[Working Time of Physicians in Germany: Results of the Micro-Census with a Focus on Established Practitioners]. / Arbeitszeit von Ärztinnen und Ärzten in Deutschland: Ergebnisse des Mikrozensus mit Fokus auf Niedergelassene.

Medical practitioners are considered to be an occupational group with a high workload. However, findings on working hours are incomplete. Therefore, we investigated data on "normal" working hours and corresponding preferences in the course of an analysis of the Microcensus 2017. Established physicians reported an average working time of 48,8 h per week for full-time employment, 46,2 h as dependent employees. Dependent employees working part-time, reported about 4 h more than established doctors. Male doctors reported about 4 h more than female doctors when working full-time, and 5 h less when working part-time. The proportion of part-time work was significantly higher for female physicians than for male physicians (28% vs. 10%). The specific analysis for established doctors also showed an inverse discrepancy: if part-time, female physicians worked 4 h more than male physicians; if full-time, male physicians worked 4 h more than female physicians. Established doctors worked less than employees when working part-time. Here, too, the rate was higher for female physicians (19,5% vs. 10,6%). Overall, 14% worked part-time (just under 20 h per week), 86% full-time (just under 49 h). Dentists reported slightly lower working hours, while general practitioners and specialists were about the same at 45 hours. This difference was due to differences in full-time work, which is about 50 h for general practitioners and specialists and 46 h for dentists. In contrast, part-time dentists worked longer hours (24 vs. 18 h). Only a few physicians, especially those working part-time (6,5%), stated that they would like to work more. Most of them would like to work slightly more hours. The majority of women cited family obligations (68%) as the reason for part-time work, while men mostly cited "other" reasons (76%) and less often childcare or personal/family obligations (15%). A total of 13% of those working full-time would like to work fewer hours, women slightly more often. This analysis complements sources such as the Zi Practice Panel. At the overall level, the microcensus average was 5 h lower than the ZiPP (50 h/week). The limitations for survey data known from methodology are countered by the very high sample quality.

Primary care doctors retirements in the context of an ageing population in Italy.

Background: Ongoing shortages in primary care doctors/primary care paediatricians and increasing healthcare needs due to ageing of the population represent a great challenge for healthcare providers, managers, and policymakers. To support planning of primary healthcare resource allocation we analyzed the geographic distribution of primary care doctors/primary care paediatricians across Italian regions, accounting for area-specific number and age of the population. Additionally, we estimated the number of primary care doctors/primary care paediatricians expected to retire over the next 25 years, with a focus on the next five years. Study design: Ecological study. Methods: We gathered the list of Italian general practitioners and primary care paediatricians and combined them with the data from the National Federation of Medical Doctors, Surgeons and Dentists. Using data from the National Institutes of Statistics, we calculated the average number of patients per doctor for each region using the number of residents above and under 14 years of age for general practitioners and primary care paediatricians respectively. We also calculated the number of residents over-65 and over-75 years of age per general practitioner, as elderly patients typically have higher healthcare needs. Results: On average the number of patients per general practitioner was 1,447 (SD: 190), while for paediatricians it was 1,139 (SD: 241), with six regions above the threshold of 1,500 patients per general practitioner and only one region under the threshold of 880 patients per paediatrician. We estimated that on average 2,228 general practitioners and 444 paediatricians are going to retire each year for the next five years, reaching more than 70% among the current workforce for some southern regions. The number of elderly patients per general practitioner varies substantially between regions, with two regions having >15% more patients aged over 65 years compared to the expected number. Conclusions: over 65 years compared to the expected number. Conclusions. The study highlighted that some regions do not currently have the required primary care workforce, and the expec-ted retirements and the ageing of the population will exacerbate the pressure on the already over-stretched healthcare services. A response from healthcare administrations and policymakers is urgently required to allow equitable access to quality primary care across the country.

[Income of physicians in private practice in Germany: Results of a micro census]. / Einkommen von niedergelassenen Ärztinnen und Ärzten in Deutschland: Ergebnisse des Mikrozensus.

