Skills Of General Practitioners Research Articles

Evaluation of the McGill-Tongji Blended Education Program for Teacher Leaders in General Practice: The importance of partnership and contextualization in International Primary Care Training Initiatives.

Strong primary health care (PHC) systems require well-established PHC education systems to enhance the skills of general practitioners (GPs). However, the literature on the experiences of international collaboration in primary care education in low- and middle-income countries remains limited. The purpose of this study was to evaluate the implementation and perceived impact of the McGill-Tongji Blended Education Program for Teacher Leaders in General Practice (referred to as the "Tongji Program"). In 2020-2021, the McGill Department of Family Medicine (Montreal, Canada) and Tongji University School of Medicine (TUSM,Shanghai, China) jointly implemented the Tongji Program in Shanghai, China to improve the teaching capacity of PHC teachers. We conducted an exploratory longitudinal case study with a mixed methods design for the evaluation. Quantitative (QUAN) data was collected through questionnaire surveys and qualitative (QUAL) data was collected through focus group discussions. The evaluation showed that learners in Tongji Program were primarily female GPs (21/22，95%) with less than 4 years of experience in teaching (16/22，73%). This program was considered a successful learning experience by most participants (19/22, 86%) with higher order learning tasks such as critical thinking and problem-solving. They also agreed that this program helped them feel more prepared to teach (21/22，95%), and developed a positive attitude toward primary care (21/22，95%). The QUAL interview revealed that both the Tongji and McGill organizers noted that TUSM showed strong leadership in organization, education, and coordination. Both students and teachers agreed that by adapting training content into contextualized delivery formats and settings, the Tongji Program successfully overcame language and technology barriers. Committed partnerships and contextualization were key to the success of the Tongji Program. Future research should focus on how international primary care education programs affect learners' behavior in their practice settings, and explore barriers and facilitators to change.

The Feasibility of an Educational Course for General Practitioners on Otolaryngologic Morbidity.

Objective To test feasibility by enhancing the knowledge and skills of general practitioners (GPs) in managing ear, nose, and throat (ENT) morbidity within primary care settingsthrough a three-hour educational course. Methods A structured course focused on common ENT disorders was conducted. Case morbidity was selected based on appropriate criteria. The participants (n=34) were GPs randomly assigned to control and intervention groups. A questionnaire assessed knowledge, attitudes, and practices (KAP)before and after the course using proper analysis. Results The intervention group showed significant improvement in responses within five of sixteen questions (p<0.05). Participants demonstrated greater knowledge responsiveness in relation to epistaxis and CENTOR criteria, while knowledge response improvement was poor in regard to vestibular morbidity. Overall improvement in KAP scores (p<0.05), with high effect sizes, was achieved before and after the seminar. Conclusions The three-hour ENT course for GPs was found to be feasible, emphasizing the need for targeted short-duration courses within GP educationsupported by locally relevant information on common ENT conditions. Future research should explore the long-term impact of similar collaborative interventions in primary care.

Norwegian general practitioners’ perceptions of their depression care – a national survey

BackgroundThe General Practitioner (GP) is often the first professional contact for patients with depression. Depression care constitutes a substantial part of GPs’ workload.ObjectiveTo assess how GPs experience their patients’ expectations and their own provision of depression care; further, how their depression care was associated with doctor- and practice-characteristics.MethodsA cross-sectional questionnaire study about depression care in general practice among the GPs in the Norwegian Physician Survey of 2021.ResultsOf the 221 responding GPs, 50% were female and 70% agreed to have constant time pressure due to workload. The GPs believed that patients with depression were interested in their professional assessment (87.2%) and saw them as providers of talking therapy (76,9%). Still, 77,8% of the GPs thought the patients expected a referral. Talking therapy was commonly provided (79.6%) along with consultations of more than 30 min (80.4%). The youngest age group and GPs with shorter patient lists spent more time. Most GPs (92.3%) considered their help to be of great benefit for depressed patients. However, one-fourth of the GPs did not feel competent in providing talking therapy, less frequently reported by the GPs aged 40–54 years.ConclusionsTalking therapy is commonly provided by GPs. However, there is a need to investigate what GP talking therapy implies, and to strengthen GP skills in this regard. Overall, the GPs experience their depression care to be useful for their patients, and do not de-prioritize this although they experience workload pressure.

