Survey Of General Practitioners Research Articles

Use of thromboprophylaxis guidelines and risk stratification tools in atrial fibrillation: A survey of general practitioners in Australia

Use of thromboprophylaxis guidelines and risk stratification tools in atrial fibrillation: A survey of general practitioners in Australia

Insomnia: Recent Advances in Genetic Aspects and Therapies

Insomnia has a significant global incidence rate. Previous observational studies, general practitioner surveys, and medical trials suggest that a variety of patient and physician factors are associated with this, including low patient reporting of insomnia, limited healthcare professional training, office-based time constraints, and misconceptions about the seriousness of insomnia, treatment benefits, and the risks associated with hypnotic use. Here, we discuss the recently studied genetic aspects of insomnia pathogenesis and the orexin system and acupuncture as potential therapeutic strategies.

Management of cough in Canadian primary care and specialty practices: A survey of current knowledge of clinicians and allied health professionals

RATIONALE Cough is one of the most common causes for medical consultation. However, we do not know whether its management is optimal in Canada. Although guidelines are available, awareness of these and implementation of their recommendations are uncertain. OBJECTIVE The objective of this research was to evaluate the diagnostic approach and management of cough, as well as knowledge of cough guidelines in Canada. METHODS A cross-sectional online survey of general practitioners (GPs), specialists (SPs) and allied health professionals (AHPs) was conducted anonymously in Canada. Participants answered multiple-choice questions on etiology, diagnosis, follow-up and treatment (only physicians) of cough and knowledge and application of cough guidelines. MEASUREMENTS AND MAIN RESULTS A total of 248 respondents completed the survey (43 GPs, 27 SPs, and 178 AHPs). In the investigation of a patient with chronic cough, a chest radiograph was the most common test ordered by physicians (GPs: 51.2%, SPs: 59.3%) and spirometry with bronchodilator reversibility (61.2%) by AHPs. GPs most often treated cough of unknown etiology with combined inhaled corticosteroid (ICS)-long-acting β2-agonist (LABA) (25.8%) and SPs with a nasal corticosteroid (NCS)(29.8%). NCS was also the most often prescribed treatment for cough considered originating in the upper respiratory tract (GPs: 60.4%, SPs: 76.2%). When cough was believed to be due to asthma or gastroesophageal reflux disease, treatment was appropriate in most cases. Awareness of current cough guidelines content was poor in all groups (GPs: 14.0%, SPs: 51.9%, AHPs: 26.6%). CONCLUSIONS Physicians and AHPs’ knowledge and application of guidelines for the management of chronic cough remains poor.

General practice care following acute exacerbations of COPD: A survey of Australian general practitioners.

Acute exacerbations of COPD (AECOPDs) are one of the leading causes of preventable hospital admissions in Australia. Exacerbations are the strongest predictor for future exacerbations. The period immediately following an exacerbation is a high-risk period for recurrence and critical time to intervene. The aim of this study was to identify current general practice care for patients following an AECOPD in Australia and gain insights into knowledge of evidence-based care. A cross-sectional survey was created and disseminated electronically to Australian general practitioners (GPs). Data were analysed descriptively. Comparisons between groups were made using Chi squared tests. From 64 responses, 47% were familiar with the COPD-X Plan. Only 50% described reviewing patients within seven days of discharge mostly related to a lack of awareness of the hospital admission. 50% of surveyed GPs reported hospital discharge summaries did not provide the information they required. Smoking, immunisation and medications were regularly assessed by >90% respondents at follow-up visits, while referrals to pulmonary rehabilitation, and evaluation of spirometry and oxygen therapy were not prioritised. GPs appear to require support to increase their familiarity with COPD guidelines and inform evidence-based clinical practice. The handover/communication process from hospital to primary care appears an important area for future improvement.

