Diagnosing and managing prescription opioid use disorder in patients prescribed opioids for chronic pain in Australian general practice settings: a qualitative study using the theory of Planned Behaviour.

BACKGROUND: Chronic pain is a debilitating and common health issue. General Practitioners (GPs) often prescribe opioids to treat chronic pain, despite limited evidence of benefit and increasing evidence of harms, including prescription Opioid Use Disorder (pOUD). Australian GPs are worried about the harms of long-term opioids, but few are involved in the treatment of pOUD. There is little research on GPs' experiences diagnosing and managing pOUD in their chronic pain patients. METHODS: This qualitative research used semi-structured interviews and a case study to investigate GPs' experiences through the lens of the Theory of Planned Behaviour (TPB). TPB describes three factors, an individual's perceived beliefs/attitudes, perceived social norms and perceived behavioural controls. Participants were interviewed via an online video conferencing platform. Interviews were transcribed verbatim and thematically analysed. RESULTS: Twenty-four GPs took part. Participants were aware of the complex presentations for chronic pain patients and concerned about long-term opioid use. Their approach was holistic, but they had limited understanding of pOUD diagnosis and suggested that pOUD had only one treatment: Opioid Agonist Treatment (OAT). Participants felt uncomfortable prescribing opioids and were fearful of difficult, conflictual conversations with patients about the possibility of pOUD. This led to avoidance and negative attitudes towards diagnosing pOUD. There were few positive social norms, few colleagues diagnosed or managed pOUD. Participants reported that their colleagues only offered positive support as this would allow them to avoid managing pOUD themselves, while patients and other staff were often unsupportive. Negative behavioural controls were common with low levels of knowledge, skill, professional supports, inadequate time and remuneration described by many participants. They felt OAT was not core general practice and required specialist management. This dichotomous approach was reflected in their views that the health system only supported treatment for chronic pain or pOUD, not both conditions. CONCLUSIONS: Negative beliefs, negative social norms and negative behavioural controls decreased individual behavioural intention for this group of GPs. Diagnosing and managing pOUD in chronic pain patients prescribed opioids was perceived as difficult and unsupported. Interventions to change behaviour must address negative perceptions in order to lead to more positive intentions to engage in the management of pOUD.

Job satisfaction and turnover of the first group of rural-oriented tuition-waived medical students in Guangxi, China: a mixed-method study.

BACKGROUND: In 2010, China launched a rural-oriented tuition-waived medical education (RTME) programme to train more general practitioners (GPs) to meet the needs of the rural health workforce. Motivating and maintaining GPs is an important consideration for the shortage in the rural health workforce. This study aimed to investigate job satisfaction and turnover among the first group of rural-oriented tuition-waived medical students (RTMSs) who had completed a three-year compulsory service in Guangxi, as well as the factors affecting RTMSs turnover. METHODS: This study adopted a mixed-method approach. A quantitative survey of 129 RTMSs was analysed (81.6% response rate), and qualitative interviews were conducted with 30 stakeholders, including 18 RTMSs, six administrators of the County Health Bureau, and six administrators of township health centers (THCs). A t-test, chi-square test, Fisher's exact test, and logistic regression analysis were used to examine the quantitative data, and thematic analysis was used to analyse the qualitative data. RESULTS: Among the 129 participants, the turnover rate was high, with 103 RTMSs reporting turnover (79.84%). Interpersonal relationships scored the highest in job satisfaction (3.63 ± 0.64) among RTMSs, while working conditions were rated the lowest (2.61 ± 0.85). Marital status (odds ratio [OR] = 0.236, 95% confidence interval [95%CI] = 0.059-0.953, P = 0.043), only child status (OR = 8.660, 95%CI = 1.714-43.762, P = 0.009), and job return satisfaction (OR = 0.290, 95%CI = 0.090-0.942, P = 0.039) were significantly associated with turnover. Univariate analyses showed that income had a significant influence on turnover, but the relationship gone by multivariable; however it was deemed important in the qualitative study. Qualitative analysis revealed that turnover was influenced by the working atmosphere, effort-reward imbalance, professional competence, and opportunities for training and promotion. CONCLUSIONS: This study provides insights for the policymakers about the priority areas for retaining GPs in rural locations and provides reference values for the retention of GPs in other regions with a shortage of rural health workers. For RTMSs to continue providing services to rural areas, the government should improve their salaries, balance their income and workload, provide more opportunities for training and career promotion, and managers should recognise their efforts and create an optimistic working atmosphere.