Osteoporosis e-learning courses: A systematic review to develop a comprehensive virtual course for General Practitioners.

One of the key strategies for effective management of osteoporosis is training health care professionals on early diagnosis and treatment of osteoporosis according to a structured course. The aim was to investigate the e-learning courses on osteoporosis around the world in order to develop an online course on osteoporosis management for general practitioners (GPs). In this review, the Web of Science, Scopus, PubMed, Embase, and ERIC databases and the Google search engine were searched until March, 2021.Then, the contents of the eligible courses were extracted by two researchers independently and verified. After that, the content for an online course for GPs was developed and approved by a panel of experts constituted of endocrinologists, orthopedists, and other specialties involved in the management of osteoporosis to develop the final online course for GPs. In this review, 22 e-learning courses provided through 3 studies, and 19 websites were included. The content of the osteoporosis e-learning course was categorized into ten thematic categories including bone health, osteoporosis definitions and pathophysiology, prevention of osteoporosis, diagnosis of osteoporosis, fractures, non-pharmacological treatments, pharmacological treatments, treatment follow-up, postmenopausal considerations and hands-on work. The final modules for the osteoporosis e-learning contained five main categories, including bone measurement and fracture risk assessment, diagnosis of osteoporosis, clinical management, monitoring and follow-up, and sarcopenia. Through a systematic approach, we developed modules for e-learning of osteoporosis management, which can be used to improve knowledge and skills of GPs in their practice in our setting. The online version contains supplementary material available at 10.1007/s40200-023-01361-8.

Self-care behaviour among arterial hypertension patients: role of a general practitioner in Latvia

Abstract Background Engagement in self-care behaviours is a crucial part of arterial hypertension (AH) management. Yet, now patients practice self-care selectively and with low adherence. This study aimed to determine the association between patients’ experience with a general practitioner (GP) and positive self-care behaviours among people with arterial hypertension in Latvia. Methods A cross-sectional study of 950 participants aged 15-74 (median 62, 38.7% male) with AH from a population survey in Latvia in 2022 was conducted. Logistic regression was used to determine respondents’ experience with a GP (overall attitude, providing information and counselling on a lifestyle change) in relation to having positive self-care behaviour (use of medication, weight loss, physical activity (PA), salt intake, smoking cessation) adjusting for age, sex and education. Results Most of the participants reported being satisfied with their GP (94.1%) and the information provided about their disease (84.8-89.4%). Regular use of AH medications was reported by 83.6%, and lifestyle change attempts by 5.2-16.1%. Regular medication use increased by receiving information about complications of AH (aOR=4.43, p ≤ 0.001), and being satisfied with the provided information about the treatment plan (aOR=1.91, p = 0.011), and alternative treatment methods (aOR=2.21, p ≤ 0.001). Receiving advice to change eating habits increased adhering to a diet for weight loss (aOR=4.16, p ≤ 0.001), reducing salt intake (aOR=4.64, p ≤ 0.001), and increasing PA (aOR=4.33, p ≤ 0.001). Similarly, advice to increase PA or reduce weight was statistically significantly associated with other self-care behaviours. None of the factors had a statistically significant impact on smoking cessation. Conclusions Patients’ experiences with a GP are important factors in determining engagement in positive self-care behaviour regarding medication use, PA, and changes in eating habits. The GP's role in smoking cessation requires to be strengthened. Key messages • Arterial hypertension patients are more engaged in self-care when supported by a general practitioner. Yet patients are more focused on medication use than lifestyle change. • Strengthening the communication skills of general practitioners is crucial for improving the disease-related health literacy of arterial hypertension patients and their ability to practice self-care.

Dutch GPs' perspectives on addressing obesity: a qualitative study.

