RESUMO
BACKGROUND: Health policymakers have tried to improve the care pathway for cancer patients by improving collaboration between participating healthcare professionals by involving the general practitioner (GP). OBJECTIVE(S): To explore how patients, GPs, oncologists and nurses interacted and how they perceived, in their practice, professional roles, collaboration, and cancer care pathways. METHODS: Between January 2018 and December 2021, we conducted a qualitative study that combined phenomenology and a general inductive analysis, based on semi-structured interviews with cancer patients and their GPs, oncologists, and nurses in France. RESULTS: Our analysis of 59 interviews showed that the stakeholders had different perceptions of the cancer care pathway. Task division was implicit and depended on what each health professional thought he/she should be doing; this led to the blurring of certain tasks (announcement of the diagnosis, coordination, and follow-up). The healthcare professionals were stuck in frameworks centred on their own needs and expectations and were unaware of the other health professionals' needs and expectations. Outside the hospital, GPs and nurses worked in isolation; they were not aware of the other stakeholders and did not communicate with them. GPs and nurses justified this attitude by the lack of a perceived need. Interprofessional communication varied as a function of the needs, involvement and knowledge of the other health professionals and was often mediated by the patient. CONCLUSION: In the cancer management in France, to improve cancer care pathway, there is a need to train healthcare professionals in interprofessional collaboration delivering care tailored to patient needs and preferences.
In the management of patients with cancer, the division of tasks between health professionals was not clear and was not discussed by the group.Communication within the health professionals was mediated often by the patient.Interprofessional collaboration is strongly encouraged by France's public health policies but was not mentioned or put into practice by the health professionals.
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Atitude do Pessoal de Saúde , Clínicos Gerais , Neoplasias , Pesquisa Qualitativa , Humanos , França , Neoplasias/terapia , Feminino , Masculino , Clínicos Gerais/organização & administração , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/organização & administração , Adulto , Oncologistas , Idoso , Relações Interprofissionais , Enfermeiras e Enfermeiros , Entrevistas como Assunto , Comunicação Interdisciplinar , Procedimentos Clínicos , Comportamento CooperativoRESUMO
INTRODUCTION: Currently there is a shortage of general practitioners (GP), and this is expected to increase in the coming years. Despite this need, it is a specialty that is supposedly little demanded, leaving specialized training places unfilled in recent years. The purpose of this study is to present new parameters to more objectively measure the demand and the relationship between supply and demand. METHODS: A database was used with the results of the places assigned in the MIR calls from 2002 to 2023. The calculated parameters were quoting index (CI), quote order, the order of top demand and the order of total demand of the GP specialty. The software R version 4.3.02 was used for statistical analysis. RESULTS: The specialty quotation and top demand have remained constant during the study period, while there has been a slight and progressive worsening of the total demand. Nevertheless, the total demand for Family Medicine in the last call for MIR exam was higher than that for specialties such as urology, neurology, ENT, endocrinology, oncology, intensive care medicine or neurosurgery, among others. CONCLUSIONS: In contrast to the subjective perception of the worsening attractiveness Family Medicine in the last MIR calls, using objective parameters, we found that the attractiveness of the specialty, measured as quotation (supply/demand ratio) and demand, has remained stable (with a slight worsening of total demand).
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Medicina Comunitária , Medicina de Família e Comunidade , Humanos , Especialização , Espanha , Escolha da Profissão , Clínicos Gerais/estatística & dados numéricos , Clínicos Gerais/organização & administração , Medicina , Necessidades e Demandas de Serviços de Saúde , Bases de Dados FactuaisAssuntos
Medicina Geral/organização & administração , Clínicos Gerais/provisão & distribuição , Acessibilidade aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Medicina Estatal/organização & administração , Inglaterra , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/organização & administração , Política de Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Medicina Estatal/estatística & dados numéricosRESUMO
BACKGROUND: To date, there has been no systematic research on the intermediate level service (level 2) in outpatient palliative care that was introduced in Germany in 2017. Accordingly, the Polite research project aims at: (1) investigating the current state of level 2 palliative care and (2) developing recommendations for its optimisation. METHODS: The multi-perspective, observational study will follow a mixed-methods approach across two study phases. In phase 1a, quantitative routinely collected data from a statutory general local health insurance provider will be used to identify patients who received level 2 or other outpatient palliative care in the years 2017-2019. In phase 1b, a questionnaire will be sent to all registered general practitioners (GPs) in Lower Saxony to collect information on the number and characteristics of physicians offering level 2 palliative care. In phase 1c, a quantitative, standardised online questionnaire for teams providing specialised outpatient palliative care will be administered to assess the interfaces of level 2 palliative care. In phase 2a, the results from phases 1a-c will be discussed in an expert workshop with the aim of developing ideas to adapt and optimise level 2 outpatient palliative care. Finally, in phase 2b, the empirically derived recommendations from phases 1 and 2a will be agreed upon via a multi-round Delphi survey involving experts with sufficient influence to promote the project results and recommendations nationally. DISCUSSION: The results of the project will facilitate the optimisation of outpatient palliative care, as well as its administration, nationwide. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register (Deutsches Register Klinischer Studien) (Registration N° DRKS00024785); date of registration: 06th May 2021) and is searchable under the International Clinical Trials Registry Platform Search Portal of the World Health Organization, under the German Clinical Trials Register number.
