Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 953
Filtrar
1.
Pan Afr Med J ; 34: 37, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31803341

RESUMO

Introduction: In Cameroon, there is medical scepticism and negligence towards patients with mental disorders. Objective assessment might be the solution. Depressive disorders are the most common form of mental disorders and Douala has the second largest group of general practitioners in the country. Thus, the purpose of this study was to evaluate the attitude of general practitioners of Douala towards patients with depressive disorders. Method: We conducted a cross-sectional descriptive study of general outpatient services from February to June 2017. We asked 3 patients of each general practitioner enrolled in the study to fill the Patient Health Questionnaire version-9 (HQP-9) to assess if they were depressed. During each consultation, we filled a clinical information form to know whether the general practitioner had diagnosed a depressive disorder and, if so, which treatment he had adopted. Finally, we administered to general practitioner a questionnaire to know their challenges of treating depression. Results: The prevalence of depressive disorders in general practice consultations was estimated to be 32.5% in the city of Douala and the rate of diagnoses made by general practitioners was 1.92%. Diagnosed patients only received some. Conclusion: Despite the low interest in depressive disorders, in Cameroon they are a public health problem due to their frequency and to depression-related morbi-mortality.


Assuntos
Atitude do Pessoal de Saúde , Transtorno Depressivo/terapia , Clínicos Gerais/estatística & dados numéricos , Camarões , Estudos Transversais , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Prevalência
2.
An Bras Dermatol ; 94(5): 532-541, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777353

RESUMO

BACKGROUND: The knowledge of general practitioners about photoprotection is unknown. OBJECTIVES: To develop and validate an instrument to evaluate the knowledge of general practitioners and pediatricians about photoprotection, gauging the knowledge of these professionals. METHODS: The study followed the steps: (1) Literature identification and item elaboration related to the theme; (2) Content validation; (3) Apparent validation; (4) Construct validation: internal consistency analysis and discriminatory analysis; (5) Reliability analysis. In Step 4, the instrument was applied to 217 general practitioners and pediatricians who worked in the host city of the study; the scores were compared with dermatologists scores. RESULTS: The final instrument had 41 items and showed satisfactory internal consistency (Cronbach's alpha=0.780), satisfactory reproducibility and good test-retest reliability (good-to-excellent kappa statistic in more than 60% of items). The discriminatory analysis registered a mean score of 54.1 points for dermatologists and 31.1 points for generalists and pediatricians, from a total of 82 possible points, representing a statistically significant difference (p<0.001). Generalists and pediatricians demonstrated an understanding of the relationship between excessive sun exposure and skin cancer, but they revealed lack of technical information necessary for their professional practice. STUDY LIMITATIONS: The instrument evaluates only knowledge, without evaluating the conduct of the participants. CONCLUSION: The results show that the instrument has good internal consistency and good reproducibility. It could be useful in the identification of general practitioners and pediatricians knowledge gaps on the subject, for the subsequent development of training and educational strategies.


Assuntos
Clínicos Gerais/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Pediatras/estatística & dados numéricos , Proteção Radiológica/métodos , Energia Solar , Inquéritos e Questionários/normas , Raios Ultravioleta/efeitos adversos , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição à Radiação/prevenção & controle , Reprodutibilidade dos Testes , Neoplasias Cutâneas/prevenção & controle , Estatísticas não Paramétricas , Protetores Solares/uso terapêutico
3.
Presse Med ; 48(12): e382-e388, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31757737

RESUMO

BACKGROUND: Rare diseases are defined by a prevalence of less than one out of 2000 persons. In clinical practice, their management is difficult, due to their diversity, their complexity and a lack of adapted physician training. OBJECTIVE: The aims of this study were to identify rare skin diseases in a reference center, to describe the difficulties encountered by general practitioners (GPs) in management of these uncommon cases, and to pinpoint the characteristics of the GPs having the most problems. METHODS: A survey conducted from March to June 2017 involving GPs at least one of whose rare skin disease patients was being monitored in a reference center. RESULTS: All in all, 96/195 (49.2%) of the GPs contacted completed the questionnaire, and virtually all of them (95%) reported five main categories of difficulties: giving a diagnosis, monitoring treatment, coordinating care, providing support, and ensuring management of intercurrent pathologies. The most widely reported difficulties were related to diagnosis (88.5%) and care coordination (76%). The GPs most in need of assistance were those practicing in rural areas (11 times more likely to experience difficulties), those with over 10 years of experience (up to 9.8 times more risk) and those not considering their role in the management of patients with rare diseases as instrumental (2.28 times more risk). CONCLUSIONS: This study brought to light the difficulties encountered by GPs in management of patients with rare skin diseases. We identified those the most in need of assistance, who are to be targeted for actions aimed at improving the care and treatment of patients suffering from rare skin diseases.


