Perceptions of general practitioners towards managing dental presentations in Australia: a qualitative study.

Background Patients presenting with dental pain are common in general practice, despite dental infections being most appropriately managed with dental treatment to address the cause of the infection. Although antibiotics are not appropriate for the management of localised toothache without signs of systemic spread, general practitioners (GPs) often prescribe antibiotics and analgesics for the management of dental pain. The aim of this study was to explore GPs' perceptions and management of dental presentations in Australia. Methods Twelve semi-structured interviews were conducted with GPs across Victoria, Australia, between October 2022 and January 2023. Data were thematically analysed. Results The study found that dental pain was the most common presenting complaint for patients attending general practice with a dental problem. Five major themes were identified in this study: knowledge, beliefs about capabilities, emotion, environmental context and resources, and social influences/social professional role and identity. In terms of knowledge and capabilities, GPs would advise patients to seek dental care, as they are aware that antibiotics would not resolve the underlying issue. Challenges for GPs included limited training in oral and dental treatment, as well as emotions, such as patient anxiety and phobia resulting in patients seeking dental care through a GP rather than a dentist. Barriers due to the context, such as access to dental care, long waiting lists within the public dental system and cost, were some of the reasons patients present to general practice rather than a seeing a dentist. Furthermore, issues that influenced GPs' antibiotic prescribing included patients' expectations for antibiotics to treat their dental pain, as well as dentists advising their patients to attend their GP for antibiotics prior to dental treatment. Conclusions This study identified factors that influenced GPs' management of patients with dental conditions. To address these issues, it is imperative to develop interventions addressing patients' knowledge around oral health, as well as providing improved access to dental care for these patients.

General practitioners' well-being in Belgium: results from the cross-sectional PRICOV-19 study.

BACKGROUND: The mental health and well-being of GPs is a critical issue as they play a vital role in providing healthcare services to individuals and communities. Research has shown that GPs often face high levels of stress, burnout, and mental health problems due to their demanding work environment. During the COVID-19 pandemic, GPs faced additional challenges which further impacted their mental health and well-being. This study aims to investigate the impact of systemic work-related stressors on the level of well-being of GPs in Belgium during the pandemic, with a particular emphasis on identifying regional variations between Flanders, Wallonia, and Brussels-Capital. METHODS: Data were collected with a self-reported online questionnaire from 479 GPs Belgian practices between December 2020 and August 2021 as part of the international PRICOV-19 study that explored the organization of general practices during COVID-19 in 38 countries to guarantee safe, effective, patient-centered, and equitable care. Well-being was evaluated by the Mayo Clinic's expanded 9-item well-being index. RESULTS: The findings of this study reveal notable regional discrepancies in the degree of well-being experienced by Belgian GPs, with the Walloon region displaying the lowest level of well-being (37%) in a population highly susceptible to professional distress (57%). Among the key stressors contributing to such distress, financial difficulties among patients (p < 0.011), the fee-for-service payment system (p = 0.013), a lack of work-related purpose (p = 0.047), and inadequate work-life balance (p < 0.001) were identified as significant factors. When examining the influence of regional disparities, it was found that the sole significant interaction between work-related stressors and region regarding the probability of experiencing distress was related to the possibility of workload sharing among practice personnel. CONCLUSION: The findings from this study underscore the imperative for more comprehensive research aimed at scrutinizing the differences in well-being across the three regions in Belgium and identifying the systemic factors that influence the practice environment, as opposed to exclusively concentrating on enhancing individual resilience.

Experiences and perspectives of colorectal cancer survivors and general practitioners on the delivery of survivorship care in general practice: a mixed methods study.

