Patients General Practitioners Research Articles

‘It is difficult for us to assess the severity!’ A qualitative analysis of parents' expectations to postoperative care after ventilation tube surgery

ObjectiveSurgery with ventilation tubes (VT) in children suffering from otitis media with effusion is quite common. However, the knowledge surrounding parents' expectations to the treatment and postoperative care is sparse. The aim of this study was to describe the parents' expectations to VT surgery and postoperative care shortly after surgery. MethodsA qualitative study was conducted based on semi-structured individual interviews with parents recruited from a study where postoperative care was randomized to either an otolaryngologist or the patient's general practitioner (GP). The interviews were conducted within the first weeks after surgery and analyzed by reflexive thematic analysis. ResultsIn total, 13 parents aged 29–42 years participated in the study. We identified three main themes elucidating parents' expectations to VT surgery and postoperative care: 1) Preconceptions about VT surgery and hearing - most parents expected surgery to restore the child's normal hearing, and some were uncertain about their knowledge of normal hearing and VT treatment; 2) A safety net to ensure hearing and function - it was reassuring if the child received structured postoperative care that secured and notified appointments and had quick access to a specialist if needed; 3) High-quality care - most parents expected the otolaryngologist to provide the highest level of quality of care due to their specialist competence, special equipment and sufficient understanding of the problem to communicate well with parents. Postoperative care by the GP was perceived as incomplete among most parents due to a lack of both specialist competence and access to audiometry. ConclusionParents expect postoperative care to safeguard their child as long as needed after VT surgery, and they expect access to high-quality care. Low health literacy among some parents challenges the current method of postoperative care and requires that more emphasis be set on both informing and educating parents regarding hearing and VT treatment.

Can routine assessment of older people's mental health lead to improved outcomes: A regression discontinuity analysis.

To assess whether case finding for depression among people aged 65 and above improves mental health. Opportunistic evaluation using a regression discontinuity analysis with data from a randomised controlled trial. The REFORM trial, a falls prevention study that recruited patients from NHS podiatry clinics. 1010 community-dwelling adults over the age of 65 with at least one risk factor for falling (recent previous fall or fear of falling). Letter sent to patient's General Practitioner if they scored 10 points or above on the 15-item Geriatric Depression Scale (GDS-15) informing them of the patient's risk of depression. GDS-15 score six months after initial completion of GDS-15. 895 (88.6%) of the 1010 participants randomised into REFORM had a valid baseline and six-month GDS-15 score and were included in this study. The mean GDS-15 baseline score was 3.5 (SD 3.0, median 3.0, range 0-15); 639 (71.4%) scored 0-4, 204 (22.8%) scored 5-9 indicating mild depression, and 52 (5.8%) scored 10 or higher indicating severe depression. At six months follow-up, those scoring 10 points or higher at baseline had, on average, a reduction of 1.08 points on the GDS-15 scale (95% confidence interval -1.83 to -0.33, p = 0.005) compared to those scoring less than 10, using the simplest linear regression model. Case finding of depression in podiatry patients based on a GDS-15 score of 10 or more followed by a letter to their General Practitioner significantly reduced depression severity. Whether this applies to all older patients in primary care is unknown. Further research is required to confirm these findings. Regression discontinuity analyses could be prespecified and embedded within other existing research studies.

Exploring general practitioners' decision-making in the management of women with uncomplicated urinary tract infections: a qualitative study.

