Primary Care General Practitioners Research Articles

Understanding delays in chronic limb-threatening ischaemia care: Application of the theoretical domains framework to identify factors affecting primary care clinicians' referral behaviours.

Patients in the community with suspected Chronic limb-threatening ischaemia (CLTI) should be urgently referred to vascular services for investigation and management. The Theoretical Domains Framework (TDF) allows identification of influences on health professional behaviour in order to inform future interventions. Here, the TDF is used to explore primary care clinicians' behaviours with regards to recognition and referral of CLTI. Semi-structured interviews were conducted with 20 podiatrists, nurses and general practitioners in primary care. Directed content analysis was performed according to the framework method. Utterances were coded to TDF domains, and belief statements were defined by grouping similar utterances. Relevance of domains was confirmed according to belief frequency, presence of conflicting beliefs and the content of the beliefs indicating relevance. Nine TDF domains were identified as relevant to primary care clinicians: Knowledge, Environmental context and resources, Memory, Decision and attention processes, Beliefs about capabilities, Skills, Emotions, Reinforcement and Behavioural regulation. Relationships across domains were identified, including how primary care clinician confidence and working in a highly pressurized environment can affect behaviour. We have identified key barriers and enablers to timely recognition and referral behaviour. These beliefs identify targets for theory-driven behaviour change interventions to reduce delays in CLTI pathways.

Teleconsulting in wound care: Connecting the primary care to the wound specialist reduces unnecessary referrals.

In the Netherlands the primary care (General Practitioner or homecare nurse) encounter a variety of wounds ranging from traumatic to diabetic foot ulcers. According to a recent study 82.4% of the patients with a wound can be treated in a primary setting with the GP as medical supervisor. The remaining 17.6% of patients need more extensive care including advice by a specialised doctor, diagnosis and treatment. Prompt analyses and treatment of underlying causes by specialised doctors in a multidisciplinary setting is necessary for treating patients with complicated wound. This article describes the impact of Electronic Health Consultation on all wounds treated in the primary care. And describes the effect on the duration until referral to the hospital and the influence on the amount of unnecessary referrals to the hospital. All data was collected prospectively from June 2020 until October 2021. The study involved a process where primary care could seek advice from a Wound Physician at the Alrijne Wound Centre through a specialised Electronic Health Consultation. A total of 118 patients were analysed. 41/118 (34.7%) patients required a physical consultation with analysis and treatment in the hospital, after teleconsultation. The remaining 77/118 (65.3%) could be treated in primary care after Electronic Health Consultation. The mean duration of wound existence until Electronic Health Consultation was 39.3 days (range 5-271, SD: 38.5). 3/41 (7.3%) of the referrals were unnecessary. Electronic Health Consultation serves as a valuable and efficient tool for enhancing wound care, ultimately contributing to improved patient management and resource allocation within the healthcare system. This article describes the impact of Electronic Health Consultation on all wounds treated in the primary care and the influence on the duration until referral to the hospital and the influence on the amount of unnecessary referrals to the hospital.

Clinical Pharmacists Performing Medication Review in Collaboration with General Practitioners in Primary Care: A Qualitative Evaluation

Clinical Pharmacists Performing Medication Review in Collaboration with General Practitioners in Primary Care: A Qualitative Evaluation

Identifying latent subgroups in the older population seeking primary health care for a new episode of back pain – findings from the BACE-N cohort

BackgroundBack pain is the number one condition contributing to years lived with disability worldwide, and one of the most common reasons for seeking primary care. Research on this condition in the ageing population is sparse. Further, the heterogeneity of patients with back pain complicates the management in clinical care. It is possible that subgrouping people with similar characteristics would improve management. This paper aimed to identify latent classes based on demographics, pain characteristics, psychosocial behavior, and beliefs and attitudes about back pain, among older patients seeking primary care with a new episode of back pain, and to examine if there were differences regarding the classes’ first point-of-contact.MethodsThe study was part of the international BACE (Back complaints in elders) consortium and included 435 patients aged ≥ 55 years seeking primary care (general practitioners, physiotherapists, and chiropractors) in Norway from April 2015 to March 2020. A latent class analysis was performed to identify latent classes. The classes were described in terms of baseline characteristics and first point-of-contact in primary care.ResultsFour latent classes were identified. The mean age was similar across groups, as were high expectations towards improvement. Class 1 (n = 169, 39%), the “positive” class, had more positive attitudes and beliefs, less pain catastrophizing and shorter duration of current pain episode. Class 2 (n = 31, 7%), the “fearful” class, exhibited the most fear avoidance behavior, and had higher mean pain intensity. Class 3 (n = 33, 8%), the “distressed” class, had the highest scores on depression, disability, and catastrophizing. Finally, class 4 (n = 202, 46%), the “hopeful” class, showed the highest expectations for recovery, although having high pain intensity. The identified four classes showed high internal homogeneity, sufficient between-group heterogeneity and were considered clinically meaningful. The distribution of first point-of-contact was similar across classes, except for the positive class where significantly more patients visited chiropractors compared to general practitioners and physiotherapists.ConclusionsThe identified classes may contribute to targeting clinical management of these patients. Longitudinal research on these latent classes is needed to explore whether the latent classes have prognostic value. Validation studies are needed to evaluate external validity.Trial registrationClinicaltrials.gov NCT04261309.

