Training Of GPs Research Articles

A unified educational space for internists and general practitioners (family doctors) as a way to improve the quality of training

The article examines the implementation of the principle of educational space unity, ensuring the quality of education throughout the Russia. We also describe the interdependence of practical health care needs for primary care specialists capable of providing high-quality primary care and the functions of an integrated system of a unified educational space for internists and general practitioners (family doctors) (GPs) focused on the social order.Aim. To analyze the conceptual foundations of the system of a unified educational space for internists and GPs (family doctors) as ways to improve the quality of training of specialists.Material and methods. The following were used in this study: analysis of educational trends in the modern world and medical education in particular; structural and functional analysis in the study of legislation regulating the training of internists and GPs (family doctors); a system approach that defines the components of a unified educational space for in ternists and GPs (family doctors); a method for predicting changes in the de velopment of a unified educational space for internists and GPs (family doctors).Results. Having considered the potential capabilities of a unified educational space for internists and GPs (family doctors), the following were revealed: regulatory, social, educational, managerial factors influencing the training of internists and GPs (family doctors) were identified; strategies for the development of a unified educational space for internists and GPs (family doctors) were determined at the level of goals, content, processes, and results; the relationship between the training of internists and GPs (family doctors) and the needs of practical healthcare was established; the internal components and functions of a unified educational space for internists and GPs (family doctors) have been identified and substantiated, and the framework factors have been defined. A theoretical model of a unified educational space for internists and GPs (family doctors) has been created, including external factors, target, motivational, design, content, managerial and evaluative components, as well as planned results, manifested in the functions.Conclusion. To summarize, we can state the following: for effective and high-quality management training of internists and GPs (family doc tors), a unified educational space is of paramount importance, this will make it possible to preserve the best traditions of the country's therapeutic school and its future development.

A unified educational space for internists and general practitioners (family doctors) as a way to improve the quality of training

The article examines the implementation of the principle of educational space unity, ensuring the quality of education throughout the Russia. We also describe the interdependence of practical health care needs for primary care specialists capable of providing high-quality primary care and the functions of an integrated system of a unified educational space for internists and general practitioners (family doctors) (GPs) focused on the social order.Aim. To analyze the conceptual foundations of the system of a unified educational space for internists and GPs (family doctors) as ways to improve the quality of training of specialists.Material and methods. The following were used in this study: analysis of educational trends in the modern world and medical education in particular; structural and functional analysis in the study of legislation regulating the training of internists and GPs (family doctors); a system approach that defines the components of a unified educational space for in ternists and GPs (family doctors); a method for predicting changes in the de velopment of a unified educational space for internists and GPs (family doctors).Results. Having considered the potential capabilities of a unified educational space for internists and GPs (family doctors), the following were revealed: regulatory, social, educational, managerial factors influencing the training of internists and GPs (family doctors) were identified; strategies for the development of a unified educational space for internists and GPs (family doctors) were determined at the level of goals, content, processes, and results; the relationship between the training of internists and GPs (family doctors) and the needs of practical healthcare was established; the internal components and functions of a unified educational space for internists and GPs (family doctors) have been identified and substantiated, and the framework factors have been defined. A theoretical model of a unified educational space for internists and GPs (family doctors) has been created, including external factors, target, motivational, design, content, managerial and evaluative components, as well as planned results, manifested in the functions.Conclusion. To summarize, we can state the following: for effective and high-quality management training of internists and GPs (family doc tors), a unified educational space is of paramount importance, this will make it possible to preserve the best traditions of the country's therapeutic school and its future development.

'Beyond the Scale': A Qualitative Exploration of the Impact of Weight Stigma Experienced by Patients With Obesity in General Practice.