Perspective of obstetric care-providers on being involved in cervical cancer screening during antenatal care in the Netherlands.

BACKGROUND: The aim of this study was to determine attitude of Dutch midwifes, gynecologists and general practitioners (GPs) towards involvement in antenatal cervical cancer screening (CCS) in the Netherlands. METHODS: In 2021, Dutch midwives, gynecologists, and GPs were offered a single digital questionnaire assessing perceived feasibility, benefits, and harms of antenatal CCS. RESULTS: A total of 6943 Questionnaires were send and response rate was 18% (N = 1260). Of all respondents, 78% considered antenatal CCS via obstetric care providers feasible. Most respondents (85%) agreed that offering CCS in person can increase motivation to attend. Most midwives (93%) considered that women would feel less encumbered if cervical sampling would be performed by obstetric care providers, rather than by GPs. CONCLUSION: Results indicate that introduction of antenatal CCS is considered feasible by a majority of Dutch midwifes, gynecologists, and GPs. Considered benefits include improved motivation to attend and reduced test related barriers.

Early-career general practitioners' career intentions in Estonia: A qualitative study.

BACKGROUND: The shortage of general practitioners (GPs) is a worsening problem in many countries and poses a threat to the services provided by primary care and by extension for the entire healthcare system. Issues with GP workforce recruitment and retention can be reasons for this shortage. OBJECTIVES: To describe GP trainees and newly qualified GPs experiences and perceptions on how their training and early experiences of work influence their career intentions in primary care in Estonia. METHODS: A qualitative study with GP trainees (n = 12) and newly qualified GPs (n = 13) using semi-structured group interviews (n = 6) was conducted. Interviews were conducted from October until November 2020. Data were analysed using thematic analysis with NVivo Software. RESULTS: Although early-career GPs in Estonia envision their future roles as GP practice owners with patient list, this is often postponed due to various reasons. Early-career GPs expressed a sense of unpreparedness to fill all the roles of GPs' and found the process of establishing a GP practice and taking on a patient lists very complicated. They value work-life balance and prefer workplaces, which offer flexible working conditions. CONCLUSION: Potential strategies were identified to enhance the willingness of early-career GPs to continue their career as GP practice owners with patient list: improving the GP training program by placing more emphasis on managing skills and making the process of establishing GP practice and taking on a patient list less bureaucratic and more accessible.

This study highlights the career intentions of GP trainees and newly qualified GPs in Estonia.Participants of this study perceive the many different roles of being a GP as very challenging.Understanding early-career GPs ideas about the future work environments can be helpful in shaping future workforce strategies.

"Trying to write a story together": general practitioners' perspectives on culturally sensitive care.

BACKGROUND: Culturally sensitive care is integral to effective and equitable healthcare delivery, necessitating an understanding and acknowledgment of patients' cultural needs, preferences, and expectations. This study investigates the perceptions of cultural sensitivity among general practitioners (GPs), focusing on their intentions, willingness and perceived responsibilities in providing care tailored to cultural needs. METHODS: In-depth interviews were conducted with 21 Flemish GPs to explore their perspectives on culturally sensitive care. Data analysis followed a conventional qualitative content analysis approach within a constructivist framework. A coding scheme was developed to identify recurring themes and patterns in the GPs' responses. RESULTS: Findings reveal that culturally sensitive care provision is perceived as a multifaceted process, initiated by an exploration phase where GPs inquire about patients' cultural needs and preferences. Two pivotal factors shaping culturally sensitive care emerged: patients' specific cultural expectations and GPs' perceived responsibilities. These factors guided the process of culturally sensitive care towards three distinct outcomes, ranging from complete adaptation to patients' cultural requirements driven by a high sense of responsibility, through negotiation and compromise, to a paternalistic approach where GPs expect patients to conform to GPs' values and expectations. Three typologies of GPs in providing culturally sensitive care were identified: genuinely culturally sensitive, surface-level culturally sensitive, and those perceiving diversity as a threat. Stereotyping and othering persist in healthcare, underscoring the importance of critical consciousness and cultural reflexivity in providing patient-centered and equitable care. CONCLUSIONS: This study emphasizes the significance of empathy and underscores the necessity for GPs to embrace the exploration and acknowledgement of patients' preferences and cultural needs as integral aspects of their professional role. It highlights the importance of shared decision-making, critical consciousness, cultural desire and empathy. Understanding these nuances is essential for enhancing culturally sensitive care and mitigating healthcare disparities.

