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1.
J Matern Fetal Neonatal Med ; 37(1): 2325580, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38433401

RESUMO

This article examines the applicability of obstetrical randomized controlled trials (RCTs) in the real-world and proposes a classification of the value of these trials based on their potential for achieving sustainable practices. In the context of this discussion, real-world results pertain to the potential impact of the RCT on sustainable interventions and practices, and its implications for healthcare practice or policy, in the country (or countries) that was conducted. While RCTs are generally regarded as the gold standard of medical evidence, their effectiveness in producing meaningful real-world results depends, among various other factors, on the clarity and specificity of the trial definitions used for diagnosis (characteristics of the study group or enrollment criteria) and treatment (intervention). The definitions used for diagnosis and treatment, especially in pragmatic trials, can influence the likelihood for real-world implementation. By analyzing notable obstetrical RCTs, the authors find that trials with well-defined diagnoses and treatments that can be implemented without specialized expertise are more likely to generate results that are relevant to general practice, indicating higher value. In contrast, RCTs with ambiguous or undefined diagnoses and treatments often lead to variations in practice and produce unreliable real-world outcomes and practices suggesting lower value. Recognizing this variability can offer valuable guidance for the design and evaluation of RCTs in obstetrics.


Assuntos
Medicina Geral , Obstetrícia , Feminino , Gravidez , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Instalações de Saúde , Probabilidade
2.
South Med J ; 117(3): 122-127, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38428931

RESUMO

OBJECTIVES: Internal Medicine (IM) residents have reported dissatisfaction with continuity clinic (CC) training, which may contribute to the increasing shortage of primary care physicians. Studies show balancing inpatient and outpatient duties as a driver of dissatisfaction, but few studies have compared CC with inpatient (IP) training, following transition to an X + Y model, or assessed the impact of show rates, continuity, and telemedicine use on resident perceptions. The aim of this study was to adapt a validated survey to compare residents' perceptions of their CC with their inpatient medicine training and examine the impact of objective clinic measures on training. METHODS: This quantitative cross-sectional study included a survey that was sent to 152 residents at an academic IM program in May-June 2021. Clinic measures such as show versus no-show rates, continuity with the residents' own patients, and visit modality were obtained through the electronic health records at Veterans Affairs and non-Veterans Affairs CCs. RESULTS: The survey response rate was 78% (118/152). Residents were more satisfied with inpatient general medicine rotations than their CC experience (4.5 vs 3.3 on a 5-point scale, P < 0.001). Residents were more likely to pursue a profession in inpatient IM than in primary care (3.7 vs 2.3, P < 0.001). No correlation was found between higher show rates, continuity with patients, or proportion of visits conducted through telemedicine and resident satisfaction with CC. CONCLUSIONS: This study aligns with previous findings of IM resident dissatisfaction with CC training while adding a side-by-side comparison to inpatient training and including objective CC data. We identified new areas for improvement of CC training, including residents' medical knowledge through review of quality metrics, making CC representative of real-world practice, and mentorship from faculty.


Assuntos
Medicina Geral , Internato e Residência , Humanos , Estudos Transversais , Instituições de Assistência Ambulatorial , Inquéritos e Questionários
3.
BMC Prim Care ; 25(1): 75, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38429634

