Number Of General Practitioners Research Articles

Impact of Global Country Indicators on Life Expectancy

Investigating the factors that influence life expectancy is crucial for improving public health, planning healthcare and social services, and pension provision. Understanding these factors enables the development and implementation of effective policies to enhance the quality of life. This article presents a study that analyzes data from 195 countries, covering demographic, economic, healthcare, and education factors, to identify those that impact life expectancy. Various models were experimented with, including linear regression, random forest, gradient boosting, SVM, and artificial neural networks. Different machine learning algorithms, combinations of features, and strategies for handling missing dataset values were tested in building the models. The best-performing model used linear regression. It was found that reproductive characteristics, the number of individuals enrolled in higher education, and the number of general practitioners had the highest correlation with life expectancy. Surprisingly, out-of-pocket health expenditure was not a leading factor in determining life expectancy.

Burden of atopic dermatitis in Europe: A population-centred approach leveraging web search data in 21 European countries.

The complexity, high prevalence, and substantial personal and socioeconomic burden collectively render atopic dermatitis (AD) a major public health concern. Using crowdsourced Internet data has the potential to provide unique insights into this concern, as demonstrated by several previous studies. However, a comprehensive comparison across European countries remains lacking. The study aimed to investigate AD-related web searches across Europe to assess spatiotemporal variations and associations between disease-related and external factors. AD-related web search data were extracted for 21 European countries between February 2019 and January 2023. Descriptive analysis and autocorrelation functions were performed to examine spatiotemporal patterns. Correlations (r) were used to evaluate the associations between web searches and disease-related, socioeconomic and meteorological data. Over 241 million AD-related web searches were identified, with search volume varying substantially among European countries (p < 0.001) and correlating with AD prevalence and disease burden (both r = 0.51, p = 0.019). Search volume increased between 2019 and 2023 in all countries and seasonally peaked in January and March. Negative correlations with median population age (r = -0.46, p = 0.039), number of general practitioners (r = -0.29, p = 0.226) and specialists (r = -0.27, p = 0.270) were observed. Moderate to strong correlations were found between search volume and cold, humid and windy weather with fewer sunshine hours, while higher online interest typically occurred 1-3 months after such weather conditions. The study highlights the great potential of online crowdsourced data analysis, for example, to investigate the impact of climate change or to identify unmet needs at a population level. Furthermore, the growing online interest in AD and the corresponding seasonal peaks emphasize the necessity of adapting treatment plans, intensifying public health campaigns, and disseminating reliable online information by governments and healthcare providers, especially during these periods.

Évaluation des échanges professionnels entre médecins généralistes et psychiatres