Early diagnosis and treatment of obesity in primary care may help to tackle the obesity pandemic. Nonetheless, GPs frequently fail to address obesity and demonstrate limited adherence to guidelines. To explore Dutch GPs' perspectives on addressing obesity regarding the following three target behaviours: discussing weight; diagnosing; and referring patients with obesity. A qualitative focus group study with Dutch GPs. Six focus groups were conducted with a purposive sample of 21 GPs. Thematic analysis was performed using deductive coding, according to the Theoretical Domains Framework (TDF). For discussing weight, the main barriers identified were a presented complaint unrelated to obesity (environmental context and resources), concerns about a negative response from the patient (beliefs about consequences), and worries about obesity being a sensitive subject to discuss (emotions). A long-term trustworthy relationship (social influences) facilitated discussing weight. For diagnosing patients with obesity, the main barriers were related to resources; for example, lack of (appropriate) measuring equipment and time (environmental context and resources). For referring patients with obesity, the main barriers were no referral options nearby (environmental context and resources), and doubts about the positive effects of the referral on weight change (beliefs about consequences). Different barriers for discussing weight, diagnosing, and referring patients with obesity were identified, underscoring the importance for tailored interventions to these specific behaviours. Improving knowledge and skills of GPs seems insufficient as this study showed that particular attention should be paid to establishing long-term relationships, addressing GPs' beliefs about consequences, and creating a supportive environment with sufficient time and resources.

Exploring behaviour change in general practice consultations: A realist approach.

While general practice involves supporting patients to modify their behaviour, General Practitioners (GPs) vary in their approach to behaviour change during consultations. We aimed to identify mechanisms supporting GPs to undertake successful behaviour change in consultations for people with T2DM by exploring (a) the role of GPs in behaviour change, (b) what happens in GP consultations that supports or impedes behaviour change and (c) how context moderates the behaviour change consultation. Semi-structured interviews with academic clinicians (n = 13), GPs (n = 7) and patients with T2DM (n = 16) across Australia. Data were analysed thematically using a realist evaluation approach. Perspectives about the role of GPs were highly variable, ranging from the provision of test results and information to a relational approach towards shared goals. A GP-patient relationship that includes collaboration, continuity and patient-driven care may contribute to a sense of successful change. Different patient and GP characteristics were perceived to moderate the effectiveness and experience of behaviour change consultations. When patient factors are recognised in consultations, a relational approach becomes possible and priorities around behaviour change, that might be missed in a transactional approach, can be identified. Therefore, GP skills for engaging patients are linked to a person-centred approach.

Factors influencing the translation of shared cancer follow-up care into clinical practice: a systematic review

BackgroundThe increasing incidence of cancer, coupled with improved survivorship, has increased demand for cancer follow-up care and the need to find alternative models of care. Shared cancer follow-up care in...

Communication skills of general practitioners in Nairobi, Kenya: a descriptive observational study.

High-quality primary care needs to be person-centred, and GPs must communicate effectively to ensure continuity and coordination of care. In Kenya, there is little knowledge about the quality of communication in consultations by GPs. To evaluate the quality of communication in consultations by GPs. Descriptive, observational study of 23 GP consultations in 13 private sector primary care facilities in Nairobi, Kenya. One consultation with a randomly selected adult patient was recorded per GP, and 16 communication skills evaluated with the Stellenbosch University Observation Tool (SUOT). A total percentage score was calculated per consultation, and compared with the GPs' demographics and the consultation complexity and duration using the Statistical Package for Social Sciences (SPSS, version 25). The GPs' median age was 30.0 years (interquartile range [IQR] 29.0-32.0) and median consultation time was 7.0 minutes (IQR 3.0-9.0). Median overall score was 64.3% (IQR 48.4-75.7). GPs demonstrated skills in gathering information, making and explaining the diagnosis, and suggesting appropriate management. GPs did not make an appropriate introduction, explore the context or patients' perspectives, allow shared decision making, or provide adequate safety netting. There was a positive correlation between the scores and duration of the consultations (r = 0.680; P = 0.001). The score was higher in consultations of moderate complexity (78.1, IQR 57.1-86.7) versus low complexity (52.2, IQR 45.1-66.6) (P = 0.012). Consultations were brief and biomedical by young GPs. GPs need further training in communication skills, particularly with regard to delivering person-centred consultations. Deploying family physicians to the primary care setting would also improve the overall quality of service delivery.