Follow-up survey of general practitioners in Zhejiang Province post-completion of position transition training in 2017–2020

BackgroundPosition transition training for general practitioners in Zhejiang Province started in 2017 and has since been held once a year. By the beginning of 2022, four training sessions were completed. The purpose of this survey was to establish the current situation of trainees after their graduation and provide reference for the evaluation of the training effect.MethodsOf the 738 trainees who completed the training, 253 were contacted and followed up. A self-designed questionnaire was used to conduct the survey through online filling in. The content included questions to elucidate the following information: whereabouts after the training, registration as a general practitioner, undertaken general practice teaching and scientific research work, current occupational environment, improvement of post competence after receiving position transition training, willingness to complete survey, willingness to participate in future training programs, etc.ResultsA number of 253 valid questionnaires were collected with a recovery rate of 100%. Notably, 93.68% of the participants successfully completed their training and obtained the Training Certificate of General Practitioners. Further, 83.4% were registered as general practitioners, 82.94% of which added on the basis of the original registered scope of practice. Currently, most of them work in primary health care institutions, primarily occupied with medical treatment, chronic disease management, COVID-19 prevention and control, health education, and prevention and health care. Of them, 27.01% were currently undertaking teaching work, and only 3.32% of them were conducting scientific research work related to general practice. The overall satisfaction of the trainees in the three theoretical training bases was above 90%, with no statistically significant difference among them (P > 0.05). Importantly, 84.11% of the followed-up personnel hoped to continue to participate in similar training in the future to improve their general practitioner core competences.ConclusionThe position transition training in Zhejiang Province has achieved good results, but the details of training and the implementation of policies in individual regions need to be improved. Most of the graduates were willing to continue their education, especially in general practitioners with special interests.

Acceptance of Teledermatology: Results of a Survey of General Practitioners and Dermatologists in Saxony (Germany)

The aim of this study was to investigate acceptance and intention to use teledermatological application by means of a survey of general practitioners and dermatologists in Saxony (Germany). Considering the demographic development in Saxony and the low regional density of medical specialists, this federal state is particularly well suited for conducting a survey dealing with telemedicine. Based on a stratified random selection, 108 physicians were interviewed via self-administered postal or online questionnaire (60 general practitioners and 48 dermatologists, response rate: 23.5%). The theory of acceptance and use of technology (UTAUT) was applied to teledermatology. Four central hypotheses were deduced and tested with logistic regressions. The tested hypotheses postulating relationships between performance expectancy, effort expectancy, social influence and facilitating conditions and the intention to use teledermatology were partly confirmed. In addition, teledermatology was shown to have potential among Saxon general practitioners, as 9.5% of their patients came to the medical office for treatment of skin diseases; 78% of general practitioners offered skin cancer screenings. The population structure and the low density of medical specialists in Saxony would be favourable prerequisites for the implementation of teledermatology. Survey results failed to show any reservations of general practitioners and dermatologists towards teledermatology.

Primary and Community Care Transformation in Post-COVID Era: Nationwide General Practitioner Survey.

The health emergency caused by COVID-19 has led to substantial changes in the usual working system of primary healthcare centers and in relations with users. The Catalan Society of Family and Community Medicine designed a survey that aimed to collect the opinions and facilitate the participation of its partners on what the future work model of general practitioners (GPs) should look like post-COVID-19. Online survey of Family and Community Medicine members consisting of filiation data, 22 Likert-type multiple-choice questions grouped in five thematic axes, and a free text question. The number of respondents to the questionnaire was 1051 (22.6% of all members): 83.2% said they spent excessive time on bureaucratic tasks; 91.8% were against call center systems; 66% believed that home care is the responsibility of every family doctor; 77.5% supported continuity of care as a fundamental value of patient-centered care; and >90% defended the contracting of complementary tests and first hospital visits from primary healthcare (PHC). The survey responses describe a strong consensus on the identity and competencies of the GP and on the needs of and the threats to the PHC system. The demand for an increase in health resources, greater professional leadership, elimination of bureaucracy, an increase in the number of health professionals, and greater management autonomy, are the axes towards which a new era in PHC should be directed.

Exploring patients' advance care planning needs during the annual 75+ health assessment: survey of Australian GPs' views and current practice.