RESUMO

BACKGROUND: Medicare provides significant funding to improve, encourage and coordinate better practices in primary care. Medicare-rebated Chronic Disease Management (CDM) plans are a structured approach to managing chronic diseases in Australia. These chronic disease care plans are intended to be a vehicle to deliver guideline-based / evidence-based care.. However, recommended care is not always provided, and health outcomes are often not achieved. This scoping review aimed to identify the specific components of CDM plans that are most effective in promoting self-management, as well as the factors that may hinder or facilitate the implementation of these plans in general practice settings in Australia. METHOD: A comprehensive search was conducted using multiple electronic databases, considering inclusion and exclusion criteria. Two reviewers independently screened the titles and abstracts of the identified studies via Covidence, and the full texts of eligible studies were reviewed for inclusion. A data extraction template was developed based on the Cochrane Effective Practice and Organization of Care Group (EPOC) to classify the intervention methods and study outcomes. A narrative synthesis approach was used to summarize the findings of the included studies. The quality of the included studies was assessed using the JBI Critical Appraisal Checklist. RESULTS: Seventeen articles were included in the review for analysis and highlighted the effectiveness of CDM plans on improving patient self-management. The findings demonstrated that the implementation of CDM plans can have a positive impact on patient self-management. However, the current approach is geared towards providing care to patients, but there are limited opportunities for patients to engage in their care actively. Furthermore, the focus is often on achieving the outcomes outlined in the CDM plans, which may not necessarily align with the patient's needs and preferences. The findings highlighted the significance of mutual obligations and responsibilities of team care for patients and healthcare professionals, interprofessional collaborative practice in primary care settings, and regular CDM plan reviews. CONCLUSION: Self-management support remains more aligned with a patient-centred collaboration approach and shared decision-making and is yet to be common practice. Identifying influential factors at different levels of patients, healthcare professionals, and services affecting patients' self-management via CDM plans can be crucial to developing the plans.


Assuntos
Diabetes Mellitus , Medicina Geral , Autogestão , Idoso , Humanos , Programas Nacionais de Saúde , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Austrália/epidemiologia , Gerenciamento Clínico
4.
Radiology ; 310(3): e231972, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38470234

RESUMO

Background Previous studies have shown an increase in the number of authors on radiologic articles between 1950 and 2013, but the cause is unclear. Purpose To determine whether authorship rate in radiologic and general medical literature has continued to increase and to assess study variables associated with increased author numbers. Materials and Methods PubMed/Medline was searched for articles published between January 1998 and October 2022 in general radiology and general medical journals with the top five highest current impact factors. Generalized linear regression analysis was used to calculate adjusted incidence rate ratios (IRRs) for the numbers of authors. Wald tests assessed the associations between study variables and the numbers of authors per article. Combined mixed-effects regression analysis was performed to compare general medicine and radiology journals. Results There were 3381 original radiologic research articles that were analyzed. Authorship rate increased between 1998 (median, six authors; IQR, 4) and 2022 (median, 11 authors; IQR, 8). Later publication year was associated with more authors per article (IRR, 1.02; 95% CI: 1.01, 1.02; P < .001) after adjusting for publishing journal, continent of origin of first author, number of countries involved, PubMed/Medline original article type, study design, number of disciplines involved, multicenter or single-center study, reporting of a priori power calculation, reporting of obtaining informed consent, study sample size, and number of article pages. There were 1250 general medicine original research articles that were analyzed. Later publication year was also associated with more authors after adjustment for the study variables (IRR, 1.04; 95% CI: 1.03, 1.05; P < .001). There was a stronger increase in authorship by publication year for general medicine journals compared with radiology journals (IRR, 1.02; 95% CI: 1.01, 1.02; P < .001). Conclusion An increase in authorship rate was observed in the radiologic and general medical literature between 1998 and 2022, and the number of authors per article was independently associated with later year of publication. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Arrivé in this issue.


Assuntos
Medicina Geral , Radiologia , Humanos , Autoria , Projetos de Pesquisa
6.
Aust J Gen Pract ; 53(3): 121-126, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38437652

RESUMO

BACKGROUND: Sport-related concussion (SRC) is a traumatic brain injury that occurs during sport or exercise activity. SRC is a growing health concern in Australia, with increasing public awareness and presentations to general practitioners being increasingly common. OBJECTIVE: This article will focus on the assessment and management of SRC in general practice, including guidance for returning patients to sport. Concussion prevention, potential long-term complications, and the decision-making process regarding retirement from sport are beyond the scope of this article. DISCUSSION: Recognising concussion can be difficult, as clinical symptoms and signs of SRC can evolve over a period of hours to days. General practitioners should be aware of the range of clinical concussion presentations. The key principles of management include relative rest, followed by a graduated return to cognitive and physical activity. Involvement of a multidisciplinary team can improve symptoms for those patients whose concussion symptoms are prolonged.