Clinical skills of general practitioners in Nairobi, Kenya: a cross-sectional study.

Quality service delivery in primary care requires motivated and competent health professionals. In the Kenyan private sector, GPs with no postgraduate training in family medicine offer primary care. There is a paucity of evidence on the ability of primary care providers to deliver comprehensive care and no such evidence is available for GPs practising in the private sector in Kenya. To evaluate GPs' training and experience in the skills required for comprehensive primary care. A cross-sectional descriptive survey in 13 primary care clinics in the private sector of Nairobi, Kenya. A questionnaire, originally designed for a national survey of primary care doctors in South Africa, was adapted. The study collected self-reported data on performance of clinical skills by 25 GPs. Data were analysed using the Statistical Package for Social Sciences (SPSS, version 25). GPs were mostly aged <40 years, with ≤10 years of experience, and there was an equal sex distribution. GPs reported moderate performance with adult health, communication and consultation, and clinical administration; and weak performance with emergencies, child health, surgery, ear, nose, and throat (ENT) and eyes, women's health, and orthopaedics. The GPs lacked training in specific skills such as proctoscopies, contraceptive devices, skin procedures, intra-articular injections, red reflex tests, and use of genograms. GPs lacked training and performed poorly in some of the essential skills required in primary care. Continuing professional development, training in family medicine, broadening the model of care, and deployment of family physicians to the clinics could improve care comprehensiveness.

The interface between primary care and care homes: General Practitioner experiences of working in care homes for older people.

Supporting residents in care homes for older people is an important, though little studied, aspect of the General Practitioner (GP) role. This study explored GPs' experiences of working to support older people living in care homes, and the challenges and facilitators to providing effective care in this unique practice environment. A qualitative online survey was shared with GPs in England via Twitter and through Named Doctor for Safeguarding networks. This was available from October 2019-March 2020 and was completed by 58 GPs. Responses were analysed using inductive Thematic Analysis. Participants highlighted the complexity of care home residents' health, with multiple long-term conditions frequently reported. Furthermore, dementia and communication difficulties meant the GPs were often reliant on communication with others (staff and families). GPs had to navigate multiple relationships within care homes, including with residents, staff/managers, families and other healthcare practitioners, all of whom could have competing perspectives and priorities. Gaining access to information about resident health could be challenging, and was affected by staff continuity/discontinuity; lack of Wi-Fi access was also common. Care home organisation of and support for the visit was important. We conclude that care home work requires GP skills to meet resident healthcare needs, as well as to navigate multiple relationships. GPs are often reliant on others; this has important implications, both risking marginalising the resident voice, and in respect of recognising and reporting abuse.

Burden of cerebral adrenoleukodystrophy on affected children and their families through the eyes of family caregivers

Aim: This research assessed the needs of family caregivers of children with cerebral adrenoleukodystrophy (cALD), focusing on the diagnostic process; the burden of the disease on the child and their caregiver’s quality of life; and the physical, social, psychological, professional, and financial impacts on the whole family. Methods: Family caregivers of children with cALD were recruited via the European Leukodystrophies Association International’s online platform, Leuconnect, to respond to a quantitative survey and a quality-of-life questionnaire and participate in a qualitative semi-structured interview. The questions focused on disease experience from onset to diagnosis and consequences on current life. Twelve family caregivers of 14 children were interviewed. Results: cALD diagnosis took an average of 16.5 months, and 8 of 12 children were misdiagnosed, with parents often describing a lack of listening from doctors. Caregivers described bedridden children whose poor quality of life correlated with a high Neurologic Function Score. On average, they needed to care for their children 7.7 h/day, with serious consequences for their employment, social life, and psychological state. Conclusion: Our interviews with family caregivers helped us to consider limiting diagnostic wandering by improving the skills of general practitioners and public knowledge of pathology. By gathering information on precise daily routines centered around a dependent child, we can better understand how to effectively support families by adapting not only the global care of the child but also to the following needs expressed for the entire family: better information, coordination of both care and administrative procedures, and real respite.

