payer claims database between 2010 and 2021 (n = 5.42 million patients). Claims from 37 patients with TTR-HO were analyzed on a quarterly basis over 2 years. The analysis considered inpatient, outpatient, and prescription data. In the follow-up period, patients with TTR-HO are hospitalized 3.68 times on average; 37% of hospitalizations in year 1 and 31% in year 2 are due to TTR-HO. On average, patients see a general practitioner 12.27 times and various specialists 20.45 times. The need for complex neuroendocrine therapy develops quickly, with most patients having 2–3 neuroendocrine prescriptions in any given quarter. The management of patients with TTR-HO requires frequent inpatient and outpatient visits for tumor follow-up and management of incident comorbidities, and most patients with TTR-HO require intense polytherapy.

A novel tool for assessing pediatric emergency care in low- and middle-income countries: a pilot study

Abstract Background Globally, most children seek emergency care at general rather than specialized pediatric emergency departments. There remains significant variation in the provision of pediatric emergency care, particularly in resource-constrained settings. The objective of this study is to pilot a self-assessment tool to evaluate pediatric emergency care capabilities in low- and middle-income country (LMIC) hospitals on the African Continent. Methods This was a prospective cross-sectional descriptive study using a convenience sample of sub-Saharan African hospitals. The assessment tool was developed by operationalizing the technical contents of existing standards and guidelines from international bodies including the World Health Organization and International Federation of Emergency Medicine. The pilot was conducted at emergency departments located across different regions on the African continent. Descriptive statistics were used to evaluate different domains of pediatric emergency care capabilities including pediatric triage, protocols, staffing, training, equipment, consumables, and medicines. Results Sixteen hospitals with emergency departments completed the assessment tool (participation rate of 76%). The hospitals were in nine different countries across four regions of sub-Saharan Africa. National/academic hospitals comprised 56.3% of the participating hospitals. The majority, 44%, of these hospitals saw pediatric patient volumes of 2,000–4,999 patients per year. Dedicated pediatric triage spaces and resuscitation spaces were available at 37.5% and 56.3%, respectively. Formal pediatric resuscitation guidelines were used at 62.5%. Doctors on the self-assessment teams came from primarily pediatrics and general practitioner training backgrounds (both 68.8%). Basic respiratory and airway support equipment (e.g. oxygen, bag-valve mask devices) were available in all participating hospitals, whereas advanced airway equipment (e.g. pediatric intubation equipment) was available in 37.5% of hospitals. Most medicines from the World Health Organization Essential Medicines list were available at participating hospitals. Conclusions To date, this is the first assessment tool dedicated to the comprehensive evaluation of pediatric emergency care in LMICs. This pilot provides a first approach to evaluate pediatric emergency healthcare capabilities in the hospital setting with future directions to improve the tool based on qualitative feedback.

An audit on the assessment and management of osteoporosis in a Parkinson's and related diseases clinic in Australia.

Patients with Parkinson's disease (PD) and atypical parkinsonian syndromes are at increased risk of falls and should be actively screened and treated for osteoporosis. In 2024, the Royal Australian College of General Practitioners (RACGP) revised their practice guidelines for diagnosing and managing osteoporosis in postmenopausal women and men aged over 50years. We conducted the first Australian study to audit these guidelines in patients with PD and atypical parkinsonian syndromes. We audited all PD, Dementia with Lewy Bodies, Progressive Supranuclear Palsy and Multiple System Atrophy cases attending our neurology service between January and March 2024 against the RACGP osteoporosis guidelines. We identified patients at risk of osteoporosis or minimal trauma fractures and assessed if they had been referred to their general practitioner (GP) for appropriate management or were already receiving appropriate osteoporosis treatment. This audit evaluated 230 patients, 199 of which had PD. We identified 78 patients over the age of 50years with risk factors that should trigger a GP bone health assessment as per the guidelines. Twenty-six of these patients were already being managed appropriately. However, only 12 of the remaining 52 'at risk' patients (23%) were directed to seek screening for osteoporosis by their GP, leaving 77% (40/52) without appropriate guidance. Our major recommendations include following the guidelines and referring patients for a bone health screen with their GP if they have risk factors for osteoporosis. This audit highlighted that assessment of osteoporosis and fracture risk by Specialists needs to be improved.