BACKGROUND: Many colorectal cancer (CRC) survivors experience ongoing sequelae from their cancer treatment. Limited evidence exists regarding how CRC survivors and general practitioners (GPs) manage these sequelae in the community. This study aimed to explore the experiences and perspectives of CRC survivors and GPs on current approaches to monitoring and managing sequelae of CRC treatment. METHODS: We conducted a mixed-methods study using cross-sectional national surveys and qualitative interviews with CRC survivors and GPs to explore: (1) treatment sequelae experienced by CRC survivors, (2) how these were monitored and managed by general practitioners, and (3) suggestions to improve ongoing management of the treatment sequelae. Survey responses were reported descriptively. Qualitative data were thematically analysed using an interpretive descriptive approach. RESULTS: Seventy participants completed surveys: 51 CRC survivors and 19 GPs, and four interviews were conducted with GPs. CRC survivors experienced a range of treatment sequelae, but often did not discuss these with their GPs (experienced vs discussed: 86% vs 47% for fatigue/lack of energy, 78% vs 27% for psychological/emotional concern, 63% vs 22% for impaired sleep, 69% vs 29% for weight loss/gain, 59% vs 16% for sexual and intimacy concerns). GPs reported inadequate information transfer from cancer services and workload as major barriers to optimal care. CONCLUSIONS: System-level changes that facilitate adequate information transfer from cancer services to GPs upon CRC treatment completion, as well as addressing time constraint issues essential for comprehensive monitoring and management of CRC treatment sequelae, could enhance the care of CRC survivors in the community setting.

General practitioners' experiences of providing lifestyle advice to patients with depression: A qualitative focus group study.

OBJECTIVE: Depression is an increasingly common mental health disorder in the UK, managed predominantly in the community by GPs. Emerging evidence suggests lifestyle medicine is a key component in the management of depression. We aimed to explore GPs' experiences, attitudes, and challenges to providing lifestyle advice to patients with depression. METHOD: Focus groups were conducted virtually with UK GPs (May-July 2022). A topic guide facilitated the discussion and included questions on experiences, current practices, competence, challenges, and service provision. Data were analysed using template analysis. RESULTS: 'Supporting Effective Conversations'; 'Willing, but Blocked from Establishing Relational Care'; 'Working Towards Patient Empowerment'; and 'Control Over the Prognosis' were all elements of how individualised lifestyle advice was key to the management of depression. Establishing a doctor-patient relationship by building trust and rapport was fundamental to having effective conversations about lifestyle behaviours. Empowering patients to make positive lifestyle changes required tailoring advice using a patient-centred approach. Confidence varied across participants, depending on education, experience, type of patient, and severity of depression. CONCLUSIONS: GPs play an important role in managing depression using lifestyle medicine and a patient-centred approach. Organisational and educational changes are necessary to facilitate GPs in providing optimal care to patients with depression.

Improving general practice management of patients with chronic musculoskeletal pain: Interdisciplinarity, coherence, and concerns.

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.

How general practitioners used job crafting strategies during the COVID-19 pandemic in Sweden.

OBJECTIVE: General practitioners (GPs) played a crucial role in limiting the impact of the COVID-19 pandemic, and many GPs experienced they did not have the prerequisites to provide adequate care. However, GPs developed approaches that helped them to provide care to patients through various job crafting strategies. The aim of this study is to identify how job crafting strategies were deployed by GPs at the beginning of the COVID-19 pandemic in Sweden and the significance of the strategies on their work situation. DESIGN: A qualitative design with semi-structured interviews. The data was analysed using qualitative content analysis with job crafting as the conceptual framework for the analysis process. SETTING: Primary healthcare in five healthcare regions in Sweden. SUBJECTS: Fourteen GPs participated in individual interviews. RESULTS: In their endeavours to organise and provide care, GPs shaped the task, relational and cognitive boundaries of their work. GPs felt proud about finding new ways of working when given room to manoeuvre. Intensified collaboration between healthcare professionals made GPs more confident in their clinical work. GPs expressed that they consequently felt stronger in their professional role through what they accomplished in the organisation of care. CONCLUSIONS/IMPLICATIONS: The results suggest that the job crafting strategies GPs used were meaningful to them in clinical practice. Knowledge about how GPs' job crafting strategies were deployed might be useful for healthcare organisations in preparing for future health crises. Taking advantage of GPs' experiences and strategies is considered important for promoting sustainable working conditions for GPs in the future.

During the onset of the COVID-19 pandemic in Sweden, general practitioners took immediate action to re-organise their day-to-day work tasks.To manage professional uncertainty about how to provide the best possible care, general practitioners sought support from other healthcare peers.The professional self-confidence of general practitioners increased through what they accomplished when facing a major health crisis.

Qualitative study investigating the professional and personal effects of patient suicide on general practitioners in Northern Ireland.