Obesity is a complex, chronic, relapsing disease that requires an individualised approach to treatment. However, weight stigma (WS) experienced in healthcare settings poses a significant barrier to achieving person-centred care for obesity. Understanding the experiences of people living with obesity (PwO) can inform interventions to reduce WS and optimise patient outcomes. This study explores how patients with obesity perceive WS in general practice settings; its impact on their psychological well-being and health behaviours, and the patients suggestions for mitigating it. In-depth semistructured interviews were conducted with 11 PwO who had experienced WS in general practice settings in Ireland. The interviews were conducted online via Zoom between May and August 2023; interviews lasted between 31 and 63 min (M = 34.36 min). Interviews were audio-recorded, transcribed verbatim and analysed using inductive reflexive thematic analysis. Three overarching themes specific to participants' experience of WS in general practice were generated: (1) shame, blame and 'failure'; (2) eat less, move more-the go-to treatment; (3) worthiness tied to compliance. A fourth theme: (4) the desire for a considered approach, outlines the participants' suggestions for reducing WS by improving the quality of patient-provider interactions in general practice. The findings call for a paradigm shift in the management of obesity in general practice: emphasising training for GPs in weight-sensitive communication and promoting respectful, collaborative, and individualised care to reduce WS and improve outcomes for people with obesity. PPI collaborators played an active and equal role in shaping the research, contributing to the development of the research questions, refining the interview schedule, identifying key themes in the data, and granting final approval to the submitted and published version of the study.

Patients' requests for radiological imaging: A qualitative study on general practitioners' perspectives.

With the increasing availability of information, patients are becoming more informed about radiology procedures and requesting imaging studies. This qualitative study aims to explore factors that influence general practitioners' (GPs) decisions to fulfil patient requests for imaging studies during clinical consultation. Semi-structured interviews were conducted with 10 GPs working across five private medical centres in Northwest Sydney. Conventional content analysis was used with emergent themes to identify GPs perspectives. Six themes stood out from the interviews with GPs fulfilling patient requests for imaging studies. They included four pertaining to patient factors: patient expectations, 'therapeutic scans', 'impressive labels' and entitled. Two further themes pertained to the GP perspective and included defensive medicine, and 'new patients'. Requests are fulfilled from anxious or health-obsessed patients, with GPs worrying about litigation if they refuse. However, GPs decline requests from patients with entitlement attitudes or during first visits. The findings suggest that GPs struggle to balance their responsibilities as gatekeepers of imaging with patients' expectations of request fulfilment. Clear guidelines on the appropriate use of diagnostic imaging and its limitations could help patients understand its proper use and ease anxiety. Additionally, education and training for GPs could help them manage patient expectations and provide appropriate care. Patients, service users, caregivers, people with lived experiences or members of the public were not directly involved in the design, conduct, analysis or interpretation of the study. However, our study was conducted in primary care facilities where the GPs were interviewed about patients' requests for diagnostic imaging based on their own initiatives. GPs' perspectives in managing patient expectations and healthcare utilisation were explored within the Australian Medicare system, where medical imaging and image-guided procedures come at little to no cost to the individual. The study findings contribute to a better understanding of the challenges faced by GPs in dealing with patient consumerism and requests for diagnostic imaging, as well as factors influencing request fulfilment or denial. Insights gained from this study may inform future research about delivering patient-centred care within a similar context.

Risks of delivering care by telephone or video in general practice: review of national complaints data.

Remote consulting was rolled out across general practice in 2020 in response to the COVID-19 pandemic. Although most consultations are carried out safely, there are some cases where remote care may contribute to adverse outcomes. To understand the risks of delivering care by telephone or video in general practice. The learning validation national summary of primary care complaints was obtained from NHS England for quarter 4, 2020-2021 to quarter 4, 2021-2022. A thematic analysis was performed on these cases by reviewer 1, with validation of themes by reviewer 2. Common areas of risk in relation to telephone and video consultations include repeated telephone consultations with the same patient, especially for patients with vague symptoms or those at high risk; a failure to review chronic problems face to face; failures of practice processes, failure to listen, for example, to a patient or relative saying that a face-to-face appointment is required; and over-confidence in diagnoses reached without physical examination. In children, risk related to inappropriate barriers to face-to-face consultation and a failure to recognise conditions requiring urgent treatment.Medical conditions that were more likely to result in harm, included breast lump, chest pain and breathing difficulties, abdominal symptoms, trauma, non-resolving skin problems, and palliative care. Analysis of complaints gives pointers for action on improving awareness and training for GPs and practice teams around risks when consulting remotely.

