Individual General Practitioners Research Articles

Collective Intelligence Increases Diagnostic Accuracy in a General Practice Setting.

General practitioners (GPs) work in an ill-defined environment where diagnostic errors are prevalent. Previous research indicates that aggregating independent diagnoses can improve diagnostic accuracy in a range of settings. We examined whether aggregating independent diagnoses can also improve diagnostic accuracy for GP decision making. In addition, we investigated the potential benefit of such an approach in combination with a decision support system (DSS). We simulated virtual groups using data sets from 2 previously published studies. In study 1, 260 GPs independently diagnosed 9 patient cases in a vignette-based study. In study 2, 30 GPs independently diagnosed 12 patient actors in a patient-facing study. In both data sets, GPs provided diagnoses in a control condition and/or DSS condition(s). Each GP's diagnosis, confidence rating, and years of experience were entered into a computer simulation. Virtual groups of varying sizes (range: 3-9) were created, and different collective intelligence rules (plurality, confidence, and seniority) were applied to determine each group's final diagnosis. Diagnostic accuracy was used as the performance measure. Aggregating independent diagnoses by weighing them equally (i.e., the plurality rule) substantially outperformed average individual accuracy, and this effect increased with increasing group size. Selecting diagnoses based on confidence only led to marginal improvements, while selecting based on seniority reduced accuracy. Combining the plurality rule with a DSS further boosted performance. Combining independent diagnoses may substantially improve a GP's diagnostic accuracy and subsequent patient outcomes. This approach did, however, not improve accuracy in all patient cases. Therefore, future work should focus on uncovering the conditions under which collective intelligence is most beneficial in general practice. We examined whether aggregating independent diagnoses of GPs can improve diagnostic accuracy.Using data sets of 2 previously published studies, we composed virtual groups of GPs and combined their independent diagnoses using 3 collective intelligence rules (plurality, confidence, and seniority).Aggregating independent diagnoses by weighing them equally substantially outperformed average individual GP accuracy, and this effect increased with increasing group size.Combining independent diagnoses may substantially improve GP's diagnostic accuracy and subsequent patient outcomes.

Behavioural determinants shaping infection prevention and control behaviour among healthcare workers in Dutch general practices: a qualitative study reflecting on pre-, during and post-COVID-19 pandemic

BackgroundSince the Coronavirus Disease 2019 (COVID-19) pandemic, awareness of infection prevention and control (IPC) has increased in primary care settings. This study aimed to examine behavioural determinants shaping IPC behaviour pre-, during, and post-pandemic among healthcare workers (HCWs) in general practices, to inform optimised IPC in primary care.MethodsFor this qualitative study, semi-structured in-depth interviews were conducted during two study periods: (1) pre-COVID-19 pandemic: July 2019-February 2020, with 14 general practitioners (GPs) and medical assistants, and (2) during the COVID-19 pandemic: July 2022-February 2023, with 22 GPs and medical assistants. The design was informed by behaviour change theories. Data were analysed using thematic analysis.ResultsMain themes were: (1) risk perception and IPC awareness, (2) attitudes towards IPC and professional responsibility, (3) decision-making process and risk considerations for IPC adherence, (4) social norm and social influence in GP practice team, and (5) environmental context and resource availability in GP practice. During the pandemic, risk perception and awareness of the importance of IPC increased compared to the pre-pandemic period. A consistent belief emerged that IPC is part of professional responsibility, while needing to be balanced with other aspects of patient care. Decision-making is dependent on the individual GP and mainly influenced by risk assessments and sustainability considerations. The social context in the practice team can reinforce IPC behaviours. GP practice building and layout, and limited IPC resource and material availability were reported as main barriers.ConclusionsThe theory-informed insights of this study can be used for targeted interventions to optimise IPC behaviour in general practices. Adopting multifaceted strategies to target the various determinants is recommended to sustain IPC, by implementing continuous education using tailored communication, integrating IPC in work routines and organisational workflows, refining existing IPC protocols by incorporating decision-making tools for HCWs, fostering a culture of IPC through knowledge-sharing and teamwork, and addressing GP practice physical environment and IPC resource barriers.

Antibiotic prescription in ambulatory care for COVID-19 patients: a cohort analysis in four European countries.