Assuntos
Concussão Encefálica , Medicina Geral , Clínicos Gerais , Esportes , Humanos , Medicina de Família e Comunidade , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia
7.
Aust J Gen Pract ; 53(3): 87, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38437654
8.
Aust J Gen Pract ; 53(3): 146-151, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38437660

RESUMO

BACKGROUND AND OBJECTIVES: Strategies to improve vaccination rates have been implemented with considerable benefits. The main objective of this study was to assess the impact of a supported general practice intervention to 'catch up' overdue children. METHOD: Between 2017 and 2018, a public health nurse visited 23 general practices with high numbers of overdue children to assist staff identify and follow up truly overdue children. A comparison group consisted of a random sample of overdue children from other practices. The intervention was assessed by reviewing Australian Immunisation Register (AIR) records in 2019. RESULTS: Although the intervention group had a significantly higher proportion of children who had their AIR records corrected for vaccines administered prior to the initial practice visit, the intervention did not result in higher vaccination rates. DISCUSSION: Support to general practices can improve vaccination data on the AIR; however, simple reminders alone are unlikely to increase vaccination rates for truly overdue children.


Assuntos
Medicina Geral , Vacinação , Criança , Humanos , Austrália , Imunização , Medicina de Família e Comunidade
9.
Scand J Pain ; 24(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38451744

RESUMO

OBJECTIVES: Management of patients with chronic musculoskeletal pain (CMP) remains a challenge in general practice. The general practitioner (GP) often experiences diagnostic uncertainty despite frequently referring patients with CMP to specialized departments. Therefore, it remains imperative to gain insights on how to optimize and reframe the current setup for the management of patients with CMP. The objective was to explore GP's perspectives on the challenges, needs, and visions for improving the management of patients with CMP. METHODS: A qualitative study with co-design using the future workshop approach. Eight GPs participated in the future workshop (five females). Insights and visions emerged from the GP's discussions and sharing of their experiences in managing patients with CMP. The audio-recorded data were subjected to thematic text analysis. RESULTS: The thematic analysis revealed four main themes, including (1) challenges with current pain management, (2) barriers to pain management, (3) the need for a biopsychosocial perspective, and (4) solutions and visions. All challenges are related to the complexity and diagnostic uncertainty for this patient population. GPs experienced that the patients' biomedical understanding of their pain was a barrier for management and underlined the need for a biopsychosocial approach when managing the patients. The GPs described taking on the role of coordinators for their patients with CMP but could feel ill-equipped to handle diagnostic uncertainty. An interdisciplinary unit was recommended as a possible solution to introduce a biopsychosocial approach for the examination, diagnosis, and management of the patient's CMP. CONCLUSIONS: The complexity and diagnostic uncertainty of patients with CMP warrants a revision of the current setup. Establishing an interdisciplinary unit using a biopsychosocial approach was recommended as an option to improve the current management for patients with CMP.


Assuntos
Medicina Geral , Clínicos Gerais , Dor Musculoesquelética , Feminino , Humanos , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/terapia , Clínicos Gerais/psicologia , Manejo da Dor , Incerteza
10.
N Z Med J ; 137(1591): 11-29, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38452229

RESUMO

AIM: In Aotearoa New Zealand, primary care is organised by enrolling patients with a primary care provider. However, the benefits of this arrangement are frustrated when providers "close their books" due to insufficient capacity for new patients. We investigated the extent, evolution and impact of this situation on health access and equity in access to primary healthcare. METHOD: We distributed a survey for general practice personnel in 2022, yielding 227 valid responses. We examined responses across respondents' practice characteristics, including practice size, rural-urban setting, average co-payments, region and ethnic composition of the catchment population. RESULTS: Most general practices are selectively enrolling their patients. In 2022, only 28% of respondents freely enrolled new people. Since 2019, most respondents (79%) had "closed books" or limited enrolments at some point. The situation worsened between 2019 and 2022, compromising equal opportunity and access in healthcare. CONCLUSION: Restricted enrolment poses a widespread barrier to health access and equity, and it worsened since the beginning of the COVID-19 pandemic. Addressing closed books and limited enrolments in general practice could significantly improve health services' access and equity. The study aims to inform ongoing health reforms.