How do patients perceive the retirement of their general practitioner? A qualitative interview study in France.

OBJECTIVES: The perspective of general practitioners' (GPs) on retirement and the factors influencing their attitude towards retirement have been previously investigated. However, while the number of GPs has been declining for many years in France, leading to the emergence of medical deserts, the impact on their patients remains to be explored. The aim of this study was to understand patients' perceptions of their GP's retirement. DESIGN: A semistructured interview-based qualitative study was conducted, using Interpretative Phenomenological Analysis. SETTING: Interviews were conducted in two general practices located in Essonne, Ile-de-France, France, between January and April 2014. PARTICIPANTS: Thirteen women and five men, aged 21-94 years, were included in this study. Exclusion criteria were the non-declaration of the physician as the declared doctor and being under 18 years of age. RESULTS: The GP-patient relationship is a link that is built up over time, over the course of several consultations. Patients choose their GP based on qualities or skills they value. In this way, the physician chosen is unique for their patients; this choice reflects a certain loyalty to their physician. The interaction with the family sphere reinforces this relationship through the multiple links created during care. When a GP retires, this link is broken. Patients' reactions can range from indifference to real grief. CONCLUSION: This study confirms the importance of the link between the GPs and their patients and highlights the need to prepare patients for their GP's retirement.

'A Rose By Any Other Name': would re-branding help general practice?

BACKGROUND: Primary care is a challenging and evolving specialty. We are increasingly dealing with patients who present with complex multi-morbidities and varied constellations of symptoms that we need to masterly unravel with limited time and resources. Yet, how many times have we said or heard 'just a GP.' AIM: This study investigated the attitudes and opinions of primary care professionals towards a change in title to reflect our evolving role. METHOD: We conducted a cross-sectional survey from 15 to 22 March 2022. A PubMed literature search was undertaken to formulate a questionnaire that was distributed through an online link to medical students and primary care health professionals. RESULTS: There were 401 medical professionals and students who participated in the survey. Overwhelmingly, 95% felt that the public perceives the professional status and qualifications of GPs as inferior to that of hospital consultants. 94% felt hospital colleagues and other health professionals perceived the professional status and qualifications of GPs as inferior to consultants. 90% would support a change in title from GP to consultant in primary care or family medicine consultant (or similar). Many felt this would reflect the evolving role of GPs. 72% felt strongly that the title change would help improve the current GP recruitment crisis. CONCLUSION: General practice is on a knife edge. Real, meaningful changes are needed to avoid a mass exodus of GPs for pastures new. Perhaps changing our title to reflect our expertise in family medicine could be one of many essential measures to improve public and professional perceptions.

Knowledge and representations of sex workers by GPs in Brussels: a qualitative study using semi-structured interviews.

BACKGROUND: A majority of sex-workers (SWers) do not have a GP aware of their professional activity, which prevents appropriate support to this group. One of the reasons is fear of the doctors' judgment. AIM: The objective of this research is to identify how sex-work is perceived by primary care practitioners, and how they follow-up this public. METHOD: This qualitative study using semi-structured interviews with 12 GPs practicing in Brussels was conducted from October 2021 to March 2023. RESULTS: Results show a lack of understanding of what SW is, of the legal context and of the people who practice it. Doctors know about related health issues, but not about their proportion or origin. The main factor identified as leading to SW is economic insecurity. Sample analysis shows theoretical positions close to a pro-sex stance (néo-réglementarisme). CONCLUSION: This study demonstrates that primary care doctors' knowledge of SW is limited, and that these limitations can lead to stigmatisation and suboptimal treatment. The following recommendations are to: draw up a list of doctors who can welcome SWers without being judgmental and make this list available to associations active in the field of SW; co-construct a training course, in partnership with SWers, aimed at GPs (it would include sections on the historical and legal context, the approach to harm reduction and substance abuse, PreP, PEP, and a communication guide); and teach courses on marginalised populations with specific health needs during the initial training of medical students.