To analyse antibiotic prescription rates in ambulatory care for COVID-19 patients by general practitioners (GPs) in four European countries. A total of 4,513,955 anonymised electronic prescribing records of 3656 GPs in four European countries were analysed. Diagnosis and prescriptions were retrieved. Antibiotic prescription rates during COVID-19 consultations were analysed and compared between France, the UK, Belgium and Romania. Overall prescription rate was in France and Belgium (6.66 and 7.46%). However, analysing median GP prescribing rates, we found that 33.9% of the GPs in Belgium prescribed antibiotics with a median of 16 prescriptions per 100 COVID-19 consultations, while 55.21% of the GPs in France prescribed a median of 8 antibiotic prescriptions per 100 COVID-19 consultations. Overall antibiotic prescription rates were less in Romania than in the UK (22% vs 32%); however, 73% of the Romanian GPs vs 57% of the British GPs prescribed antibiotics. Depending on the country, the proportion of each type of antibiotic was statistically different, with the proportion of azithromycin being more than 50% of all antibiotics in each country except for the UK where it was less than 1%. Both individual GPs prescribing patterns in addition to overall consumption patterns should be analysed in order to implement a tailored antimicrobial stewardship programme. Furthermore, antibiotic prescribing rates in COVID-19 are lower than other respiratory tract infections.

Quick adaptation of the organisation of general practices during the COVID-19 pandemic in the Netherlands

BackgroundGeneral practices have adapted the practice organisation to the circumstances of the COVID-19 pandemic. In this article we describe several adjustments in general practices in the field of patient flow management, appointments, triage, referral and infection prevention. We also examined how practices relate to the policy of the government and of the professional organisations during the pandemic.MethodsA cross-sectional online survey was conducted among a sample of 893 general practitioners (GPs) during February and March 2021. The response rate was 17%. Because the questionnaire concerns practices and not individual GPs, one practice owner per practice received an invitation with a link to the online questionnaire. One reminder has been sent.ResultsGeneral practices adapted their organisation during the corona pandemic, partly based on information and advice from their professional organisations. The adjustments were necessary to ensure that patient care continued as much and as safely as possible, often remotely. The use of video consultations quickly increased from 6% to 65% of the practices. The cooperation with neighbouring practices improved and practices felt supported by the professional organisations.ConclusionsThe pandemic itself, remote care and stricter patient flow management have put pressure on the quality of care and patient safety. The accessibility of the practices was sometimes limited. In the perception of patients, this was stronger than in reality.

General practitioners ending their practice and impact on patients’ health, healthcare use and mortality: a protocol for national registry cohort studies in Norway, 2008 to 2021

IntroductionContinuous general practitioner (GP) and patient relations associate with positive health outcomes. Termination of GP practice is unavoidable, while consequences of final breaks in relations are less explored. We will...

Predictors and population health outcomes of persistent high GP turnover in English general practices: a retrospective observational study

ObjectiveEnglish primary care faces significant challenges, including ‘persistent high turnover’ of general practitioners (GPs) in some partnerships. It is unknown whether there are specific predictors of persistent high turnover and...

General practitioners' perceptions of the provision of direct-acting antivirals for hepatitis C within Australian private general practice: an exploratory qualitative study.

There is a need to increase the involvement of Australian general practitioners (GPs) working in private practice to realise the potential of direct-acting antiviral (DAA) treatments for people with the hepatitis C virus. Semi-structured interviews were conducted in 2018 with seven GPs and two practice nurses working in private general practice to elicit the experiences and perceptions of their involvement in providing care for patients with hepatitis C virus in this setting. The interviews were recorded, transcribed and thematically analysed to inform interventions to maximise the provision of DAA in private general practice. Participants described individual GPs purposely limiting their scope of clinical practice (SOCP) and expressed an expectation that DAA provision would not be included in all GP's SOCP. When GPs delineate their SOCP, their confidence to competently provide quality health care to their patients and GPs' professional special interests are important considerations. Providing DAA training, skill development, support and resources to GPs is necessary, but may not ensure that individual private GPs will provide this care. Where GPs do not include DAA in their SOCP, care pathways need to be developed for patients who will benefit from DAA, including GP-to-GP referral. These findings may be applicable to other areas of unmet need that rely on GPs including provision of care in their SOCP.