The 75+ health assessment has been identified as a suitable trigger to introduce advance care planning (ACP) to general practice patients. Australian general practitioners (GPs) were surveyed to explore their perceptions, attitudes and practices in introducing ACP during 75+ health assessments. A cross-sectional postal survey of Australian GPs covering their personal, professional and workplace characteristics, their current practice regarding ACP within a 75+ health assessment, and their attitude towards ACP. Multivariate logistic regression was used to analyse the factors associated with routinely discussing ACP as part of the 75+ health assessment. A total of 185 (19.2%) out of 964 eligible GPs returned a completed survey. Most GPs reported that patients interested in ACP were supported by the GPs or the practice nurse. Two factors, (1) attitude that ACP is an essential component of the 75+ health assessment, and (2) regional or rural location of the practice, had a statistically and clinically significant association with the GP's self-reported discussion of ACP during 75+ health assessments. GPs showed a high level of support and involvement in discussing ACP during 75+ health assessments. ACP support during 75+ health assessments was often provided directly by the GP or via the practice nurse. Given the international evidence that ACP training programs improve skills and knowledge, and foster positive attitudes towards ACP, there is an important need to continue funding ACP training programs for GPs and practice nurses.

General practitioners' perspectives on discharge summaries from a health network of three hospitals in South Australia.

ObjectivesTo explore general practitioners' perspectives on the discharge summaries they receive about their patients who have been discharged from hospital.MethodsA survey of general practitioners in the catchment of a major metropolitan South Australian health service consisting of three teaching hospitals was undertaken. Surveys were disseminated electronically and via hardcopy mailout to general practitioners. The 36-question survey focused on five constructs of discharge summaries: accessibility, length and clarity, format, transparency, and medicines content.ResultsA total of 150 general practitioners responded (response rate, 27.6%). Respondents were vocationally registered (96%), predominately from metropolitan practices (90.2%), and 65.8% were female. Overwhelmingly, 86.7% of general practitioners stated that the optimal time for receipt of discharge summaries was <48 h post-discharge, and 96.6% considered that late arrival of discharge summaries adversely impacts patient care. The ideal length of discharge summaries was reported as <4 pages by 64% of respondents. A large proportion of respondents (84.6%) would like to be notified when their patients are admitted and discharged from hospital, and 82.7% were supportive of patients receiving their own copy of the discharge summary. A total of 76.7% general practitioners reported that they had detected omissions or discrepancies in the discharge summaries. Provision of rationale for medication changes was viewed as important by 86.7%, however, only 29.3% reported that it is always or often communicated.ConclusionsGeneral practitioners supported timely receipt, concise length of discharge summary and format refinement to improve the utility and communication of this important clinical handover from hospital to community care.

Experimental system of care coordination for the home return of patients with metastatic cancer: a survey of general practitioners

BackgroundTo promote improved coordination between general practice and hospital, the French clinical trial CREDO (“Concertation de REtour à DOmicile”) is testing an innovative experimental consultation for patients with metastatic cancer who are returning home. This consultation involves the patient, the patient’s referring GP (GPref) and a GP with specific skills in oncology (GPonc) in a specialized care center. The objective of our study is to explore the satisfaction of GPsref about this consultation, in the phase of interaction between GPonc and GPref.MethodsThis observational, cross-sectional, multicenter study explored the satisfaction of GPsref who had participated in this type of consultation, via a telephone survey.ResultsOne Hundred GPsref responded to the questionnaire between April and September 2019 (overall response rate: 55%). 84.5% were satisfied with the consultation, and the majority were satisfied with its methods. Half of the GPsref learned new information during the consultation, three-quarters noted an impact on their practice, and 94.4% thought that this type of coordination between the GPref and the oncology specialist could improve general practice - hospital coordination.ConclusionsFor GPs, the CREDO consultation seems to be practical and effective in improving the coordination between general medicine and hospital. GPs would benefit from such coordination for all patients with cancer, several times during follow-up and at each occurrence of a medically significant event.