Data driven ecosystems for health and prevention: a shared decision-making model for local data governance.

Summary: As our healthcare system is in transition towards a more personalized preventive healthcare approach, enabled by the digital transformation, we aim to design a harmonized data driven population health approach, shared by local healthcare actors and wherein citizens have trust through a local data governance.
 Background: Our healthcare system is in transition towards a more personalized preventive healthcare approach, which is enabled by the digital transformation. To enable this transition, there is a need for a harmonized data driven population health approach, shared by local healthcare actors. To create this based on citizen-generated data, it is crucial that citizens have trust in sharing their data, which can be enabled by a local data governance. The trade-off or interaction between local governance of these data and cashing in on health gains based on that data should thus be investigated for all stakeholders in the quadruple helix (citizens, healthcare providers, governments, and companies). 
 Objectives: The aim of this research was to consult primary care zones, general practitioners, pharmacists, and local governments in Flanders on their current way of working, more specifically the use of data in their healthcare prevention strategy. We aimed to investigate what data they are already using, the data sources and the reason of data use. We also examined the current gaps in their data strategy and what they wanted to improve. 
 Design: The project has been externally funded by VLOCA and EMPOWERCARE Interreg 2 Seas. Online consultations were conducted with in total 16 participants from a general practitioner center, 3 primary care zones in Flanders, the overarching body of the primary care zones, a mutuality, a pharmacy network and 2 local governments. In addition, we conducted an online focus group with 25 participants within the healthcare sector, with the participants partially overlapping with the participants from the online consultations. 
 Results: The online consultations and focus group with participants from the primary healthcare sector in Flanders give an insight on the current data driven approaches in healthcare prevention. Participants indicate data is valuable in healthcare prevention, such as targeted interventions and population health management. Some participants are already working on a data driven approach in healthcare prevention. The majority, however, indicates that there is a lack on real world data relating to lifestyle.
 Conclusion: The present study gives an insight on the current use of data in healthcare prevention in Flanders. The current research informs us there is a need for a harmonized healthcare data driven approach. Moreover, it provides us insights on the trust-relationship between citizens and data, which is a necessity when data driven approaches are implemented. As next steps, the results of these consultations will be combined in an open data architecture on prevention and lifestyle. Moreover, we will further investigate how this research relates to the international context.

Spirometry practice by French general practitioners between 2010 and 2018 in adults aged 40 to 75 years

In France, most spirometries are performed by pneumologists. Spirometry is difficult to access due to the distance to medical office and long delays for appointments. This lack of accessibility contributes to the underdiagnosis of chronic obstructive pulmonary disease (COPD) among patients aged between 40 and 75 years. In recent years, general practitioners (GPs) have been performing spirometry in private practice. However, the extent of this practice is unknown. A French retrospective, repetitive transversal study analysed data from the “Système National des Données de Santé” (SNDS) database. The targeted population was GPs in primary care that performed spirometries between 2010 and 2018, in patients aged between 40 and 75 years. Between 2010 and 2018, 302,674 (7.2%) spirometries were performed in France by GPs in private practices, in patients 40 to 75 years old. 5.4% by “expert GPs” (>60 spirometries/year) and 1.8% by “non-expert GPs”. In “non-expert GPs” (2.8% of French GPs in 2018), the annual number of spirometries increased by 701 each year (p < 2.104), the annual number of GPs performing spirometries increased by 114 each year (p < 2.10−5). Overall, 24.9% of the spirometries performed by GPs were referrals from other GPs. The number of spirometries performed by GPs and the number of GPs performing spirometries has gradually increased over time. However, this increase is inadequate considering the need to early detect and follow up respiratory disorders.