To be effective, interventions aiming at increasing the appropriateness of antibiotic use in primary care should consider the perspectives of prescribing physicians. To explore the decision-making of general practitioners (GPs) when managing uncomplicated urinary tract infections (uUTIs) in women. Semi-structured interviews with 22 GPs in Bavaria and Baden-Wurttemberg (southern Germany). Verbatim transcripts analysed through inductive qualitative content analysis. We generated three main themes: factors facilitating the decision-making, factors complicating the decision-making, and consultation modalities. According to participants, following evidence-based recommendations makes the prescription decision smoother. GPs' and patients' prior experiences and beliefs guides decisions towards certain antibiotics, even if those experiences and beliefs contradict evidence-based recommendations. Patient expectations and demands also conditions antibiotic prescribing, favouring it. Organisational constraints like time pressure, the day of the week (eg, before weekends) and a lower cost of antibiotics for patients than alternative treatments favour the decision to prescribe antibiotics. Diagnostic and prognostic uncertainty complicates decision-making, as does scepticism towards evidence-based recommendations. Discordance within the patient-doctor relationship contributed to this complexity. Regarding consultation modalities, a more in-depth consultation, and shared decision-making were seen as helpful in this process. We identified different factors as intervening against or for a straightforward management decision when dealing with women with uUTIs. They reveal the complexity behind the GPs' decision-making. Providing GPs with easy-to-apply guidance while removing economic constraints to allocate sufficient consultation time, and supporting shared decision-making may help GPs appropriately manage uUTIs in women.

Tracked and self-reported nighttime smartphone use, general health, and healthcare utilization: results from the SmartSleep Study.

Nighttime smartphone use is an increasing public health concern. We investigated whether nighttime smartphone use is associated with general health and primary healthcare utilization. 4,520 individuals (age 35.6 ± 9.7 years, 35% male) provided self-reported information on smartphone use frequency, symptoms of depression, and general health (one-item perceived health and cross-symptom composite score). A subset of the study sample (n=3,221) tracked their nighttime smartphone use. Primary healthcare utilization, i.e., the number of weeks in which at least one service from the patient's general practitioner was billed in 2020, was extracted from Danish population registries. Statistical analysis comprised logistic and multiple linear regression, controlling for sociodemographics. 319 individuals (7%) reported using their smartphone almost every night or more. More frequent self-reported nighttime smartphone use was associated with poor general health across all measures. Using the smartphone almost every night or more was associated with 2.8 [95CI: 1.9,4.1] fold higher odds of reporting poor health and with an average of 1.4 [95CI: 0.7,2.1] additional GP utilizations per year compared to no use. Associations were also found for the cross-symptom composite score across all symptoms. Further adjustment for symptoms of depression attenuated some associations. Smartphone use towards the end of the sleep period (sleep-offset use) was associated with poorer self-reported general health, but not with healthcare utilization. Nighttime smartphone use frequency is associated with poor general health and healthcare utilization. Further studies should investigate the underlying causal structure and nighttime smartphone use as a transdiagnostic intervention target.

The assessment of quality of care of patients with type 2 diabetes mellitus in a population-based cohort in the District of Landeck in Austria

IntroductionStructured diabetes care based on evidence-based guidelines is one of the main strategies to improve glycemic control and to reduce long-term complications in diabetes mellitus. MethodsThis study is based on the “Diabetes-Landeck Cohort”, a population-based cohort of patients with diabetes mellitus type 2 (T2DM). We assessed the quality of diabetes care and compared it between three groups of care units, that is, general practitioners (GP), diabetes specialists in private practice (DSPP), and hospitals (HOSP). ResultsThe total study population comprised 1616 patients with T2DM, including 378 patients of GP, 281 of DSPP, and 957 from HOSP. We identified statistically significant differences: DSPP showed the highest percentage of structured training, sufficient training, eye examinations and foot examinations. The group HOSP showed the highest proportion for increased HbA1c≥ 7.5 and almost all long-term complications surveyed, that is, nephropathy (23.2%), neuropathy (14.4%), diabetic foot (5.1%), and cerebrovascular diseases (10.9%). ConclusionThis population-based cohort study on patients with T2DM in Austria showed significant differences in important quality-of-care process and outcome parameters across different groups of care units. Future research should also include prediction modeling for early warning and monitoring systems as well as adjustment for patient characteristics and duration and severity of disease.

Appraisal of National Institute for Health and Care Research activity in primary care in England: cross-sectional study.