EINLEITUNG: Daten zum Einkommen von Ärzt:innen in Deutschland sind bisher nur teilweise verfügbar. Die Einkommen der niedergelassenen Ärzteschaft werden vor allem aus den Praxiserträgen abgeleitet, was aber große Interpretationsspielräume eröffnet. Ziel des Artikels ist es, diese Lücke zu schließen. METHODIK: Hierfür werden die Einkommensangaben aus dem Mikrozensus 2017 ausgewertet - mit besonderem Fokus auf niedergelassene Ärzt:innen. Neben dem persönlichen Einkommen erfolgt eine Darstellung der Einkommenssituation auf Haushaltsebene. Die Einkommensziffern werden nach Tätigkeitsumfang, Tätigkeitsgruppe (Allgemein-/Fach-/Zahnärzte), Geschlecht und Stadt/Land differenziert. ERGEBNISSE UND SCHLUSSFOLGERUNG: Das verfügbare persönliche Nettoeinkommen niedergelassener Ärzt:innen beträgt bei Vollzeittätigkeit im Mittel knapp 7.900 € pro Monat. Fachärzt:innen liegen bei 8.250 €, Allgemein- und Zahnärzt:innen bei ca. 7.700 €. Eine finanzielle Benachteiligung von Landärzt:innen lässt sich nicht feststellen, Allgemeinärzt:innen aus Gemeinden<5.000 Einwohnerinnen und Einwohner haben mit 8.700 € sogar das höchste Durchschnittseinkommen - bei einer mittleren Arbeitszeit von 51 Stunden pro Woche. Ärztinnen arbeiten häufiger in Teilzeit als Ärzte. Ein niedrigeres Einkommen resultiert überwiegend aus einem geringeren Tätigkeitsumfang. INTRODUCTION: Data on the income of physicians in Germany are only partially available to date. The income of physicians in private practice is derived primarily from practice income, but this opens up considerable scope for interpretation. The aim of this article is to close this gap. METHODOLOGY: For this purpose, the income data from the 2017 micro census were evaluated, with a special focus on physicians in private practice. In addition to personal income, the income situation was presented at the household level. The income figures were differentiated according to the scope of activity, activity group (general practitioners/specialists/dentists), gender and city/country. RESULTS AND CONCLUSION: The disposable personal income of physicians in private practice was just under € 7,900 per month on average for full-time employment. Specialists earned € 8,250, while general practitioners and dentists earned about € 7,700. Rural physicians were not found to suffer from financial disadvantages; general practitioners from municipalities with<5,000 inhabitants even had the highest average income of € 8,700, with an average working time of 51 hours per week. Female physicians worked part-time more often than did male physicians. A lower income resulted primarily from a lower scope of activity.

[Brief description of the personnel potential of healthcare in Greece, Spain and Bulgaria].

The article presents a brief descriptive overview of the human resources of healthcare in Greece, Spain and Bulgaria. It is noted that they differ in the redundancy of specialist doctors with a relative shortage of general practitioners. The medical personnel of these countries are characterized by aging, a tendency to migrate to other countries, a shortage of secondary medical personnel, an excess of the required number of dentists, which is especially pronounced in Bulgaria. In addition, the availability of medical care and the limits on the number of patients for a certain time period with one doctor, established in Greece, reduce. The salary level of doctors in these countries varies from the minimum (Greece, Bulgaria) to the maximum in Spain. At the same time, the training of medical personnel is carried out according to the Bologna system (bachelor's degree, master's degree, etc.) and is characterized by a long period (4-5 years) of preparing a doctor for independent work.

Encounters and management of oral conditions at general medical practices in Australia.