Evaluation of an intervention to improve the safety of medication therapy via HIT-supported interprofessional cooperation in long-term care – a mixed method study

BackgroundIn order to ensure the provision of appropriate and safe medication therapy in long-term care, close interprofessional cooperation and high levels of expertise are required. Online digital documentation and communication technology facilitate this process. The aim of the present study (sub-study 2 of the SiMbA-Study) was to evaluate a three-part health information technology (HIT) driven intervention on medication therapy safety in Austrian nursing homes (NHs) regarding its usefulness, practicability and implementation in routine care.MethodsA concurrent embedded mixed-methods design was conducted to evaluate the intervention. Data was collected via expert interviews, focus group discussions and quantitative survey of general practitioners, nurses, and pharmacists in 3 NHs. Usefulness and effectiveness of the intervention were investigated through summative evaluation. Formative evaluation was utilized to gain insights regarding features and factors of the implementation process necessary to a successful integration in routine care.ResultsThe sample comprised general practitioners, pharmacists, and nurses. 23 participants were interviewed, of which 17 participated in the focus group discussions and completed the quantitative Survey. All components of the intervention were deemed to be useful and effective. Effort and benefit of using health information technology were well balanced. Implementation success was mainly attributed to socio-normative factors.ConclusionsThe implementation of HIT-based measures can be effective but is prone to various pitfalls that are highlighted in the study. A critical challenge for successful implementation is the combination of both, ensuring its prerequisites, while anticipating new problems that arise from HIT-integration on the one hand and changes in interprofessional cooperation on the other.Trial registrationDRKS Data Management, ID: DRKS00012246. Registered 16.05.2017 – Retrospectively registered.

Throat infections and use of streptococcal antigen test and antibiotic treatment in general practice; a web-based survey

Objective The aim of this study was to investigate the use of streptococcal antigen tests and antibiotic prescription in general practice in Norway in relation to the national guidelines for sore throat. Design This study was based on a web-based survey. Setting Norwegian general practice. Subjects 4700 members of the Norwegian College of General Practice received the survey by E-mail. Main outcome measures General practitioner (GP) adherence to national guidelines. Results In total, 807 GPs responded and were included in the study. According to the guidelines, 20% and 30% of the GPs would perform unnecessary streptococcal antigen testing when presented with mild and severe infections respectively, while 52% would not perform the test at moderate infection. Phenoxymethylpenicillin was recommended by 95% of the GPs. Conclusion In this survey of self-selected GPs, we identified some non-adherence to National guidelines for streptococcal antigen testing and antibiotic prescribing. However, when antibiotic treatment was offered, the correct antibiotics were prescribed. Key points Norwegian guidelines for diagnosis and treatment of throat infections include the use of Centor criteria as a clinical tool to limit the unnecessary use of antibiotics. In this web-based survey, we investigated the use of streptococcal antigen tests and antibiotic prescription in general practice in relation to the national guidelines. •Streptococcal antigen tests were not always performed according to Norwegian guidelines, causing inappropriate antibiotic prescribing. •National guidelines were followed in the choice of antibiotics for sore throat.

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.

A Novel GPPAS Model: Guiding the Implementation of Antimicrobial Stewardship in Primary Care Utilising Collaboration between General Practitioners and Community Pharmacists.

Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is central to implement antimicrobial stewardship (AMS) programmes in primary care. This study aimed to design a GP/pharmacist antimicrobial stewardship (GPPAS) model for primary care in Australia. An exploratory study design was followed that included seven studies conducted from 2017 to 2021 for the development of the GPPAS model. We generated secondary and primary evidence through a systematic review, a scoping review, a rapid review, nationwide surveys of Australian GPs and CPs including qualitative components, and a pilot study of a GPPAS submodel. All study evidence was synthesised, reviewed, merged, and triangulated to design the prototype GPPAS model using a Systems Engineering Initiative for Patient Safety theoretical framework. The secondary evidence provided effective GPPAS interventions, and the primary evidence identified GP/CP interprofessional issues, challenges, and future needs for implementing GPPAS interventions. The framework of the GPPAS model informed five GPPAS implementation submodels to foster implementation of AMS education program, antimicrobial audits, diagnostic stewardship, delayed prescribing, and routine review of antimicrobial prescriptions, through improved GP–CP collaboration. The GPPAS model could be used globally as a guide for GPs and CPs to collaboratively optimise antimicrobial use in primary care. Implementation studies on the GPPAS model and submodels are required to integrate the GPPAS model into GP/pharmacist interprofessional care models in Australia for improving AMS in routine primary care.

