Insights from end-of-career general practitioners on changing working conditions and generational differences: considerations for future strategies.

The landscape of general practice has experienced notable transformations in recent decades, profoundly influencing the working conditions of general practitioners (GPs). This study aimed to examine the most salient changes affecting GPs' daily practices. Through semi-structured qualitative interviews with 15 end-of-career GPs, the study explored how these changes affected work organization, equipment, working hours, work-life balance, job satisfaction, training, patient relationships, and reputation. The interviews revealed that these changes were perceived as barriers, opportunities, or a complex interplay of both for general practice. While the interviewed GPs valued technological advancements and reported positive developments in working conditions, challenges included a gradual reduction in the range of tasks, growing administrative burdens, and less practical training for young physicians. Other changes, such as new doctor-patient dynamics, the transition from single to group practice, and differing professional expectations of the younger generation, were seen as both challenging and strengthening for general practice. By combining these factors and trade-offs observed by end-of-career GPs in our study over the past few decades with general societal changes, we provide ideas for the design of future framework conditions in general practice that might enhance the attractiveness of the profession. These insights offer key considerations that can guide future strategies for general practice and medical education.

How stressful was the COVID-19 vaccination procedure? Comparison between mass vaccination centers and general practices.

Negative past experiences with vaccines or unfamiliar environments can be sources of stress during the COVID-19 vaccination procedure. We examined whether the perceived stressfulness of the vaccination procedure differ between mass vaccination centers and general practitioner (GP) practices. A survey was distributed (07/2021-10/2021) among newly vaccinated individuals in ten GP practices (n = 364) and two vaccine centers (n = 474). Stress was low at all sites. The perceived stressfulness of the procedure was higher among younger participants and those in GP practices, and increased with longer waiting time at the site. Stress decreased with better comprehensibility of the procedure and higher satisfaction with patient education. Participants who expressed greater concern about the health risks of COVID-19 vaccines perceived the vaccination procedure as more stressful. Our findings indicate opportunities for improvements in future vaccination campaigns and highlight the important role of healthcare providers in mitigating stress by addressing individual concerns.

Saxon Epidemiological Study in General Practice-6 (SESAM-6): protocol of a cross-sectional study.

INTRODUCTION: General practitioners (GPs) are mostly the first point of contact for patients with health problems in Germany. There is only a limited epidemiological overview data that describe the GP consultation hours based on other than billing data. Therefore, the aim of Saxon Epidemiological Study in General Practice-6 (SESAM-6) is to examine the frequency of reasons for encounter, prevalence of long-term diagnosed diseases and diagnostic and therapeutic decisions in general practice. This knowledge is fundamental to identify the healthcare needs and to develop strategies to improve the GP care. The results of the study will be incorporated into the undergraduate, postgraduate and continuing medical education for GP. METHODS AND ANALYSIS: This cross-sectional study SESAM-6 is conducted in general practices in the state of Saxony, Germany. The study design is based on previous SESAM studies. Participating physicians are assigned to 1 week per quarter (over a survey period of 12 months) in which every fifth doctor-patient contact is recorded for one-half of the day (morning or afternoon). To facilitate valid statements, a minimum of 50 GP is required to document a total of at least 2500 doctor-patient contacts. Univariable, multivariable and subgroup analyses as well as comparisons to the previous SESAM data sets will be conducted. ETHICS AND DISSEMINATION: The study was approved by the Ethics Committee of the Technical University of Dresden in March 2023 (SR-EK-7502023). Participation in the study is voluntary and will not be remunerated. The study results will be published in peer-reviewed scientific journals, preferably with open access. They will also be disseminated at scientific and public symposia, congresses and conferences. A final report will be published to summarise the central results and provided to all study participants and the public.

Statin adherence in patients enrolled in the disease management program for coronary artery disease - comparison between patients' and general practitioners' self-reports and patient records.

INTRODUCTION: Patients with coronary artery disease (CAD) should take a statin daily for secondary prevention. However, statin adherence in patients with CAD is low. This study investigated the proportion of adherent patients enrolled in the disease management program for CAD (DMP-CAD). Adherence was examined by comparing patients' self-reports, general practitioners' (GPs) self-reports, and prescription data. METHODS: Between October 2019 and March 2020, all patients enrolled in the DMP-CAD in three GP practices in Germany were invited to participate in the study. Participants completed a questionnaire on the tolerability of statins. Further, prescription data from patient records, low-density lipoprotein (LDL) levels, and GPs' assessment of statin adherence were examined. The Medication Possession Ratio (MPR) served as a measurement tool for adherence. RESULTS: Seventy-four patients were included. MPR showed high statin adherence for most patients (83.8%). However, GPs did not reliably identify non-adherence in their patients. Generally, the mean LDL values were above the guideline recommendations (97.7 ± 27.9 mg/dl), with higher values in the non-adherent (123.6 ± 42 mg/dl) than in the adherent group (93.1 ± 22 mg/dl). Non-adherent patients were more likely to be employed (41.7% vs. 11.3%). DISCUSSION: Patients in this study showed high statin adherence. However, the LDL target value was often not reached. Therefore, GPs should take advantage of the good adherence of their patients and try to lower LDL levels by adjusting the dosage and/or changing the statin prescribed. Future studies should investigate typical characteristics of non-adherent patients in DMP-CAD so that GPs can target these patient groups and improve their adherence.