BACKGROUND: Poor oral health has been widely recognised as an ongoing public health issue. Patients with oral conditions may visit either a general practitioner (GP) or a dental practitioner for management. The aims of this study are to report (i) the GP management rate of oral health conditions by patient and GP demographics, (ii) what specific oral conditions were managed, and (iii) how GPs managed oral conditions. METHODS: Data from the Bettering the Evaluation and Care of Health study (2006 to 2016 inclusive) were analysed. Descriptive statistics with 95% confidence intervals around point estimates were used to summarise data. Multivariate logistic regression was performed to determine the independent effect of patient and GP characteristics. RESULTS: A total of 972,100 GP encounters were included in the dataset, with oral condition-related encounters managed at a rate of 1.19 oral conditions per 100 GP encounters. Patients who were aged 54 years or younger, resided in a socioeconomically disadvantaged area, came from a non-English speaking background or Indigenous background were more likely to have oral conditions managed by GPs. The most commonly reported oral conditions were dental and oral mucosa-related. Over 60% of oral conditions were managed by GPs through prescribed medications. CONCLUSIONS: This study provided an overview of management of oral conditions by GPs in Australia. Patients from certain vulnerable demographic groups were more likely to attend a GP for management of oral conditions. Common oral conditions and management approaches were identified. The findings of this study contribute to public health and health policy discussions around optimising primary care provision in oral health.

Contacts with general practitioners, dentists, and medical specialists among nursing home residents: a cross-sectional study in 44 German nursing homes.

BACKGROUND: Nursing home residents have high medical care needs. Their medical care utilization is, however, lower compared to community-dwelling elderly and varies widely among nursing homes. This study quantified the utilization of general practitioners (GPs), dentists, and medical specialists among nursing homes and residents, and investigated whether dentist utilization is associated with individual and nursing home characteristics. METHODS: Forty-four nursing homes invited 2124 residents to participate in a cross-sectional study. For 10 medical specialties, data on contacts in nursing homes, practices, and by telephone in the last 12 months were assessed at individual and nursing home level. The proportion of nursing homes and residents with any form of contact, and the median number and interquartile range (IQR) of contacts among individuals with contact were determined. Using multilevel logistic regression, associations between the probability of individual dental care utilization and sex, age, LTC grade, years of residence, sponsorship, number of nursing home beds, and transport and medical escort services for consultations at a practice were investigated. RESULTS: The proportion of nursing homes with any form of contact with physicians ranged from 100% for GPs, dentists, and urologists to 76.7% for gynecologists and orthopedists. Among the nursing homes, 442 residents participated (20.8% response). The proportion of residents with any contact varied from 97.8% for GPs, 38.5% for neurologists/psychiatrists, and 32.3% for dentists to 3.0% for gynecologists. Only for GPs, neurologists/psychiatrists, dentists, otorhinolaryngologists, urologists, and dermatologists, the proportion was higher for nursing home contacts than for practice and telephone contacts. Among residents with any contact, the median number of contacts was highest for GPs (11.0 [IQR 7.0-16.0]), urologists (4.0 [IQR 2.0-7.0]), and neurologists/psychiatrists (3.0 [IQR 2.0-5.0]). Dentist utilization varied widely among nursing homes (median odds ratio 2.5) and was associated with higher age. CONCLUSIONS: Almost all residents had regular contact to GPs, but only one third had contact with dentists. Lower proportions with contact were found for medical specialists, except for neurologists/psychiatrists. Reasons for the large variations in dental care utilization among nursing homes should be identified. TRIAL REGISTRATION: DRKS00012383 [2017/12/06].

Diagnosis consensus among endodontic specialists and general practitioners: An international survey and a proposed modification to the current diagnostic terminology.

INTRODUCTION: This survey aimed to determine the consensus amongst endodontic specialists in North America and practitioners worldwide to diagnose the pulp and periapical conditions of selected case scenarios encountered in daily practice using the American Association of Endodontists (AAE) pulpal and periapical diagnostic terms. Secondly, an attempt was made to suggest modifications in terms accordingly. METHODOLOGY: A survey designed by two endodontic educators was sent to endodontists in North America and clinicians worldwide through an electronic database. The survey included socio-demographic questions followed by the clinical and radiographic presentations of four clinical scenarios. The participants were then requested to provide the pulpal and the periapical diagnosis of 11 teeth presented in these cases (22 answers in total/participant) using the AAE diagnostic terminology. Cases were designed to include 12 pulpal/periapical conditions as control (non-controversial conditions) and ten so-called controversial conditions. A proportion threshold of 10% was required for any diagnostic term to be reported in this survey. The participants were divided into two groups based on the region of endodontic training and/or practice to 'Specialised North American' or 'International Practitioners,' and their results were statistically compared using chi-squared tests (p < .05). RESULTS: The survey included 421 participants. 74% were endodontists, and 46.1% were amongst the 'Specialised North American' group and 53.9% amongst the 'International Practitioners'. Eleven of 12 control conditions had an almost complete agreement amongst the participants regarding the diagnostic terms selected, ranging between 82% and 96%, with no other diagnostic term exceeding the 10% threshold. All the controversial conditions yielded more than one diagnostic term selected/condition that exceeded the 10% threshold for groups ('Specialised North American' and 'International practitioners'). There were no differences in the diagnostic terms selected between the two groups; however, the weight for each term varied between the groups in some cases. CONCLUSION: There is a lack of consensus amongst clinicians, regardless of their training and region of practice, on the appropriate diagnostic terms to be used in particular clinical conditions. More diagnostic terms and modifications in the current terms may be required to establish a more reliable diagnostic terminology.