OBJECTIVE: There is a dearth in suicide literature addressing the impact on general practitioners (GPs) of losing a patient. We aimed to examine the personal and professional impact as well as the availability of support and why GPs did or did not use it. DESIGN: A qualitative study using one-to-one interviews with participants recruited using snowball sampling. SETTING: The study was conducted in a primary care setting. PARTICIPANTS: Interviews were held with 19 GPs within primary care in Northern Ireland. RESULTS: GPs are impacted both personally and professionally when they lose a patient to suicide, but may not access formal help due to commonly held idealised notions of a 'good' GP who is regarded as having solid imperturbability. Fear of professional repercussions also plays a major role in deterring help-seeking. CONCLUSIONS: There is a need for a systemic culture shift within general practice which allows doctors to seek support when their physical or mental health require it. This may help prevent stress, burnout and early retirement.

Physical activity advice given by French general practitioners for low back pain and the role of digital e-health applications: a qualitative study.

BACKGROUND: Low back pain is the fourth most common reason for consulting a general practitioner (GP) among people aged 40-50 years. Beyond the overall benefits of physical activity (PA) on health (psychological, cardiovascular, etc.), PA for low back pain seems to improve the prognosis in terms of pain, disability, and quality of life. The French National Health Insurance developed media campaigns to promote physical activity with low back pain and a smartphone application (app). Despite the known benefits and campaigns, GPs do not routinely provide advice about physical activity during low back pain consultations. To promote giving physical activity advice for low back pain, there is a need to understand how GPs currently provide this advice and whether technology could help. This study aims to explore the content of physical activity advice for low back pain that GPs provide in France, and their opinion about healthcare smartphone app provided electronically via the internet (e-health apps) as a support for this advice. METHODS: This qualitative study was conducted with semi-structured individual interviews among French GPs. The verbatim was double coded using a coding tree. Thematic analysis was performed using an inductive approach. RESULTS: Sixteen GPs from Maine et Loire, Sarthe, and Mayenne were included. The thematic analysis identified the following themes: GPs use a global patient-centred approach to physical activity advice for low back pain. The main goal is to enable patients to participate in their care. Advice was almost always general with little information about duration and frequency. The importance of patient-appropriate and easily achievable activities was emphasised. GPs referred patients to physiotherapists to reinforce regular physical activity, maintain motivation and improve patient adherence through supervision and follow-up. GPs knew little about e-health apps but felt they could be useful with young patients. The main barriers to their use included poor internet connection, lack of technical knowledge and no supervision meaning patients could injure themselves. CONCLUSIONS: This is one of the first studies to assess the contents of physical activity advice GPs provide for low back pain. Further research is needed into the implementation of e-health apps for low back pain management. TRIAL REGISTRATION: Not applicable.

Cancer follow-up in primary care after treatment with curative intent: Views of patients with breast and colorectal cancer.

OBJECTIVE: Increased cancer survival leads to more patients requiring oncological follow-up. Debate about how best to coordinate this care has led to the proposed involvement of general practitioners (GPs) rather than continued reliance on hospital care. However, we still require patient opinions to inform this debate. METHODS: This qualitative interview study explored opinions about organization of follow-up care of patients treated curatively for breast and colorectal cancer. Thematic analysis was applied. RESULTS: We interviewed 29 patients and identified three themes concerning care substitution: "benefits and barriers," "requirements," and "suitable patient groups." Benefits included accessibility, continuity, contextual knowledge, and psychosocial support. Barriers included concerns about cancer-specific expertise of GPs and longer waiting times. Requirements were sufficient time and remuneration, sufficient training, clear protocols, and shared-care including efficient communication with specialists. CONCLUSIONS: According to patients with cancer, formal GP involvement appears feasible, although important barriers must be overcome before instituting care substitution. A possible solution are personalized follow-up plans based on three-way conversations with the specialist and the GP after the initial hospital care. PRACTICE IMPLICATIONS: With adequate training, time, and remuneration, formal GP involvement could ensure more comprehensive care, possibly starting with less complex cases.

Psychiatric disorders and the cancer diagnostic process in general practice: a combined questionnaire and register study exploring the patients' experiences in Denmark.