ObjectivesThere is in France a higher prevalence of psychiatric disorders and higher than average psychotropic consumption in the general population. Considering these elements and the need to involve two complementary medical specialities to manage these disorders, general practice and psychiatry, the necessity for optimal professional exchanges is a major public health concern. In the French public health system, primary care is overseen by self-employed general practitioners. The French psychiatric public sector is said to be “sectorised”, i.e. organised in specific sectors. These sectors include in-patient care entities and out-patient services. The private sector in psychiatry is not sectorised and is mainly composed of self-employed psychiatrists and private clinics. A 2004 law designed to govern who is authorized to refer patients to specialists, stipulated that general practitioners were the only authorized referring doctors for primary care. In the meantime, the number of general practitioners being consulted for cases of depression has doubled between 2005 and 2010. Less than a quarter of these patients were referred to a psychiatrist. Our main objective is to assess the satisfaction with and the efficiency of exchanges between psychiatrists and general practitioners. We also endeavour to identify the main channels through which collaborative care involving these two specialists can be improved. Materials and methodsOur work is an observational, transverse, monocentric and descriptive study carried out using analogous feedback forms mailed by post from June to September 2016. The feedback forms were designed to be analysed both separately and comparatively. Two hundred and ninety nine self-employed general practitioners and 46 psychiatrists employed in the public sector returned the forms. The psychiatric private sector was excluded. All of these doctors worked within three specific geographical treatment zones: Saint-Étienne, Ondaine and Pays de Gier (350,000 inhabitants). The results were treated anonymously via Microsoft Excel® and IBM Corporation SPSS Statistics®. This study was approved by the ethics committee of the university hospital center (CHU) of Saint-Étienne. The doctors’ registers were retrieved via the databases of the Departmental Council of Doctors (CDOM) of the Loire and that of the CHU of Saint-Étienne. ResultsOne hundred and twenty four general practitioners and 30 psychiatrists responded to the feedback form completely. Response rates were 41.4 % for the family physicians and 65.2 % for the psychiatrists. Respectively, 57 % and 70 % knew the identity of their counterpart. A public sector psychiatrist saw 91.9 % of the patients also treated by general practitioners. Of the attending doctors, 79.8 % reported a one third or less return rate of follow-up information from the psychiatrist for the patients they treated together. Similarly, 76.7 % of the psychiatrists reported a return rate of one third or less. One hundred percent (p<0.05) of the general practitioners who did not know the psychiatrists were dissatisfied with their collaboration. Likewise, 98.9% (p<0.05) of the general practitioners who rarely or never received correspondence from the psychiatrists were dissatisfied. Respectively, 77.7% (p>0.05) and 69.5% (p>0.05) of the psychiatrists were dissatisfied. In favor of participating in a standard addressing and return letter process, were 53.4% of the psychiatrists. On the contrary, 64.9% of the general practitioners were against such a process. Willing to receive additional medical training in the psychiatric field were 74.5 % of the family physicians. One out of five psychiatrists considered it a high priority for general practitioners to receive additional training in the psychiatric field. Sharing hospitalisation and consultation reports, along with general practitioners continuous medical training, were considered to be the top priorities for any approach for improving communication. ConclusionsWe observed a high level of dissatisfaction among the participants as a result of the lack of communication. As mentioned above, the field of psychiatry is compartmentalised, psychiatrists are less available for general practitioners. General practitioners are not sufficiently trained but are willing to take more training to improve their practice in the psychiatric field. The results of this study show that first and foremost there is a need to systematise mailings, to simplify phone-based opinion sharing, and to increase the frequency of cross-field training among general practitioners. All of the above could improve exchanges and the management of patients suffering from psychiatric disorders.

Analysis of Needs and Service Capacity of BPJS at First-Level Healthcare Facilities in Bandung District

The community's need for BPJS services at Primary Health Facilities (FKTP) can be well met if adequate service capacity is available. This research aims to analyze the gap between the needs and capacity of BPJS services in FKTPs in Bandung District. This quantitative study uses secondary data owned by Dinas Kesehatan Provinsi Jawa Barat and BPJS Kesehatan Kantor Cabang Soreang. The calculation of needs uses the number of BPJS participants registered in each FKTP, and the calculation of service capacity is based on the duration of service and the number of general practitioners in the FKTP. Out of the 187 FKTPs analyzed, 125 FKTPs are experiencing overcapacity, 58 FKTPs are undercapacity, and 4 FKTPs are optimal. FKTPs with optimal conditions have an average ratio of doctors to BPJS participants of 1:6250. The gap between needs and capacity will impact the quality of service and the financial health of these FKTPs. This issue needs to be addressed by redistributing the number of BPJS participants registered in FKTPs so that the primary healthcare needs of the community in Bandung District can be met.

Would you like to be a general practitioner? Baseline findings of a longitudinal survey among Danish medical trainees