Patient perspectives on stress after ICU and a short primary care based psychological intervention – results from a qualitative sub‑study of the PICTURE trial

BackgroundApproximately 20–25% of patients who survive medical treatment at an intensive care unit (ICU) develop post-traumatic stress symptoms. There is currently a gap in follow-up care for them. As part of the PICTURE study, general practitioners (GPs) carried out a brief interview-based intervention. The aim of this sub-study is to record the most distressing memories of ICU treatment from the patient’s perspective and their evaluation of a GP-based brief psychological intervention.MethodsParticipants were recruited from the intervention group of the main PICTURE study using selective sampling. All of them had experienced an ICU stay with mechanical ventilation and severe organ failure in the previous two years. They were interviewed about their experience of psychological stress during their ICU stay and their retrospective evaluation of the intervention. Semi-structured, guideline-based telephone interviews were conducted for this purpose, processed, and analyzed using the structuring qualitative content analysis based on Mayring.FindingsWhen asked N = 8 patients about the most stressful memory of their stay at ICU, the main themes were helplessness, pain, fixation, inability to communicate and sleep disturbances. The question of amnesia regarding the stay in the ICU was answered affirmatively by half of the interviewees but was not experienced as stressful. The brief trauma-focused intervention carried out by their GPs was well received by all respondents.ConclusionsThe interviewees confirm that aversive traumatizing experiences are often associated with intensive care treatment and reinforce each other. These are due to the treatment setting but should be reduced wherever possible. In view of chronification and the lack of specific follow-up treatment options for these patients and the long waiting times for psychotherapy, the implementation of low-threshold treatment options by GPs appears to be ideally suited to closing this gap in care, particularly for patients with mild to moderate symptoms of a post-traumatic stress disorder.Trial registrationThe main trial was registered at ClinTrials gov (NCT03315390) and at the German Register of Clinical Trials (DRKS, DRKS00012589) on 17/10/2017.

Multidisciplinary Approach in the Treatment of Gastric and Duodenal ulcer Complicated by Bleeding

A multidisciplinary team is a team of specialists from different fields of medicine, united by the solution of one problem on previously agreed principles. A possible example of this approach in the treatment of gastric ulcer and duodenal ulcer complicated by bleeding is the joint interaction of doctors - general surgeons, endoscopists, gastroenterologists, general practitioners, therapists, nutritionists, psychologists. Since these specialists often encounter these dangerous diseases, a joint approach to their treatment is fully justified. When considering many medical problems, cooperation and joint work of several at once is necessary, both narrow specialists and general practitioners who work in the same team and try to achieve a common goal. In modern world medical practice, this approach is used more and more, because it allows you to combine the knowledge of different doctors, for the benefit of the patient and make the treatment closer to this patient. Today, a multidisciplinary approach of a team of doctors of different specialties is increasingly engaged in the treatment of patients in the world's leading clinics. It is believed that this approach has a future, because it allows to easily and quickly determine the sequence and priority of treatment methods. Also, recommendations to the patient are given in agreement and situations where one contradicts the other are excluded. Collegiality is observed.

Effectiveness of low-dose amitriptyline and mirtazapine in patients with insomnia disorder with sleep maintenance problems: a randomised, double-blind, placebo-controlled trial in general practice (DREAMING)

Background: Low-dose amitriptyline and mirtazapine are widely prescribed off-label for insomnia disorder. However, evidence from placebo-controlled studies is lacking. Aim: To assess the effectiveness of low-dose mirtazapine and amitriptyline in patients with insomnia disorder. Design and setting: Pragmatic, double-blind, randomised, placebo-controlled trial in general practice. Methods: Patients (18-85 years) with insomnia disorder with sleep maintenance problems for whom non-pharmacological treatment was insufficient were randomised to either mirtazapine (7.5-15 mg/day) or amitriptyline (10-20 mg/day) or placebo for 16 weeks (optional double dose regime in week 3-14). Primary outcome: Insomnia Severity Index (ISI) total score at week 6 (range 0-28, assessed at baseline, 6, 12, 20 and 52 weeks), clinically relevant ‘improvement’ (>7 points lower than baseline) and ‘recovery’ (total score ≤10). Results: 80 participants were included. At 6 weeks, in the intention-to-treat analyses, mirtazapine and amitriptyline led to statistically significantly lower ISI scores compared to placebo (mean difference −6.0 points, 95% confidence interval −9.0 to −3.1; and −3.4 points, −6.3 to −0.4, respectively). From 12 weeks onwards no statistically significant differences in ISI scores were observed. Mirtazapine, but not amitriptyline, resulted in statistically significantly higher improvement and recovery rates compared to placebo at week 6 (52 and 40 compared to 14%, 56 and 36 compared to 14% respectively). Conclusion: Compared to placebo low-dose mirtazapine provided a statistically significant and clinically relevant reduction of insomnia severity at 6 weeks, but not at later time points. Low-dose amitriptyline resulted in a statistically significant reduction at 6 weeks only which was not clinically relevant.