GP perspectives regarding suicide prevention: a systematic scoping review.

BACKGROUND: Suicide is a major public health issue and is the leading cause of death of men under the age of 50 in the UK. Patients are more likely to visit their GP in the month leading up to a suicide attempt, thus highlighting the key role GPs play in suicide prevention. AIM: The aim of this systematic scoping review was to explore the current qualitative research on GPs' perspectives of suicide prevention in primary care. METHOD: This review was reported in accordance with PRISMA-ScR guidance. A three-step search strategy was used. Articles at full-text review were assessed for their inclusion in the study against predetermined eligibility criteria (English language, qualitative in nature, and a focus on GPs' perspectives of suicide prevention). Data was extracted using a standardised form and a narrative approach was used to describe the main themes elicited from the studies. RESULTS: There were 2210 articles screened. Twelve studies from seven countries were included at full text review. The majority of studies used semi-structured interviews (n=9) and transcripts were analysed using variations of thematic analysis. Four main themes were elicited from the included studies: challenges to managing suicidal behaviour, fragmented relationships with mental health services, personal attitudes of GPs regarding suicidal behaviour, and identified needs to improve suicide prevention in primary care. CONCLUSION: The challenges experienced by GPs when managing suicidal behaviour are well documented. More work is needed to explore what approaches GPs find effective in managing suicidal behaviour, especially in younger patients.

The influence of GPs' personal experience on perceived competence in depression management.

BACKGROUND: Managing depression in general practice is a multifaceted task, influenced by factors such as the condition's characteristics, patient-specific variables, and the personal habits of attending physicians. A study by Dumesnil et al. in France highlighted the impact of GPs' personal experiences with depression on their patient care approaches. AIM: This study investigated how the personal experiences of Belgian GPs influence their self-perceived competence in managing patients with depression. METHOD: This transversal study was conducted through questionnaires distributed in a GP training (2020-2022). Statistical analyses (Chi-square test/multivariate logistic regression) were conducted using STATA-SE 17.0. RESULTS: Out of 325 GPs, 30.46% of GPs had experienced depression and 16.62% had taken antidepressants. After categorisation and adjustment, the personal experience of GPs does not influence self-efficacy in diagnosing and supporting depressed patients. Higher self-efficacy scores were associated with an advanced age (60-64y/o) (aOR:7,9;IC95%), working in a multidisciplinary practice (aOR:3,4), prior training on the issue (aOR:2,1), and male gender (aOR:0,5). GPs with personal experiences of depression (aOR:2,6), advanced age (aOR:4,1) and working in multidisciplinary practices (aOR:3,4) had more appropriate responses to the proposed clinical situations than other groups. CONCLUSION: This study reveals that the personal experience of depression among GPs does not influence their perceived competencies, contrary to having received prior training on the issue. However, experiencing depression is associated with more appropriate responses to clinical situations. These results are consistent with existing literature regarding socio-demographic factors and practice type. In the future, it is important to consider these factors when developing continuing education programs.

Liver disease as new work in the context of protocolised primary care - do GPs have a role? A qualitative interview study.

BACKGROUND: Liver disease is common, but not part of routine chronic disease management in primary care. AIM: The aim of this study was to explore the challenges of implementing pathways of care for liver disease within existing highly protocolised structures in primary care. METHOD: Semi-structured interviews with 20 health professionals working in primary care. Interviews were informed by normalisation process theory (NPT) and boundary theory. Data were subject to thematic analysis. RESULTS: Three themes were identified relating to chronic disease work; definitions; need and worth, and roles. Participants identified that understanding and value of roles within chronic disease management were pre-defined by targets imposed on them as part of national incentives schemes. Structural boundaries constrained professional autonomy and the potential to influence this area of primary care management, including taking on new work. CONCLUSION: The inability to influence care decisions blurs occupational boundaries and goes to the core of what it means to be a professional. Unless liver disease sits within this target-based system, it is unlikely to become part of routine work in primary care.

The attitudes of general practices towards clinical research.