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Assistência Ambulatorial/organização & administração , Gerenciamento de Dados/estatística & dados numéricos , Atenção à Saúde/organização & administração , Seguro Saúde/estatística & dados numéricos , Cuidados Paliativos/organização & administração , Sistema de Registros , Clínicos Gerais/organização & administração , Alemanha , Humanos , Seguro Saúde/economia , Projetos de Pesquisa , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: despite the high prevalence and significant burden of mental disorders, they remain grossly under-diagnosed and undertreated. In low-income countries, such as Mali, integrating mental health services into primary care is the most viable way of closing the treatment gap. This program aimed to provide a mental health training intervention to rural general practitioners (GPs), to organize community awareness activities, and to evaluate the impact on mental health knowledge and through the number of new patients diagnosed with mental disorders and managed by these general practitioners. METHODS: a pre-test/post-test design and the monthly monitoring of the number of new patients diagnosed with mental disorders by the trained GPs were used to evaluate the effect of the training interventions (two face-to-face group training workshops followed by individual follow-up supervisions) and of the community awareness activities. RESULTS: the mean knowledge score of the 19 GPs who completed the initial 12-day group training raised from 24.6/100 at baseline, to 61.5/100 after training (p<0.001), a 150% increase. Among them, sixteen completed the second 6-day group training with a mean score increasing from 50.2/100 to 70.1/100 (p<0.001), a 39.6% improvement. Between July 2018 and June 2020, 2,396 new patients were diagnosed with a mental disorder by the 19 GPs who took part in the program. CONCLUSION: despite limited data regarding the effect of the community awareness component at this stage, the findings from this study suggest that the training intervention improved GPs' knowledge and skills, resulting in a significant number of new patients being identified and managed.
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Fortalecimento Institucional , Clínicos Gerais/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Competência Clínica , Clínicos Gerais/educação , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Mali , Transtornos Mentais/diagnóstico , Saúde Mental , Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/organização & administraçãoRESUMO
BACKGROUND: SARS-CoV-2 infection is currently the most significant public health challenge. Its presentation ranges from mild to severe respiratory failure and septic shock. Rapid transmission of the virus is dangerous with a high possibility of life-threatening complications. Lack of treatment standards for SARS-CoV-2 is responsible for the current dilemma in clinical medicine. METHODS: An electronic literature search was done using PubMed to gather information on the pathogenesis, transmission of infection, clinical symptoms, diagnosis, and therapeutic options for COVID-19. Search items included "SARS-CoV-2", "COVID-19" and "coronavirus infection". RESULTS: In light of the current global crisis caused by SARS-CoV-2, the exchange of information within the scientific community should be quick and extremely transparent. Thus, this review presents the available information necessary for a general practitioner. Such presentation of data should allow the reader quick access to basic and crucial information related to epidemiology, viral transmission, clinical symptoms, diagnostics, treatment, and complications that may occur in the course of COVID-19. CONCLUSION: Rapidly increasing amounts of information about the diagnosis and treatment of patients with SARS-CoV-2 allow a better understanding of the etiology and course of the infection. In the current epidemiological situation, readily accessible information helps minimize the time to acquire knowledge and focus on prevention methods, diagnostic and treatment options. Thus, this review highlights key issues related to SARS-CoV-2 infection and contains the most useful data for daily medical practice.