GP roles in emergency medical services: a systematic mapping review and narrative synthesis.

A significant proportion of emergency medical services (EMS) work is for problems that may be amenable to timely primary care management and could benefit from GP input. Utilising GPs in EMS may reduce avoidable emergency department (ED) conveyance, releasing emergency ambulances for higher-acuity care, and meeting patient needs earlier in the evolution of an emergency call. To collate and summarise evidence on how GPs are utilised in EMS. Systematic mapping review and narrative synthesis. A systematic literature search was conducted using search terms for general practice and emergency care. Primary research articles investigating the utilisation of GPs in non-critical EMS were included. An inductive framework was used to structure the results alongside a narrative synthesis. Twenty-one articles were included. GPs were embedded in EMS for urgent management of high-acuity patients or used as an intervention to avoid unnecessary ED conveyance in selected lower-acuity patients. The importance of interprofessional relationships and training for GPs involved in EMS was highlighted. No studies explored patient-reported outcomes. Outcomes measured were predominantly ED non-conveyance and admission avoidance, with GP services as an intervention reducing the likelihood of these outcomes. Embedding GPs in EMS might service different purposes depending on context. There is some evidence that GP EMS services may reduce the likelihood of ED conveyance and hospital admission in selected cases; it is unclear whether this is owing to case selection or GP involvement. Future research should incorporate patients' views and experiences.

Using a mixed method to identify communication skills training priorities for Chinese general practitioners in diabetes care

BackgroundIn China diabetes care is gradually shifting from secondary to primary care with great infrastructure investment and GP training. However, most GPs in China lack communication skills training, which is a huge obstacle in communication with their patients in primary care. In this study we seek to identify training priorities that is evidence-based, appropriate for the context of primary care in China, and that meet the real needs of both GPs and people with diabetes.MethodsA mixed method approach was used. A conceptual framework was designed based on the MRC framework, action research and adult learning theories. Through a systematic review of the literature and qualitative research with GPs and patients with diabetes, a list of communication skills training components was developed by the research team. A modified nominal group technique (NGT) with GPs was used to evaluate these contents. Purposive sampling was used to recruit a variation of participants (age, work area, practice years and education background) from general practices in Guangzhou city, China. Eight structured nominal groups were facilitated to elicit the views of group members, and participants rated the 9-point Likert scale of importance and feasibility of the training items independently, before and after focus groups. The ranking of each item was calculated, based on the mean Likert score ratings from all participants. Video recordings of four NGT group discussions were thematically analysed using the Framework Method to explore reasons for any differences in rating items.Results29 males and 29 female GPs from 28 general practices participated in NGT group discussions, with a mean age of 38.5 years and mean 12.3 years of practice experience. Based on the mean scores of importance and feasibility rating scores, the top 3 ranked priorities for communication training were ‘health education’ (importance 8.39, feasibility 7.67), ‘discussing and explaining blood glucose monitoring’ (8.31, 7.46), and ‘diabetes complications and cardiovascular disease risk communication’ (8.36, 7.12). Five main themes were identified from focus group discussions through qualitative analysis: ‘impact on diabetes patients’, ‘GP attitudes towards communication skills’, ‘patient-related factors influencing the application of communication skills by GPs, ‘local contextual factors’, and ‘training implementation’.ConclusionsPriorities for communication skills training for Chinese GPs in diabetes care were identified. These are set in the context of GPs’ current experience of communication with patients in China who have diabetes, which is often unsatisfactory. This study describes the baseline from which better primary care for diabetes in China needs to be developed. Based on suggestions from GPs themselves, it identifies an agenda for improvement in communication as a key component of diabetes care in China.