Co-Designing a Consumer-Focused Digital Reporting Health Platform to Improve Adverse Medicine Event Reporting: Protocol for a Multimethod Research Project (the ReMedi Project)

Background Adverse medicine events (AMEs) are unintended effects that occur following administration of medicines. Up to 70% of AMEs are not reported to, and hence remain undetected by, health care professionals and only 6% of AMEs are reported to regulators. Increased reporting by consumers, health care professionals, and pharmaceutical companies to medicine regulatory authorities is needed to increase the safety of medicines. Objective We describe a project that aims to co-design a digital reporting platform to improve detection and management of AMEs by consumers and health care professionals and improve reporting to regulators. Methods The project will be conducted in 3 phases and uses a co-design methodology that prioritizes equity in designing with stakeholders. Our project is guided by the Consolidated Framework for Implementation Research. In phase 1, we will engage with 3 stakeholder groups—consumers, health care professionals, and regulators—to define digital platform development standards. We will conduct a series of individual interviews, focus group discussions, and co-design workshops with the stakeholder groups. In phase 2, we will work with a software developer and user interaction design experts to prototype, test, and develop the digital reporting platform based on findings from phase 1. In phase 3, we will implement and trial the digital reporting platform in South Australia through general practices and pharmacies. Consumers who have recently started using medicines new to them will be recruited to use the digital reporting platform to report any apparent, suspected, or possible AMEs since starting the new medicine. Process and outcome evaluations will be conducted to assess the implementation process and to determine whether the new platform has increased AME detection and reporting. Results This project, initiated in 2023, will run until 2026. Phase 1 will result in persona profiles and user journey maps that define the standards for the user-friendly platform and interactive data visualization tool or dashboard that will be developed and further improved in phase 2. Finally, phase 3 will provide insights of the implemented platform regarding its impact on AME detection, management, and reporting. Findings will be published progressively as we complete the different phases of the project. Conclusions This project adopts a co-design methodology to develop a new digital reporting platform for AME detection and reporting, considering the perspectives and lived experience of stakeholders and addressing their requirements throughout the entire process. The overarching goal of the project is to leverage the potential of both consumers and technology to address the existing challenges of underdetection and underreporting of AMEs to health care professionals and regulators. The project potentially will improve individual patient safety and generate new data for regulatory purposes related to medicine safety and effectiveness. International Registered Report Identifier (IRRID) DERR1-10.2196/60084

The employment of recommended root canal treatment procedures by dentists in Croatia and the Czech Republic.

This study aimed to evaluate the compliance of dentists in Croatia and the Czech Republic with endodontic recommendations and identify the subjective and objective factors influencing their adherence to them. A total of 1386 dentists from Croatia and the Czech Republic participated in an online survey through a self-administered, author-designed questionnaire. After excluding those who did not perform root canal treatments (RCT), 1376 responses (394 from Croatia and 982 from the Czech Republic) were statistically analysed. The median age of respondents was 40 years, with a higher proportion of females in both countries. Croatian dentists treated fewer patients weekly but performed more RCTs and placed more composite fillings than their Czech counterparts. Czech dentists more frequently employed magnification devices, rubber dam (RD), pre-endodontic build-ups, nickel-titanium (NiTi) instruments, irrigant activation, bioceramic sealers, indirect post-endodontic restoration of lateral teeth, and single-visit treatments. These practices were also more common among endodontists than general dental practitioners and other specialists in both countries. Croatian dentists adhered more consistently to the recommended irrigation protocol. In the Czech group, adherence to recommended procedures, such as magnification, RD usage, and irrigation protocol correlated with younger age, smaller weekly number of patients, and preference for treating patients in the supine position. No such correlations were observed among the Croatian dentists. Despite notable improvements in recent years, dentists still do not fully comply with the recommended RCT working procedures in Croatia and the Czech Republic.