BackgroundRecruiting and securing primary care physician workforce has been the center of international attention for decades. In Denmark, the number of general practitioners has decreased by 8.5% since 2013. However, a rising population age and increasing prevalence of chronic diseases and multimorbidity place an even greater future need for general practitioners in Denmark. The choice of general practice as specialty has been associated with a range of both intrinsic and extrinsic factors, however, few studies have examined the recruitment potential that lies within medical trainees’ who are undecided about general practice specialization. The aim of this study was, therefore, to explore how medical trainees who are undecided about general practice specialization (GP-positive/undecided) differ from medical trainees who are either committed (GP-committed) or not committed to a general practice career (GP-non-committed) regarding factors related to future work life.MethodsThe present study concerns baseline findings from a longitudinal survey study. An online questionnaire was e-mailed to a national cohort of medical trainees during their transition from under- to postgraduate education. The associations between orientations towards general practice specialization and work-related factors and potential influencing factors, respectively, were analyzed using uni- and multivariable modified Poisson regression models.ResultsOf 1,188 invited participants, 461 filled out key study variables concerning specialty preferences and rejections, corresponding to a response rate of 38.8%. We found significant positive associations between GP-positive/undecided orientation and valuing a good work/life balance and the opportunity to organize own working hours when compared to GP-non-committed respondents. Compared to the GP-committed orientations, the GP-positive/undecided orientation was associated with a positive attitude towards technology, working shift hours, and an openness towards several career paths. Across all orientations, undergraduate exposure to the specialties was found to be highly influential on the specialty preferences.ConclusionGP-positive/undecided medical trainees value autonomy over their working hours more than the GP-non-committed, but less than the GP-committed. However, the GP-positive/undecided respondents present more openness to different career opportunities and the use of technology in daily work. We suggest using this knowledge in the planning of recruitment strategies aiming to increase interest in general practice specialization.

Deprescribing as a Way to Reduce Inappropriate Use of Drugs for Overactive Bladder in Primary Care (DROP): Protocol for a Cluster Randomized Controlled Trial With an Embedded Explanatory Sequential Mixed Methods Study.

Potentially inappropriate medication remains a significant concern in general practices, particularly in the context of overactive bladder (OAB) treatment for individuals aged 65 years and older. This study focuses on the exploration of alternative options for treating OAB and the deprescribing of anticholinergic drugs commonly used in OAB. The research aims to comprehensively evaluate the efficiency of deprescribing through a mixed methods approach, combining quantitative assessment and qualitative exploration of perceptions, experiences, and potential barriers among patients and health care personnel. This study aims to evaluate the efficiency and safety of the intervention in which health care staff in primary care encourage patients to participate in deprescribing their drugs for OAB. In addition, we aim to identify factors contributing to or obstructing the deprescribing process that will drive more informed decisions in the field of deprescribing and support effective and safe treatment of patients. The drugs for overactive bladder in primary care (DROP) study uses a rigorous research design, using a randomized controlled trial (RCT) with an embedded sequential explanatory mixed methods approach. All general practices within the North Denmark Region will be paired based on the number of general practitioners (GPs) and urban or rural locations. The matched pairs will be randomized into intervention and control groups. The intervention group will receive an algorithm designed to guide the deprescribing of drugs for OAB, promoting appropriate medication use. Quantitative data will be collected from the RCT including data from Danish registries for prescription analysis. Qualitative data will be obtained through interviews and focus groups with GPs, staff members, and patients. Finally, the quantitative and qualitative findings are merged to understand deprescribing for OAB comprehensively. This integrated approach enhances insights and supports future intervention improvement. The DROP study is currently in progress, with randomization of general practices underway. While they have not been invited to participate yet, they will be. The inclusion of GP practices is scheduled from December 2023 to April 2024. The follow-up period for each patient is 6 months. Results will be analyzed through an intention-to-treat analysis for the RCT and a thematic analysis for the qualitative component. Quantitative outcomes will focus on changes in prescriptions and symptoms, while the qualitative analysis will explore experiences and perceptions. The DROP study aims to provide an evidence-based intervention in primary care that ensures the deprescription of drugs for OAB when there is an unfavorable risk-benefit profile. The DROP study's contribution lies in generating evidence for deprescribing practices and influencing best practices in health care. ClinicalTrials.gov NCT06110975; https://clinicaltrials.gov/study/NCT06110975. DERR1-10.2196/56277.

Sex disparities in the utilization of nurse-assisted peritoneal dialysis: a mediation analysis using data from the REIN registry.