The GP’s perceived role and use of language concerning the existential dimension of palliative patients: a Dutch interview study

BackgroundPalliative patients have to cope with their disease and impending death. Knowing what this means for a patient is crucial for person-centred care. Although guidelines state it is a GP core task to explore existential issues of palliative patients, this is not standard practice.AimExploring Dutch GPs’ perceived role regarding addressing the existential dimension of palliative patients, and which vocabulary GPs use when doing this.Design and settingQualitative study amongst Dutch GPs. Participants were recruited by purposive sampling and snowballing, considering gender, working experience and ideological personal beliefs.MethodSemi-structured in-depth interviews were performed, transcribed and analysed using content analysis.ResultsSeventeen GPs participated. Three themes were identified: Language, Perceived role and Practice. Interviewees generally saw it as their role to pay attention to the existential dimension of palliative patients. However, not all knew how to define this role, or how to refer patients with existential struggles to a spiritual counsellor. The multidisciplinary Dutch guideline ‘Existential and Spiritual Aspects of Palliative Care’ seemed largely unknown. Interviewees mostly fulfilled their role in an intuitive, pragmatic way. Questions such as “What does it mean for you to be seriously ill?” or “Do you have support from someone or something?” fitted daily practice.ConclusionThis study emphasizes the importance of basic GP education in exploring existential issues. The coexistence of a professionally obliged attention and an intuitive approach seems to be in conflict. We recommend appropriate training for GPs, research on the potential enhancement of collaboration between GPs and spiritual counsellors and implementation of the relevant guideline on well-known platforms.

The Balint Group Experience for Forensic Mental Health Professionals

AimsBalint groups were initially set up to meet the needs of GPs in better understanding the emotional aspects of complex doctor-patient relationships. They have since been taken up in the training of psychiatrists, GPs, and medical students, having been shown to improve communication skills and sensitise participants to their own psychological processes. Working as a Care Coordinator in a Forensic Community team is a highly challenging role where, by definition, there is the spectre of risk of harm to others. There is very little published data on the use of Balint groups in nursing populations, even less so in the Forensic mental health setting. The aim of this project was to evaluate a longitudinal Balint group for mental health professionals in the Forensic service of Cambridge and Peterborough NHS Foundation Trust, and to report on the perceived benefits to attending in terms of personal and professional development.MethodsThe evaluation used a standardised mixed methods approach, with the sample consisting of members of the Forensic South Community Service Balint group n = 5. For the evaluation period the job roles were solely clinical nurse specialists, taking a snapshot of the group between September 2020 and January 2022. The group met monthly for one hour virtually, led by Dr Arends, a specialist registrar in psychiatry with appropriate training in Balint leadership. The format in sessions was in keeping with the Balint method, as per The Balint Society, emphasising confidentiality. Data were gathered via survey tool, adapted from the literature using Likert scales and white space questions to identify barriers and facilitators.ResultsParticipants scored the group highly across the board in terms of acceptability, clinical impact, and fidelity measures. Notably 60% strongly agreed and 40% agreed the group was a safe place to express and process anxieties and frustrations about their work. All participants either agreed or strongly agreed the group had changed the way they think and practice, and that they felt able to consider their clinical encounters in a new light.ConclusionFacilitators identified were of increased team working through cohesion and notably of increased appreciation for the functional and symbolic elements of the symptoms their patients presented with, suggesting that the value of the group existed in its providing of space to metabolise the often intense demands of Forensic patients, together and as a team. The main theme within barriers to the group processes were external in terms of other clinical demands requiring prioritisation.

An online survey and interview of GPs in the UK for assessing their satisfaction regarding the medical training curriculum and NICE guidelines for the management of menopause.