Pressure on Appointments in General Practice: Relieved Through Joint Consultations

Background: Obtaining appointments at a general practice was critical for reducing avoidable hospital admissions, and ultimately saving healthcare costs. In the United Kingdom (UK), problematic access of appointments at individual general practices persisted resulting from increasing health complexities in primary care, which were exacerbated by shortages of medical doctors as general practitioners (GP). The UK government pursued the employing of care-coordinators at primary care networks to allocate care to non-GP health professionals as a solution, but patient demand for GP appointments at individual practices continued to surge. Aims: This paper reports on an investigation of the ideal way to address patient demand on GP appointments at individual practices. It aimed to report on the effects of two newly implemented joint consultations, one comprising a nursing team and another, a multi-disciplinary team comprising medical doctors and nursing personnel. Methods: Three reviews were conducted in a 3500 patient-list-sized GP practice located in North-Eastern part of England. The aim was to analyse retrospective data of the telephony system to explore the effect of joint consultations on demand of GP appointments that were made through the telephony system. The number and lengths of incoming telephone calls to secure GP or nursing appointments at the practice were analysed descriptively. The periods of analysis were from January to August in the years 2021, 2022 and 2023. Results: Since implementation of the two joint consultations, there was a 32% reduction in telephone calls for GP appointments. There was also a shortening of the duration of these telephone calls and decreasing trends of missed calls. The increased lengths of calls towards the tail end of the 3rd review period in 2023 demonstrated increased patient awareness and cooperation for in-depth discussions about their symptoms prior to securing appointments. Conclusions: The joint consultations had significantly decreased patient demands for GP appointments via telephone. In addition, the joint consultations had not only allowed holistic care needs to be addressed, but also, they had permitted appropriate care to be delivered in a timely fashion. It is therefore important to ensure appropriate healthcare funding to support the implementation of joint consultations at individual GP practices.

Safety and efficacy of treatment with vitamin K antagonists in patients managed in a network of anticoagulation services or as routine general care

This is a retrospective, record-linkage study aimed at comparing the effectiveness and safety of two management models of vitamin K antagonists: a Network model (NAS), in which anticoagulation clinics and general practitioners (GP) share the same management software and database, and an individual General Practitioners model. Main outcomes were thromboembolic events (TE), major bleeding (MB) and all-cause mortality. Crude incidence rate and sub-distribution hazard ratio were calculated. Fine and Grey models were used to calculate SHR in multi-variable analysis. 9,418 patients in the NAS and 5,508 in the Routine General Care (RGC) cohort were included. Patients in the NAS cohort had a lower incidence of TE and mortality in respect to the RGC (sHR 0.76%, 95% CI 0.64-0.90 and 0.82%, 95% CI 0.75-0.89, respectively). More patients in the NAS than in the RGC cohort attained a Time in Therapeutic Range >60% (62.2% vs 35.7%, p<0.001). No statistically significant difference was found in MB incidence. This study shows that the NAS model for vitamin K antagonist oral anticoagulants management significantly improves the TTR and reduces the incidence of TE and mortality, without affecting the MB rate.

Boundary Work in Response to Professionals’ Contextual Constraints: Micro-strategies in Interprofessional Collaboration

Boundary-work research has extensively explored how professionals engage in boundary work to protect or expand their professional boundaries in interprofessional collaboration (IPC). Yet professionals’ contextual constraints in everyday work, such as time pressure or legal restrictions, often result in competing interests of the professionals involved in IPC, prompting them to engage in boundary work to limit—instead of protect or expand—their boundaries. Our empirical analysis uses comprehensive qualitative data on IPC in Germany between self-employed general practitioners (GPs) and registered nurses employed in nursing homes. In this IPC, GPs’ efficiency interests frequently compete with nurses’ safeguarding interests, leading both professionals to engage in boundary-work efforts to limit their boundaries. Our findings provide a comprehensive understanding and framework of professionals’ boundary work, showing that individual GPs and nurses typically hold a portfolio of various defending and accommodating micro-strategies. Based on our first-order findings, we identify how different sources of power enable particular micro-strategies and explore how the choice of micro-strategies depends on different forms of trust in the collaborating partner. Last, we outline interactions of micro-strategies, illustrating how the outcomes of professionals’ bilateral boundary work depend on the sequence of these strategies.

Evidence-based strategies for better antibiotic prescribing.

Antibiotic resistance is a key global health threat, and antibiotic overuse isasignificant contributing factor. Antibiotic stewardship is a vital issue forgeneral practice. The aim of this article is to discuss evidence-based strategies for general practitioners (GPs) and general practices to contribute to antibiotic stewardship and, thus, reduce the overall burden of antibiotic prescribing in the community. For individual GPs, and for practices, there is good evidence for the effectiveness of several strategies. As well as having a firm grasp of the clinical evidence in the area, important strategies for GPs include: eliciting and exploring patient understanding and expectations, and incorporating these in communication and management; offering delayed prescribing; using appropriate non-antibiotic symptomatic management; and, when prescribing antibiotics, doing so only for genuine clinical indications, with the appropriate antibiotic, at the appropriate dose, for the shortest appropriate duration. Practices can adopt a practice culture and practice-wide prescribing policies that promote antibiotic stewardship.