Os desafios para o ensino de emergências de psiquiatria em desastres e conflitos armados

Abstract: Introduction: The Mozambican population has been recurrently affected by traumatic situations due to natural (cyclones, droughts, floods) or man-made (armed conflicts) catastrophes, which can lead to the development of mental disorders that, if not identified and treated, result in severe sequelae and cause chronicity. Objectives: To promote a reflection on the inclusion of emergency psychiatric topics in natural disasters and armed conflicts in the disciplines or modules of psychiatry in undergraduate medical school courses in Mozambique. Methods: Narrative literature review carried out between April and June 2021, focusing on the research of articles and documents published on the virtual platforms Research4life, PubMed, Hifa-PT, Google Scholar and that address the topics of natural disasters and armed conflicts and the teaching of these topics to medical students in the discipline of psychiatry. Results: The inclusion of psychiatric emergencies in situations of natural disasters and armed conflicts in the medical course can provide general practitioners who work in primary health care with knowledge and skills to recognize and act in psychiatric emergencies caused by natural disasters and armed conflicts, taking into account the fact that the country currently has few doctors specialized in psychiatry. Final considerations: The adequacy of the organization and assistance in psychiatric emergencies to the population exposed to natural disasters and armed conflicts contributes to the resilience and protection of the mental health of the communities. In this article, we reflect on the challenge of incorporating the topics of psychiatric emergencies caused by exposure to natural disasters and armed conflicts as a contribution to improving the skills of general practitioners in responding to the pressing mental health demands of this vulnerable population.

DEVELOPMENT OF MOBILE ECG APPLICATION TO IMPROVE ECG INTERPRETATION SKILLS OF GENERAL PRACTITIONERS AND MEDICAL STUDENTS

ABSTRACT Background: Electrocardiogram (ECG) has become a crucial examination in the management of cardiac emergencies. Accordingly, improvement of ECG interpretation skills is mandatory for general practitioners as the front-liners in emergency cases. The Mobile ECG application was developed as mobile learning media to facilitate continuing improvement of ECG interpretation skills.Aims: This study aimed to investigate the impact of the Mobile ECG application toward ECG interpretation skills of general practitioners and medical students and evaluate its usability.Methods: A pilot quasi-experimental study was conducted in a 1-week timeframe using webinar and the Mobile ECG application. Subjects were recruited through consecutive sampling. They met the following criteria: 1) registered as general practitioners or medical students, 2) completed the basic ECG pre and post-tests, and 3) agreed to participate in the study. The Mobile ECG is a web-based application which consists of modules, quizzes, and gallery of ECG interpretations. Pre and post-test analysis and system usability scale (SUS) questionnaire were used to evaluate the impact and usability of the application.Results: A total of 252 subjects were recruited and 80.2% were general practitioners. There was a significant increase in post-test scores compared to pre-test (p=0.000) for all subjects. General practitioners significantly gained more score increment than medical students (1.08 vs 0.16, p=0.001). Based on the SUS score of 67.5, the application was marginally accepted by the users.Conclusion: To conclude, the implementation of the Mobile ECG application did improve basic ECG interpretation skills. According to the SUS score, this application still needs improvement.

Welcomeness for people with substance use disorders to general practice: a qualitative study.

Good primary care for people with substance use disorders (SUDs) is crucial given the high prevalence of SUDs and overdose deaths. To explore general practice care for people with a history of SUDs from the perspectives of women involved with the criminal justice system. Qualitative interview study with pre- and postrelease interviews, undertaken in Australian prisons and community settings. We utilized thematic analysis informed by constructivist grounded theory. We undertook 65 interviews with 39 women. Access to and experience of general practitioner (GP) care was affected by perceived welcomeness, decisions around disclosure, and consultation experiences related to medication prescription. Participants reported that they were not as welcome as other patients, welcome could be conditional on not disclosing SUDs or only requesting unrelated healthcare, and GPs did not always differentiate between past and current drug use. Participants perceived difficulty finding general practices where the potential benefit of disclosing SUDs outweighed the risks of stigmatized reactions and lack of GP skills and interest. Participants did not always recognize that care beyond physical health could occur in general practice. The pejorative implications of labelling patients as "doctor shoppers" were challenged by participants, as they considered it could be necessary to attend multiple GPs to find a welcoming practice. People with histories of SUDs do not uniformly experience welcomeness in general practice, perpetuating poor engagement in healthcare and poor outcomes related to SUDs. Programmes targeting prescription drug misuse through general practice should also promote welcomeness for people with SUDs.