Background:The UK is home to 13 million menopausal women. The aim of this study was to determine the views of GPs on their levels of confidence and comfort when advising or treating menopausal women and assess the need for further training.Method:An anonymous online questionnaire was sent out to GPs working within the NHS across the UK between January 2021 and March 2021. The questionnaire was circulated via GP e-mail lists, Facebook, and LinkedIn, and included an option for respondents to volunteer for a semi-structured interview.Results:The questionnaire had 173 responses. 52% of GPs indicated that they were not offered enough support to be able to advise and treat women with menopausal symptoms appropriately. 77.5% of GPs expressed that there is a need to improve training provided on menopause in medical school and GP training. 60.7% of GPs felt comfortable managing menopausal women and offering them management options. 22.5% of the respondents felt that the NICE guidelines are easy and clear guidance for clinical practice. Five GPs were further interviewed, and the analysis of the responses showed the perceived need by the GPs for improvements in medical training regarding menopause.Conclusion:There is a need for better support and medical training for GPs to help them advice and treat women with menopausal symptoms. This is key for ensuring that every woman in the UK feels supported in their journey during the menopausal transition and is offered evidence-based advice to help them make informed decisions.

GPs' perspectives on diagnosing childhood urinary tract infections: a qualitative study.

BackgroundDiagnosis and management of childhood urinary tract infection (UTI) is challenging in general practice because of a range of factors.AimTo explore GPs’ perspectives concerning the barriers to and facilitators for diagnosis and management of childhood UTI.Design and settingQualitative study in general practice in Belgium.MethodSemi-structured interviews with 23 GPs from January 2021 to June 2021 were carried out. Interviews were video-recorded and audio-recorded, transcribed verbatim, and analysed using a thematic approach.ResultsThe barriers to early diagnosis of UTI were the assumption of low UTI prevalence and aspecific presentation of UTI in children, difficulties in urine collection, and diagnostic uncertainty. All GPs indicated that they sampled urine in either children with specific UTI features (for example, dysuria, abdominal pain) or unexplained fever. Facilitators for UTI screening were instructional material for parents, skill training for GPs, additional nursing staff, novel non-invasive convenient collection methods, online decision support informing parents when to bring a urine sample to the consultation, and an accurate, easy-to-use point-of-care test for UTI. Empirical antibiotic treatment was initiated based on dipstick test results, clinical features suggestive of UTI, severity of illness, gut feeling, long duration of fever, time of the day, and parents’ ability to judge disease severity.ConclusionThe assumption of a low UTI prevalence, absence of obvious UTI features, and difficult urine sampling might cause childhood UTIs to go undetected in general practice. Diagnostic uncertainty makes appropriate treatment challenging.

Nationwide implementation of online communication skills training to reduce overprescribing of antibiotics: a stepped-wedge cluster randomized trial in general practice.

ObjectivesPrimary care is responsible for a large proportion of unnecessary antibiotic use, which is one of the main drivers of antibiotic resistance. Randomized trials have found that online communication skills training for GPs reduces antibiotic prescribing for respiratory infections. This study assesses the real-world effect of implementing online communication skills training in general practice.MethodsIn a closed cohort stepped-wedge cluster randomized trial all Belgian GPs were invited to participate in online communication skills training courses (TRACE and INTRO) and provided with linked patient information booklets. The primary outcome was the antibiotic prescribing rate per 1000 patient contacts. Intention-to-treat and per protocol analyses were performed. Trial registration at ClinicalTrials.gov: NCT03265028.ResultsIn total, 118 487 observations from 10 375 GPs were included in the analysis. Overall, 299 (2.88%) GPs completed TRACE and 93 (0.90%) completed INTRO, 30 of which completed both. There was no effect of the national implementation of TRACE and INTRO on the population-level antibiotic prescribing rate (prescribing rate ratio [PRR] = 0.99 [95% CI: 0.97–1.02]). GPs who actually completed TRACE prescribed fewer antibiotic prescriptions (PRR = 0.93 [95% CI: 0.90–0.95]).ConclusionsInviting GPs to complete an online communication skills training course and providing them with the linked patient information booklets did not reduce antibiotic prescribing. However, GPs who completed TRACE prescribed 7% fewer antibiotics, especially during winter. This suggests a significant decrease in population-wide antibiotic consumption could be achieved by focusing on increasing the uptake of this intervention by identifying and overcoming barriers to participation.