RELEASE (REdressing Long-tErm Antidepressant uSE): protocol for a 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1 in general practice

BackgroundMany people experience withdrawal symptoms when they attempt to stop antidepressants. Withdrawal symptoms are readily misconstrued for relapse or ongoing need for medication, contributing to long-term use (> 12 months). Long-term antidepressant use is increasing internationally yet is not recommended for most people. Long-term use is associated with adverse effects including weight gain, sexual dysfunction, lethargy, emotional numbing and increased risk of falls and fractures. This study aims to determine the effectiveness of two multi-strategy interventions (RELEASE and RELEASE+) in supporting the safe cessation of long-term antidepressants, estimate cost-effectiveness, and evaluate implementation strategies.MethodsDesign3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1. Setting: primary care general practices in southeast Queensland, Australia. Population: adults 18 years or older taking antidepressants for longer than 1 year. Practices will be randomised on a 1.5:1:1 ratio of Usual care:RELEASE:RELEASE+. Intervention: RELEASE for patients includes evidence-based information and resources and an invitation to medication review; RELEASE for GPs includes education, training and printable resources via practice management software. RELEASE+ includes additional internet support for patients and prescribing support including audit and feedback for GPs. Outcome measures: the primary outcome is antidepressant use at 12 months self-reported by patients. Cessation is defined as 0 mg antidepressant maintained for at least 2 weeks. Secondary outcomes: at 6 and 12 months are health-related quality of life, antidepressant side effects, well-being, withdrawal symptoms, emotional numbing, beliefs about antidepressants, depressive symptoms, and anxiety symptoms; and at 12 months 75% reduction in antidepressant dose; aggregated practice level antidepressant prescribing, and health service utilisation for costs. Sample size: 653 patients from 28 practices. A concurrent evaluation of implementation will be through mixed methods including interviews with up to 40 patients and primary care general practitioners, brief e-surveys, and study administrative data to assess implementation outcomes (adoption and fidelity).DiscussionThe RELEASE study will develop new knowledge applicable internationally on the effectiveness, cost-effectiveness, and implementation of two multi-strategy interventions in supporting the safe cessation of long-term antidepressants to improve primary health care and outcomes for patients.Trial registrationANZCTR, ACTRN12622001379707p. Registered on 27 October 2022.

Perceptions of primary health care nurses and general practitioners in the care of older people with urinary incontinence.

To identify the challenges and opportunities among primary health care nurses and general practitioners (GPs) in the care of older people with urinary incontinence (UI) and other chronic conditions in China. UI is highly prevalent among community-dwelling older people with chronic conditions but is underreported and poorly managed. Understanding the factors that affect primary health care professionals' practices in their care for this population is imperative to foster nurse-led UI care services. A qualitative descriptive study. Four focus groups were held with 24 primary health care nurses and GPs in Changsha, Hunan Province, China, between July and September 2021. A reflective thematic analysis was used to identify themes. This study revealed misconceptions regarding older people living with UI and other chronic conditions in primary care health professional participants. Moreover, primary health care nurses had very limited autonomy in UI diagnosis and initiating care interventions for this patient population. By reflecting on practices, participants recognized various practical solutions to improve the detection and management of UI. Participants also identified barriers to accessing care services in older people with UI. They suggested changes in the health care system to achieve universal access to UI care services for older people. Nurse-led UI care services in primary health care for community-dwelling older people with chronic conditions are in high demand but are underdeveloped due to professional and health care system factors. Findings from this study provide new insights into challenges faced by primary health care professionals and illuminate practical solutions to address these challenges. Adherence to COREQ guidelines was maintained. No patient or public contribution.

Clotting Factor Deficiencies as an Underlying Cause of Abnormal Uterine Bleeding in Women of Reproductive Age: A Literature Review.