OBJECTIVE: Patients with psychiatric disorders are at risk of experiencing suboptimal cancer diagnostics and treatment. This study investigates how this patient group perceives the cancer diagnostic process in general practice. DESIGN: Cross-sectional study using questionnaire and register data. SETTING: General practice in Denmark. SUBJECTS: Patients diagnosed with cancer in late 2016 completed a questionnaire about their experiences with their general practitioner (GP) in the cancer diagnostic process (n = 3411). Information on pre-existing psychiatric disorders was obtained from register data on psychiatric hospital contacts and primary care treated psychiatric disorders through psychotropic medications. Logistic regression was used to analyse the association between psychiatric disorders and the patients' experiences. MAIN OUTCOME MEASURES: Patients' experiences, including cancer worry, feeling being taken seriously, and the perceived time between booking an appointment and the first GP consultation.[Box: see text]. RESULTS: A total of 13% of patients had an indication of a psychiatric disorder. This group more often perceived the time interval as too short between the first booking of a consultation and the first GP consultation. Patients with primary care treated psychiatric disorders were more likely to worry about cancer at the first presentation and to share this concern with their GP compared with patients without psychiatric disorders. We observed no statistically significant association between patients with psychiatric disorders and perceiving the waiting time to referral from general practice, being taken seriously, trust in the GP's abilities, and the patients' knowledge of the process following the GP referral. CONCLUSION: The patients' experiences with the cancer diagnostic process in general practice did not vary largely between patients with and without psychiatric disorders. Worrying about cancer may be a particular concern for patients with primary care treated psychiatric disorders.

It is unknown how patients with psychiatric disorders perceive the cancer diagnostic process in general practice.This study found an association between having a psychiatric disorder and more often perceiving the time interval as too short between the first booking of a consultation and the first GP consultation.An association was found between having a primary care treated psychiatric disorder and being worried about cancer and more often sharing these concerns with the GP.Experiences with the cancer diagnostic process in general practice did not differ between patients with a hospital treated psychiatric disorder and patients with no indication of psychiatric disorders.

Overseas general practitioners (GPs) and prescription behaviour in England.

The UK imports many doctors from abroad, where medical training and experience may differ. This study aims to understand how drug prescription behaviour varies in English GP practices with higher shares of foreign-trained GPs. Results indicate that in general prac- tices with a high proportion of GPs trained outside the UK, there are higher prescriptions for antibiotics, mental health medication, analgesics, antacids, and statins, while controlling for patient and practice characteristics. However, we found no significant impact on pa- tient satisfaction or unplanned hospitalisations, suggesting that this behaviour may be due to over-prescribing. Identifying differences in prescribing habits amongst GPs is crucial in deter- mining best policies for ensuring consistent services across GP practices and reducing health inequalities.

Returning-to-work after mental health-associated sick leave: a qualitative interview study exploring the experiences of general practitioners in Germany.

BACKGROUND AND AIM: Psychiatric disorders are increasing globally. Especially when these disorders affect working people, this places a financial burden on society due to long-term sick leave, the incapacity to work and the inability to earn and pay taxes. General practitioners (GPs) are often the first health professionals to be consulted by those suffering from mental health disorders. This study investigated the experiences of GPs regarding their patients with mental health disorders and identified factors that are important for a successful return to work. METHODS: This qualitative study used semi-structured interviews to explore the opinions of GPs (n = 12) working in Munich, Germany, or its metropolitan area. The interviews were audio-recorded, transcribed, and analyzed using the reflexive thematic analysis method. RESULTS: GPs think of themselves as important players in the rehabilitation process of patients with mental health disorders. In their daily routine, they face many obstacles to ensure the best treatment and outcome for their patients. They also suffer from poor collaboration with other stakeholders, such as psychiatric hospitals, therapists or employers. They indicate that the mental health disorder of each patient is unique, including the barriers to and possibilities of a successful return to work. Additionally, the workplace appears to play a crucial role in the success rate of re-entry into work. It can exacerbate the course of mental health disorders or support recovery. Fear, shame and stigmatization of the patients are personal factors responsible for prolonged sick leave. CONCLUSION: We conclude that GPs believe that they can have a major impact on the rehabilitation of patients with mental health disorders. As such, special focus should be placed on supporting them in this context.

Where the joy comes from: a qualitative exploration of deep GP-patient relationships.