The National Institute for Health and Care Research (NIHR) was set up to enhance clinical and health research activity in a variety of National Health Service (NHS) healthcare settings, including primary care. To appraise how overall General Practitioner (GP) practice performance, location, and staffing levels may interact with NIHR Portfolio activity in primary care in England. Cross-sectional summary of GP practice research activity and practice descriptors; complete data from 6,171 GP practices was collated from NIHR (using data for 2013-2023 for Portfolio studies), Public Health England, Care Quality Commission, and NHS Digital sources, respectively. In primary care, 1 million patients have been recruited into NIHR Portfolio studies in the last decade. The top 10% of practices-measured by different studies recruited to-contributed over 50% of that accrual. When the top decile of GP practices is compared to the 20% least active GP practices, research activity is significantly and individually linked with larger GP practices. Furthermore, it is significantly yet modestly associated with GP practice performance (positive patient feedback, Care Quality Commission rating), lower locality deprivation levels, and lower patient to GP ratios. Research activity in GP practices is-as seen previously with hospitals-significantly linked with better GP practice performance and patient feedback. Practice list size and staffing levels in particular interact with the aforementioned. This should be taken into account when determining strategies to increase patient and GP practice participation in NIHR Portfolio research studies.

The quality of older adults’ involvement in clinical communication with general practitioners: evidence from rural towns in Australia

ObjectiveA study was conducted about the putative links of older rural Australians’ health knowledge and preparation with their quality of involvement in patient-general practitioner (GP) communication during health intake visits. MethodsIt was a cross-sectional study between January 2021 and April 2022. The 32-item quality of involvement in communication scale was designed and incorporated into the SurveyGizmo software. This online survey was administered by sending an email request to the Renmark Rotary Club, which actively promoted this study across five rural towns in South Australia. 121 participants completed the surveys. Mean-sum scores were calculated based on the questionnaire responses to evaluate outcomes, specifically initiation of information, active participation, and emotional expression. We employed different methods including t-tests, ANOVA, and leaner regressions to analyse data. ResultsThe demographic profile of participants characterised by a female predominance (58.7%, 71/121), a majority falling within the 65‒< 70 age bracket (47.1%, 57/121), and a high level of educational attainment (58.7% had completed high school or higher, 71/121). Additionally, 35% of the participants predominantly spoke a language other than English at home. Regarding the initiation of information with GPs, the mean sum-score was (20.5 ± 3.7), indicating a marginally above-average level of engagement. Contrarily, the active participation was suboptimal, as suggested by a mean sum score of (35.9 ± 6.3). Furthermore, the emotional expression was relatively low, with a mean score of (13.9 ± 1.8). Substantial variations were discerned in the quality of patient-GP communication, contingent upon factors such as educational background, language spoken at home, health literacy, and preparatory measures for clinical visits. Participants who predominantly spoke a language other than English at home demonstrated significantly lower levels of information initiation with their GPs (P < 0.001). Higher educational attainment was positively correlated with increased active participation (P < 0.001). Enhanced health literacy and thorough visit preparation were significantly associated with increased levels of active participation (P < 0.001). ConclusionMeaningful engagement through recognition, empowerment, and support (health literacy programs) for older rural adults is suggested for improving their quality of involvement in communication with GPs.

Continuity of care and consultation mode in general practice: a cross-sectional and longitudinal study using patient-level and practice-level data from before and during the COVID-19 pandemic in England

ObjectivesInvestigate trends in continuity of care with a general practitioner (GP) before and during the COVID-19 pandemic. Identify whether continuity of care is associated with consultation mode, controlling for other...

A multicentre review of the direct-access mammography programme in Ireland for women with breast pain

To assess the current use of the direct access mammography pathway for breast pain and the rate of breast cancer detection in this patient cohort. A retrospective review of general practitioner (GP)-referred mammograms performed during a 12-month period from January to December 2022 across four tertiary referral centres. With the use of medical records and GP referrals, patient demographics, presenting symptoms, family history, and clinical outcomes were recorded. The present study comprised 2,046 patients of which 21.6% did not report breast pain at the time of referral. Thirty-five per cent had a positive family history with 40% of these patients having no breast pain. Twelve per cent were recalled with 30% of these patients requiring biopsy. An overall cancer detection rate (CDR) of 7 per 1000 was determined for women with mastalgia. A CDR of 0 per 1,000 was determined for women <50 years with mastalgia alone and no additional risk factors for malignancy. Fisher's exact test showed no statistically significant association between breast pain and breast cancer. There was no statistically significant relationship found between breast pain and breast cancer. This review suggests a low cancer detection rate in women <50 years. In women <50 years with mastalgia without additional symptoms or family history, breast imaging is not required.