Assuntos
Competência Clínica , Clínicos Gerais , Padrões de Prática Médica , Doenças Raras/terapia , Dermatopatias/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Criança , Pré-Escolar , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Feminino , França/epidemiologia , Medicina Geral/educação , Clínicos Gerais/normas , Clínicos Gerais/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Doenças Raras/epidemiologia , Dermatopatias/epidemiologia , Inquéritos e Questionários , Adulto Jovem
4.
BMJ ; 367: l6015, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690553

RESUMO

OBJECTIVE: To evaluate the association between gifts from pharmaceutical companies to French general practitioners (GPs) and their drug prescribing patterns. DESIGN: Retrospective study using data from two French databases (National Health Data System, managed by the French National Health Insurance system, and Transparency in Healthcare). SETTING: Primary care, France. PARTICIPANTS: 41 257 GPs who in 2016 worked exclusively in the private sector and had at least five registered patients. The GPs were divided into six groups according to the monetary value of the received gifts reported by pharmaceutical, medical device, and other health related companies in the Transparency in Healthcare database. MAIN OUTCOME MEASURES: The main outcome measures were the amount reimbursed by the French National Health Insurance for drug prescriptions per visit (to the practice or at home) and 11 drug prescription efficiency indicators used by the National Health Insurance to calculate the performance related financial incentives of the doctors. Doctor and patient characteristics were used as adjustment variables. The significance threshold was 0.001 for statistical analyses. RESULTS: The amount reimbursed by the National Health Insurance for drug prescriptions per visit was lower in the GP group with no gifts reported in the Transparency in Healthcare database in 2016 and since its launch in 2013 (no gift group) compared with the GP groups with at least one gift in 2016 (-€5.33 (99.9% confidence interval -€6.99 to -€3.66) compared with the GP group with gifts valued at €1000 or more reported in 2016) (P<0.001). The no gift group also more frequently prescribed generic antibiotics (2.17%, 1.47% to 2.88% compared with the ≥€1000 group), antihypertensives (4.24%, 3.72% to 4.77% compared with the ≥€1000 group), and statins (12.14%, 11.03% to 13.26% compared with the ≥€1000 group) than GPs with at least one gift between 2013 and 2016 (P<0.001). The no gift group also prescribed fewer benzodiazepines for more than 12 weeks (-0.68%, -1.13% to -0.23% compared with the €240-€999 group) and vasodilators (-0.15%, -0.28% to -0.03% compared with the ≥€1000 group) than GPs with gifts valued at €240 or more reported in 2016, and more angiotensin converting enzyme (ACE) inhibitors compared with all ACE and sartan prescriptions (1.67%, 0.62% to 2.71%) compared with GPs with gifts valued at €1000 or more reported in 2016 (P<0.001). Differences were not significant for the prescription of aspirin and generic antidepressants and generic proton pump inhibitors. CONCLUSION: The findings suggest that French GPs who do not receive gifts from pharmaceutical companies have better drug prescription efficiency indicators and less costly drug prescriptions than GPs who receive gifts. This observational study is susceptible to residual confounding and therefore no causal relation can be concluded. TRIAL REGISTRATION: OSF register OSF.IO/8M3QR.


Assuntos
Indústria Farmacêutica/economia , Prescrições de Medicamentos/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Doações , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Indústria Farmacêutica/estatística & dados numéricos , Prescrições de Medicamentos/economia , Medicamentos Genéricos/economia , Feminino , França , Clínicos Gerais/economia , Humanos , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Padrões de Prática Médica/economia , Medicamentos sob Prescrição/economia , Estudos Retrospectivos , Adulto Jovem
7.
Rev Med Suisse ; 15(660): 1488-1495, 2019 Aug 28.
Artigo em Francês | MEDLINE | ID: mdl-31496172

RESUMO

The population of liver transplant recipients has increased in Switzerland over the last few years. Morbidity and mortality after liver transplantation are due, in the early post-transplant period, to surgical and infectious complications as well as to rejection, whereas cardiovascular, metabolic, renal and oncologic complications are the most frequent complications in the late post-transplant period. The role of the general practitioner in the long-term follow-up of liver transplant recipients is of the highest importance and can represent the first-line care of these patients as soon as 6 to 12 months post-transplantation, while maintaining a close and regular collaboration with the transplant center. Multidisciplinary and structured follow-up, along with some specific screening tests, is warranted in order to refine patient management in a timely manner and to optimize outcomes.