This study was carried out to evaluate the association between patient sex and the proportion of nurse-assisted peritoneal dialysis (PD) at dialysis initiation and to explore whether sex disparities in nurse-assisted PD utilization was explained by predialysis care and/or by social deprivation using mediation analysis. This was a retrospective study using data from the Renal Epidemiology and Information Network (REIN) registry linked to the French National Healthcare Database (SNDS) of incident patients between 1 January 2017 and 30 June 2018. A regression logistic was used for statistical analysis. A mediation analysis explored the direct effect of sex on nurse-assisted PD proportion and the indirect effect through the European Deprivation Index (EDI), and the number of general practitioner (GP) and nephrologist visits before dialysis initiation. Among 1706 patients on PD, there were 637 women (37.3%) and 1069 men (62.7%). Nurse-assisted PD proportion was 332/610 (54.4%) for women vs 464/1036 (44.8%) for men. In the multivariable analysis women were more likely to be treated by nurse-assisted PD {odds ratio (OR) 1.92 [95% confidence interval (CI) 1.46-2.52]}. Nurse-assisted PD was associated with the median number of GP visits [OR 1.44 (95% CI 1.11-1.86)] and with the median number of nephrologist visits [OR 0.59 (95% CI 0.46-0.76)]. The mediation analysis showed a direct effect of sex on nurse-assisted PD [OR 1.90 (95% CI 1.80-2.01)] and an indirect effect through the median number of GP visits [OR 1.05 (95% CI 1.04-1.06], the median number of nephrologist visits [OR 1.02 (95% CI 1.02-1.03)] and quintile 5 of the EDI [OR 1.03 (95% CI 1.02-1.03)]. Women were more frequently treated by nurse-assisted PD than men. Differences between women and men in predialysis care and social deprivation could explain the greater utilization of nurse-assisted PD among women.

How to improve the capacity of general practitioners? – a Flemish approach

“Barely any region left with freely accessible primary health care in Flanders.” This is one of the many newspaper headlines that was recently published to emphasize the fact that more and more general practitioners refuse to take in new patients, because they run out of capacity to provide patients with proper health care. Where does it go wrong? &#x0D; Accessibilty to general practitioners is a hot topic for the Flemish policymakers. An aging population and an increase of mental health problems asks a lot from the general practitioners, as well as the shift of tasks from hospitals towards primary health care and the growing attention for prevention. However, is there a real shortage in general practitioners? Looking abroad learns that the number of general practitioners might not be the major cause of the capacity problem, but that the true bottleneck might lie in the way of organizing primary health care capacity and accessibility. Embedded in a landscape of health care where general practitioners mostly work on a self-employed base, and the fragmented governmental structure in Belgium as an extra obstacle makes this a major challenge for the near future.&#x0D; A dialogue between policy makers from all Belgian governments was opened to create a common approach: each government will take actions within their own authorities. The Flemish government worked out a plan to counter this massive challenge in primary health care through different initiatives, in cooperation with representatives of the general practitioners on the field, local authorities and umbrella organizations.&#x0D; Flanders commits itself by installing three major fundaments which can create change in the way general practitioners are organized: a first step is to create an accurate and up-to-date database of the current available general practitioners health care services compared with the local care need; in parallel the funding of general practitioners will be expanded in a way which stimulates interdisciplinary collaboration and optimizes health care capacity; on top of that the Flemish government is experimenting with new forms of primary care practices in which integrated care is the keystone and which are supported by local authorities and in close connection with welfare services. &#x0D; These projects described above are in full development. On the working field more and more general practitioners are willing to put their shoulders under these initiatives to create solid solutions for the future. &#x0D; The international audience of this lecture might recognize similar issues they encounter in their own countries and will be able to see similarities and differences compared to the Flemish context. By drawing these parallels one can have a broader view on the approach of improving health care capacity and accessibility. &#x0D; These Flemish projects will be brought together with the initiatives from the other Belgian governments at a roundtable discussion to align all the initiatives on primary health care capacity and create a future proof primary health care capacity in Belgium.