Development of otoscopy skills among general practitioners: how to improve the effectiveness of training?

The article presents the results of research of theoretical knowledge and practical skills of general practitioners with more than 5 years of experience.&#x0D; The aim of the study is to assess the level of proficiency in otoscopy by General practitioners using a simulator, depending on various socio-demographic characteristics.&#x0D; Materials and methods. The study was conducted at the Department of family medicine of North-Western State Medical University named after I.I. Mechnikov. Doctors who agreed to participate in the project filled out a socio-demographic questionnaire, tests to test theoretical knowledge, for the level of proficiency in otoscopy, was evaluated using a checklist. Statistical analysis of the data was performed using the SPSS 22.0 program (SPSS Inc., Chicago, Illinois, USA). The study involved 24 General practitioners with more than 5 years of experience.&#x0D; Results. Analysis of the results showed that 66.7% of General practitioners rated their skill in otoscopy as satisfactory or higher, but only 54.1% were able to correctly perform 70% of the actions according to the checklist.&#x0D; Conclusions. 1. The level of theoretical knowledge in otoscopy among General practitioners with experience who took part in the study was quite low: 62.5% of respondents did not achieve satisfactory results. A low level of proficiency in otoscopy among General practitioners was also revealed when evaluating the performance of manipulation on the simulator only 20.8% of doctors correctly performed 80% of the actions according to the checklist. 2. Independent assessment of the level of proficiency in otoscopy in General practitioners is not a predictor of the success of its demonstration on the simulator in accordance with the checklist. 3. The level of proficiency in otoscopy in the study group of General practitioners did not have a statistically significant relationship with the basic level of theoretical knowledge, work experience and regular otoscopy in everyday practice.

Bayesian strategy selection identifies optimal solutions to complex problems using an example from GP prescribing

Complex health problems require multi-strategy, multi-target interventions. We present a method that uses machine learning techniques to choose optimal interventions from a set of possible interventions within a case study aiming to increase General Practitioner (GP) discussions of physical activity (PA) with their patients. Interventions were developed based on a causal loop diagram with 26 GPs across 13 clinics in Geelong, Australia. GPs prioritised eight from more than 80 potential interventions to increase GP discussion of PA with patients. Following a 2-week baseline, a multi-arm bandit algorithm was used to assign optimal strategies to GP clinics with the target outcome being GP PA discussion rates. The algorithm was updated weekly and the process iterated until the more promising strategies emerged (a duration of seven weeks). The top three performing strategies were continued for 3 weeks to improve the power of the hypothesis test of effectiveness for each strategy compared to baseline. GPs recorded a total of 11,176 conversations about PA. GPs identified 15 factors affecting GP PA discussion rates with patients including GP skills and awareness, fragmentation of care and fear of adverse outcomes. The two most effective strategies were correctly identified within seven weeks of the algorithm-based assignment of strategies. These were clinic reception staff providing PA information to patients at check in and PA screening questionnaires completed in the waiting room. This study demonstrates an efficient way to test and identify optimal strategies from multiple possible solutions.

Knowledge and practices of fundoscopy among general practitioners in Qassim Province, Saudi Arabia, for the management of diabetic retinopathy and diabetic macular edema: A cross-sectional study.