Adoption of Hygienic Meat Production and Handling Practices among Value Chain Stakeholders of Chevon and Carabeef in Kerala, India

This study investigated the adoption of hygienic practices in Kerala's chevon and carabeef value chain, focusing on production and handling methods. Using a stratified multistage sampling approach, the research examined three stakeholder groups: farmers (producers), traders, and retailers. For farmers, the assessment covered hygiene practices in feeding, environmental management, livestock health, and biosecurity. For traders and retailers, evaluation parameters included animal welfare standards, handling protocols, transportation compliance, regulatory adherence, traceability systems, slaughter hygiene, packaging methods, and waste management practices. Demographic analysis revealed that participants were predominantly middle-aged males with secondary education and substantial industry experience. The findings indicated moderate adoption of hygiene practices across all stakeholder categories. The domain-specific analysis highlighted critical areas requiring improvement: antimicrobial resistance management, residue monitoring, biosecurity protocols, and general hygiene practices throughout the value chain. For meat traders and retailers specifically, the study identified regulatory compliance, product traceability, personal and environmental hygiene, and waste management as key areas needing enhancement. These findings underscore the necessity for targeted interventions to improve hygiene standards across Kerala's red meat value chain.

Social issues in general practice – a survey assessing the interprofessional perspective of general practitioners and social workers regarding frequency, challenges, and needs

BackgroundHealth or illness and social issues cannot be viewed in isolation. Social problems can influence well-being and disease. General Practitioners (GPs) are requested to offer counselling opportunities to respond to the social issues of their patients adequately. Counselling on non-medical issues in general practice increases GPs’ workload. The study aimed to analyse the occurrence of social problems as well as the strengths and weaknesses of existing working agreements between social services and GPs in primary care.MethodsWe carried out a cross-sectional online survey between December 2022 and January 2023 among a sample of Swiss GPs from the Sentinella-Network, the uniham-bb-Network and social workers from the SAGES-Network.ResultsFindings come from a sample of 143 GPs (mean age 54 years, 37.8% female) and 41 social workers (mean age 43 years, 75.6% female). GPs face a median of 3 patients with social problems per week (IQR 5.2). They reported encountering patients facing “Finance” issues most frequently, with 78.8% encountering such cases between “more than 3 patients per week” and “1–3 patients per month”. “Work” (76.4%) and “Loneliness” (73.7%) were also among the most commonly encountered social problems. When suspecting the problem, GPs more often addressed the issue if it was about “Addiction” (83.2%), “Loneliness” (72.3%), or “Protection” (71.4%). More than half of GPs (56.0%) reported having contact with social workers less than once a month, while approximately half of the social workers reported having contact with GPs 1 to 3 times a month (48.7%). GPs (69.3%) and social workers (76.3%) would like more contact. The most frequently mentioned benefits of an increased collaboration from the GPs’ perspective were “improved quality of care (more time for medical issues)” (64.8%) and “improved mental health of patients” (55.6%).ConclusionsSocial problems in general practice are common, but the interprofessional cooperation between GPs and social workers is scarce. However, both parties appear to be in favour of closer interprofessional collaboration and seem to be willing to attempt to improve joint patient care in the future. The integration of social workers into general practice is promising for a comprehensive, interprofessional, and preventative patient approach to providing the best healthcare.

Current Trends in Endodontic Clinical Practice in Croatia: A Report From a Croatian National Survey.

To assess the state of endodontic practices and identify factors influencing the use of modern endodontic techniques among dental practitioners in Croatia. A questionnaire was distributed to all dental offices in Croatia, yielding 819 responses (27% response rate). Data were descriptively analyzed and statistically modeled. Nearly 74% of endodontic treatments in Croatia are performed by general practitioners (17 teeth per month per practitioner), while endodontic specialists handle the highest number of treatments per specialist (67 teeth per month, representing 15% of total treatments). 56% of respondents use radiography before the procedure "always" or "almost always" with intra-oral periapical radiography being the most commonly used technique. Rubber dams are used "never" to "rarely" by 74% of respondents. Apex-locators are highly prevalent, used "almost always" to "always" by 83% of practitioners. Magnifiers are rarely used, with 63% of respondents reporting they "never" use them. Lasers are never used by 92% of respondents, whereas 59% frequently use engine-driven instrumentation. 76% of respondents "always" or "almost always" determine the working length of the root canal. Sodium hypochlorite is the most common irrigant (88%), and EDTA for smear layer removal is used by 36% of respondents. The cold lateral condensation is the most popular obturation technique (64%). CBCT is unused by 59% of responders, most probably because it is not accessible. Croatian endodontic practices are comparable to those in countries with similar economic status, but there is substantial potential, particularly among general practitioners, to enhance knowledge and awareness of modern technologies through continuous education. Underused techniques in Croatia include rubber dams, magnifiers, lasers, and CBCT.