The impact of family doctor system on patients' utilisation of general practitioner in primary care facilities-Evidence from Hangzhou, China.

OBJECTIVE: This study aims to examine whether participating in the contracted family doctor system increases patients' utilisation of primary care general practitioner for multiple disease outcomes in China. METHODS: Binary logistic regression models were estimated using data collected from 372 community residents in nine selected districts of Hangzhou, China. RESULTS: Findings revealed that (1) for patients with influenza, diabetes, upper respiratory infection, and gingivitis, those who participated in the contracted family doctor system were approximately 4.3 times, 98.4%, 92.5%, and 52.8% more likely to choose primary care general practitioners (GP) for their initial diagnosis, respectively, as compared with their counterparts who did not have contracted family doctors; (2) For patients with stroke or cerebrovascular disease and cholecystitis or cholelithiasis, those who had contracted family doctors were 1.111 times and 80.6% more likely to choose primary care GP for their subsequent disease maintenance, respectively, as compared to their counterparts without contracted family doctors. CONCLUSION: Our findings indicate that the contracted family doctor system not only increases the utilisation of primary care GP for patients with many chronic conditions but also promotes the overall completion of China's hierarchical medical system in the long run. Policy implications were provided to help policymakers actively construct and develop the contracted family doctor system to promote the hierarchical medical system in China.

Perceived risk and pandemic response awareness in low-capacity public primary health care in Greece.

INTRODUCTION: Primary health care (PHC), the cornerstone of health systems, has an important role in infectious disease control. The SARS-CoV-2 (COVID-19) pandemic has put a burden on health systems worldwide and especially on healthcare workers at the first line delivering their services in remote areas of Greece. This study investigates preparedness and awareness level of primary healthcare workers (PHCWs) and their risk perception in managing the pandemic during its initial phase. METHODS: A cross-sectional survey was conducted in public PHC units in Greece. A web-based 14-item questionnaire, tested in a pilot study, was administered by a pre-existing panel of the Education and Research Network in PHC of Aristotle University of Thessaloniki, Greece. Associations were assessed between epidemic response awareness, risk perception, participant demographics and work settings. Participants were grouped by profession in first-line physicians (general practitioners, internal medicine specialists, pediatricians), first-line non-physicians (nurses, health visitors, paramedics) and second-line PHCWs (dentists, microbiologists, administrators, midwifes, laboratory technicians, nutritionists and social workers). Univariate logistic regression and multivariable analysis were performed and linear regression was performed to examine the effect of participants' awareness of the preparedness plan to their working area characteristics. RESULTS: A total of 441 PHCWs participated in the survey. Risks were perceived at a lower level by second-line PHCWs than by first-line PHCWs (B=-0.78, 95% confidence interval (CI) -1.49- -0.08; p=0.028). Older PHCWs had less concerns than younger PHCWs (B=-0.04, 95%CI -0.08- -0.01; p=0.025) and more experienced participants had more concerns than less experienced (B=0.04, 95%CI 0.00,0.07; p=0.050). PHCWs in rural settings presented with more preparedness awareness, compared to PHCWs in urban areas (B=1.10, 95%CI 0.28,1.92; p=0.008), while PHCWs living with high risk individuals showed less situation awareness (-0.55, 95%CI -0.95-0.16; p=0.006). CONCLUSION: PHCWs in rural areas revealed a relatively high awareness of the response measures and management protocol requirements that were in place, compared to their colleagues in urban areas. As expected, first-line PHCWs directly exposed to emergencies expressed more concerns than second-line PHCWs. Learning from the challenges occurring during the initial phase of the pandemic could help PHC facilities address COVID-19 effectively and PHCWs' sense of security and confidence could be augmented, even when working in remote areas of the country. When planning training, distributing equipment and proposing protocols, the characteristics of the area and the needs of PHCWs, and population should be cautiously considered.