Assessing and addressing diabetes distress among adults with type 2 diabetes: An online survey of Australian general practitioners

AimDiabetes distress is experienced by up to 36% of adults with type 2 diabetes. Australian type 2 diabetes guidelines recommend annual assessment of diabetes distress in general practice. This study explores general practitioners' knowledge, current practice, and factors influencing implementation of guidelines, including Person Reported Outcome Measure (PROM) use. MethodsA cross-sectional online survey was disseminated via e-mail to 4776 Australian general practitioners listed on the Australasian Medical Publishing Company database. Results264 (5%) surveys were returned. 75% indicated that general practitioners were the most appropriate professionals to assess diabetes distress. Sixteen percent reported asking about diabetes distress during type 2 diabetes consultations more than half the time, with 13% using a PROM more than half the time: 64% use the Kessler-10, and 1.9% use the Problem Areas in Diabetes (PAID) scale. While general practitioners had positive beliefs about the consequences of assessing and addressing diabetes distress, they also reported barriers in motivation, environment, and knowledge of guidelines. ConclusionMost respondents endorsed general practitioners’ role in assessing diabetes distress, but few ask about or assess diabetes distress in routine consultations. To support uptake of guideline recommendations for diabetes-specific PROM use, environmental factors, specifically time, need to be addressed.

Task sharing in an interprofessional medication management program – a survey of general practitioners and community pharmacists

BackgroundPharmacist-led medication review and medication management programs (MMP) are well-known strategies to improve medication safety and effectiveness. If performed interprofessionally, outcomes might even improve. However, little is known about task sharing in interprofessional MMP, in which general practitioners (GPs) and community pharmacists (CPs) collaboratively perform medication reviews and continuously follow-up on patients with designated medical and pharmaceutical tasks, respectively. In 2016, ARMIN (Arzneimittelinitiative Sachsen-Thüringen) an interprofessional MMP was launched in two German federal states, Saxony and Thuringia. The aim of this study was to understand how GPs and CPs share tasks in MMP when reviewing the patients’ medication.MethodsThis was a cross-sectional postal survey among GPs and CPs who participated in the MMP. Participants were asked who completed which MMP tasks, e.g., checking drug-drug interactions, dosing, and side effects. In total, 15 MMP tasks were surveyed using a 5-point Likert scale ranging from “I complete this task alone” to “GP/CP completes this task alone”. The study was conducted between 11/2020 and 04/2021. Data was analyzed using descriptive statistics.ResultsIn total, 114/165 (69.1%) GPs and 166/243 (68.3%) CPs returned a questionnaire. The majority of GPs and CPs reported (i) checking clinical parameters and medication overuse and underuse to be completed by GPs, (ii) checking storage conditions of drugs and initial compilation of the patient’s medication including brown bag review being mostly performed by CPs, and (iii) checking side-effects, non-adherence, and continuous updating of the medication list were carried out jointly. The responses differed most for problems with self-medication and adding and removing over-the-counter medicines from the medication list. In addition, the responses revealed that some MMP tasks were not sufficiently performed by either GPs or CPs.ConclusionsBoth GPs’ and CPs’ expertise are needed to perform MMP as comprehensively as possible. Future studies should explore how GPs and CPs can complement each other in MMP most efficiently.

Development and Use of a Cardiac Clinical Guideline Mobile App in Australia: Acceptability and Multi-Methods Study.