Clotting Factor deficiencies are rare disorders with variations in clinical presentation and severity of symptoms ranging from asymptomatic to mild to life-threatening bleeding. Thus, they pose a diagnostic and therapeutic challenge, mainly for the primary health care providers, general practitioners, and gynecologists who are more likely to first encounter these patients. An additional diagnostic challenge arises from the variable laboratory presentations, as PT, PTT, and BT are not always affected. The morbidity is higher among women of reproductive age since Abnormal Uterine Bleeding-specifically Heavy Menstrual Bleeding-is one of the most prevalent manifestations of these disorders, and in some cases of severe deficiencies has led to life-threatening episodes of bleeding requiring blood transfusions or even immediate surgical intervention. Physician awareness is important as, in the case of some of these disorders-i.e., Factor XIII deficiency-prophylactic treatment is available and recommended. Although uncommon, the potential for rare bleeding disorders and for hemophilia carrier states should be considered in women with HMB, after more prevalent causes have been excluded. Currently, there is no consensus on the management of women in these instances and it is reliant on the physicians' knowledge.

Using the Integrated Cognitive Assessment (ICA) to improve the efficiency of primary care referrals to memory services

AbstractBackgroundExisting primary care cognitive assessment tools are crude or time‐consuming screening instruments which can only detect cognitive impairment when it is well established, impacting carers and patient quality‐of‐life.We initiated the Accelerating Dementia Pathway Technologies (ADePT) study to develop a real‐world evidence basis to support the adoption of the Integrated Cognitive Assessment (ICA), a 5 minute computerised cognitive test that employs artificial intelligence to improve its accuracy, as an inexpensive screening tool for the detection of cognitive impairment and improving the efficiency of the dementia care pathway.MethodPatients referred to memory clinics from primary care General Practitioners (GPs) were recruited. Participants completed the ICA either at home or in the clinic along with medical history and usability questionnaires. The GP referral and ICA outcome were compared with the specialist diagnosis obtained at the memory clinic.The clinical outcomes as well as costing data were used as part of an economic analysis to assess the potential health economic benefits of the use of the ICA in the dementia diagnosis pathway in the United Kingdom.Result87 participants referred to memory clinics were recruited who completed all assessments (40 dementia, 19 mild cognitive impairment, 12 inconclusive, 5 healthy, 3 non‐dementia conditions). From these patients the ICA was able to identify cognitive impairment with a sensitivity of ∼90%.The results of the health economics model, utilising real world data collected from the ADePT study estimates that if the ICA were introduced in a primary care setting then it could result in a cost saving to the health and social care system of approximately £147 per patient over a lifetime horizon (∼£44m of direct costs to the health care system) or £283 per patient if introduced into a secondary care setting.ConclusionThe results from this study demonstrate the potential of the ICA as a screening tool to support accurate referrals from primary care settings to memory clinics. The introduction of disease modifying treatments for Alzheimer’s and dementia will further improve the case for earlier detection of the condition and therefore increase the cost‐effectiveness of more accurate screening using tests such as the ICA tool.

Modern organization aspects of the prevention of ischemic stroke in patients with extracranial carotid stenosis

Stroke is the second leading cause of death and the third leading cause of disability globally. This literature review described risk factors and diagnostic aspects of ischemic stroke prevention. Carotid stenosis and occlusion is a treatable cause of ischemic stroke, which can be diagnosed by duplex scanning of the brachiocephalic arteries. The reasons for the low effectiveness of preventive measures for ischemic stroke are the incomplete collection of anamnesis for risk factors that affect the clinical prognosis, the low use of modern diagnostic methods by primary health care general practitioners in the screening of patients.

Knowledge, attitudes and practice of female genital mutilation and cutting: An observational cross-sectional study in primary care (FGM/C Study).

Female genital mutilation and cutting (FGM/C) describes procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Increasing migration means many communities living in the UK originate from countries where FGM/C is practiced. Consequently, clinicians in the UK are increasingly exposed to women and children who have experienced FGM/C. To explore the knowledge, attitudes and practice of primary care general practitioners and practice nurses about FGM/C. An observational cross-sectional study with general practitioners (GPs) and practice nurses (PNs) working in primary care in the West Midlands, United Kingdom. An online survey was circulated to GPs and PNs between September 2019 and December 2019. 137 survey responses were received. Study participants were predominantly female (81.8%) and general practitioners (59.9%) with a mean age of 47.3 (SD =9.1). 19.7% of responders reported seeing more than one patient with FGM/C in the last 12 months. 91% of responders had received some form of FGM/C training; however the format and frequency of training varied and 34.3% felt they had received inadequate training to manage treatment of FGM/C. Results suggest varying degrees of competence and confidence associated with recognising and managing patients with FGM/C in primary care in the West Midlands. Given that FGM/C patients typically present in primary care it is important that clinicians can provide appropriate support underpinned by up-to-date training.