Needs and availability of medical specialists' and allied health professionals' visits in German nursing homes: a cross-sectional study of nursing home staff.

BACKGROUND: The medical care for nursing home residents is estimated to be partly inadequate in Germany. The aim of this study is to investigate the needs and utilization of general practitioners (GPs), medical specialists and allied health professionals. METHODS: A survey was sent to a nationwide random sample of 1069 nursing homes in Germany in January 2019. Nursing staff managers were asked about medical care. Regular nursing home visits by medical specialists and allied health professionals were defined as at least one contact per year to at least one nursing home resident. RESULTS: A total of 486 persons responded (45.5%). On average, nursing homes have contact to 8.6 (interquartile range: 4-10) different GPs. Almost 70% of respondents agreed that residents' medical care should be coordinated by GPs. However, only 46.0% stated that specialist treatment should require GP referral. A high need was seen for care from physiotherapists (91.0%), neurologists or psychiatrists (89.3%), dentists (73.7%), and urologists (71.3%). Regarding the actual utilization of medical specialists and health professionals, most nursing homes have regular contact to physiotherapists (97.1%), psychiatrists or neurologists (90.4%), speech therapists (85.0%), and dentists (84.8%). Remarkable discrepancies between need and utilization were found for urologists and ophthalmologists. CONCLUSION: There is large variance in the number of GPs per nursing home, and needs for medical specialists, especially urologists and ophthalmologists, seem unmet. Interprofessional collaboration between GPs, medical specialists and allied health professionals should be improved, and GPs should play a more coordinating role.

Perceptions and practices of general practitioners on providing oral health care to people with diabetes - a qualitative study.

BACKGROUND: Poorly controlled diabetes leads to multiple complications including oral health problems. General practitioners (GPs) are at the forefront of management of chronic diseases in primary health care. Diabetes guidelines encourage a proactive role for GPs in oral health complications management in people with diabetes, yet little is known about this area of care. This study aimed to explore current practices, perceptions and barriers of GPs towards oral health care for people with diabetes. METHODS: We employed a qualitative research method utilising telephone interviews. Purposive and snowball sampling were used to recruit 12 GPs from Greater Sydney region. A thematic analysis involving an inductive approach was used to identify and analyse contextual patterns and themes. RESULTS: A majority of participants were males (n = 10), working in group practices (n = 11) with a mean ± SD age of 55 ± 11.4 years and 25 ± 13.6 years work experience. Three major themes emerged: oral health care practices in general practice settings; barriers and enablers to oral health care; and role of diabetes care providers in promoting oral health. Most GPs acknowledged the importance of oral health care for people with diabetes, identifying their compromised immune capacity and greater risks of infections as risk factors. GPs reported 20-30% of their patients having oral health problems, however their current oral health care practices relating to education, risk assessment and referrals were reported as very limited. GPs identified several barriers including time constraints, absence of referral pathways, and limited knowledge and training in promoting oral health care. They also reported patient barriers including oral health care costs and lower oral health awareness. GPs perceived that resources such as education/training, a standardised assessment tool and patient education materials could support them in promoting oral health care. GPs also perceived that other diabetes care providers such as diabetes educators could play an important role in promoting oral health. CONCLUSIONS: Despite current recommendations, GPs' current oral health care practices among people with diabetes are limited. Further strategies including capacity building GPs by developing appropriate oral health training programs and simple risk assessment tools along with accessible referral pathways are needed to address the current barriers.

Oral health training for general practitioners and general practice teams.