BackgroundImplementation of clinical guidelines into routine practice remains highly variable. Strategies to increase guideline uptake include developing digital tools and mobile apps for use in clinical practice. The National Heart Foundation of Australia in collaboration with the Cardiac Society of Australia and New Zealand published 3 key cardiac clinical guidelines, including the Australian clinical guidelines for the (1) prevention and detection of atrial fibrillation, (2) detection and management of heart failure, and (3) management of acute coronary syndromes. To improve access and uptake for health care providers, we developed the Smart Heart Guideline App.ObjectiveThis study aims to evaluate the acceptability, implementation, and usability of an Australian-specific cardiac guidelines mobile app.MethodsWe used an iterative multiple methods development and implementation approach. First, we conducted a cross-sectional web-based survey with end users (n=504 health professionals) in 2017 to determine the acceptability of an Australian-specific cardiac clinical guidelines mobile app. Second, the Smart Heart Guidelines app was created using a design, user testing, and revision process. The app includes interactive algorithms and flowcharts to inform diagnosis and management at the point of care. The freely available app was launched in October 2019 on iOS and Android operating systems and promoted and implemented using multiple methods. Third, data from 2 annual national cross-sectional general practitioner (GP) surveys in 2019 and 2020 were evaluated to understand the awareness and use of the clinical guidelines and the app. Fourth, data from the app stores were analyzed between October 1, 2019, and June 30, 2021, to evaluate usage.ResultsMost health professionals surveyed (447/504, 89%) reported accessing resources electronically, and most (318/504, 63%) reported that they would use an Australian-specific cardiac guidelines app. GPs surveyed in 2019 were aware of the heart failure (159/312, 51%) and atrial fibrillation (140/312, 45%) guidelines, and in 2020, a total of 34 of 189 (18%) reported that they were aware of the app. The app was downloaded 11,313 times (7483, 66% from the Apple App Store; 3830, 34% from Google Play) during the first 20-month period. Most downloads (6300/7483, 84%) were a result of searching for the app in the stores. Monthly download rates varied. App Store data showed that people used the app twice (on average 2.06 times) during the 20 months. Many (3256/3830, 85%) Android users deleted the app.ConclusionsHealth professionals supported the development of the Smart Heart Guidelines app. Although initial downloads were promising, the frequency of using the app was low and deletion rates were high. Further evaluation of users’ experience of the most and least useful components of the app is needed.

How do general practitioners test and treat gonococcal infections in the Australian Capital Territory? Implications for disease surveillance and control.

The incidence of Neisseria gonorrhoeae (gonorrhoea) and Treponema pallidum (syphilis) infections in the Australian Capital Territory (ACT) has increased since 2014 in people reporting heterosexual exposure. This population is more likely to present to general practice rather than to specialised sexual health clinics, with potential implications for disease surveillance and control. This study aimed to explore: conformity of self-reported clinical practice with sexually transmitted infection guidelines in general practice; gaps in sexual health knowledge and skills; and areas for improved support from ACT Health Communicable Disease Control. A cross-sectional survey of general practitioners (GPs) and nurse practitioners (NPs) practicing in the ACT was conducted in December 2020, using a 17-item questionnaire and semi-structured interviews. Twenty-three GPs and one NP returned completed surveys (response rate 5.3%); four GPs and one NP participated in interviews. In its complex setting of competing demands, GP practice may not always meet national guidelines. In response to clinical vignettes, although all GPs ordered investigations for gonorrhoea, only 25% of these met the gold-standard by including endocervical or vaginal swabs. With respect to assessing antimicrobial sensitivities to guide treatment, only 58% correctly reported following up a positive gonococcal polymerase chain reaction test with a culture. Around two-thirds of respondents (62.5%) identified the appropriate antibiotic therapy and 75% correctly identified the responsibility of the diagnosing clinician to discuss contact tracing with the patient. Suggestions for increased support focussed on education, communication efficiency, and providing a 'safety net' for follow up.

Clarification of increased liver values in primary care - Findings from a series of studies from a general practitioner and specialist perspective