The Determinants of Healthcare Service Quality in Hospitals in Cities/Districts in Central Java

This study aims to analyze the determinants of healthcare service quality in hospitals in cities/districts in Central Java, with healthcare services as the dependent variable and the number of general practitioners, specialist doctors, healthcare personnel, bed capacity, population size, hospital level in cities/districts, and economic growth as the independent variables.The research method used in this study is a descriptive analytic study with a quantitative approach. Secondary data were utilized, including hospital data from the Indonesian Ministry of Health website, economic data from the Central Bureau of Statistics (BPS) of Central Java website, and population data from the Indonesian Ministry of Home Affairs website. The research sample consists of 86 hospitals.The study employs a logistic regression analysis model where the dependent variable is a binary variable. The analysis results indicate a significant positive relationship between the number of specialist doctors and healthcare service quality. However, the number of general practitioners, healthcare personnel, bed capacity, population size, hospital level, and economic growth have less significant influence on healthcare service quality.These findings underscore the importance of human resources factors, such as the number of specialist doctors, in improving healthcare service quality. Therefore, support should be provided to encourage doctors to specialize in various medical fields. It is hoped that these findings can serve as a basis for making better decisions in human resources planning, thereby ensuring the provision of high-quality healthcare services to the public in cities/districts in Central Java.

DISTRICT-LEVEL VARIATION IN COVID-19 VACCINATION RATES AND AVAILABILITY OF VACCINATION SERVICES IN BULGARIA

Purpose: Since early 2022, the COVID-19 vaccination rate in Bulgaria has remained low, with large regional differences. This study examines the association between the availability of vaccination sites and the number of administered doses, and the extent to which district-level variation is attributable to differences in vaccination services provision. Materials and Methods: Data on COVID-19 vaccine doses administered by districts were used. This data set was combined with district-level information on available vaccination sites, such as general practitioners and temporary vaccination points. The district-level differences in vaccination coverage and service provision were illustrated through country heat maps, and the association between the variables was explored using two linear regression models. Results: According to the first regression model, the number of general practitioners and temporary vaccination points accounted for only 3.8% of the district-level variation in administrated doses. As covariates in the second model, sociodemographic and economic data were included. The combined influence of these factors explained 42.2% of the variance across districts. According to the findings, the average annual gross wage is a significant determinant of the district-level differences in the number of administrated doses. Conclusion: There is no statistically significant association between administered doses and vaccination sites by districts, which does not correspond to the findings of other international studies. District-level variation in vaccination rates is associated with some sociodemographic and economic differences. The paucity of district-level data impedes further analyses of the vaccine coverage differences and their underlying determinants.

Analysis and Forecast of Indicators Related to Medical Workers and Medical Technology in Selected Countries of Eastern Europe and Balkan.

Health indicators measure certain health characteristics in a specific population or country and can help navigate the health systems. As the global population is rising, the demand for an increase in the number of health workers is simultaneously rising. The aim of this study was to compare and predict the indicators related to the number of medical workers and medical technologies in selected countries in Eastern Europe and Balkan in the studied period. The article analyzed the reported data of selected health indicators extracted from the European Health for All database. The indicators of interest were the number of physicians, pharmacists, general practitioners and dentists per 100,000 people. To observe the changes in these indicators through the available years, we used linear trends, regression analysis and forecasting to the year 2025. The regression analysis shows that the majority of the observed countries will experience an increase in the number of general practitioners, pharmacists, health workers/professionals and dentists, as well as in the number of computerized tomography scanners and the number of magnetic resonance units, predicted to occur by 2025. Following trends of medical indicators can help the government and health sector to focus and navigate the best investments for each country according to the level of their development.

Evaluating the decentralization of public hospitals in Turkey in terms of technical efficiency: data envelopment analysis and Malmquist index

PurposeDecree Law No. 663 introduced a decentralized organizational structure and administration pertaining to Turkish public hospitals in November 2011. This study aims to explore the effects of the public hospital unions (PHUs), which were a result of Decree Law No. 663, on the efficiency and productivity of public hospitals.Design/methodology/approachData envelopment analysis (DEA) and DEA-based Malmquist total factor productivity (TFP) index were used from 2011 to 2016. Raw materials and supply expenses, salaries and fringe benefits, other service costs, general administrative expenses, total number of beds, number of specialists, number of residents, number of general practitioners, number of nurses and midwives and other medical officials were used as input variables. Working capital turnover, number of inpatients, number of outpatients and number of surgical operations for Groups A, B and C were used as output variables.FindingsAccording to the DEA scores, the percentage of efficient hospitals showed a declining trend from 2011 to 2016. The TFP results also showed a decreasing trend from 2011 to 2016.Practical implicationsProviding administrative and financial autonomy to public hospital managers may cause efficiency and productivity losses, which is contrary to expectations.Originality/valueThis study is the first to reveal the impact of decentralization of public healthcare providers on their performance levels in Turkey.