BACKGROUND: During the financial year 2021/2022, the PANORAMIC study utilised the primary care setting to provide vital research into oral antivirals for COVID-19, recruiting more than 26 000 participants. Alongside the relentless work conducted by practices in supporting vaccine research, the number of GPs recruiting to National Institute for Health and Care Research (NIHR) portfolio studies in England remains consistently around 45% year on year despite the support offered by the NIHR. This figure varies across regions, falling to 23% in Greater Manchester, and rising to 95% in Northwest London, in 2022/2023. These figures suggest a regional inequality in access to potentially life-changing research from primary care providers. AIM: To identify the barriers and challenges facing practices that reduce their likelihood of engaging in clinical research, as well as potential incentives and motivators that would support or encourage them to take part. METHOD: Various factors must be considered as contributing to these figures, such as funding, regional deprivation, and the workload and workforce crisis; however, very little literature exists regarding GPs' attitudes towards research that is backed by data. To address this, a series of online and face-to-face data collection activities will take place, in Greater Manchester, and later from a sample of the GPs across all NIHR regions. RESULTS: Data collection to begin summer 2024. CONCLUSION: Knowledge gained from these activities will help inform researchers and research organisations, such as the NIHR, to provide support and opportunities for GPs across England, ensuring that more of the population has access to clinical research opportunities through their GP.

Attentes des femmes VIctimes de violences Conjugales envers leur Médecin Généraliste (AVIC-MG), une étude descriptive.

INTRODUCTION: In France, 122 women were killed by their partner or ex-partner in 2021. PURPOSE OF THE RESEARCH: The principal objective of the AVIC-MG study, on women victims of domestic violence and their expectations of their general practitioner, was to observe whether the women in question, who visit specialist facilities for victims of domestic violence, would like to be questioned about domestic violence by their general practitioner (GP). The secondary objective was to describe this population of women and the characteristics of their GP visits during the last twelve months. RESULTS: The study showed that more than 90 percent of these women had consulted a GP in the last twelve months and 65 percent of the mothers in the group had consulted a GP for their child(ren). The majority of these women (82 percent) wanted the GP to ask them about domestic violence. They had gone to the GP for specific reasons: fatigue, pain, psychological suffering (anxiety, sadness, difficulty sleeping). CONCLUSION: The majority of women victims of domestic violence would like primary care practitioners to identify the abuse. Tools are available to help GPs with this complex identification, in particular the DECLICVIOLENCE.FR website.

Enhancing long COVID care in general practice: A qualitative study.

INTRODUCTION: Research suggests that general practice can play an important role in managing long COVID. However, studies investigating the perspectives of general practitioners (GPs) and patients are lacking and knowledge regarding optimal long COVID care in general practice is therefore limited. AIM: To investigate GPs' and patients' perspectives on the topic of long COVID and its management in general practice. METHODS: Brief questionnaires (GP n = 11, Patient n = 7) and in-depth semi-structured interviews (GP n = 10, Patient n = 7) were conducted with GPs and patients from Irish general practices during July 2022-January 2023. Interviews were conducted via telephone and audio recordings were transcribed. A phenomenological analysis involving reflexive thematic analysis and constant comparison techniques was adopted. RESULTS: Analysis of interviews with GPs (male = 7, female = 3; median age = 50yrs (IQR = 39.5-56)) and patients (males = 2, female = 5; median age = 58yrs (IQR = 45-62yrs) generated four themes. These were (1) Complex presentations (2) the value of standardising care, (3) choosing the right path, and (4) supportive and collaborative doctor-patient relationships. Strong agreement was observed among GPs and patients regarding the need for holistic and integrated multidisciplinary care. Supportive and collaborative doctor-patient relationships were largely well received by GPs and patients also. GPs strongly endorsed standardising long COVID care operations. CONCLUSION: GPs and patients indicated that structured, integrated, and collaborative care can help optimise long COVID management in general practice. GPs are advised to incorporate these elements into their long COVID care practices going forward. Future research examining stakeholder's perspectives using larger and longitudinal samples is advised to enhance the generalisability of evidence in this area.

Perspectives on telehealth implementation in Australia: An exploratory qualitative study with practice managers and general practitioners.