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COVID-19/epidemiologia , Clínicos Gerais/organização & administração , Disseminação de Informação , Papel do Médico , Teste para COVID-19/estatística & dados numéricos , Humanos , SARS-CoV-2RESUMO
BACKGROUND: Despite significant developments in palliative care in recent decades, we still find important differences in access to and delivery of care in rural Norway. OBJECTIVE: The aim of this study was to explore what healthcare professionals consider necessary to provide equality in care for palliative patients in rural areas. METHODS: A qualitative approach with focus group discussions and individual interviews with 52 health professionals was used, starting with 5 uniprofessional focus groups of general practitioners and nurses/cancer nurses, followed by 5 interprofessional groups and 6 individual interviews. Interview transcripts were analyzed thematically. RESULTS: We found local variations in organization, competence and access to palliative care, and challenging geographical conditions. It was essential to be proactive, flexible and willing to go the extra mile, but this may conceal the need for a stronger focus on competence and organization of palliative care. Access to written guidelines and practical tools was important, as was forming palliative teams for particular situations. CONCLUSIONS: Palliative care needs strengthening in rural areas, and increased competence for all healthcare professionals is vital to increase equality in care. Geographical conditions require locally adapted solutions. Access to guidelines and interprofessional collaboration are essential. IMPLICATIONS FOR PRACTICE: Rural palliative care needs in Norway are improving, as exemplified by at least 1 cancer nurse assigned to each local authority, and access to guidelines and palliative tools and interprofessional collaboration.
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Clínicos Gerais/organização & administração , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/organização & administração , Neoplasias/terapia , Cuidados Paliativos/organização & administração , Serviços de Saúde Rural/organização & administração , Adulto , Humanos , Masculino , Noruega , Pesquisa QualitativaRESUMO
BACKGROUND: Falls are an increasing problem among older people. There are several evidence-based interventions available to prevent falls. However, these are not always well implemented in the primary care setting. General practitioners (GPs) are often the first point of contact for health issues, making them the designated professionals for providing falls prevention. Because GPs are often unaware which patients have a high fall risk and patients themselves do not always know they have a high fall risk, this study aims to evaluate the implementation of a targeted fall risk screening strategy among independently living, frail older people in the primary care setting. MATERIALS AND METHODS: The targeted fall risk screening strategy used in this study consists of tools for screening high fall risk and for identifying the underlying cause(s) of the high fall risk, an accredited training course in falls prevention for professionals, and service provision by certified physio- and exercise therapists who are able to offer evidence-based falls prevention interventions. This targeted fall risk screening strategy will be implemented in the primary care setting and evaluated at the level of the GP practice and at the level of the patient by using the RE-AIM model of Glasgow et al. In a pre-posttest design, data will be collected of the total number of frail older people who are screened, referred and enrolled for fall-preventive care. Furthermore, barriers and facilitators of the implementation of the fall risk screening strategy will be identified by conducting focus groups and interviews with the care providers and frail older patients. Additionally, the influence of the falls prevention interventions on frail older patients will be evaluated by using a pre-posttest design with a 12-month follow-up period during which data are collected regarding patients' stability, mobility, strength, balance, self-efficacy, health status, and daily activities. STUDY REGISTRATION: This study is approved by the Medical Ethics Committee Brabant, the Netherlands (NL61582.028.17/ P1732) and registered at the Netherlands Trial Register, NL7917.
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Acidentes por Quedas/prevenção & controle , Protocolos Clínicos , Idoso Fragilizado/estatística & dados numéricos , Clínicos Gerais/organização & administração , Programas de Rastreamento/métodos , Atenção Primária à Saúde/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Países Baixos , Desenvolvimento de Programas , Encaminhamento e ConsultaRESUMO
BACKGROUND: In Australia registrar training to become a general practitioner (GP) involves three to four years of supervised learning with at least 50% of GP registrars training wholly in rural areas. In particular rural over regional GP placements are important for developing future GPs with broader skills because the rural scope of practice is wider. Having enough GP supervisors in smaller rural communities is essential such training. We aimed to explore what makes rural GPs' based outside of major regional centres, participate in supervising or not, their experiences of supervising, and impact of their practice context. METHODS: Semi-structured interviews were undertaken with 25 GPs based in rural Tasmania (outside of major regions - Hobart and Launceston), in towns of < 25,000 population, to explore the GPs' professional backgrounds, their experiences of supervising GP registrars, their practice context and their decisions about supervising GP registrars or not. Thematic analysis was undertaken; key ideas, concepts and experiences were identified and then reviewed and further refined to core themes. RESULTS: Supervising was perceived to positively impact on quality of clinical care, reduce busy-ness and improve patient access to primary care. It was energising for GPs working in rural contexts. Rural GPs noted business factors impacted the decision to participate in supervision and the experience of participating: including uncertainty and discontinuity of registrar supply (rotational training systems), registrar competence and generating income. CONCLUSIONS: Supervising is strongly positive for rural GPs and related to job satisfaction but increasing supervision capacity in rural areas may depend on better policies to assure continuity of rural registrars as well as policies and systems that enable viable supervision models tailored to the context.