Improving primary palliative care \u2013 a Delphi consensus study on measures for general practice in Germany

BackgroundThe majority of severely ill and dying people in Germany can be administered primary palliative care (PPC) by general practitioners (GP). However, the current provision of PPC does not match the needs of the population. Although several public health strategies aim at strengthening the role of GPs in PPC provision, it remains challenging for GP teams to integrate PPC into their daily routines.AimA Delphi study with GPs was conducted to achieve consensus on specific measures for improving the integration of PPC into everyday GP practice.MethodsThe study is part of the junior research project “Primary Palliative Care in General Practice” (ALLPRAX). After having developed, tested and evaluated 26 practical measures for GP practices to improve their PPC, a Delphi consensus study among GPs took place. In 2020, 569 GPs were asked to rate the relevance and feasibility of the measures on a 4-point Likert scale via an anonymous online questionnaire. Consensus was defined as a sum percentage of ‘strongly agree’ and ‘somewhat agree’ responses ≥75% after two rounds. Between these rounds, measures that were not consented in the first round were adapted in light of respondents’ free text comments and suggestions.ResultsThe response rate was 11.3% in round 1 (n = 64) and 53.1% in round 2 (n = 34). From the initial n = 26 measures, n = 20 measures achieved consensus and were included in the final intervention package. The consented measures pertained to four main topics: advance care planning with patients, consulting and informing patients and family caregivers, GP office organisation and continuing education. N = 6 measures did not achieve consensus, predominantly due to time and workload constraints.ConclusionThe consented measures provide valuable support to improve the provision of PPC by GPs. They can be used freely and flexibly, according to the needs of individual GP teams, and are thus suitable for implementation nationwide.Trial registrationThe study was registered in the German Clinical Trials Register (Registration N° DRKS00011821; 4 December 2017; https://apps.who.int/trialsearch/) and the German Register of Health Care Research (Registration N° VfD_ALLPRAX_16_003817; 30 March 2017).

Evaluation of a Bariatric Monitoring Pass for Primary Care Physicians

There are a growing number of patients undergoing bariatric surgery requiring lifelong follow-up. Therefore, follow-up care can no longer be covered by specialized outpatient clinics alone due to the sharp rise in the number of bariatric patients. Bariatric Patients in Primary Care: Postoperative Nutrition and Lifestyle Management (BagEL) is a survey to evaluate a newly developed structured disease management program including nutrition and lifestyle management in primary care. The study is conceived as a randomized cohort study with a control group. An expert questionnaire for general practitioners (GPs) was developed to assess the usability of a structured postoperative care system regarding nutrition and lifestyle management for bariatric patients in primary care. A structured follow-up program in primary care with a so-called bariatric monitoring passport (BMP) was provided for patients in the intervention (INT) group and the existing information sheet "Metabolic surgery and perioperative care" for the control (CON) group. 124 patients, who met inclusion criteria and who underwent a bariatric procedure first time, served as ambassadors for delivery of the expert questionnaire and study documents to their individual GPs. A total of 39 (31.5%) different GPs from 124 ambassador patients responded. For the primary outcome "Does the aftercare-booklets support treatment of bariatric patients?" GPs of the INT group rated the new designed aftercare booklet (INT) significantly more helpful for treating bariatric patients than the one from the CON group (p = 0.041). These results suggest that GPs are welcoming supportive tools like our BMP to improve the care of long-term follow-up of bariatric patients and should actively participate in the development of lifelong disease management plans necessary to cope with the rapidly growing number of patients.

Evaluating the Impact of COVID-19 on the Adoption of Virtual Care in General Practice in 20 Countries (inSIGHT): Protocol and Rationale Study.