BACKGROUND: There is a lack of understanding regarding the impact of telehealth on clinical delivery and the feasibility of sustained implementation by health services. The COVID-19 pandemic provided an ideal opportunity to identify factors related to the implementation of telehealth. This study assessed factors that influenced telehealth implementation during COVID-19 in the Western region of Victoria, Australia, from the perspectives of practice managers and general practitioners (GPs). METHODS: Employing a qualitative approach, we conducted semi-structured interviews with 14 GPs and 11 practice managers across metropolitan and rural settings in the Western region of Victoria, Australia. Interviews were conducted between December 2021 to June 2022, which included periods during and beyond the peak of the COVID-19 pandemic. Themes were synthesised using the Consolidated Framework for Implementation Research, which comprised five domains: innovation, inner setting, outer setting, individuals and implementation process. An additional domain related to billing and finances was added. RESULTS: The innovation domain revealed that telehealth was identified by both stakeholder groups as a critical tool for improving healthcare access for vulnerable patients. GPs highlighted the role of telehealth in follow-up care and the need for extended telephone consultation services. For the implementation process, both stakeholder groups identified a shift in attitudes among GPs from reluctance to acceptance of telehealth. In terms of outer setting, constant changes in regulations posed challenges to administrative staff. Practice managers faced difficulties in acquiring information on changes, but those with robust professional networks were well supported. Initial loss of incentive funding and government-imposed billing methods posed hurdles for clinics. Both stakeholder groups highlighted the need for education around videoconference and a standardised telehealth platform. CONCLUSION: Evolving telehealth regulations during the emergence of COVID-19 posed financial, operational and administrative challenges to primary care clinics. To ensure sustainability, policymakers should improve stakeholder communication, set interoperability standards, and ensure sustainable funding for telehealth.

Management of physical and psychological trauma resulting from motor vehicle crashes in Australian general practice: a mixed-methods approach.

BACKGROUND: In Australia, motor vehicle crashes (MVC)-related health data are available from insurance claims and hospitals but not from primary care settings. This study aimed to identify the frequency of MVC-related consultations in Australian general practices, explore the pharmacological management of health conditions related to those crashes, and investigate general practitioners' (GPs) perceived barriers and enablers in managing these patients. METHODS: Mixed-methods study. The quantitative component explored annual MVC-related consultation rates over seven years, the frequency of chronic pain, depression, anxiety or sleep issues after MVC, and management with opioids, antidepressants, anxiolytics or sedatives in a sample of 1,438,864 patients aged 16 + years attending 402 Australian general practices (MedicineInsight). Subsequently, we used content analysis of 81 GPs' qualitative responses to an online survey that included some of our quantitative findings to explore their experiences and attitudes to managing patients after MVC. RESULTS: MVC-related consultation rates remained stable between 2012 and 2018 at around 9.0 per 10,000 consultations. In 2017/2018 compared to their peers, those experiencing a MVC had a higher frequency of chronic pain (48% vs. 26%), depression/anxiety (20% vs. 13%) and sleep issues (7% vs. 4%). In general, medications were prescribed more after MVC. Opioid prescribing was much higher among patients after MVC than their peers, whether they consulted for chronic pain (23.8% 95%CI 21.6;26.0 vs. 15.2%, 95%CI 14.5;15.8 in 2017/2018, respectively) or not (15.8%, 95%CI 13.9;17.6 vs. 6.7%, 95% CI 6.4;7.0 in 2017/2018). Qualitative analyses identified a lack of guidelines, local referral pathways and decision frameworks as critical barriers for GPs to manage patients after MVC. GPs also expressed interest in having better access to management tools for specific MVC-related consequences (e.g., whiplash/seatbelt injuries, acute/chronic pain management, mental health issues). CONCLUSION: Chronic pain, mental health issues and the prescription of opioids were more frequent among patients experiencing MVC. This reinforces the relevance of appropriate management to limit the physical and psychological impact of MVC. GPs identified a lack of available resources (e.g. education, checklists and management support tools) for managing MVC-related consequences, and the need for local referral pathways and specific guidelines to escalate treatments.

Exploring the perceptions and experiences of community rehabilitation for Long COVID from the perspectives of Scottish general practitioners' and people living with Long COVID: a qualitative study.