Veränderung hausärztlicher und psychotherapeutischer Versorgung in Deutschland während der ersten beiden COVID-19-Lockdowns 2020 und 2021: Zwei Befragungswellen unter Berücksichtigung von Geschlechtsidentität und sexueller Orientierung

IntroductionMeasures against the COVID-19 pandemic led to restrictions in ambulatory health care in Germany. While the restrictions have been described from claims data, the patients‘ perspective has been missing. Lesbian, gay, bisexual, trans-, inter- and asexual persons (LGBTIA) might have been particularly affected by these restrictions because of their vulnerability. Thus, our research questions were: 1) How did the restrictions during the pandemic influence primary care and psychotherapy in Germany from the patients’ perspective? 2) Are there differences between LGBTIA and cis-heterosexual persons regarding these restrictions? MethodsWe conducted an online survey with two survey waves in March/April 2020 and January/February 2021. Sampling was conducted via multiplicators and via snowball sampling. Amongst others, the survey contained open-ended questions regarding primary care and psychotherapy. From the answers of the first survey wave we constructed quantitative items for the second survey wave. Descriptive and inferential statistical analysis was conducted, including linear regression with R. Results6,784 participants took part in the survey (2,641 in the first survey wave), 5,442 of whom identified as LGBTIA. Categories of changes in primary care were: no health care utilization, no changes in primary care, insecurity regarding primary care, and changes in primary care which could be less frequent utilization, differing procedures or changes in ways of communication. In the second wave, LGBTIA participants rated the worsening of primary care during the pandemic as being more pronounced. Regarding psychotherapy, the change can be described as no change in care, changes in the form of therapy, treatment in emergencies only and a longer break from psychotherapy. There was no different rating by LGBTIA persons compared to cis-heterosexual persons in the second survey wave. Telephone and video consultations were more common in psychotherapy than in primary care. DiscussionLGBTIA persons were oversampled, so the sample included more people from urban areas than the German population. Due to the online survey form, older people were underrepresented relative to their numbers in the general German population. ConclusionWith respect to future pandemics general practitioners in primary care must be prepared that psychotherapy might be paused and delayed for some time. Video and telephone consultations should be offered to overcome pandemic-related restrictions in the future. General practitioners should know the gender identity and sexual orientation of their patients in order to proactively address health care barriers.

Naar een betere omkadering van de huisartsenpraktijk in de eerstelijnsgezondheidszorg

Towards a better framing of primary care general practice: the contribution of the ‘practice assistant in primary care’ and the ‘nurse in general practice’ One of the most important observations during the COVID-19 pandemic was that general practitioners (GPs) often lack professional support, mainly within 3 domains: reception function, administrative tasks and performing simple interventions such as taking samples for COVID-19 tests. GPs are asking to be relieved of improper tasks and to be able to focus on the core tasks for which they have been trained. Since 2007, many actors advocated the training of a ‘practice assistant in primary care’. Practice assistants support the GP and other primary care providers with the fulfilment of the reception function and the performance of IT and administrative tasks. Under the supervision of the responsible primary care provider, they can assume some frequently performed, protocolized technical-supportive medical tasks. In this way, GPs can carry out individual consultations, counseling and other interventions more efficiently and focus on their core tasks. In addition, for more than 5 years there have been a number of courses in Flanders to train nurses to become professionals in a primary care practice: the ‘nurses in the GP practice’. These nurses autonomously support GPs in treating, guiding and caring for patients in primary care. This program also responds proactively to the changing healthcare landscape. The practice assistant and the nurse practitioner have complementary roles to strengthen the GPs in primary care.

Facilitators and barriers to the introduction of atrial fibrillation screening in primary care: a qualitative descriptive study of general practitioners in primary care.

Atrial fibrillation (AF), the most common cardiac arrhythmia, is a major risk factor for stroke. AF is often asymptomatic and, if identified, treatment can be offered that can reduce stroke risk by up to two thirds. AF screening meets many of the Wilson Jungner criteria for screening. While AF screening is recommended in clinical practice and internationally, the optimal mode and location for AF screening remains under investigation. Primary care has been identified as a potential setting. This study aimed to identify facilitators and barriers to AF screening from the perspective of GPs. The study adopted a qualitative descriptive design conducted in the south of Ireland. 58 GPs were invited from the north Cork region to participate in individual interviews at their practices, rural and urban, with a view to recruiting a purposive sample of up to 12 GPs. The interviews were audio-recorded, transcribed verbatim and analysed using a framework analysis. Eight GPs (four male, four female) from five practices participated. Five GPs were from urban practices and three were from rural practices. Facilitators and barriers were sub-categorised into patient facilitators, practice facilitators, GP facilitators, patient barriers, practice barriers, GP barriers, attitudes to AF screening, willingness to facilitate and priority ranking. All eight participants expressed a willingness to engage in AF screening. Time was the barrier discussed most frequently by all participants along with the need for additional staff. Programme structure was the most discussed facilitator by all participants and patient awareness campaigns. Despite barriers to AF screening identified by GPs, there was a significant willingness to engage and identify potential facilitators to support such screening.