Objectives:Blindness is one of the most widespread final pathways of diabetic retinopathy and its associated diabetic macular edema. The general practitioners are the first to encounter these diabetic patients. Fundoscopy is now considered as an ideal way for the diagnosis of patients with diabetic retinopathy. Therefore, this study was undertaken to know the ability and skills of general practitioners for the diagnosis and management of patients with diabetic retinopathy and diabetic macular edema.Methods:This study was conducted in all major cities in Qassim province of Saudi Arabia during January to May 2017. A validated questionnaire was used to assess the general practitioners’ knowledge and practice for the management of diabetic retinopathy and diabetic macular edema. Questions related to referrals, diagnosis, and treatment options to diabetic retinopathy and diabetic macular edema were asked to the general practitioners.Results:Of 96 general practitioners, 76 returned the questionnaire with a response rate of 79.2%. Only 26.3% general practitioners referred patients with type 1 diabetes to ophthalmologists as per guidelines set by the American Academy of Ophthalmology, whereas 74% of general practitioners showed good knowledge for referring patients with type 2 diabetes to ophthalmology clinics. Lack of knowledge was also noticed for the treatment of diabetic retinopathy, as only 36.8% of general practitioners replied positive for dilated fundus examination option, whereas 78.9% of general practitioners chose laser photocoagulation as a treatment option. Similar response from them was observed for patients with diabetic macular edema. Furthermore, data also showed years in practice of general practitioners was well correlated with their knowledge for the management of diabetic retinopathy and diabetic macular edema.Conclusion:The general practitioners included in this study showed lack of knowledge in handling patients with diabetic retinopathy and diabetic macular edema. Therefore, refresher courses are needed that highlight the acquisition of their skills in fundoscopy.

Analysis of knowledge and clinical skill competition results in general practitioners attending grass-roots health post training

The knowledge and clinical skill competition scores of 331 general practitioners (GPs), who attended the grassroots health posts training in Sichuan Province and Chengdu Municipality in 2016 and 2017, were documented. The factors influencing the competition results were analyzed. The mean knowledge test score of 331 participants were higher than the clinical skill score [(76.89±6.56) vs. (54.13±10.91) , P 0.05). The levels of clinical skills of general practitioners at the grass-roots level need to be further improved, according to relevant influencing factors. Key words: General practitioner; Clinical knowledge; Clinical skill

Perceptions of insulin use in type 2 diabetes in primary care: a thematic synthesis

BackgroundIncreasing numbers of patients with type 2 diabetes mellitus are progressing to insulin therapy, and despite its potency many such individuals still have suboptimal glycaemic control. Insulin initiation and intensification is now often conducted by Practice Nurses and General Practitioners in many parts of the UK. Therefore, gaining insight into perspectives of patients and primary care clinicians is important in determining self-management and engagement with insulin. A thematic synthesis of studies was conducted exploring the views and experiences of people with type 2 diabetes and of healthcare professionals on insulin use and management in the context of primary care.MethodsProtocol based systematic searches of electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Web of Science) were performed on 1 October 2014 and updated on 31 March 2015, to identify studies that identified the views and experiences of adults with type 2 diabetes or primary care clinicians on the use of insulin in the management of type 2 diabetes. Studies meeting the review inclusion criteria were critically appraised using the CASP qualitative research checklist or Barley’s checklist for survey designs. A thematic synthesis was then conducted of the collected studies.ResultsThirty-four studies were selected. Of these, 12 used qualitative interviews (nine with patients and three with healthcare professionals) and 22 were survey based (14 with patients, three with healthcare professionals, and five with both). Twelve key themes were identified and formed three domains, patient perceptions, healthcare professional perceptions, and health professional-patient relationships. The patient-centred themes were: insulin-related beliefs, social influences, psychological factors, hypoglycaemia, and therapy barriers. The clinician-related themes were: insulin skills of general practitioners, healthcare integration, healthcare professional-perceived barriers, hypoglycaemia, and explanations for adherence. Healthcare professional-patient relationship themes were drawn from the perspectives of patients and from clinicians.ConclusionsThis review reveals multiple barriers to optimal insulin use in primary care at both the patient and healthcare professional levels. These barriers indicate the need for multimodal interventions to: improve the knowledge and competencies of primary care professionals in insulin use; provide more effective patient education and self-management support; and introduce integrated insulin support systems.