BackgroundIn recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role.ObjectiveThis study aims to explore the perspectives of general practitioners (GPs) and family doctors on the (1) use of virtual care during the COVID-19 pandemic, (2) perceived impact on quality and safety of care, and (3) essential factors for high-quality and sustainable use of virtual care in the future.MethodsThis study used an online cross-sectional questionnaire completed by GPs distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers’ personal contact networks. GPs were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and relationships between the use of virtual care and perceptions on impact on quality and safety of care and participants’ characteristics may be explored. Qualitative data (free-text responses) will be analyzed using framework analysis.ResultsData collection took place from June 2020 to September 2020. As of this manuscript’s submission, a total of 1605 GP respondents participated in the questionnaire. Further data analysis is currently ongoing.ConclusionsThe study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care, and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP and family doctor characteristics and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design.International Registered Report Identifier (IRRID)DERR1-10.2196/30099

Area-level deprivation and geographic factors influencing utilisation of General Practitioner services

Inequities in access to General Practitioner (GP) services are a key policy concern given the role of GPs as gatekeepers to secondary care services. Geographic or area-level factors, including local deprivation and supply of healthcare providers, are important elements of access. In considering how area-level deprivation relates to GP utilisation, two potentially opposing factors may be important. The supply of healthcare services tends to be lower in areas of higher deprivation. However, poorer health status among individuals in deprived areas suggests greater need for healthcare. To explore the relationship of area-level deprivation to healthcare utilisation, we use data from the Healthy Ireland survey, which provided a sample of 6326 respondents to face-to-face interviews.A u-shaped relationship between GP supply and area-level deprivation is observed in the data. Modelling reveals that residing in more deprived communities has a strong, statistically significant positive association with having seen a GP within the last four weeks, controlling for individual characteristics and GP supply. All else equal, residing in an area ranked in the most deprived quintile increases the odds of a respondent having visited the GP in four weeks by 1.43 (95% Confidence Interval: 1.15–1.78), compared to the least deprived quintile (p-value< 0.001). The findings indicate that the level of deprivation in an area may be relevant to decisions about how to allocate primary care resources.

Exploring pharmacists' perceptions of integrating pharmacists into the general practice setting

BackgroundIn several countries worldwide, pharmacists have integrated into the general practice setting. This has resulted in enhanced medication management, a reduction in patients' appointments with general practitioners (GPs), and decreased medication costs. However, there is a paucity of research that has focused on exploring pharmacists' views of this emerging role prior to its implementation in countries where it is not yet commonplace. ObjectiveTo explore pharmacsists' perceptions of integrating pharmacists into the general practice setting, the proposed roles for such pharmacists, and the factors affecting integration. MethodsSemi-structured interviews were conducted with pharmacists in Ireland, who were sampled based on years of experience in community pharmacy and work location using convenience and snowball sampling. The interviews were audio-recorded and transcribed verbatim, which subsequently underwent thematic analysis. ResultsTwelve pharmacists – with a median of six years' experience as a community pharmacist – were interviewed between September and October 2019. Four main themes were generated:(i) expectations of integrated role (including the importance of role definition, pharmacist experience, and increased job satisfaction);(ii) altered pharmacist-patient dynamic in primary care (including patient trust, patient safety, and the impact on community pharmacist roles);(iii) GP-pharmacist relationship (including pre-existing relationships, autonomy, reducing GP workload, and individual GP attributes);(iv) logistical issues and financial implications (including practice characteristics, co-location time, and supporting evidence-based implementation). ConclusionThis study is unique as it has focused solely on exploring pharmacists' perceptions of integrating into general practice in a country where such roles are mostly non-existent. The attitudes of pharmacists in this study were primarily positive, for reasons such as intrinsic motivation, reducing GP workload, and improving patient health outcomes. However, the routine implementation of these roles will require funding and support from key stakeholders (other than pharmacists) and should be guided by the evidence from other countries.

Dementia prevention and primary care: Estimation of the target population

The prevention of dementia, especially the cardiovascular prevention of cognitive disorders, is increasingly coming into the focus of health services research. The aim of this study is to determine the possible target population for dementia prevention approaches as well as frequency of health examinations (HE) in individual general practitioner offices (GP). 987 GP practices, which are covered by the nationwide IMS Disease Analyzer database (IQVIA) have been investigated for the prevalence of the following diagnoses, which are considered risk factors for the development of dementia Hypertension, obesity, hearing loss in each age group 45-65 and diabetes and depression in the age group 65 and older. In addition, it was recorded how many of these patients received a HE). In a sample of 2,398,405 patients receiving primary care, the target population relevant for dementia prevention measures in 2018 consisted of 191,883 patients with hypertension, 23,308 with obesity, 5,059 with hearing loss, 120,200 with diabetes and 43,233 with depression. More than a quarter of these patients have already had a HE. In 2018, patients with hypertension (N=51), diabetes (N=30.5) and depression (N=11.3) were the most frequently treated patients, less frequently patients with obesity (N=8.2) and hearing loss (N=1.6). On the basis of defined diagnoses in certain phases of life, a manageable group of patients can be identified who are eligible for specific dementia preventive interventions. The implementation of dementia preventive interventions in practices will be more difficult for the less frequent treatment diagnoses obesity and hearing loss than for the much more frequent treatment diagnoses hypertension, diabetes and depression.