OBJECTIVES: To explore the experience of accessing Long COVID community rehabilitation from the perspectives of people with Long COVID and general practitioners (GPs). DESIGN: Qualitative descriptive study employing one-to-one semistructured virtual interviews analysed using the framework method. SETTING: Four National Health Service Scotland territorial health boards. PARTICIPANTS: 11 people with Long COVID (1 male, 10 female; aged 40-65 (mean 53) and 13 GPs (5 male, 8 female). RESULTS: Four key themes were identified: (1) The lived experience of Long COVID, describing the negative impact of Long COVID on participants' health and quality of life; (2) The challenges of an emergent and complex chronic condition, including uncertainties related to diagnosis and management; (3) Systemic challenges for Long COVID service delivery, including lack of clear pathways for access and referral, siloed services, limited resource and a perceived lack of holistic care, and (4) Perceptions and experiences of Long COVID and its management, including rehabilitation. In this theme, a lack of knowledge by GPs and people with Long COVID on the potential role of community rehabilitation for Long COVID was identified. Having prior knowledge of rehabilitation or being a healthcare professional appeared to facilitate access to community rehabilitation. Finally, people with Long COVID who had received rehabilitation had generally found it beneficial. CONCLUSIONS: There are several patient, GP and service-level barriers to accessing community rehabilitation for Long COVID. There is a need for greater understanding by the public, GPs and other potential referrers of the role of community rehabilitation professionals in the management of Long COVID. There is also a need for community rehabilitation services to be well promoted and accessible to the people with Long COVID for whom they may be appropriate. The findings of this study can be used by those (re)designing community rehabilitation services for people with Long COVID.

"I do not know the advantages of having a general practitioner" - a qualitative study exploring the views of low-acuity emergency patients without a regular general practitioner toward primary care.

BACKGROUND: Emergency departments (ED) worldwide have to cope with rising patient numbers. Low-acuity consulters who could receive a more suitable treatment in primary care (PC) increase caseloads, and lack of PC attachment has been discussed as a determinant. This qualitative study explores factors that contribute to non-utilization of general practitioner (GP) care among patients with no current attachment to a GP. METHOD: Qualitative semi-structured telephone interviews were conducted with 32 low-acuity ED consulters with no self-reported attachment to a GP. Participants were recruited from three EDs in the city center of Berlin, Germany. Data were analyzed by qualitative content analysis. RESULTS: Interviewed patients reported heterogeneous factors contributing to their PC utilization behavior and underlying views and experiences. Participants most prominently voiced a rare need for medical services, a distinct mobility behavior, and a lack of knowledge about the role of a GP and health care options. Views about and experiences with GP care that contribute to non-utilization were predominantly related to little confidence in GP care, preference for directly consulting medical specialists, and negative experiences with GP care in the past. Contrasting their reported utilization behavior, many interviewees still recognized the advantages of GP care continuity. CONCLUSION: Understanding reasons of low-acuity ED patients for GP non-utilization can play an important role in the design and implementation of patient-centered care interventions for PC integration. Increasing GP utilization, continuity of care and health literacy might have positive effects on patient decision-making in acute situations and in turn decrease ED burden. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00023480; date: 2020/11/27.

The hidden work of general practitioners: An ethnography.

High quality primary care is a foundational element of effective health services. Internationally, primary care physicians (general practitioners (GPs), family doctors) are experiencing significant workload pressures. How non-patient-facing work contributes to these pressures and what constitutes this work is poorly understood and often unrecognised and undervalued by patients, policy makers, and even clinicians engaged in it. This paper examines non-patient-facing work ethnographically, informed by practice theory, the Listening Guide, and empirical ethics. Ethnographic observations (104 h), in-depth interviews (n = 16; 8 with GPs and 8 with other primary care staff) and reflexive workshops were conducted in two general practices in England. Our analysis shows that 'hidden work' was integral to direct patient care, involving diverse clinical practices such as: interpreting test results; crafting referrals; and accepting interruptions from clinical colleagues. We suggest the term 'hidden care work' more accurately reflects the care-ful nature of this work, which was laden with ambiguity and clinical uncertainty. Completing hidden care work outside of expected working hours was normalised, creating feelings of inefficiency, and exacerbating workload pressure. Pushing tasks forward into an imagined future (when conditions might allow its completion) commonly led to overspill into GPs' own time. GPs experienced tension between their desire to provide safe, continuous, 'caring' care and the desire to work a manageable day, in a context of increasing demand and burgeoning complexity.