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Clínicos Gerais/organização & administração , Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , Austrália , Feminino , Humanos , Satisfação no Emprego , Masculino , Pesquisa Qualitativa , População Rural , TasmâniaRESUMO
Addictovigilance is a safety monitoring targeted at substances with potential for abuse and dependence. This vigilance was involved during the period of COVID-19 epidemic due to the significant changes in access to drugs and psychological disruption caused by the pandemic and lockdown. This article aims to present the different steps implemented by the French Addictovigilance network in collaboration with the French Health authorities from March to May 2020, including monitoring of potential harmful events, and scientific communication. The first events were identified through the continuity of the networking between the French addictovigilance centres and their partners: community pharmacies, general practitioners, specialized structures and emergency wards. As soon as the lockdown began, first cases of overdoses (lethal or not) were reported with opioids, mainly with methadone, and other opioids (heroin, oxycodone, tramadol or antitussive codeine). Lockdown-related noteworthy events consisted in clinical cases or other relevant information for which lockdown clearly played an important role: among the many substances identified at least once, pregabalin, benzodiazepines, cannabis, cocaine and nitrous oxide were the most significant in terms of prevalence, seriousness or particularly specific to the lockdown context. Despite significant decrease in the activity and travel limited to vital needs, community pharmacies continued to identify falsified prescriptions in this period, highlighting an increase in suspicious requests for pregabalin, codeine and tramadol. In parallel, the French addictovigilance network continued its communications efforts in the period, issuing a newsletter on tramadol, a press release on methadone and naloxone, and participating in the COVID-19 frequently asked questions (FAQs) of the French Society of Pharmacology and Therapeutic website (https://sfpt-fr.org/covid19). COVID-19 epidemic has been an important challenge for addictovigilance, and has proved that this monitoring is highly essential for alerting health professionals and health authorities to points of vigilance in the field of psychoactive substances.
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Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Quarentena , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , COVID-19 , Serviços Comunitários de Farmácia/organização & administração , Overdose de Drogas/epidemiologia , França/epidemiologia , Clínicos Gerais/organização & administração , Pessoal de Saúde/organização & administração , Humanos , Pandemias , Transtornos Relacionados ao Uso de Substâncias/complicaçõesRESUMO
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a rapid change in workload across healthcare systems. Factors related to this adaptation in UK primary care have not yet been examined. AIM: To assess the responsiveness and prioritisation of primary care consultation type for older adults during the COVID-19 pandemic. DESIGN AND SETTING: A cross-sectional database study examining consultations between 17 February and 10 May 2020 for patients aged ≥65 years, drawn from primary care practices within the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network, UK. METHOD: The authors reported the proportion of consultation type across five categories: clinical administration, electronic/video, face-to-face, telephone, and home visits. Temporal trends in telephone and face-to-face consultations were analysed by polypharmacy, frailty status, and socioeconomic group using incidence rate ratios (IRR). RESULTS: Across 3 851 304 consultations, the population median age was 75 years (interquartile range [IQR] 70-82); and 46% (n = 82 926) of the cohort (N = 180 420) were male. The rate of telephone and electronic/video consultations more than doubled across the study period (106.0% and 102.8%, respectively). Face-to-face consultations fell by 64.6% and home visits by 62.6%. This predominantly occurred across week 11 (week commencing 9 March 2020), coinciding with national policy change. Polypharmacy and frailty were associated with a relative increase in consultations. The greatest relative increase was among people taking ≥10 medications compared with those taking none (face-to-face IRR 9.90, 95% CI = 9.55 to 10.26; telephone IRR 17.64, 95% CI = 16.89 to 18.41). CONCLUSION: Primary care has undergone an unprecedented in-pandemic reorganisation while retaining focus on patients with increased complexity.