The role of oral health in promoting general health and wellbeing is recognised, but there is minimal oral health training for doctors, including GPs. The Directorate of Multi-Disciplinary Dental Education (DMDE) at Health Education England North East and North Cumbria has introduced oral health training for GPs, incorporating training recommended by NICE oral health guidance. DMDE oral health training for GPs and general practice teams covered the diagnosis, prevention and management of oral disease, relevant prescribing and accessing dental care. Training has been shown to be worthwhile, positively impacting upon the clinical practice of GPs and thereby improving patient care. General health benefits are anticipated. Interactive training, as outlined in the DMDE lesson plan, was deemed effective. 1-hour courses conveniently delivered within general practices were most popular with GPs. Online courses have been less popular. Barriers to training were overcome through producing a promotional brochure and gaining the support of NHS medical leaders, who assisted with its distribution. A shift to training the trainer will improve the cost-effectiveness and sustainability of training. It is recommended that all GPs receive oral health training.

Community pharmacy integration within the primary care pathway for people with long-term conditions: a focus group study of patients', pharmacists' and GPs' experiences and expectations.

BACKGROUND: This study aimed to use marketing theory to examine the views of patients, pharmacists and general practitioners (GPs) on how community pharmacies are currently used and to identify how community pharmacy services may be better integrated within the primary care pathway for people with long-term conditions (LTCs). METHODS: A qualitative research design was used. Two focus groups were conducted with respiratory patients (n = 6, 5) and two with type 2 diabetes patients (both n = 5). Two focus groups were held with pharmacists (n = 7, 5) and two with GPs (both n = 5). The "7Ps marketing mix" ("product", "price", "place", "promotion", "people", "process", "physical evidence") was used to frame data collection and analysis. Data was analysed using thematic analysis. RESULTS: Due to the access and convenience of community pharmacies ("place"), all stakeholder groups recommended using community pharmacies over GP practices for services such as management of minor ailments, medication reviews and routine check-ups for well managed LTCs ("product"). All stakeholder groups preferred pharmacy services with clear specifications which focused on specific interventions to reduce variability in service delivery and quality ("process"). However, all stressed the importance of having an appropriate system to share relevant information, allowing pharmacists and GPs two-way flow ("process"). Pharmacists and GPs mentioned difficulties in collaborating with each other due to inter-professional tensions arising from funding conflicts, which leads to duplication of services and inefficient workflow within the primary care pathway ("people"). Patients and GPs were sometimes doubtful of community pharmacies' potential to expand services due to limited space, size and poor quality consultation rooms ("physical evidence"). However, all stakeholder groups recommended promoting community pharmacy services locally and nationally ("promotion"). Patients felt the most effective form of promotion was first-hand experience of high quality pharmacy services and peer word-of-mouth. The added value of using pharmacy services was faster access and convenience for patients, and freeing up GPs' time to focus on more complex patients ("value"). CONCLUSIONS: Using the 7Ps marketing mix highlighted factors which could influence utilisation and integration of community pharmacy services within the primary care pathway for patients with LTCs. Further research is needed to identify their relative importance.

An observational study of the use of acute hospital care by people with intellectual disabilities in England.

INTRODUCTION: Providing safe, high-quality admitted-patient care for people with intellectual disabilities (IDs) requires consideration for their special needs particularly in relation to communication and consent. To make allowance for these special requirements, it would be helpful for hospitals to know how often they are likely to arise. This study set out to identify the amount and patterns of use of acute, non-psychiatric hospital admitted-patient care in England by people with ID. Patterns are considered in relation to clinical specialties, modes of admission (emergency or planned) and life stages (children and young people, working age and older adults). In each case, patterns for people with ID are compared with patterns for those without. METHODS: Descriptive observational study using a major general practitioner (GP) research database (Clinical Practice Research Datalink GOLD) linked to routine national statistical records of admitted-patient care. RESULTS: Overall people identified by their GP as having ID had higher rates of admitted-patient care episodes and longer durations of stay than those without. Differences varied considerably between clinical specialties with rates more elevated in medical and paediatric than surgical specialties. Admitted-patient care rates for women with ID in obstetrics and gynaecology were lower than for other women, while rates for admitted-patient dental care were much higher for both men and women with ID. In an average English health administrative area with a local population of 250 000 people, at any time, there are likely to be approximately 670 people receiving acute admitted-patient care. Approximately six of these are likely to have been identified by their GP as having ID. At 0.9% of hospital in-patients, this is just under twice the proportion in the population. CONCLUSION AND IMPLICATIONS: Our figures are likely to be an underestimate as GP identification of people with ID is known to be far from complete. However, they indicate that the number of people with ID in acute hospital settings is likely to be substantially more than a recent survey of English health services indicated they were aware of. The study is intended to help guide expectations for acute hospitals seeking to audit the completeness of their identification of people with ID and to indicate their likely distribution between clinical specialties.