STATE OF ORGANIZATION OF PROVIDING ONCOLOGICAL MEDICAL CARE TO THE POPULATION OF UKRAINE.

Aim: The purpose of this work is to study the state of organizational factors in the provision of oncology care to the population of Ukraine and to determine the needs of the population in oncology care. Materials and Methods: The following materials were used in study: a report on diseases of malignant neoplasms; report on medical personnel; report on contingents of patients with malignant neoplasms. The used methods were: bibliosemantic, content analysis, analytical, statistical and graphical methods. Conclusions: The oncological control system in Ukraine is represented by institutions of various levels. The number of specialized beds is increasing from 8,587 in 2015 to 9,088 in 2021. there is a tendency to decrease the total number of medical personnel by 12% and the number of general practitioners - family medicine by 1.5%. During the period from 2015 to 2021, the contingent of patients with neoplasms increased by 21-24%. The rate of neglect of cases of malignant neoplasms registered in Ukraine during 2022 was 22.4%, which is 1.4% more than in 2021. The system of oncology medical care of Ukraine is at a sufficient level, but there are certain difficulties caused by certain difficulties of the primary health care sector due to the decrease in the number of medical specialists. In the modern context, there are difficulties caused by the difficult migration situation of the population against the background of Russia's military aggression against Ukraine.

Evaluation of the health performances of the regions affiliated to the the ministry of health by multi-criteria decision making techniques

Aim: The aim of this study is to determine the health performances of the regions in the 2019 Health Statistics Yearbook by using multi-criteria decision making techniques.&#x0D; Material and Method: The study is a cross-sectional study and the data used in the study were obtained from the Ministry of Health Statistics Yearbook 2019. The population of the study consists of 12 regions (Western Anatolia, Western Black Sea, Eastern Black Sea, Eastern Black Sea, Eastern Marmara, Aegean, Istanbul, Central Anatolia, Mediterranean, Northeastern Anatolia, Western Marmara, Southeastern Anatolia, and Central Anatolia) included in the 2019 Health Statistics Yearbook. No sample was selected, and all regions were included in the study. ENTROPY Method was used for weighting the criteria and TOPSIS Method was used for ranking the alternatives. A total of 11 criteria, including six benefit criteria (number of general practitioners per 100,000 people, number of specialists per 100,000 people, number of hospital beds per 10,000 people, number of nurses and midwives per 100,000 people, number of hemodialysis devices per million people, and number of MRI devices per million people) and 5 cost criteria (infant mortality rate, maternal mortality rate, population per family medicine unit, crude mortality rate, population per 112 emergency aid station) were evaluated. Analyses were performed in Microsoft Excel program.&#x0D; Results: In the study, the three most effective criteria used to determine the health performances of the regions were respectively determined as maternal mortality rate (28.68%), population per 112 emergency aid stations (17.43%), and crude death rate (15.63%). As a result of the analyzes of the TOPSIS Method, the five regions with the best health performance among the regions are Western Anatolia (0.68), Western Black Sea (0.66), Eastern Black Sea (0.65), Eastern Marmara (0.63), and Aegean (0.56) has been identified. While the average performance score of the regions is found as 0.53, Istanbul (0.51), Middle East Anatolia (0.50), Mediterranean (0.49), Northeast Anatolia (0.46), West Marmara (0.44), Southeastern Anatolia (0.40), and Central Anatolia (0.33) regions remained below this average.&#x0D; Conclusion: The most important criteria in evaluating the health performances of regions are; maternal mortality rate, population per 112 emergency aid stations, and crude death rate. The regions with the best health performance are Western Anatolia, Western Black Sea and Eastern Black Sea. In order to improve the health performance of the regions, maternal mortality rate, crude death rate and population per family physician should be reduced.