Dermatological care of elderly people with psoriasis before and after entering a nursing home : A qualitative analysis from the perspective of medical providers

HintergrundDemografische Veränderungen bewirken einen steilen Anstieg der Anzahl der über 65-Jährigen. Damit verbunden ist die Zunahme der Anzahl pflegebedürftiger, multimorbid Erkrankter. National wie auch international gibt es keine Informationen insbesondere zur Versorgung von Psoriasiserkrankten im Setting Pflegeheim und zur Frage, wie diese durch den Eintritt in ein Pflegeheim beeinflusst wird.FragestellungZiel war es, anhand von Interviews bzw. Fokusgruppen die Ergebnisse vorausgehender Routinedatenanalysen zur Versorgung Psoriasiserkrankter in Pflegeheimen mit medizinischen Versorgern (Dermatologen, Allgemeinmediziner, Pflegedienstleitungen und Pflegekräfte) zu diskutieren, Schwierigkeiten der Versorgung aufzudecken und abschließend Handlungsempfehlungen für eine zukunftsfähige gerontodermatologische Versorgung abzuleiten.Material und MethodenDurchgeführt wurden qualitative Leitfaden-gestützte Interviews und Fokusgruppen mit Dermatologen (n = 5), Allgemeinmedizinern (n = 7), Pflegekräften (n = 7) und Pflegedienstleitungen (n = 2). Die Daten wurden inhaltsanalytisch ausgewertet.ErgebnisseDie Auswertung ergab insgesamt 344 Aussagen, die insgesamt 14 Hauptkategorien zugeordnet werden konnten. Die Ergebnisse zeigen, dass für die Versorgungsqualität von Menschen mit Hautkrankheiten, insbesondere Psoriasis, in Pflegeinrichtungen ein Verbesserungsbedarf besteht. Dieser zeigt sich sowohl auf ärztlicher als auch auf pflegerischer Ebene. Laut der Versorger (N = 21) kann dies insbesondere durch eine verstärkte digitale Versorgung, dermatologische Schulungen für Hausärzte und Pflegefachkräfte sowie engere Kooperationen zwischen den einzelnen Disziplinen adressiert werden.SchlussfolgerungDigitale Pflegekonsile, aber auch eine spezifische Leitlinie zur „Haut des alternden Menschen“ können von Nutzen sein, um die dermatologische Versorgungssituation im Pflegeheim zu verbessern und somit das Wohlbefinden der Betroffenen zu steigern.

The relationship between the quality of GPs training and the content of educational programs

This paper examines the problem of the relationship between the quality of GPs training and the content of educational programs in the context of a new structure of professional education. The authors have identified legislative provisions governing changes in the foundations for the development of Federal state educational standards for higher education (the level of highly qualified personnel training in clinical studies). They have also determined regulatory requirements for the structure of clinical studies program, the level of training of GPs and the conditions for implementing the program. The paper presents guidelines for professional competencies identification as a result of GPs training. The composition and structure of GP professional competence has been determined. The comparative characteristics of professional competencies and labor functions have been presented. The authors have presented the assessment results of the quality of the content of GPs training programs carried out by the experts of Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia as well as scientific and pedagogical workers of therapeutic departments of 24 medical universities of the Ministry of Health of Russia. The study has shown that in modern conditions the content of GPs training requires updating, since the quality of specialists training is determined by their ability to solve professional problems using knowledge that provides the development of skills for GP labor functions performing. The obtained materials can serve as a basis for further monitoring of the quality of specialists training.