Assuntos
Medicina Geral , Pandemias , Humanos , Nova Zelândia , Inquéritos e Questionários , Acesso aos Serviços de Saúde , Atenção Primária à Saúde
11.
BMJ ; 384: q582, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38453189
12.
Sci Rep ; 14(1): 5733, 2024 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-38459178

RESUMO

Gender is a key determinant of health and healthcare use. The question of whether physicians are aware of gender issues is important to avoid gender bias in medical practice. This study aimed to validate the Nijmegen Gender Awareness in Medicine Scale (N-GAMS) in a representative population of French general practitioners (GPs) and to analyze their gender sensitivity and the presence of gender stereotypes among them. The N-GAMS, already validated in medical students, measures gender awareness through 3 subscores: gender sensitivity (GS) and gender-role ideology towards patients (GRIP) and doctors (GRID) (gender stereotypes). After translation into French, it was distributed to 900 GPs. The scale was validated through exploratory factor analysis (EFA). Psychometric properties were tested. Multivariate linear regressions were conducted to explore the associations between GPs' characteristics and N-GAMS subscores. EFA identified 3 meaningful factors consistent with prior theory. Subscores exhibited good internal consistency. The main findings were that GRIP was significantly higher in older physicians, in male physicians, among those who less involved their patients in decisions, and those who were not training supervisors. For GRID, results were quite similar to those of GRIP. GS was significantly higher for physicians working in health centres or medical homes and for those with gynecological practices but lower when they less involved patients in medical decisions. This study suggests that it is necessary to teach gender issues not only in medical schools but also as part of continuing medical education.


Assuntos
Medicina Geral , Clínicos Gerais , Glutamina/análogos & derivados , Humanos , Masculino , Feminino , Idoso , Estudos Transversais , Inquéritos e Questionários , Sexismo , França
13.
BMC Med Educ ; 24(1): 294, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38491385

RESUMO

BACKGROUND: The global primary healthcare workforce is declining, leading to a shortage of general practitioners. Although various educational models aim to increase interest in general practice, effective interventions are limited. The reasons for this low appeal among medical graduates remain unclear. METHODS: This cross-sectional study surveyed medical students' and residents' attitudes towards general practice in Tyrol, Austria. The online questionnaire addressed professional values, general practice-related issues, personal professional intentions, and demographics. Data analysis employed chi-square tests and multivariate logistic regression to explore predictors of interest in general practice. RESULTS: The study included 528 students and 103 residents. Key values identified were stable positions, assured income, and work-family reconciliation. General practice was recognised for long-term patient relationships and patient contact, with students attributing more positive work-environmental characteristics and higher reputation to it than residents. Few participants (students: 3.2%, residents: 11.7%) had opted for general practice; about half were considering it as career option. Reasons not to choose general practice were preferences for other specialties, intrinsic characteristics of general practice, workload, insufficient time for the patients, financial pressures, low reputation, and perceived mediocre training quality. Predictors of interest in general practice included perception of independent decision-making, importance of work-family balance (students), better practical experiences in general practice during medical school (students and residents), younger age, and perceiving general practice as offering a promising future (residents). Both groups felt underprepared by medical school and/or general practice training for general practice roles. The attractiveness of specialist medicine over general practice was related to clearer content boundaries, better career opportunities, and higher incomes. CONCLUSIONS: According to these results, measures to improve attractiveness of general practice should focus on (i) high-quality undergraduate education including practical experiences, and (ii) on ensuring professional autonomy, work-family reconciliation, and job stability. Efforts to encourage more graduates to pursue this essential healthcare sector are crucial for strengthening primary healthcare and public health services. TRIAL REGISTRATION: The study has not been registered as it did not include a direct medical intervention on human participants.