P68 Identifying the Content and Context of Pain Within Education and Training of General Practitioners

P68 Identifying the Content and Context of Pain Within Education and Training of General Practitioners

Contextualising the association of socioeconomic deprivation with hospitalisation rates of myocardial infarction in a rural area in eastern Germany.

Evidence on the association of socioeconomic deprivation with occurrence of acute myocardial infarction (AMI) is available from international studies and urban settings in western Germany. This study aimed to assess this association based on small geographical areas in a rural setting in eastern Germany. This study used routine data of all patients with AMI who were treated in the Hospital Brandenburg in the city of Brandenburg, Germany, between May 2019 and May 2020. Hospitalisation rates of AMI were calculated for postal code regions that were located within the catchment area of the Hospital Brandenburg. Poisson regression was used to compare hospitalisation rates in areas with medium socioeconomic deprivation to areas with high deprivation, controlling for age group, sex and period (before or during COVID-19 pandemic). Publicly available social, infrastructure and healthcare-related features were mapped to characterise the study region. In total, 265 cases of AMI were registered in the study area, which comprised 116,126 inhabitants. The city of Brandenburg was characterised by the highest level of socioeconomic deprivation, while neighbouring areas showed a rural settlement structure and medium levels of deprivation. The number of general practitioners per 10 000 inhabitants did not differ between both areas. The adjusted rate ratio comparing hospitalisations due to AMI in areas with medium socioeconomic deprivation to areas with high socioeconomic deprivation was 0.71 (95%CI 0.56-0.91, p=0.01). This study adds evidence about the association of socioeconomic deprivation and AMI occurrence from a rural area in eastern Germany. Further research about the relationship of socioeconomic deprivation and cardiovascular health is needed from heterogeneous contexts.

General Practitioner Time Availability Per Inhabitant Per Year: A New Indicator to Measure Access to Primary Care.

The number of general practitioners (GPs) per inhabitant, used commonly as an indicator of primary care (PC) access, reports only imprecisely on the true availability of GPs. The aim of this study is to develop a new PC access indicator that better reflects the availability of GPs to take care of patients at the population level, the average GP time availability per inhabitant per year. We extracted the data from the Commonwealth Fund International Health Policy Survey of Primary Care Physicians conducted in 2015, including 11 Western countries and 12,049 randomly drawn GPs. We built the indicator by combining two questions about weekly workload in hours and percentage of time spent on face-to-face contact with patients. The indicator was then adjusted regarding the number of GPs, the weeks worked per year and the country's population size. On average, GPs worked 43 h a week. The average time spent on face-to-face contact with patients was 30.5 h/week (35 h including emails and telephone contact), ranging from 22 h in Sweden and 38 h in France. The mean time available of GPs for face-to-face contact was 69 min/inhabitant/year, ranging from 38 min in Sweden to 118 min in Australia. Including email and telephone contact, the mean contact time rose to 79 min/inhabitant/year, ranging from 48 min in Sweden to 127 min in Australia. The new indicator provides an accurate and sensitive estimate of a GP's true time availability at the population level. Results should be interpreted in the context of PC workforce organization, which may help guide GP workforce development.

Analysis of the Healthcare and Overall Economic Competitiveness of Santiago, Isabela, Philippines

City of Santiago, Isabela, is otherwise known as the “Queen City of the North” and the only independent component city in region 2 that substantially contributes to the overall production and competitiveness of the region. This study aimed to determine the influence of the state of healthcare to the economic competitiveness, identify the determinants that contribute to the demand for healthcare, discover the factors that affect the choices of consumers to healthcare services, and measure the effect of healthcare inputs on the level of mortality rate in the City of Santiago, Isabela, Philippines. Primary and secondary data were utilized, and even employed descriptive and inferential statistics for the analysis. This study discovered that the competitive index has a significant positive impact on the total annual patients and healthcare facilities while the annual healthcare expenditure of the City of Santiago is insignificant. The demand for healthcare services arises because of demographic, medical-related, and socio-economic factors. Moreover, the prime factor influencing residents' acquiring healthcare services is the quality itself. Lastly, the mortality rate has a significant inverse impact on the number of general practitioners and medical specialists in the city, while the number of hospital beds showed a significant positive effect.