Referral patterns of pediatric dentists and general practitioners to orthodontists based on case complexity.

OBJECTIVE: The objectives of this research were to investigate and compare general and pediatric dentists' subjective judgments of orthodontic case complexity and to determine how their perceptions of case complexity influence their decisions to refer the patient to an orthodontist. METHODS: Twenty pediatric dentists and 21 general dentists participated in the study. Pretreatment orthodontic records of 20 patients with a variety of malocclusions and a range of American Board of Orthodontics Discrepancy Index (DI) scores were used. Respondents were asked about their background and training in orthodontics. They were also asked to identify the subjective complexity of each case with the use of a 100-point visual analog scale (VAS) and whether they would refer the patient to an orthodontic specialist. A mixed-model multivariate data analysis was used to evaluate the subjective case complexity with the use of fixed factors such as DI score, type of panel member, experience, annual continuing education rate, and gender. Generalized linear mixed models were used to investigate the referral patterns of the general dentists and pediatric dentists. Level of significance was set at P < 0.05 for all statistical analyses. RESULTS: General dentists appeared to provide more overall orthodontic treatment than pediatric dentists; many general dentists provide limited orthodontic treatment and clear aligner therapy (P < 0.05). The perceived complexity score for cases was not significantly different between the 2 groups (P = 0.82). The association between DI score and perceived complexity was similar in both groups (P = 0.183) and there was a high correlation between DI and VAS score in the sample (r = 0.71; 95% Cl 0.38-0.87). Pediatric dentists had higher referral rates for cases with DI scores both below and above 20. Significant differences were noted between the pediatric and general dentists in the individual case referral decision as evaluated by the DI (P < 0.037) and VAS (P < 0.042) scores. CONCLUSIONS: General dentists provided more orthodontic care than the pediatric dentists. Both groups identified case complexity similarly, with only minor differences, but pediatric dentists had higher referral rates to orthodontic specialists regardless of the initial case complexity.

General practice recruitment - a survey of awareness and influence of the Scottish Targeted Enhanced Recruitment Scheme (TERS).

The World Health Organisation reported that health-care systems worldwide have problems with the recruitment and retention of general practitioners (GPs) into clinical practice, particularly to rural and under-served areas. A recent survey of United Kingdom (UK) trainees found that they valued posts with good training conditions, were in desirable locations and gave opportunities for their partner. The Scottish Government has set a target to increase the number of GPs in Scotland by 800 in the next 10 years. In recent years, GP speciality training recruitment has been challenging with significant vacancies in some training programmes, primarily in rural areas, or urban areas with a history of poorer recruitment. Recruitment incentive schemes are in operation in different countries in the UK. The Scottish Government introduced a Targeted Enhanced Recruitment Scheme (TERS), offering a £20,000 payment to GPST trainees accepting a targeted post. This study aimed to evaluate awareness and influence of the TERS initiative on programme choice in Scotland in August 2017. A survey was developed and sent to GP trainees taking up a GPST post in August 2017. Ninety-five out of 245 doctors responded (response rate of 39%). Almost two-thirds (65.3%) were aware of TERS at the time of application and this was via word of mouth and from the National Recruitment Office website. Only 21% of GPSTs aware of TERS were influenced by it in their choice of training location. The locations of family, spouse or partner, and of pre-existing geographical preferences were more influential than TERS.

[Could general practitioners play a part in the public health concern on fighting microplastics?] / Lutte contre les microplastiques : un objectif de santé publique pour les médecins généralistes ?