The experiences of physiotherapy independent prescribing in primary care: implications for practice.

To explore the experiences of musculoskeletal (MSk) physiotherapy independent prescribing in primary care from the perspectives of physiotherapists and General Practitioners (GPs) and identify the implications these have for contemporary physiotherapy practice in primary care. Legislative change in the United Kingdom (UK) in 2013 enabled physiotherapists holding a postgraduate non-medicalprescribing qualification to independently prescribe certain drugs that assist in patient management. Independent prescribing by physiotherapists is a relatively contemporary development in role change and purpose, occurring alongside the development of physiotherapy first contact practitioner (FCP) roles in primary care. A critical realist approach was used, with qualitative data collected via 15 semi-structured interviews with physiotherapists and GPs in primary care. Thematic analysis was applied. Fifteen participants were interviewed (13 physiotherapists, 2 GPs). Of the 13 physiotherapists, 8 were physiotherapy independent prescribers, 3 were MSk service leads, and 3 were physiotherapy consultants. Participants worked across 15 sites and 12 organisations. Whilst physiotherapists were empowered by their independent prescribing qualification, they were frustrated by current UK Controlled Drugs legislation. Physiotherapists reported vulnerability, isolation, and risk as potential challenges to independent prescribing, but noted clinical experience and 'patient mileage' as vital to mitigate these. Participants identified the need to establish prescribing impact, particularly around difficult to measure aspects such as more holistic conversations and enhanced practice directly attributed to prescribing knowledge. GPs were supportive of physiotherapists prescribing. Establishment of physiotherapy independent prescribing value and impact is required to evaluate the role of, and requirement for, physiotherapy independent prescribers within primary care physiotherapy FCP roles. Additionally, there is a need for a review of physiotherapy prescribing permitted formulary, and development of support mechanisms for physiotherapists at individual and system levels to build prescribing self-efficacy and autonomy, and to advance and sustain physiotherapy independent prescribing in primary care.

Self-Perceived Competence of Primary Healthcare Physicians in Managing Medical Emergencies in Health Centers; Kingdom of Bahrain: A Cross-Sectional Study

Background: Primary care physicians (PCPs) are the first point of contact for individuals when seeking healthcare and the cornerstone for providing a wide variety of preventive and curative services. Family physicians and general practitioners in primary care often encounter medical emergencies and their role in dealing with emergencies is essential to improve the patient’s outcome. Data about self-perceived competence of primary care physicians in dealing with emergencies in primary care in the Kingdom of Bahrain are lacking. This study aims at assessing the self-perceived competence of primary healthcare physicians in dealing with emergencies in primary care settings. Methods: A descriptive questionnaire-based cross-sectional study of primary healthcare family physicians and general practitioners in the Kingdom of Bahrain was conducted in January to February 2022. A total of 375 family physicians and general practitioners working in health centers were identified from Ministry of health database and 7 element anonymous self-administered electronic questionnaires were sent to their email to evaluate their level of competence in managing emergencies. Results: out of 375 PCPs; 184 (45.5%) participated and returned answered questionnaires. Most of the PCPs were females 117 (83.6%) with median age of 35 years. Regarding the level of competency in managing emergencies the majority either agreed feeling competent (37.5%) or were not sure if they feel competent in managing emergencies in primary care(37.5%).The study did not find any statistical significance or correlation between the reported competency among primary care physicians(PCPs) and age (P=0.486), years of practice(P=0.462), specialty(P=0.053), or the attended course; basic life support (BLS)(p=0.334),advanced cardiovascular life support (ACLS) (P=0.156), advanced trauma life support (ATLS)(P=0.691), pediatric advanced life support (PALS) (P=0.920).Study revealed that highest number of participants reported not feeling comfortable in dealing with major and multiple traumas in adults (n= 67, 47.86%) and pediatrics (n= 63, 45%) . The lowest level of competence in performing emergency skills was found in transcutaneous pacing, cardioversion, and nasogastric tube (NGT) insertion at which PCPs reported that they wouldn’t know how to start transcutaneous pacing (n= 67, 47.9%), while (n= 51, 36.4%) would perform cardioversion and nasogastric tube insertion (n= 43, 30.7%) only if no-one else was available. Most PCPs (n= 137, 97.9%) think that they need training in emergencies and the preferred method is practical training in health center by qualified staff (n= 122, 87.1%). Conclusion: Based on study findings, more efforts should be directed towards practical training of healthcare physicians in dealing with emergencies and the barriers should be explored. More practical training sessions should be devoted to pediatric emergencies, transcutaneous pacing, and cardioversion.