Prescription of Physical Activity by General Practitioners in Type 2 Diabetes: Practice and Barriers in French Guiana.

BackgroundGeneral practitioners (GPs) are the major primary healthcare players in the management of type 2 diabetes. In addition to a well-balanced diet, physical activity (PA) appears as a necessary non-medicinal therapy in the management of diabetic patients. However, GPs emphasize several obstacles to its prescription. The aim of this study is to evaluate the practices, barriers, and factors favoring the prescription of PA in type 2 diabetic patients by GPs in French Guiana.MethodWe conducted a cross-sectional descriptive study using a questionnaire, designed to interview 152 French Guiana GPs and describe their practice in prescribing PA in type 2 diabetic patients.ResultsOur results revealed that the prescription of PA as a non-medicinal therapeutic choice in the management of type 2 diabetes was practiced by 74% of the French Guiana GPs. However, only 37% of GPs responded that they implemented the recommendations; indeed, only one-third knew about them. The majority of GPs were interested in PA training, but only 11% were actually trained in this practice. The lack of structure adapted to the practice of PA and the lack of awareness of the benefits of PA in metabolic pathology appeared as the main obstacles to PA prescription.ConclusionThis study highlights the importance of improving the training of GPs in the prescription of PA, the development of adapted PA structures, and collaboration between the different actors within the framework of the sport-health system in type 2 diabetes in French Guiana.

Self-reported sick leave following a brief preventive intervention on work-related stress

Abstract Background General practitioners (GPs) play an important role for early identification and prevention of sick leave among patients perceiving ill health due to work-relates stress. In order to fulfil the role, they need adequate methodologies and tools. This study aimed to evaluate the effectiveness of a brief intervention in primary health care including early identification of work-related stress combined with feedback at consultation on the number of self-reported sick leave days. Methods A randomised controlled trial was performed at seven primary health care centres in western Sweden. Self-reported sick leave data collected between November 2015 and January 2017 were analysed prospectively. The study included 271 employed, non-sick-listed patients aged 18-64 years seeking care for mental and/or physical health complaints. The intervention group received a brief intervention about work-related stress, including training for GPs, screening of patients' work-related stress, feedback to patients on screening results and discussion of measures at GP consultation. The control group received treatment as usual. Results At 6-month follow-up 59/105 (56%) in the intervention group and 61/115 (53%) in the control group reported no sick leave. At 12-month follow-up the corresponding numbers were 61/119 (51%) and 57/122 (47%) respectively. There were no statistically significant differences between the intervention group and the control group in the median number of self-reported sick leave days. Conclusions The brief intervention showed no effect on the numbers of self-reported sick leave days. However, using sick leave as an outcome measure was difficult, as sick leave is multifactorial and the data has a non-normal distribution. In addition, sick leave might be used as an indicator as well as a possible treatment of ill health. Other actions and interventions to address patients perceiving ill health due to work-related stress should be explored. Key messages Sick leave is used as an indicator and as a treatment of ill health, which can complicate the evaluation of studies. The complexity of primary health care trials calls for other evaluation methods.

Psychosocial demands and resources for working time organization in GP practices. Results from a team-based ethnographic study in Germany