General practitioners’ consultation counts and associated factors in Swiss primary care – A retrospective observational study

Research on individual general practitioner (GP) workload, e.g. in terms of consultation counts, is scarce. Accurate measures are desirable because GPs' consultation counts might be related to their work satisfaction and arguably, there is a limit to the number of consultations a GP can hold per day without jeopardizing quality of care. Moreover, understanding the association of consultation counts with GP characteristics is crucial given current trends in general practice, such as the increasing proportion of female GPs, part-time work and group practices. The aim of this study was to describe GPs' consultation counts and efficiency and to assess associations with GP and practice variables. In this retrospective observational study we used routine data in electronic medical records obtained from 245 Swiss GPs in 2018. We described GPs' daily consultation counts as well as their efficiencies (i.e. total consultation counts adjusted for part-time work) and used hierarchical linear models to find associations of the GPs' total consultation counts in 2018 with GP- and practice-level variables. The median daily consultation count was 28 over all GPs and 33 for full-time working GPs. Total consultation counts increased non-linearly with part-time status, with high part-time working GPs (60%-90% of full-time) being equally or more efficient than full-time workers. Excluding part-time status in the regression resulted in higher consultation counts for male GPs working in single practices and with older patients, whereas part-time adjusted consultation counts were unaffected by GP gender and practice type. Female gender, part-time work in the range of 60%-90% of full-time, and working in group practices do not decrease GP efficiency. However, the challenge of recruiting sufficient numbers of GPs remains.

Understanding patients’ trust toward community healthcare providers under different primary care settings in China: Impact of hospital ownership and registration mode

AbstractChina is currently undertaking healthcare reform, and promoting general practitioner (GP) practice is a major improvement. The key to the success of the GP practice is whether or not patients are willing to accept and trust in GPs in community healthcare centers (CHCs). The objective of this study is to evaluate the impact of hospital ownership (public or private) and registration mode (registering with a CHC or a GP on patients’ trust in community health services. A user experiment was conducted, and 204 nonstudent participants were invited to finish simulated registration tasks in a self‐developed online registration system. Patients’ trust in CHCs, GPs, and GPs’ treatment outcomes was measured. The results indicated that patients had a significantly higher level of trust in private CHCs and private sector GPs, but they showed a higher level of trust in the treatment outcomes of public sector GPs due to the influence of their past medical experience seeing community doctors. The registration mode only influenced patients’ trust in GPs’ professional skills, that is, patients had a higher level of trust in GPs’ professional skills when registering with CHCs compared to registering with individual GPs.

Non-drug and drug alternatives to benzodiazepines for insomnia in primary care: Study among GPs and pharmacies in a Southwest region of France

Benzodiazepines and related drugs are the most commonly prescribed drugs in the treatment of insomnia, and referral to psychotherapy is rare when recommended as first-line treatment for chronic insomnia. The frequency of referral to psychologists, of use of alternative drugs to benzodiazepines, either prescribed by general practitioners (GPs) or dispensed by community pharmacies, is unknown in France. We aimed to describe the non-pharmacological approaches recommended, such as cognitive behavioral therapies (CBT), and the drugs, including alternatives drugs to benzodiazepines, used by GPs and community pharmacies for patients complaining of insomnia. A cross-sectional study was conducted during 3 months in 2015 on the management of individual GPs' patients and pharmacies' customers consecutively consulting for insomnia in the Midi-Pyrénées region of southwest France. Participating GPs and pharmacists completed a form, for each patient, on their management (drugs, sleeping advices, referral to psychotherapy). Fifty-five GPs included 263 patients and 43 community pharmacies included 354 customers in the study. Among patients, 193 (73,4%) had already used benzodiazepine. Thirty-eight patients (14.4%) and 2 customers (0.5%) were recommended non-drug therapies (mostly CBT). Benzodiazepines were prescribed 188 times (69.1% of the prescriptions) by GPs. Alternative drugs prescribed were mostly antihistamines (n=26; 9.6%) and antidepressants (n=17; 6.3%). Antihistamines were the most commonly dispensed drugs by pharmacists (n=149; 39.4%). While non-pharmacological treatments, such as CBT, are safe and widely recommended, benzodiazepines and antihistamines remain widely used despite the lack of long term benefit and the risk of adverse drug reactions.