BACKGROUND: Relationship-based, whole person care is foundational to quality general practice. Previous research has identified several characteristics of deep General Practitioner (GP)-patient relationships and their association with improved patient concordance, satisfaction and perceived health outcomes. Psychological attachment theory has been used to understand therapeutic relationships, but has only been explored to a limited extent in the general practice context. Additionally, evolving changes in sociocultural and commercial practice contexts may threaten relationship-based care. In view of this, we aimed to explore the nature and experience of deep GP-patient relationships, as identified by patients, from GP and patient perspectives. METHODS: Semi-structured interview design. An initial survey assessed patients' perceived depth of their relationship with their GP, using the Health Care Provider Attachment Figure Survey and Patient-Doctor Depth of Relationship Scale. Patients who reported a deep relationship, and their GPs, were purposively selected for individual interviews exploring their experience of these relationships. A post-interview survey assessed interviewees' attachment styles, using the Modified and Brief Experiences in Close Relationships Scale. Patient interviewees also rated the patient-centredness of their GP's clinic using the Person-Centred Primary Care Measure. Transcripts were analysed using thematic analysis. RESULTS: Thirteen patients and five GPs were interviewed. Four themes characterised deep relationships: the 'professional'; human connection; trust; and 'above and beyond'. Patient, GP and practice team all contributed to their cultivation. CONCLUSIONS: We present a revised conceptual framework of deep GP-patient relationships. Deep relationships come to the fore in times of patient trouble. Like attachment relationships, they provide a sense of safety, caring and support for patients experiencing vulnerability. They can stretch GP boundaries and capacity for self-care, but also provide joy and vocational satisfaction. Patients may not always desire or need deep relationships with their GP. However, findings highlight the importance of enabling and cultivating these for times of patient hardship, and challenges of doing so within current healthcare climates.

COVID-19- related work, managerial factors and exhaustion among general practitioners in Sweden: a cross-sectional study.

INTRODUCTION: A significant number of international studies show that general practitioners (GPs) suffered from burnout when working during the COVID-19 pandemic. A Swedish study found that more than 16% of GPs had exhaustion in spring 2021. Exhaustion can be regarded as an initial stage of burnout. A knowledge gap remains on GPs´ working conditions, the impact of management during the pandemic and how it was associated with exhaustion. This study aims to explore the association between severe symptoms of exhaustion and COVID-19 pandemic-related work and managerial factors among Swedish GPs and whether managerial factors have an impact on the association between exhaustion and COVID-19-related work factors. METHODS: Cross-sectional data was drawn from the Longitudinal Occupational Health survey in Health Care Sweden (LOHHCS), which included a representative sample of practicing doctors in Sweden. The sample consisted of 6699 doctors with a response rate of 41.2%. This study constitutes a sample of doctors who reported working in primary care facilities at the time of data collection, i.e. 1013 GPs. The Burnout Assessment Tool (BAT) was used to assess severe symptoms of exhaustion. Questions were also asked about pandemic-related work and managerial factors. The data was analysed using descriptive statistics and multivariate logistic regression to identify the association between exhaustion, work and managerial factors. RESULTS: The multivariate analysis showed that GPs who managed COVID-19 patients were about twice as likely to report severe symptoms of exhaustion. Further, GPs who reported that management was unsupportive, provided unsatisfactory working conditions and unsatisfactory policies for patient prioritisation were between two and four times more likely to report severe symptoms of exhaustion. CONCLUSIONS: COVID-19-related work and managerial factors had a significant impact on the mental health of GPs. Furthermore, the potentially protective effect that satisfactory management actions had on mental health was limited. In the aftermath of the COVID-19 pandemic and in preparation for future major crises that have a high impact on healthcare, there is a need to investigate the measures that can be taken to enable GPs to carry out their work, while maintaining their wellbeing.

Mental health of general practitioners in Chongqing, China during COVID-19: a cross-sectional study.

OBJECTIVES: In the context of the COVID-19 pandemic, general practitioners (GPs) continue to face unprecedented challenges that affect their mental health. However, few studies have assessed the mental health status of GPs. This study aimed to provide preliminary understanding of stress, job burn-out and well-being levels among GPs to train and manage them during public health emergencies. DESIGN: We conducted a cross-sectional online self-report survey. SETTING: The survey was conducted in Chongqing, China from July to August 2022. PARTICIPANTS: Data were collected from 2145 GPs, with an effective response rate of 91.0%. PRIMARY AND SECONDARY OUTCOME MEASURES: The main evaluation indicators were stress (Cohen's Perceived Stress Scale), job burn-out (Maslach Burnout Inventory-Human Services Survey Scale) and well-being (WHO-5 Well-Being Index). Multiple linear regression analysis was used to compare the effect of different demographic characteristics on the impact of stress, job burn-out and decreased well-being. RESULTS: Stress, job burn-out and decreased well-being were common among GPs. In this study, 59.7% experienced job burn-out, 76.1% experienced high levels of stress and 52.0% may have experienced depression. The main factors that influenced stress, burn-out and well-being were differences in age, working hours per week, title, part-time management work, work-life balance, sleep disorders, whether GPs received adequate recognition by patients and the work team and mental toughness (p<0.05). CONCLUSION: This survey is the first to investigate stress, job burn-out and well-being levels among local GPs in China during the COVID-19 pandemic. Curbing stress and job burn-out levels and ensuring well-being among GPs could be achieved by reducing paperwork, management work and working hours; promoting life and work balance; and increasing resilience among GPs. The findings provide a basis for policy-makers to formulate strategies for developing general practice.