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...

Comprehensive pharmacological geriatric assessment compared to usual care in an older adult with cancer in the absence of polypharmacy.

Medication reconciliation as part of a Comprehensive Geriatric Assessment by a specialist pharmacist is a process that has been shown to be beneficial in terms of medication adherence in patients taking oral anticancer medication and potentially cost-effective in cancer patients. Medication review guidelines in older adults with cancer suggest using polypharmacy (≥ 5 medications) as an indication for medication review in older adults with cancer. We present a case where a medication review as part of a Comprehensive Geriatric Assessment in the absence of polypharmacy resulted in two pharmacist interventions when standard care resulted in no intervention. A 71-year-old male prescribed capecitabine for rectal cancer had a medication reconciliation done as standard care before starting an oral anticancer medication. He then proceeded to get a medication review as part of a Comprehensive Geriatric Assessment and was deemed to have a potentially excessive anticholinergic burden and underprescribed gastro protection. This case is interesting as it occurred in a patient who would not have met the current inclusion criteria for a medication review as part of a Comprehensive Geriatric Assessment. As a result of the Comprehensive Geriatric Assessment, a letter was written to the patient's general practitioner, recommending a change to anti-depressant therapy to optimise anticholinergic burden, as well as introducing a proton-pump inhibitor upon completion of the Capecitabine protocol concurrent with radiotherapy, to confer gastro-protection against the antidepressant medication, as per the START criteria. Upon discharge from medical oncology, neither of the changes had been adopted by the patient's general practitioner. This highlights one of the challenges facing clinical pharmacists in an outpatient setting, where evidence-based recommendations are not always implemented as care transitions from tertiary to primary care. Comprehensive Geriatric Assessment is a process that identifies potential issues in older adults with cancer that aren't identified with standard medication review. This is also evident for medication reviews as part of a Comprehensive Geriatric Assessment, and where resources allow, and recommendations are likely to be accepted, it should be offered to all older adults with cancer. Pharmacists are still faced with challenges in implementing recommendations from medication reviews, particularly in healthcare systems where pharmacist prescribing has yet to be introduced.

A personalized intervention to prevent depression in primary care based on risk predictive algorithms and decision support systems: protocol of the e-predictD study.

ClinicalTrials.gov, identifier: NCT03990792.

High Rates of Progression From Screening to Requiring Investigation: Early Report From the Te Kūiti Access to Cardiology Pilot Study