BackgroundGeneral practitioners (GPs) are challenged, e.g. by long working hours, and as employers they are responsible for the creation of working conditions that prevent work-related psychosocial risks. Leadership behaviour plays an important role within the working conditions of employees, thus we focused on two research questions: To what extent and how do GPs fulfil their role as entrepreneurs and leaders responsible for occupational safety and health of the team members in the organization of working time of the employees? What psychosocial factors result from the way of organization of working time for the practice team?MethodsData was collected by participant observations, individual interviews with six GPs, and five focus group discussions with 19 members of the practice staff in total. We gained access to five general practices through a teaching network associated with the Institute for General Medicine, University Hospital Essen (Germany). The analysis was carried out according to the Grounded Theory approach.ResultsGPs have several roles and related tasks to fulfil in the organization of working time. This can lead to perceived psychological stress. With regard to the organization of predictable working hours, vacations and sickness absence, the GPs determined the scope of action of the practice assistants. The delegation of these tasks took place to varying degrees and resulted in different work-related resources and stressors.ConclusionWe described transactional and transformational leadership behaviours which are all related to specific psychosocial demands and resources and may overlap on site. Leadership training seems recommendable as part of the training of GPs and other future leaders of micro-enterprises to promote self-reflection by the entrepreneurs and leaders and strengthen occupational health of leaders and staff.

GP preferences for discussing statin deprescribing: a discrete choice experiment.

Deprescribing (planned, supervised discontinuation) of statins may be considered in some older persons. This should be carefully discussed between patients and GPs. We examined GPs' preferences for discussing statin deprescribing by conducting a discrete choice experiment (DCE) sent to a stratified random sample of 500 Danish GPs. Attributes were discussion topics (goals of therapy, evidence on statin use in older persons, adverse effects, uncertainty), and levels were the depth of the discussion topics (none, brief, detailed). We used mixed logistic regression for analysis. A total of 90 GPs (mean age 48, 54% female, mean 11 years in practice) completed the DCE. There was substantial variability in which topics GPs felt were most important to discuss; however, GPs generally preferred a brief discussion of topics to detailed ones. The most important discussion topic appeared to be goals of therapy. GPs felt a brief discussion of evidence was important but not a detailed one, while adverse effects and uncertainty were felt to be less important to discuss. GPs prefer brief discussions on a range of topics when discussing statin deprescribing but have differing views on which topics are most important. For deprescribing communication tools to be useful to GPs in clinical practice, they may need to focus on brief coverage of the range of relevant topics. Future work should evaluate patient preferences, and opportunities for education and training for GPs on deprescribing communication.

143 Barriers and Facilitators of General Practice in the Care Home Setting- A Qualitative Study to Inform Training of GPS

Abstract Introduction Care home (CH) residents receive varying quality and availability of healthcare. GPs are tasked with the responsibility of providing effective care to this growing demographic. The study aimed to gain an insight into the experiences of GPs carrying out CH work, in order to produce training recommendations. Method Two trainees, one trainer and twelve senior GPs were recruited informally through professional networks. Each completed a semi-structured interview about their work within CHs. Transcriptions were made and then analysed using thematic analysis. Results The two trainee participants had different experiences of CH work, but neither had received any specific training. The trainer GP acknowledged that multiple existing trainee competencies were relevant to CHs, but that inconsistencies in CH exposure were present and that specific training would be beneficial. The senior GP participants did not recall having received CH-specific training. Many factors contributed to the delivery of care within the CHs and made it distinct from the work within the GP surgery. Participants reported a variety of approaches to care, these related to different multidisciplinary teams, the involvement of CH staff, and the complex nature of the care of residents. Advance care planning was a beneficial approach used by some of the GPs that required particular attention and skills. Conclusion A tension was present between the care GPs wanted to provide and the complexities that inhibited them from doing so. The challenges relate to the need for multidisciplinary care teams to address complex needs of individual residents, and an acknowledgement of the importance of the relationship with the CH staff in supporting continuity of care. Overall, the complex nature of CH work, and the current inconsistencies in trainee’s exposure, justify the need for a new approach to provide all trainee GPs with experience of working within the CH setting.

Training general practitioners in melanoma diagnosis: a scoping review of the literature

BackgroundGeneral practitioners (GPs) play a key role in early melanoma detection. To help GPs deal with suspicious skin lesions, melanoma diagnostic training programmes have been developed. However, it is unclear...