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Betacoronavirus , Infecções por Coronavirus/terapia , Visita Domiciliar/estatística & dados numéricos , Pneumonia Viral/terapia , Atenção Primária à Saúde/organização & administração , Idoso , COVID-19 , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Clínicos Gerais/organização & administração , Humanos , Masculino , Pandemias , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Reino Unido/epidemiologiaRESUMO
OBJECTIVES: With 70% of care home residents experiencing a medication error every day in the UK, better multi-professional working between medical practitioners, pharmacists and care homes was recommended. The aim of this study was to determine the effectiveness (falls reduction) and cost-effectiveness, of a multi-professional medication review (MPMR) service in care homes for older people. METHOD: A total of care homes in the East of England were cluster randomised to 'usual care' or two multi-professional (General practitioner, clinical pharmacist and care homes staff) medication reviews during the 12-month trial period. Target recruitment was 900 residents with 10% assumed loss to follow-up. Co-primary outcome measures were number of falls and potentially inappropriate prescribing assessed by the Screening Tool of Older Persons Prescriptions. KEY FINDINGS: A total of 826 care home residents were recruited with 324 lost to follow-up for at least one primary outcome measure. The mean number of falls per resident per annum was 3.3 for intervention and 3.0 for control (P = 0.947). Each resident was found to be prescribed 0.69 (intervention) and 0.85 (control) potentially inappropriate medicines after 12 months (P = 0.046). No significant difference identified in emergency hospital admissions or deaths. Estimated unadjusted incremental mean cost per resident was £374.26 higher in the intervention group. CONCLUSIONS: In line with other medication review based interventions in care homes, two MPMRs improved medication appropriateness but failed to demonstrate improvements in clinical outcomes. From a health system perspective costs where estimated to increase overall and therefore a different model of medicines management is required.
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Acidentes por Quedas/prevenção & controle , Prescrição Inadequada/prevenção & controle , Erros de Medicação/prevenção & controle , Conduta do Tratamento Medicamentoso/organização & administração , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Inglaterra , Feminino , Clínicos Gerais/organização & administração , Instituição de Longa Permanência para Idosos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Conduta do Tratamento Medicamentoso/economia , Casas de Saúde , Farmacêuticos/organização & administraçãoRESUMO
Many healthcare systems are organised such that General Practitioners (GPs) often have a key role in identifying autism spectrum disorders (hereafter collectively referred to as autism) in children. In this review, we explored what GPs know about autism and the factors that influence their ability to identify and manage care for their patients with autism in practice. We conducted a systematic narrative review using eight electronic databases. These included Embase and MEDLINE via Ovid, Web of Knowledge, PsycINFO via Ebscohost, PubMed, Scopus, ProQuest Dissertations and Thesis, and Applied Social Sciences Index and Abstracts (ASSIA) via ProQuest. Our search yielded 2,743 citations. Primary research studies were included, and we did not impose any geographical, language or date restrictions. We identified 17 studies that met our inclusion criteria. Studies included in the review were conducted between 2003 and 2019. We thematically synthesised the material and identified the following themes: the prototypical image of a child with autism; experience, sources of information, and managing care; barriers to identification; strategies to aid in identification; and characteristics that facilitate expertise. Together, the findings from this review present a mixed picture of GP knowledge and experiences in identifying autism and managing care for children with the condition. At one end of the continuum, there were GPs who had not heard of autism or endorsed outmoded aetiological theories. Others, however, demonstrated a sound knowledge of the conditions but had limited confidence in their ability to identify the condition. Many GPs and researchers alike called for more training and this might be effective. However, framing the problem as one of a lack of training risks silences the array of organisational factors that impact on a GP's ability to provide care for these patients.