Supporting family carers in general practice: a scoping review of clinical guidelines and recommendations.

BACKGROUND: Increasing numbers of family carers are providing informal care in community settings. This creates a number of challenges because family carers are at risk of poor physical and psychological health outcomes, with consequences both for themselves and those for whom they provide care. General Practitioners (GPs), who play a central role in community-based care, are ideally positioned to identify, assess, and signpost carers to supports. However, there is a significant gap in the literature in respect of appropriate guidance and resources to support them in this role. METHODS: A scoping review was undertaken to examine clinical guidelines and recommendations for GPs to support them in their role with family carers. This involved a multidisciplinary team, in line with Arksey & O'Malley's framework, and entailed searches of ten peer-reviewed databases and grey literature between September-November 2020. RESULTS: The searches yielded a total of 4,651 English language papers, 35 of which met the criteria for inclusion after removing duplicates, screening titles and abstracts, and performing full-text readings. Ten papers focused on resources/guidelines for GPs, twenty were research papers, three were review papers, one was a framework of quality markers for carer support, and one was an editorial. Data synthesis indicated that nine (90%) of the guidelines included some elements relating to the identification, assessment, and/or signposting of carers. Key strategies for identifying carers suggest that a whole practice approach is optimal, incorporating a role for the GP, practice staff, and for the use of appropriate supporting documentation. Important knowledge gaps were highlighted in respect of appropriate clinical assessment and evidence-based signposting pathways. CONCLUSION: Our review addresses a significant gap in the literature by providing an important synthesis of current available evidence on clinical guidelines for GPs in supporting family carers, including strategies for identification, options for assessment and potential referral/signposting routes. However, there is a need for greater transparency of the existing evidence base as well as much more research to evaluate the effectiveness and increase the routine utilisation, of clinical guidelines in primary care.

How to Improve Collaboration Between General Practitioners and Clinical Psychologists for Their Patients' Common Mental Health Problems in Primary Care Context?

BACKGROUND: Mental health problems have become a major topic of public health these last years, particularly since the pandemic of COVID-19. Primary care givers are confronted with high rates of common mental health problems (CMHPs) in population. This questions healthcare organization and specifically collaboration between general practitioners (GPs) and clinical psychologists (CPs). In this paper we aim to review recent literature to identify factors that facilitate or hinder collaboration between GPs and CPs when caring for their patients' CMHPs. METHODS: A non-systematic qualitative literature review was performed, using the PRISMA method. We restricted the review to papers published between 2010 and 2023. RESULTS: We identified 52 papers and after filtering, only 6 were included in the synthesis. Six main themes were identified: barriers to interprofessional collaboration, lack of mutual trust, mutual dissatisfaction with information exchanged, the paradox of professional secrecy, the necessity of a paradigm shift, and conceptual frameworks of collaboration. These themes were discussed to improve collaboration between GPs and CPs. CONCLUSION: This work provides some recommendations to support the development of interprofessional collaboration between GPs and CPs in primary care.

General practitioners' perceptions of dealing with patients with pressured speech: a qualitative study.