The Te Kūiti Access to Cardiology Pilot Study (TKACPS) was designed to assess, in a high Māori proportion general practitioner (GP) population (Te Kūiti) with increased cardiovascular risk (CVR), whether a simple local screening protocol followed, if indicated, by more definitive cardiology tests performed locally would identify people for treatment or tertiary referral earlier than a normal care control group. Progression from screening to investigation phase and early echocardiography data are provided. Te Kūiti GP patients aged 35–74 years, with a 5-year CVR of ≥10% (PREDICT CVD) were eligible for inclusion. Current cardiology patients (or those seen within 2 years), were excluded. Screening (Phase 1: symptom questionnaire, electrocardiogram, and plasma Troponin T, N-terminal prohormone of brain natriuretic peptide, and ST2) was followed by, if the cardiologist and GP felt indicated, Phase 2 (locally performed screening echo, Holter monitor or exercise tolerance test). For Māori patients, a hospital Kaitiaki (very well known in the community) made first contact, organised appointments, and met patients upon arrival. Of 119 patients approached so far, 23 (19.3%) were uncontactable, 18 (15.2%) declined to be involved, and 78 (65.5%) agreed to participate. Thirteen (10.9%) patients did not attend (three Tangi, one COVID) but will be rescheduled.Table 1Sex and ethnicity of patients and progression from Phase 1 to Phase 2 for the TKACPS (early data).ParticipantsN (%) of totalN (%) progress to Phase 2Māori male32 (49.2)16 of 32 (50.0)Māori female17 (26.2)10 of 17 (59.2)Non-Māori male8 (12.5)4 of 8 (50.0)Non-Māori female8 (12.5)4 of 8 (50.0)Total6534 of 65 (52.3) Open table in a new tab Table 2Preliminary data from screening echocardiography (15 patients).ParticipantsNeed referral for echo or clinicClinical advice/no actionMāori male 4 of 154 of 4 (MR3+, MR2+, fast AF, aortic root 4.8 cm)Māori female 4 of 153/1Non-Māori male 5 of 154 of 5 (LVEF 30%–35%, aortic root 4.8 and 4.5 cm, fast AF)2/0Non-Māori female 2 of 152Total8 of 15 (53.3%)6 (40.0%)/1 (6.7%) Open table in a new tab A high proportion (52.3%) of these GP patients in Te Kūiti with 5-year CVR ≥10% were judged to require further investigation after Phase 1 symptom questionnaire, electrocardiogram, and blood tests. Early Phase 2 echocardiography data suggest high rates of pathology that need follow-up (53.3%) or generated clinical advice for the GPs (40.0%).

The advising behaviour of healthcare professionals; considerations of dieticians and general practitioners regarding dairy and probiotic interventions

Dairy and probiotics are examples of products that contain ingredients that provide health benefits beyond the basic nutritional components of the food itself. However, strong evidence based on randomised controlled trials is generally lacking, which in turn leads to weak guidelines and recommendations for clinical practice. Interestingly, despite the limited regulation of probiotics, for example, a significant proportion of healthcare professionals still recommend these products. We set out studying the advising behaviour of general practitioners (GPs) and dieticians and their underlying motivations whether to advise probiotics, a relatively new intervention, and dairy, an older intervention by conducting interviews and setting out a questionnaire. This study found that the vast majority of GPs and dieticians recommended dairy and probiotics. The proportion of dieticians that do not advise both dairy and probiotics was too small for statistical analysis, therefore, the results are mainly focused on GPs. Considerations that appeared to be associated with GP advising behaviour were related to compliance with protocols and guidelines in regard to both dairy and probiotics. For probiotics in particular, GPs' knowledge and patients' interest in using probiotics was related to advising behaviour of GPs. Considerations solely related to recommending dairy were related to GPs' perceptions about the amount of evidence of dairy efficacy and the recommendation of dairy in scientific journals. The study highlights the influence of authority-driven, expertise-driven and patient-driven considerations on whether or not to proceed with recommending an intervention. Insights into the drivers of GPs to advise, gives input to stakeholders in the nutrition innovation system to understand and allow to use appropriate tools to support GPs in making an informed decision to increase the quality of care provided.

High Frequency of Tertiary Cardiology Referral, Admission or Death of Eligible Patients Following Delay in Recruiting for the Te Kūiti Access to Cardiology Pilot Study