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Atitude do Pessoal de Saúde , Transtorno do Espectro Autista/terapia , Medicina Geral/organização & administração , Clínicos Gerais/organização & administração , Transtorno do Espectro Autista/diagnóstico , Criança , Competência Clínica/normas , Medicina de Família e Comunidade , Feminino , Humanos , Padrões de Prática Médica/organização & administração , Encaminhamento e Consulta/organização & administraçãoRESUMO
BACKGROUND: In its 2006 report, From cancer patient to cancer survivor: lost in transition, the U.S. Institute of Medicine raised the need for a more coordinated and comprehensive care model for cancer survivors. Given the ever increasing number of cancer survivors, in general, and prostate cancer survivors, in particular, there is a need for a more sustainable model of follow-up care. Currently, patients who have completed primary treatment for localized prostate cancer are often included in a specialist-based follow-up care program. General practitioners already play a key role in providing continuous and comprehensive health care. Studies in breast and colorectal cancer suggest that general practitioners could also consider to provide survivorship care in prostate cancer. However, empirical data are needed to determine whether follow-up care of localized prostate cancer survivors by the general practitioner is a feasible alternative. METHODS: This multicenter, randomized, non-inferiority study will compare specialist-based (usual care) versus general practitioner-based (intervention) follow-up care of prostate cancer survivors who have completed primary treatment (prostatectomy or radiotherapy) for localized prostate cancer. Patients are being recruited from hospitals in the Netherlands, and randomly (1:1) allocated to specialist-based (N = 195) or general practitioner-based (N = 195) follow-up care. This trial will evaluate the effectiveness of primary care-based follow-up, in comparison to usual care, in terms of adherence to the prostate cancer surveillance guideline for the timing and frequency of prostate-specific antigen assessments, the time from a biochemical recurrence to retreatment decision-making, the management of treatment-related side effects, health-related quality of life, prostate cancer-related anxiety, continuity of care, and cost-effectiveness. The outcome measures will be assessed at randomization (≤6 months after treatment), and 12, 18, and 24 months after treatment. DISCUSSION: This multicenter, prospective, randomized study will provide empirical evidence regarding the (cost-) effectiveness of specialist-based follow-up care compared to general practitioner-based follow-up care for localized prostate cancer survivors. TRIAL REGISTRATION: Netherlands Trial Registry, Trial NL7068 (NTR7266). Prospectively registered on 11 June 2018.
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Assistência ao Convalescente/métodos , Ansiedade/epidemiologia , Sobreviventes de Câncer/psicologia , Clínicos Gerais/organização & administração , Neoplasias da Próstata/terapia , Assistência ao Convalescente/economia , Assistência ao Convalescente/organização & administração , Assistência ao Convalescente/normas , Idoso , Ansiedade/diagnóstico , Ansiedade/prevenção & controle , Ansiedade/psicologia , Continuidade da Assistência ao Paciente , Análise Custo-Benefício , Estudos de Equivalência como Asunto , Estudos de Viabilidade , Clínicos Gerais/economia , Fidelidade a Diretrizes/economia , Fidelidade a Diretrizes/organização & administração , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Calicreínas/sangue , Masculino , Estudos Multicêntricos como Assunto , Países Baixos/epidemiologia , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Antígeno Prostático Específico/sangue , Prostatectomia/efeitos adversos , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/psicologia , Qualidade de Vida , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Atenção Secundária à Saúde/economia , Atenção Secundária à Saúde/métodos , Atenção Secundária à Saúde/organização & administração , Atenção Secundária à Saúde/normasRESUMO
OBJECTIVE: Creating an environment that supports conditions of routine clinical practice and enables an effectiveness trial design with a pre-licensed medicine is extremely challenging. Here, we summarise our experiences and achievements with engaging and mobilising community pharmacies in and around Salford, United Kingdom, in the Phase III effectiveness Salford Lung Studies (SLS). METHODS: This article provides the authors' personal experiences and viewpoints on community pharmacy involvement in the SLS. KEY FINDINGS: More than 130 community pharmacies were enabled, and >2500 pharmacy staff trained, for involvement in the SLS. Key to community pharmacy participation in the SLS was the formation of the SLS Pharmacy Steering Group (PSG), contributing to study oversight, and the development of a pharmacy standard operating procedure document, the major principle of which was to ensure minimum disruption to the normal medicine dispensing process while ensuring compliance with regulations, guidelines, good clinical practice and requirements for pharmacovigilance. The high level of commitment and collaboration of community pharmacy in the SLS demonstrated a willingness to work together and take on additional and novel roles beyond their everyday commercial functions for the benefit of patients, despite normally competing for prescription business. CONCLUSIONS: The involvement and integration of community pharmacy as a key partner in the SLS was pivotal in securing the delivery of these world-first clinical effectiveness studies. To our knowledge, this has not been previously achieved in a study of a pre-licensed maintenance therapy for a common disease in primary care.