BACKGROUND: Empathetic listening can be particularly challenging with patients presenting pressured speech, while time pressure and costs limit practitioners' availability. We aimed to explore general practitioners' (GPs') experiences when encountering a patient with pressured speech without pathological syndrome. METHODS: Using a thematic analysis method, 19 semi-structured interviews were conducted with GPs purposively sampled in Ile-de-France region. RESULTS: Three themes emerged. First, misgivings were aroused when meeting a patient with pressured speech, including frustration, displeasure, and a struggle to maintain focus. Second, huge efforts were needed to adhere to the appropriate clinical reasoning and care for these patients who need more time and energy. The very definition of this condition varies from one clinician to another, and for some, psychiatric conditions were systematically associated. Third, implementation of specific strategies was required to adjust to these patients: trying to create distance with the patient, to organize a framework in which the patient with pressured speech can express him or herself, and even strategies to increase GPs' availability. CONCLUSION: The time and energy required to provide adequate care for patients presenting with pressured speech make it quite challenging, and this builds up pressure in the waiting room. But when medical demands take this form, there is a risk that clinicians will reject the patient or refer early to mental health services, leading to growing feelings of abandonment, the neglect of organic issues, and medical nomadism. Initial and continuing medical training focussing on advanced communication skills and multifocal approaches can foster long-term follow-up.

Supporting primary care through symptom checking artificial intelligence: a study of patient and physician attitudes in Italian general practice.

BACKGROUND: Rapid advancements in artificial intelligence (AI) have led to the adoption of AI-driven symptom checkers in primary care. This study aimed to evaluate both patients' and physicians' attitudes towards these tools in Italian general practice settings, focusing on their perceived utility, user satisfaction, and potential challenges. METHODS: This feasibility study involved ten general practitioners (GPs) and patients visiting GP offices. The patients used a chatbot-based symptom checker before their medical visit and conducted anamnestic screening for COVID-19 and a medical history algorithm concerning the current medical problem. The entered data were forwarded to the GP as medical history aid. After the medical visit, both physicians and patients evaluated their respective symptoms. Additionally, physicians performed a final overall evaluation of the symptom checker after the conclusion of the practice phase. RESULTS: Most patients did not use symptom checkers. Overall, 49% of patients and 27% of physicians reported being rather or very satisfied with the symptom checker. The most frequent patient-reported reasons for satisfaction were ease of use, precise and comprehensive questions, perceived time-saving potential, and encouragement of self-reflection. Every other patient would consider at-home use of the symptom checker for the first appraisal of health problems to save time, reduce unnecessary visits, and/or as an aid for the physician. Patients' attitudes towards the symptom checker were not significantly associated with age, sex, or level of education. Most patients (75%) and physicians (84%) indicated that the symptom checker had no effect on the duration of the medical visit. Only a few participants found the use of the symptom checker to be disruptive to the medical visit or its quality. CONCLUSIONS: The findings suggest a positive reception of the symptom checker, albeit with differing focus between patients and physicians. With the potential to be integrated further into primary care, these tools require meticulous clinical guidance to maximize their benefits. TRIAL REGISTRATION: The study was not registered, as it did not include direct medical intervention on human participants.

A complex intervention on vaccination uptake among older adults (≥ 60 years) in Germany - a study protocol with a mixed methods design.

BACKGROUND: The current uptake of many vaccinations recommended for persons aged 60 and older is unsatisfactory in Germany. Lack of confidence in the safety and efficacy of vaccinations, lack of knowledge and insecurities about possible side effects, and numerous pragmatic barriers are just some of the reasons to be mentioned. General practitioners (GPs) play a central role in the vaccination process. Therefore, effective interventions in this context are needed to address the various barriers and improve the vaccination uptake rates. METHODS: A complex intervention will be implemented and evaluated in 1057 GPs' practices in two German federal states. The components include trainings for GPs and medical assistants on communication psychology, medical aspects, and organisational vaccination processes. The primary outcome influenza vaccination rate and the secondary outcomes vaccination uptake rate of other vaccinations as well as vaccine literacy of patients will be examined. The intervention will be evaluated in a mixed methods study with a controlled design. Survey data will be analysed descriptively and by using mean comparisons as well as multivariable multilevel analyses. The qualitative data will be analysed with qualitative content analysis. The secondary data will be analysed by using descriptive statistics, a pre-post comparison by performing mean comparisons, cluster analysis, and subgroup analyses. DISCUSSION: In this study, a complex intervention to improve vaccination rates in GP practices for the vaccinations recommended for people aged 60 years and older will be implemented and evaluated. Additionally, improvements in patients' vaccine-related health literacy and knowledge, and patients' intention to get vaccinated are expected. The mixed methods design can deliver results that can be used to improve preventive health care for elderly people and to gain more knowledge on vaccination uptake and the intervention's effectiveness. TRIAL REGISTRATION: Trial registration number: DRKS00027252 (retrospectively registered).