Assessment of Cognitive Functions in Multimorbid Patients in Lithuanian Primary Care Settings: A Cross-Sectional Study Using MMSE and LT-GPCOG

Background and Objectives: The aging population has led to a rise in cognitive impairments, including dementia, often associated with multimorbidity. Early diagnosis of cognitive decline is crucial, especially in primary care, where time constraints and the limitations of diagnostic tools may hinder accurate detection. This study aims to assess the cognitive functions of multimorbid patients using the Mini-Mental State Examination (MMSE) and the Lithuanian version of the General Practitioner Assessment of Cognition (LT-GPCOG). We hypothesized that the LT-GPCOG would perform similarly to the MMSE in suspecting cognitive impairments. Materials and Methods: This cross-sectional study, conducted from 2021 to 2022, included 796 patients aged 40–85, with arterial hypertension and at least one other chronic disease, recruited from seven Lithuanian primary health care centers. Cognitive function was assessed using the MMSE and LT-GPCOG, and statistical analyses were performed using SPSS to determine the association between cognitive impairment and various demographic and clinical variables. Results: Out of 796 participants, 793 completed the study. Cognitive impairment was suspected in 5.1% of participants based on MMSE and 4.2% based on the LT-GPCOG. Statistically significant associations were found between cognitive impairment and chronic obstructive pulmonary disease (COPD) (p = 0.008 and p = 0.003) in both tests and chronic kidney disease (CKD) (p = 0.005) while testing with the MMSE. Lower education and unemployment were also correlated with cognitive impairment (p = 0.008 and p < 0.001). Conclusions: The findings suggest that regular cognitive assessments should be integrated into the management of multimorbid patients, particularly those with COPD and CKD. The LT-GPCOG proved to be an efficient alternative to the MMSE in primary care settings, demonstrating comparable diagnostic accuracy. Further studies are also needed to assess the sensitivity and specificity of the LT-GPCOG test.

Effect of integrated case-based and problem-based learning on clinical thinking skills of assistant general practitioner trainees: a randomized controlled trial

BackgroundCase-Based Learning (CBL) and Problem-Based Learning (PBL) are popular methods in medical education. However, we do not fully understand how they affect the clinical thinking skills of Assistant General Practitioner (AGP) trainees. This randomised controlled trial aimed to assess the effectiveness of combining CBL and PBL and compare their impact on the clinical thinking skills of AGP trainees with that of traditional lecture-based learning (LBL).MethodsThis randomised controlled trial involved 70 second-year AGP trainees who were randomly assigned to either the CBL-PBL group or the LBL group using a simple randomisation method. The CBL-PBL group engaged in a curriculum that integrated case-based and problem-based learning, whereas the LBL group followed a traditional lecture-based format, as described in the syllabus. To evaluate clinical thinking skills, the participants were assessed using the Clinical Thinking Skills Evaluation Scale (CTSES) and an assistant general practitioner’s professional knowledge test. In addition, this study analysed various factors that influence clinical thinking skills.ResultsCompared with the LBL group, the CBL-PBL group showed significantly improved performance in all domains assessed by the CTSES in post-course tests (p < 0.001). Specifically, the mean scores for critical, systematic, and evidence-based thinking showed notable improvement in the CBL-PBL group. Additionally, the scores on the professional knowledge test reflected a substantial increase in this group. Furthermore, multiple linear regression analysis showed that both CBL-PBL curriculum performance scores and number of weekly article readings significantly influenced the development of clinical thinking skills.ConclusionThe CBL-PBL teaching method positively influenced the clinical thinking skills of assistant general practitioner trainees, with a positive correlation between these skills and course performance in the CBL-PBL curriculum.Trial registrationNot applicable.

Primary Care Physicians' Responses to Treatment Burden in People With Type 2 Diabetes: A Qualitative Video Analysis in China.