Assuntos
Medicina Geral , Serviços de Saúde Rural , Estudantes de Medicina , Humanos , Estudos Transversais , Escolha da Profissão , Áustria , Inquéritos e Questionários
15.
Tidsskr Nor Laegeforen ; 144(4)2024 Mar 19.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-38506015

RESUMO

Background: Diet can have a major impact on health. In this study, we surveyed the extent to which the subject of diet was raised by patients in general practice and which patients desired such discussions. Material and method: We conducted a questionnaire-based cross-sectional study of patients ≥ 18 years of age at GP practices in Western Norway in 2022. The questionnaire consisted of nine questions about dietary knowledge, the desire to receive dietary guidance and lose weight, and medication use. Logistic regression was used to identify groups more likely to report a desire to receive guidance on how diet affects health. Results: A total of 2105 of the 2531 (83 %) invited patients ≥ 18 years of age completed the questionnaire, and 2075 of these were included in the analysis. One in three had raised the subject of diet with their GP. A total of 96 % reported having the knowledge they needed about diet, 56 % wanted advice or guidance on how diet affects health, 62 % wanted to lose weight and 40 % reported being confused by diet/dietary advice. Younger patients, men, patients with lower levels of education, patients who wanted to lose weight and patients taking medication for chronic conditions more frequently wanted advice/guidance on how diet affects health. Interpretation: Over half of the patients in the GP practices wanted advice/guidance on how diet affects health. Knowing who is more likely to want guidance can be useful for prioritising which consultations are appropriate for providing guidance on diet and health impacts.


Assuntos
Medicina Geral , Educação em Saúde , Masculino , Humanos , Estudos Transversais , Dieta , Inquéritos e Questionários , Redução de Peso
17.
Lancet Psychiatry ; 11(4): 262-273, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38432236

RESUMO

BACKGROUND: Screening for depression in primary care alone is not sufficient to improve clinical outcomes. However, targeted feedback of the screening results to patients might result in beneficial effects. The GET.FEEDBACK.GP trial investigated whether targeted feedback of the depression screening result to patients, in addition to feedback to general practitioners (GPs), leads to greater reductions in depression severity than GP feedback alone or no feedback. METHODS: The GET.FEEDBACK.GP trial was an investigator-initiated, multicentre, three-arm, observer-blinded, randomised controlled trial. Depression screening was conducted electronically using the Patient Health Questionnaire-9 (PHQ-9) in 64 GP practices across five regions in Germany while patients were waiting to see their GP. Currently undiagnosed patients (aged ≥18 years) who screened positive for depression (PHQ-9 score ≥10), were proficient in the German language, and had a personal consultation with a GP were randomly assigned (1:1:1) into a group that received no feedback on their depression screening result, a group in which only the GP received feedback, or a group in which both GP and patient received feedback. Randomisation was stratified by treating GP and PHQ-9 depression severity. Trial staff were masked to patient enrolment and study group allocation and GPs were masked to the feedback recieved by the patient. Written feedback, including the screening result and information on depression, was provided to the relevant groups before the consultation. The primary outcome was PHQ-9-measured depression severity at 6 months after randomisation. An intention-to-treat analysis was conducted for patients who had at least one follow-up visit. This study is registered at ClinicalTrials.gov (NCT03988985) and is complete. FINDINGS: Between July 17, 2019, and Jan 31, 2022, 25 279 patients were approached for eligibility screening, 17 150 were excluded, and 8129 patients completed screening, of whom 1030 (12·7%) screened positive for depression. 344 patients were randomly assigned to receive no feedback, 344 were assigned to receive GP-targeted feedback, and 339 were assigned to receive GP-targeted plus patient-targeted feedback. 252 (73%) patients in the no feedback group, 252 (73%) in the GP-targeted feedback group, and 256 (76%) in the GP-targeted and patient-targeted feedback group were included in the analysis of the primary outcome at 6 months, which reflected a follow-up rate of 74%. Gender was reported as female by 637 (62·1%) of 1025 participants, male by 384 (37·5%), and diverse by four (0·4%). 169 (16%) of 1026 patients with available migration data had a migration background. Mean age was 39·5 years (SD 15·2). PHQ-9 scores improved for each group between baseline and 6 months by -4·15 (95% CI -4·99 to -3·30) in the no feedback group, -4·19 (-5·04 to -3·33) in the GP feedback group, and -4·91 (-5·76 to -4·07) in the GP plus patient feedback group, with no significant difference between the three groups (global p=0·13). The difference in PHQ-9 scores when comparing the GP plus patient feedback group with the no feedback group was -0·77 (-1·60 to 0·07, d=-0·16) and when comparing with the GP-only feedback group was -0·73 (-1·56 to 0·11, d=-0·15). No increase in suicidality was observed as an adverse event in either group. INTERPRETATION: Providing targeted feedback to patients and GPs after depression screening does not significantly reduce depression severity compared with GP feedback alone or no feedback. Further research is required to investigate the potential specific effectiveness of depression screening with systematic feedback for selected subgroups. FUNDING: German Innovation Fund. TRANSLATION: For the German translation of the abstract see Supplementary Materials section.