The Te Kūiti Access to Cardiology Pilot Study was designed to assess, in a high Māori proportion general practitioner (GP) population (Te Kūiti) with increased cardiovascular risk, whether a simple local screening protocol followed, if indicated, by more definitive cardiology tests performed locally would identify people for treatment or tertiary referral earlier than a normal care control group. Delay from risk score assessments to study commencement of 2.5 years occurred due to funding and COVID-19. The frequency of tertiary cardiology referral, admission, or death in this intervening period were assessed. Te Kūiti GP patients aged 35–74 with a 5-year cardiovascular disease (CVD) risk score of ≥10% (PREDICT CVD) were eligible for the study. Current cardiology or patients within 2 years were excluded. The delay to start period was between February 2020 and August 2022 (2.5 years). The proportion of eligible patients now excluded (now under or referred to Waikato Hospital cardiology, those deceased/deceased due to cardiovascular cause, and other (moved out of area, under palliative care)) was assessed. Groups were sorted by gender (male/female) and ethnicity (Māori and non-Māori). The Table show summary data of those initially eligible patients who were later excluded. The Māori and non-Māori males and Māori females were referred or died from cardiovascular disease at rates in 2.5 years close to those predicted at 5 years by PREDICT CVD. This high rate of referral/death suggests that these groups may be good targets to attempt interventions to facilitate early diagnosis and implement preventive therapies.TableMāori maleNon-Māori maleMāori femaleNon-Māori femaleTotal number with CVD risk score of ≥10% by January 202016225711954Number excluded by August 2022 “Exclusion group”46 (28.4%)60 (23.3%)25 (21.0%)10 (18.5%)Exclusion criteria: now under cardiology/referral to cardiology made23 (14.2%)37 (14.4%)16 (13.4%)3 (5.5%)Exclusion criteria: deceased10 (6.2%)7 (2.7%)4 (3.4%)1 (1.9%)Deceased due to heart disease3 (1.9%)2 (0.8%)1 (0.8%)0 (0.0)%Total cardiovascular disease exclusions26 (16.1%)39 (15.2%)17 (14.2%)3 (5.5%)Exclusion criteria: other131656Mean CVD risk score of total number17.215.517.215.1Mean CVD risk score of exclusion group17.6316.5418.5213.6 Open table in a new tab

Qualitative study evaluating the expectations and experiences of Dutch parents of children with chronic gastrointestinal symptoms visiting their general practitioner

ObjectivesChronic gastrointestinal symptoms are common among children and affect their daily activities and quality of life. The majority will be diagnosed with a functional gastrointestinal disorder. Effective reassurance and education...

Exploring barriers and opportunities to improve osteoporosis care across the acute-to-primary care interface: a qualitative study

SummaryThis qualitative study interviewed general practitioners, patients, and FLS clinicians and identified key challenges facing stakeholders seeking to improve post-fracture osteoporosis care. Local policies and care pathways as an initial strategy may address information and service delivery issues across the acute-primary care divide.IntroductionFracture liaison services (FLS) can be effective for secondary fracture prevention, but long-term adherence to therapies remains suboptimal. Few studies have explored how services manage the transition between tertiary and primary post-fracture care. This study mapped service processes and factors influencing integration of post-clinic care, identifying barriers, supports, and opportunities for seamless healthcare.MethodsQualitative descriptive study using semi-structured interviews with FLS stakeholders at two metropolitan hospitals in New South Wales (NSW) and surrounding general practices.ResultsSeven FLS clinicians, 11 general practitioners (GPs), and seven patients were interviewed. Six key themes emerged on the transition of patient care from tertiary to primary care (PC). Interprofessional communication issues and role ambiguity posed threats to seamless care. Delayed, absent, inaccessible, or poor-quality communication frustrated GPs, while FLS clinicians lacked confidence in existing communication systems and desired bidirectional communication with PC. GPs were confident managing osteoporosis, but FLS clinicians had limited confidence that patients would discuss osteoporosis with their GP and that GPs would action recommendations. Effective PC follow-up required a positive GP–patient relationship and that patients perceived a need to engage with PC. Patient understanding of osteoporosis (influenced by patient education, knowledge, beliefs, and health behaviours) affected PC attendance. Limited public awareness of osteoporosis and healthcare policy deficits contributed to care gaps.ConclusionKey challenges were identified facing stakeholders seeking to improving post-clinic osteoporosis care. Development and implementation of local, integrated acute-community policies and care pathways as an initial intervention may address information and service delivery issues across the acute-PC divide.

Beliefs of rheumatologists and general practitioners on urate lowering therapy: a cross-sectional study.