This study aimed to examine the approaches general practitioners (GPs) use to respond to the treatment burden faced by people with type 2 diabetes. We retrospectively analyzed 29 videos of GP-patient consultations in an academic general practice clinic in China. Thematic analysis and a framework matrix approach were used to identify patterns in GPs' responses to the identified issues. The median length of the 29 video-recorded consultations was 23 minutes 54 seconds. We identified 77 segments focusing on discussions about treatment burden. In 37.7% of these segments, the GP elicited and responded to discussions about treatment burden, whereas in 23.4%, the patient initiated the discussion and the GP responded to it, leaving 39.0% in which the patient initiated the discussion but the GP did not respond. In thematic analysis, medication was the component of treatment burden most frequently identified by both patients and GPs, followed by personal resources, medical information, and administrative burden. General practitioners used 12 response approaches to address patients' treatment burden. The most frequently used included active listening and nonverbal skills, shared decision making, and confidence and self-efficacy support, which were broadly applied across various issues. In contrast, GPs typically reserved health record management, motivational interviewing, and awareness of the patient's background for specific issues. In clinical encounters, GPs used a wide variety of approaches to respond to different aspects of the treatment burden of type 2 diabetes. Our findings emphasize the need to improve GPs' response strategies through increased responsiveness and more rapid surfacing of issues during visits.

'You would rather not fill your body with pills'-patient perspectives on polypharmacy and medication reviews by pharmacists in general practice.

Polypharmacy is widespread. The demographic shift toward older patients receiving multiple medications increases risk and drug-related problems in these patients. To investigate patient perspectives on polypharmacy and the experienced effects of medication reviews by pharmacists in general practice. Twenty-two semi-structured interviews with patients with polypharmacy (>5 medications) from 6 different general practice clinics in the North Denmark region. The interviewees were from the intervention arm of a randomized clinical trial and had received a medication review with a pharmacist in addition to the usual annual check-up in general practice. Participants were interviewed at baseline (no later than 2 weeks after the medication review) and again at follow-up (6 months after the medication review). The interviews were transcribed verbatim and thematically analyzed with an inductive approach. The patients' narratives show that they face many difficulties in their everyday lives, making it hard for them to live up to society's ideal of what it is to live a healthy life. The interviewees were generally positive toward the intervention and felt comfortable having a pharmacist conduct the medication review in their usual general practice clinic. Some interviewees gained more insight into their medication from the review. Patient narratives give a comprehensive understanding of the challenges of polypharmacy. Having pharmacists conduct medication reviews in general practice could ensure more time and focus on patients and their medication management. The combined knowledge of physicians, nurses, and pharmacists regarding thorough polypharmacy management is recommended.

Facilitators and barriers to adopting a multifaceted chlamydia management intervention in general practice: qualitative findings from Management of Chlamydia Cases in Australia (MoCCA)

Background Chlamydia is one of the most common sexually transmissible infections globally and can lead to reproductive complications, including pelvic inflammatory disease and infertility. Interventions to reduce disease burden, including retesting for reinfection, partner management, and early detection of complications, are the focus of the Management of Chlamydia Cases in Australia (MoCCA) study, an implementation and feasibility trial aiming to strengthen chlamydia management in Australian general practice. This study aimed to identify factors influencing participation in and adoption of a multifaceted chlamydia management intervention within the general practice setting. Methods We conducted semi-structured interviews with general practice staff (n = 13) from clinics (n = 9) participating in the MoCCA study. Data were analysed using inductive content analysis to identify facilitators and barriers to study participation and intervention adoption. Results Participants felt that practice champions, motivated staff and interventions that improved workflow efficiency, integrated with existing processes and improved patient interactions, facilitated participation in, and adoption of, study interventions. A perceived lack of staff engagement related to time constraints, competing priorities, staff retention issues and interventions that were less convenient to use or had reduced patient uptake were identified as barriers to participation. Conclusions Identifying perceived facilitators and barriers to successful implementation of a multifaceted chlamydia intervention enables public health practitioners to better support general practice in the ongoing uptake and use of evidence-based chlamydia management strategies, ultimately aiming to reduce the burden of chlamydia and its complications in Australia.

Exploring the associative relationship between general practice engagement and hospitalisation in older carers to potentially reduce hospital burden.