The Service Capability of Primary Health Institutions under the Hierarchical Medical System.

Background: Primary health institutions (PHIs) are the foundation of the whole health system and the basic link to achieve the goal of all people enjoying primary health care. However, the service capability of primary health institutions is not under the hierarchical medical system. Method: Data were collected from the China Health Statistics Yearbook between 2014 and 2020. PHIs included community health centres, community health stations, and township hospitals in our study. The service capability of primary health institutions was analysed from the perspective of structure, process, and results. Structure capability was evaluated using the number of beds, number of personnel, number of health technicians, and proportion of the number of personnel in PHIs accounting for the total number of health personnel. Process capability was evaluated using the number of general practitioners. The number of outpatients and inpatients, medical income, the proportion of drug income, and the average number of patients and beds served by physicians in PHIs per day were employed to evaluate the resulting capability. Results: From 2014 to 2020, the number of community health service centres/stations increased, while the number of township health centres decreased. In the aspect of structure capability, the total number of personnel and health technicians in community health centres/stations and township hospitals both increased during 2014 and 2020. However, the increasing rate in PHIs was a little bit less than that of general medical institutions. The proportion of male health technicians in community health centres and township hospitals both decreased, while the proportion of female technicians in both increased. From 2014 to 2020, the number of beds in PHIs also increased from 138.12 × 104 to 164.94 × 104. However, the proportion of beds in PHIs accounting for the total number of beds in medical institutions decreased. For the resulting capability, from 2014 to 2019, the proportion of diagnosis and treatment times in PHIs decreased from 57.41% to 51.96%, although it increased in 2020. The proportion of inpatients in PHIs decreased from 20.03% to 16.11%. From 2014 to 2020, the utilisation rate of hospital beds in PHIs decreased (from 55.6% to 34% for community health centres and 60.5% to 53.6% for township hospitals). The average daily bed days of doctors in township hospitals was higher than that of doctors in community health service centres. However, the average medical cost of outpatients and the per capita medical cost of inpatients in community health service centres were higher than in township hospitals. Conclusion: In recent years, although the service capability showed an increasing trend in PHIs, the growth rate was lower than the general health institutions. The utilisation rates of PHIs, including beds and physicians, were decreased. Among PHIs, the utilisation in township hospitals was higher than in community health centres with a relatively low price. Under the hierarchical medical system and normalisation period of the COVID-19 epidemic, it is important to improve the service capability to achieve its goal of increasing PHI utilisation and decreasing secondary and tertiary hospital utilisation.

Developing telemedicine in Emergency Medical Services: A low-cost solution and practical approach connecting interfaces in emergency medicine

Background:In Germany, the number of calls for Emergency Medical Services (EMS) are increasing, while the number of general practitioners and hospitals are decreasing, resulting in a growing demand and workload for emergency physicians and paramedics. Furthermore, an aging population with increasingly complex medical histories, present emergencies in which a more detailed assessment and therapies are urgently needed. Therefore, common EMS systems need to find solutions to handle these problems.Methods:We used a user-focused five-step approach to define a technological solution: Research of current systems, definition of goals and requirements, development of concept, test series and evaluation, evaluation of costs and benefits.Results:Development of a holistic telemedical concept to connect in-hospital clinical emergency physicians and paramedics on the scene, by implementing and connecting systems that are already partially being used in common EMS in Germany. By using live audio and video communication, including vital signs between the two, a system can be established by keeping costs low, affordable and at the same time protecting patient data in line with General Data Protection Regulation.Conclusion:Implementing technologies in a practical specialty like Emergency Medicine with a user-focused approach demonstrates that the hurdle for integration into established routines can improve current processes. Evaluation of costs and usability is a main driver to define success of such concepts and can improve if such systems can be developed to be used in larger networks.