To describe beliefs of physicians and patients in primary and secondary care about urate-lowering therapy (ULT), to examine differences in physicians' medication beliefs and to examine the association of physicians' medication beliefs with the prescribed dosage of ULT, gout outcomes and patients' medication beliefs. We conducted a cross-sectional study among rheumatologists and general practitioners (GPs) and their patients using ULT in The Netherlands. All participants filled out the Beliefs About Medication Questionnaire (BMQ). Demographics of physicians were collected through questionnaires. Patient and disease characteristics were collected through questionnaires and electronic medical records. Differences between rheumatologists and GPs in the BMQ subscales Necessity and Concern and the necessity-concern difference (NCD) score were analysed by two-sample t-tests. Multilevel analyses were performed to examine the association of physicians' BMQ scores with the prescribed dosage of ULT, gout outcomes (number of gout flares, serum urate) and patients' BMQ scores. A total of 28 rheumatologists, 443 rheumatology patients, 45 GPs and 294 GP patients were included. The mean NCD scores were 7.1 (s.d. 3.6), 4.0 (s.d. 4.0), and 4.2 (s.d. 5.0) for rheumatologists, GPs and patients, respectively. Rheumatologists scored higher on necessity beliefs [mean difference 1.4 (95% CI 0.0, 2.8)] and lower on concern beliefs [mean difference -1.7 (95% CI -2.7, -0.7)] compared with GPs. No associations between physicians' beliefs and prescribed dosage of ULT, gout outcomes or patients' beliefs were found. Rheumatologists had higher necessity and lower ULT concern beliefs compared with GPs and patients. Physicians' beliefs were not related to prescribed ULT dosage and patient outcomes. The role of physicians' beliefs in gout management in patients using ULT seems limited. Future qualitative research can provide more insights into physicians' views of gout management.

Care by general practitioners for patients with asthma or COPD during the COVID-19 pandemic

The impact of the COVID-19 pandemic on general practitioners’ (GP) care for patients with asthma and/or COPD is largely unknown. To describe the impact of the pandemic on asthma or COPD-related GP care, we analysed routinely recorded electronic health records data from Dutch general practices and out-of-hours (OOH) services. During the COVID-19 pandemic (2020), the contact rates for asthma and/or COPD were significantly lower in GP practices and OOH services compared with the pre-pandemic period (2019) (respectively, 15% lower and 28% lower). The proportion of telephone contacts increased significantly with 13%-point in GP practices and 12%-point at OOH services, while the proportion of face-to-face contacts decreased. Furthermore, the proportion of high urgent contacts with OOH services decreased by 8.5%-point. To conclude, the overall contact rates in GP practices and OOH services decreased, while more contacts were remote. Lower contact rates have, after a short follow-up, not resulted in more patients with exacerbations in OOH care. However, this might still be expected after a longer follow-up.

Prescription of antibiotics by general practitioners for patients with a diagnosis of SARS- CoV-2 infection: Analysis of an electronic French health record

ObjectiveTo define the factors associated with overprescription of antibiotics by general practitioners (GPs) for patients diagnosed with COVID-19 during the first wave of the pandemic. MethodsAnonymised electronic prescribing records of 1370 GPs were analysed. Diagnosis and prescriptions were retrieved. The initiation rate by GP for 2020 was compared with 2017–2019. Prescribing habits of GPs who initiated antibiotics for > 10% of COVID-19 patients were compared with those who did not. Regional differences in prescribing habits of GPs who had consulted at least one COVID-19 patient were also analysed. ResultsFor the March–April 2020 period, GPs who initiated antibiotics for > 10% of COVID-19 patients had more consultations than those who did not. They also more frequently prescribed antibiotics for non-COVID-19 patients consulting with rhinitis and broad-spectrum antibiotics for treating cystitis. Finally, GPs in the Île-de-France region saw more COVID-19 patients and more frequently initiated antibiotics. General practitioners in southern France had a higher but non-significant ratio of azithromycin initiation rate over total antibiotic initiation rate. ConclusionThis study identified a subset of GPs with overprescribing profiles for COVID-19 and other viral infections; they also tended to prescribe broad-spectrum antibiotics for a long duration. There were also regional differences concerning antibiotic initiation rates and the ratio of azithromycin prescribed. It will be necessary to evaluate the evolution of prescribing practices during subsequent waves.