Plastic production is overwhelming, worldspread (around 300 millions tons a year) and liable to triple by 2050. Science is currently trying to assess the environmental impact of microplastics: particles that are smaller than 5 mm and end up in oceans, invading thus the marine ecosystems. By 2025, 250 millions tons of accumulated plastic waste are expected to be found in the oceans, althought these oceans provide food, well-being and therapeutics for human beings. Health actors are thus enticed to study with more depth and attention potentials risks of toxicity (additives, contaminants, etc.), sources of microplastics, and the becoming in human body of the thinnest particles (nanoplastics).General practionners could use their public health skills by staying alert and operating a preventive action in the Community (through communication, coordination and cooperation amongst local institutions, eg. school) to use plastics with more relevance. Versatility and multiple practicing (eg. Multidisciplinary group practice, well-followed recommandations…) as well as the maping of territorial networks bring hope for a diffused and assessable action, under control of health authorities.

[Winter sports†: from an emergency service to a general practitioner's office]. / Sports d'hiver†: d'un service d'urgences à un cabinet de premier recours.

In an alpine region, the winter season has a major impact on the daily practice of both an emergency department and a general practice. During the 2017-2018 season, we have listed the consultations caused by winter sports, whether traumatological or medical. The vast majority are ambulatory. Initial care and follow-up can usually be performed by a primary care physician. In this paper, we will outline the management of the knee and acromioclavicular sprain, two frequent lesions in the winter sports setting.

Dans un canton alpin comme le Valais, la saison d'hiver a un impact important sur la pratique quotidienne aussi bien d'un service d'urgences que d'un cabinet de médecine interne générale. Durant la saison 2017-2018, nous avons répertorié les consultations engendrées par la pratique des sports d'hiver, que leur motif soit traumatologique ou médical. La grande majorité des consultations sont ambulatoires. Leur prise en charge initiale et le suivi peuvent souvent être assurés par un médecin de premier recours. Les grandes lignes de la prise en charge des traumatismes du genou et de l'entorse acromio-claviculaire, lésions parmi les plus fréquentes, seront détaillées dans cet article.

[What do General Practitioners and Dentists Report about their Cooperation? A Qualitative Exploration]. / Was berichten Hausärzte und Zahnärzte über ihre Zusammenarbeit? Ergebnisse aus einer qualitativen Exploration.

OBJECTIVE: Against the background of well-described associations between oral and general health, the cooperation between general practitioners (GPs) and dentists is crucial. Besides treatment, this includes prevention. Administrative referral between these two professions is not provided by statute. Thus, the study addresses the question: How do dentists and GPs integrate the associations between oral and systemic health in daily routine? METHODS: A total of 28 semi-structured interviews were conducted with GPs and dentists from 3 structurally different regions in the Federal State of Baden-Wurttemberg. Participants were visited in their office. The interviews were recorded, transcribed and analysed by 2 dentists and sociologists using Mayrings' qualitative content analysis. RESULTS: Associations between general and oral health are partially known to both practitioners. However, contact between them is limited. GPs send patients directly to dentists, without contacting them - mainly due to a desolate dental status, rarely due to therapy-resistant headache or facial pain. Dentists contact GPs to clarify mainly medication or anticoagulation medications taken by patients prior to invasive procedures. Preventive aspects play a minor part. Consultation essentially depends on acquaintanceship. CONCLUSION: Separation by statute determines the cooperation. Oral cavity in daily care is demarcated. Holistic patient care is hindered by a lack of knowledge and daily routines.

[The image of general practitioners compared to that of dentists in the Netherlands]. / Imago van huisartsen versus tandartsen in Nederland.

The image of the professions of family doctor and dentist in the Netherlands was investigated by means of a questionnaire distributed online and in four cities. In total, 270 questionnaires were analysed. The dentist was seen more as a businessman, a solo performer for whom the interests of the patient were less highly prioritised, who,was less communicative, more associated with pain, more distant, less open to dialogue and could be trusted less than the general practitioner. Respondents also felt less safe at the dentist's office than at the general practitioner's. On average, respondents rated the general practitioner significantly higher than the dentist. Dentists scored significantly lower than general practitioners on eleven of the twelve statements. The score of the profession dentist was not significantly different from that of general practitioner in only one category, professionalism. These results indicate that the image of the dental profession is worse than that of the general practitioner.