In primary care, elevated liver values are often an incidental finding. In addition to observing symptoms, it is crucial for an effective clarification which liver values are included as indicators and when patients are referred for further diagnostics. It also depends on regular cooperation between general practitioner and specialist care level. So far, there has been a lack of reliable studies for German-speaking countries on the status quo with regard to the clarification of (unclear) elevated liver values in primary care. This overview article compresses the balance of an exploratory series of studies, the aim of which was to take stock of the general practitioner's diagnostics of (unclear) elevated liver values. Starting points for optimizing GP care are derived from the results. Between 2017 and 2021, four written surveys of general practitioners and gastroenterological specialists were carried out in different federal states. The present study review discusses the overall findings in a condensed manner at a higher level, but also deals with specific findings. When it comes to clarifying elevated liver values, there are various challenges and problems in general practitioner care. For example, GPs use widely different liver-associated laboratory parameters (95% γ-GT, 65% AST, 63% ALT) that are bundled in different clusters. In the case of elevated liver values, the majority of general practitioners prefer to wait in a controlled manner (66%), but often make use of direct and early referrals to specialists in everyday practice due to diagnostic uncertainties (40%). When working with gastroenterological specialists, there are various interface problems, which, among other things, are associated with the GP's preliminary clarification and the time of referral. Both GPs and specialists see the introduction of a structured, evidence-based diagnostic algorithm as an important approach for improving early detection and better coordination between the levels of care (80% respective 85%). It makes sense to take measures that contribute to the professionalization and standardization of general practitioner diagnostics and better structure cooperation with gastroenterological specialists. These include, for example, a broader range of training and advanced training formats, the development of a validated diagnostic pathway or the permanent establishment of a liver value-associated blood test as part of the check-up. The development of a well-founded GP-based guideline for the detection and handling of elevated liver values also appears advisable.

How do the working lives of general practitioners in rural areas compare with elsewhere in Scotland? Cross-sectional analysis of the Scottish School of Primary Care National GP Survey.

Like many countries around the world, Scotland faces a shortage of general practitioners (GPs) due to both recruitment and retention issues. Such workforce shortages are of particular concern in rural areas. There are many reasons why GPs are leaving general practice; however, satisfaction with working life is an important predictor of GP retention. It is important, therefore, to understand working life satisfaction of rural GPs. The purpose of this study was to compare the working lives and intentions to reduce work participation of rural GPs and GPs working elsewhere in Scotland. This study was a quantitative analysis of survey data from the Scottish School of Primary Care national working lives survey. GPs were classified as working in 'non-rural' or 'rural' practices based on the Scottish Government's rural binary classification system, and were compared using univariate and multivariate statistical analysis on four domains of working lives: job satisfaction, job stressors, positive and negative job attributes, and four intentions to reduce work participation: reducing working hours, working abroad, leaving direct patient care and leaving medical work entirely. A total of 2465 GPs returned the survey, giving a response rate of 56%. Three-hundred and forty seven GPs who returned the survey worked in practices in rural areas (14.1%). Rural GPs were more likely to do out-of-hours work (p<0.001), to have worked in their practice for fewer years (p=0.014), to work in single-GP partnerships (p<0.001), and to work in practices with smaller list sizes (p<0.001), than GPs in non-rural settings. Compared with GPs elsewhere, rural GPs reported higher mean job satisfaction (5.23 v 5.39, respectively; p<0.005), lower mean job stressors (3.58 v 3.29; p<0.001) and lower mean negative job attributes (4.08 vs 3.78; p<0.001). These differences remained highly significant after controlling for potential confounders (age, gender and the differences in work practices shown above). In regression analysis, a significant interaction was found between gender and rurality for job satisfaction (p=0.008), which indicated that rural female GPs' higher job satisfaction mainly accounted for rural GPs' increased job satisfaction. No significant interaction was found between gender and rurality for the other domains of working lives. Compared with GPs elsewhere, however, rural GPs were more likely to intend to work abroad (mean 1.39 v 1.55; p=0.013) and leave medical work entirely within 5 years (mean 2.15 v 2.36; p=0.039). These intentions remained significant after controlling for potential confounders. No significant interaction was found between gender and rurality for variables for intentions to reduce work participation. Rural GPs in Scotland are more satisfied with their working lives than GPs working elsewhere in Scotland, which is mainly due to higher job satisfaction in female GPs in rural areas. Despite this, rural GPs as a whole have a higher intention to leave their job in the next 5 years than their non-rural counterparts. Although some of these differences are small, they may signal serious implications for the future care of patients in rural areas and require further research to understand the drivers of this.