Assuntos
Depressão , Medicina Geral , Humanos , Masculino , Feminino , Adolescente , Adulto , Depressão/diagnóstico , Depressão/terapia , Retroalimentação , Estudos Prospectivos , Resultado do Tratamento , Alemanha
18.
BMJ ; 384: q571, 2024 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-38485115
19.
BMC Prim Care ; 25(1): 96, 2024 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-38519880

RESUMO

BACKGROUND: Patients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties. METHODS: We conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group. RESULTS: GPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations. CONCLUSION: The GPs' interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group.


Assuntos
Medicina Geral , Clínicos Gerais , Transtornos Mentais , Pessoas Mentalmente Doentes , Humanos , Transtornos Mentais/terapia , Pesquisa Qualitativa
20.
BMC Prim Care ; 25(1): 97, 2024 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-38521895

RESUMO

BACKGROUND: Patient reported experiences (PREMs) are important indices of quality of care. Similarities in demography between patient and doctor, known as social concordance, can facilitate patient-doctor interaction and may be associated with more positive patient experiences. The aim of this research is to study associations between gender concordance, age concordance and PREMs (doctor-patient communication, involvement in decision making, comprehensiveness of care and satisfaction) and to investigate whether these associations are dependent on a countries' Gender Equality Index (GEI). METHODS: Secondary analysis on a multinational survey (62.478 patients, 7.438 GPs from 34 mostly European countries) containing information on general practices and the patient experiences regarding their consultation. Multi-level analysis is used to calculate associations of both gender and age concordance with four PREMs. RESULTS: The female/female dyad was associated with better experienced doctor-patient communication and patient involvement in decision making but not with patient satisfaction and experienced comprehensiveness of care. The male/male dyad was not associated with more positive patient experiences. Age concordance was associated with more involvement in decision making, more experienced comprehensiveness, less satisfaction but not with communication. No association was found between a country's level of GEI and the effect of gender concordance. CONCLUSION: Consultations in which both patient and GP are female are associated with higher ratings of communication and involvement in decision making, irrespective of the GEI of the countries concerned. Age concordance was associated with all PREMs except communication. Although effect sizes are small, social concordance could create a suggestion of shared identity, diminish professional uncertainty and changes communication patterns, thereby enhancing health care outcomes.


Assuntos
Equidade de Gênero , Medicina Geral , Humanos , Masculino , Feminino , Comunicação , Europa (Continente)/epidemiologia , Medidas de Resultados Relatados pelo Paciente
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