Celiac disease: experience of general practitioners in Brianza Area- Monza- Milan-Italy.

The purpose of the study was to better investigate the degree of knowledge and the diagnostic approach concerning celiac disease and its extra-intestinal manifestations by general practitioners in Italy. Celiac Disease is a common chronic disease, but often goes undiagnosed because of atypical symptoms or silent disease. Currently there are non-definitive data about the disease management approach concerning celiac disease by general practitioners. To better investigate the degree of knowledge and the diagnostic approach concerning celiac disease and its extra-intestinal manifestations, questionnaire was used to assess the daily practice of diagnosis, treatment, and follow-up of this condition by general practitioners in two densely populated area in Italy: Monza-Brianza Area and Milan City. The questionnaire was composed of 18 questions that explored 3 precise domains: diagnosis criteria, correct management of celiac disease and availability for training. The frequencies of the domains explored were analyzed, analyzes were carried out to identify differences between the groups of general practitioners interviewed. Analysis of the questionnaires showed a degree of knowledge and preparation comparable to that of other countries, even though not sufficient to guarantee access to early diagnosis for all patients with celiac disease. The knowledge was not influenced by the years of experience or specific curriculum of health professionals. General practitioners under 40 were much more in favor of continuous training and were aware of its importance (OR=10.55; CI95%: 1.62-445.39), although this need was a high priority in the whole group interviewed (84.7%). Continuous specific training aimed at primary care physicians and general practitioners is the first tool to improve early diagnosis. A second opportunity is represented by the continuous dialogue between general practitioners and tertiary level hospitals and universities.

Improving access to primary care and annual health checks for people who have a learning disability: a multistakeholder qualitative study

ObjectivesTo investigate key stakeholders’ views on how to improve access to primary care in general practice settings for people with learning disabilities (or intellectual disabilities). Further to explore how inequalities...

Prescribing buprenorphine for opioid use disorder in primary care: A survey of French general practitioners in the Sentinelles network

IntroductionAlthough opioid substitution coverage in France is high and patient care with buprenorphine is mainly managed by general practitioners (GPs), buprenorphine sales have been decreasing since 2011, suggesting that French GPs are prescribing less buprenorphine. Yet this possible change in GP practices has not yet been investigated. This study aimed to examine primary care GPs' opinions about buprenorphine and habits related to prescribing buprenorphine. MethodsThe study team conducted a cross-sectional survey from March 2021 to July 2021 among a sample of GPs in the Sentinelles network, a French epidemiologic surveillance system based on primary care practitioners. The study collected information about substance use disorder (SUD) training, opinions on buprenorphine, and habits related to buprenorphine prescription were collected (initiation and renewal within the past two years). FindingsAmong the 237 participants (34 % response rate), 15.2 % reported having had specific training for SUD management. A majority reported a very positive (16 %) or positive (63.7 %) opinion of buprenorphine. Most participants agreed (61.2 %) or strongly agreed (31.2 %) that buprenorphine was efficacious in the treatment of illicit opioid use disorder. Of the 206 GPs who reported having treated patients with opioid use disorder in the past two years, 47 (22.8 %) had initiated a buprenorphine prescription, whereas 177 (85.9 %) had renewed a buprenorphine prescription. Previous SUD training was associated with initiating buprenorphine (OR 4.66; 95 % CI [2.15–10.08]), while female gender was associated with not initiating buprenorphine prescribing (OR 0.46; 95 % CI [0.22–0.98]). ConclusionA sample of French GPs who work in primary care has a positive view of buprenorphine, but the absence of SUD training among this population may be a barrier to their prescribing buprenorphine.