Assuntos
Asma/tratamento farmacológico , Serviços Comunitários de Farmácia/organização & administração , Drogas em Investigação/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Projetos de Pesquisa , Androstadienos/administração & dosagem , Androstadienos/efeitos adversos , Asma/diagnóstico , Álcoois Benzílicos/administração & dosagem , Álcoois Benzílicos/efeitos adversos , Clorobenzenos/administração & dosagem , Clorobenzenos/efeitos adversos , Ensaios Clínicos Fase III como Assunto/métodos , Ensaios Clínicos Fase III como Assunto/normas , Combinação de Medicamentos , Drogas em Investigação/efeitos adversos , Clínicos Gerais/organização & administração , Humanos , Colaboração Intersetorial , Farmacêuticos/organização & administração , Ensaios Clínicos Pragmáticos como Assunto , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Participação dos Interessados , Resultado do Tratamento , Reino UnidoRESUMO
BACKGROUND: Patients suffering from cancers are increasingly numerous in general practice consultations. The General Practitioner (GP) should be at the heart of the management of patients. Several studies have examined the perceptions of GPs confronted with the patient suffering from cancer and the relationships of GPs with oncologists, but few studies have focused on the patients' perspective. We studied the three-way relationship between the oncologist, the GP, and the patient, from the patient's point of view. METHODS: A questionnaire validated by a group consisting of GPs, oncologists, nurses, an epidemiologist and quality analyst, was administered over a three-week period to patients suffering from cancer receiving chemotherapy in a day hospital. RESULTS: The analysis was based on 403 questionnaires. Patients had confidence in the GP's knowledge of oncology in 88% of cases; 49% consulted their GP for pain, 15% for cancer-related advice, and 44% in emergencies. Perceived good GP/oncologist communication led patients to turn increasingly to their GP for cancer-related consultations (RR = 1.14; p = 0.01) and gave patients confidence in the GP's ability to manage cancer-related problems (RR = 1.30; p < 0.01). Mention by the oncologist of the GP's role increased the consultations for complications (RR = 1.82; p < 0.01) as well as recourse to the GP in an emergency (RR = 1.35; p < 0.01). CONCLUSION: Patients suffering from cancer considered that the GP was competent, but did not often consult their GP for cancer-related problems. There is a discrepancy between patients' beliefs and their behaviour. When the oncologist spoke to patients of the GP's role, patients had recourse to their GP more often. Systematically integrating a GP consultation to conclude cancer diagnosis disclosure, could improve management and care coordination.
Assuntos
Clínicos Gerais/organização & administração , Comunicação Interdisciplinar , Neoplasias/terapia , Oncologistas/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Encaminhamento e Consulta/organização & administraçãoRESUMO
OBJECTIVE: Whether care group participation by general practitioners improves delivery of diabetes care is unknown. Using 'monitoring of biomedical and lifestyle target indicators as recommended by professional guidelines' as an operationalisation for quality of care, we explored whether (1) in new practices monitoring as recommended improved a year after initial care group participation (aim 1); (2) new practices and experienced practices differed regarding monitoring (aim 2). DESIGN: Observational, real-life cohort study. SETTING: Primary care registry data from Eerstelijns Zorggroep Haaglanden (ELZHA) care group. PARTICIPANTS: Aim 1: From six new practices (n=538 people with diabetes) that joined care group ELZHA in January 2014, two practices (n=211 people) were excluded because of missing baseline data; four practices (n=182 people) were included. Aim 2: From all six new practices (n=538 people), 295 individuals were included. From 145 experienced practices (n=21 465 people), 13 744 individuals were included. EXPOSURE: Care group participation includes support by staff nurses on protocolised diabetes care implementation and availability of a system providing individual monitoring information. 'Monitoring as recommended' represented minimally one annual registration of each biomedical (HbA1c, systolic blood pressure, low-density lipoprotein) and lifestyle-related target indicator (body mass index, smoking behaviour, physical exercise). PRIMARY OUTCOME MEASURES: Aim 1: In new practices, odds of people being monitored as recommended in 2014 were compared with baseline (2013). Aim 2: Odds of monitoring as recommended in new and experienced practices in 2014 were compared. RESULTS: Aim 1: After 1-year care group participation, odds of being monitored as recommended increased threefold (OR 3.00, 95% CI 1.84 to 4.88, p<0.001). Aim 2: Compared with new practices, no significant differences in the odds of monitoring as recommended were found in experienced practices (OR 1.21, 95% CI 0.18 to 8.37, p=0.844). CONCLUSIONS: We observed a sharp increase concerning biomedical and lifestyle monitoring as recommended after 1-year care group participation, and subsequently no significant difference between new and experienced practices-indicating that providing diabetes care within a collective approach rapidly improves registration of care.