Background Caregiving is an essential yet often overlooked component of health care. Although carers play a pivotal role in reducing healthcare costs and improving patient outcomes, they are also prone to psychological and physical burdens that can lead to their own hospitalisation. This study aimed to explore the relationship between the frequency of interactions with general practitioners and hospitalisation rates among caregivers aged ≥45years in New South Wales, Australia. Methods This cohort study retrospectively identified participants from the Sax Institute's 45 and Up Study in New South Wales, linked with national datasets. The cohort comprised 26,004 individuals aged ≥45years who were caregivers. The primary outcome was hospitalisation within a 7-year period, and the intervention was whether the patient was a high or low general practice (GP) user, ascertained by determining if the average number of annual GP visits was above or below 11, respectively. Data analysis included descriptive statistics and Poisson regression models. Results The study found a statistically significant association between high GP use and reduced rates of hospitalisation among caregivers. Caregivers with frequent GP interactions had a relative risk of hospitalisation of 0.514 (95% CI: 0.479-0.550) compared with their counterparts who infrequently used GP services. This association remained significant, even after adjusting for various demographic and health-related factors with an adjusted relative risk of 0.619 (95% CI: 0.554-0.690). Conclusions The findings underscore the potential of primary care interventions in reducing hospitalisations among caregivers, in turn providing economic and societal benefits. They also highlight the need for future research to understand the specific aspects of GP interactions that contribute to this protective effect.

Factors Associated with the Timing of Initial Visit to Healthcare Providers for Injured Workers with Low Back Pain Claims: A Multijurisdiction Retrospective Cohort.

Evidence shows that patient outcomes following musculoskeletal injury have been associated with the timing of care. Despite the increasing number of injured workers presenting with low back pain (LBP) in primary care, little is known about the factors that are associated with the timing of initial healthcare provider visits. This study investigated factors that are associated with the timing of initial workers' compensation (WC)-funded care provider visits for LBP claims. We used a retrospective cohort design. A standardised multi-jurisdiction database of LBP claims with injury dates from July 2011 to June 2015 was analysed. Determinants of the time to initial general practitioner (GPs) and or musculoskeletal (MSK) therapists were investigated using an accelerated failure time model, with a time ratio (TR) > 1 indicating a longer time to initial healthcare provider visit. 9088 LBP claims were included. The median time to first healthcare provider visit was 3days (interquartile range (IQR) 1-9). Compared to General practitioners (GPs) (median 3days, IQR 1-8), the timing of initial consultation was longer if the first healthcare providers were MSK therapists (median 5days, IQR 2-14) (p < 0.001). Female workers had a shorter time to first healthcare provider visit [TR = 0.87; 95% CI (0.78, 0.97)] compared to males. It took twice as long to see MSK therapists first as it did to see GPs for injured workers [TR = 2.12; 95% CI (1.88, 2.40)]. Professional workers and those from remote areas also experienced delayed initial healthcare provider visits. The time to initial healthcare provider visit for compensable LBP varied significantly by certain occupational and contextual factors. Further research is needed to investigate the impact of the timing of initial visits to healthcare providers on claim outcomes.

Enhancing assessment practices: Incorporating developmental distress in adolescent depression diagnosis

Depression is a prevalent mental health problem, particularly in the middle to late stages of adolescence. There are certain characteristics of depression that make it difficult to diagnose and require a thorough evaluation. Primary care doctors are often the first to see teens and have a critical role in recognizing and treating the symptoms of this condition. In addition, there are groups that advise testing for depression at this time. To summarize, the major objective of this paper is to conduct a comprehensive review of the scientific literature about the screening, diagnosis, and treatment of depression in adolescents, with a particular focus on primary care settings. There are a number of environmental and genetic elements that are related with the development of depression in teenagers, making it a difficult job to comprehend the pathophysiology of this condition. Diagnosing this ailment can be challenging because of its wide range of clinical manifestations, even though there are specific screening tests and diagnostic criteria. Furthermore, it can be mistakenly identified with other mental illnesses, which is why a variety of other differential diagnoses must be used. The feasible options for therapy are determined in part by the severity of the ailment, associated risk factors, and the resources at hand. These substitutes might consist of pharmaceuticals (mostly fluoxetine) and psychotherapies (relationships and cognitive behavioural). Under no circumstances can treatment be completed without psychological education, a supportive attitude, and family involvement. Preventive measures not only have a major impact on reducing the prevalence of this illness, but they also have a major positive impact on community health generally. Because of its unpredictable clinical course and the fact that it is significantly underdiagnosed all over the globe, depression in adolescents is a disorder that is of concern to the medical profession. General practitioners are able to give early diagnosis, the beginning of therapy, and referrals to mental health experts when it is important to do so.