Assuntos
Clínicos Gerais , Transplante de Fígado , Transplantados , Seguimentos , Clínicos Gerais/normas , Clínicos Gerais/estatística & dados numéricos , Humanos , Transplante de Fígado/estatística & dados numéricos , Suíça , Transplantados/estatística & dados numéricos
8.
BMC Health Serv Res ; 19(1): 648, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492139

RESUMO

BACKGROUND: Commissioning innovative health technologies is typically complex and multi-faceted. Drawing on the negotiated order perspective, we explore the process by which commissioning organisations make their decisions to commission innovative health technologies. The empirical backdrop to this discussion is provided by a case study exploring the commissioning considerations for a new photoplethysmography-based diagnostic technology for peripheral arterial disease in primary care in the UK. METHODS: The research involved an empirical case study of four Clinical Commissioning Groups (CCGs) involved in the commissioning of services in primary and secondary care. Semi-structured in-depth interviews (16 in total) and two focus groups (a total of eight people participated, four in each group) were conducted with key individuals involved in commissioning services in the NHS including (i) senior NHS clinical leaders and directors (ii) commissioners and health care managers across CCGs and (iii) local general practitioners. RESULTS: Commissioning of a new diagnostic technology for peripheral arterial disease in primary care involves high levels of protracted negotiations over funding between providers and commissioners, alliance building, conflict resolution and compromise of objectives where the outcomes of change are highly contingent upon interventions made across different care settings. Our evidence illustrates how reconfigurations of inter-organisational relations, and of clinical and related work practices required for the successful implementation of a new technology could become the major challenge in commissioning negotiations. CONCLUSIONS: Innovative health technologies such as the diagnostic technology for peripheral arterial disease are commissioned in care pathways where the value of such technology is realised by those delivering care to patients. The detail of how care pathways are commissioned is complex and involves high degrees of uncertainty concerning such issues as prioritisation decisions, patient benefits, clinical buy-in, value for money and unintended consequences. Recent developments in the new care models and integrated care systems (ICSs) in the UK offer a unique opportunity for the successful commissioning arrangements of innovative health technologies in primary care such as the new diagnostic technology for peripheral arterial disease.


Assuntos
Tecnologia Biomédica/estatística & dados numéricos , Medicina Geral/estatística & dados numéricos , Invenções , Tecnologia Biomédica/organização & administração , Difusão de Inovações , Grupos Focais , Medicina Geral/organização & administração , Clínicos Gerais/organização & administração , Clínicos Gerais/estatística & dados numéricos , Administração de Serviços de Saúde , Humanos , Negociação , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Medicina Estatal
9.
BMC Health Serv Res ; 19(1): 609, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464616

RESUMO

BACKGROUND: There are a number of limitations to the present primary eye care system in the UK. Patients with minor eye conditions typically either have to present to their local hospital or GP, or face a charge when visiting eye care professionals (optometrists). Some areas of the UK have commissioned enhanced community services to alleviate this problem; however, many areas have not. The present study is a needs assessment of three areas (Leeds, Airedale and Bradford) without a Minor Eye Conditions Service (MECS), with the aim of determining whether such a service is clinically or economically viable. METHOD: A pro forma was developed for optometrists and practice staff to complete when a patient presented whose reason for attending was due to symptoms indicative of a problem that could not be optically corrected. This form captured the reason for visit, whether the patient was seen, the consultation funding, the outcome and where the patient would have presented to if the optometrists could not have seen them. Optometrists were invited to participate via Local Optical Committees. Results were submitted via a Google form or a Microsoft Excel document and were analysed in Microsoft Excel. RESULTS: Seventy-five percent of patients were managed in optometric practice. Nine and 16% of patients required subsequent referral to their General Practitioner or hospital ophthalmology department, respectively. Should they not have been seen, 34% of patients would have presented to accident and emergency departments and 59% to their general practitioner. 53% of patients paid privately for the optometrist appointment, 28% of patients received a free examination either through use of General Ophthalmic Service sight tests (9%) or optometrist good will (19%) and 19% of patients did not receive a consultation and were redirected to other providers (e.g. pharmacy, accident and emergency or General Practitioner). 88% of patients were satisfied with the level of service. Cost-analyses revealed a theoretical cost saving of £3198 to the NHS across our sample for the study period, indicating cost effectiveness. CONCLUSIONS: This assessment demonstrates that a minor eye condition service in the local areas would be economically and clinically viable and well received by patients.


Assuntos
Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Determinação de Necessidades de Cuidados de Saúde , Análise Custo-Benefício , Emergências/economia , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/economia , Tratamento de Emergência/estatística & dados numéricos , Inglaterra , Oftalmopatias/economia , Clínicos Gerais/economia , Clínicos Gerais/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Oftalmologia/estatística & dados numéricos , Optometria/estatística & dados numéricos , Satisfação do Paciente , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/estatística & dados numéricos
10.
Eur J Gen Pract ; 25(3): 149-156, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31339386

RESUMO

Background: A well-staffed and an efficient primary healthcare sector is beneficial for a healthcare system but some countries experience problems in recruitment to general practice. Objectives: This study explored factors influencing Danish junior doctors' choice of general practice as their specialty. Methods: This study is based on an online questionnaire collecting quantitative and qualitative data. Two focus-group interviews were conducted to inform the construction of the questionnaire to ensure high content validity. All Danish junior doctors participating in general practice specialist training in 2015 were invited to participate in the survey, from which both qualitative and quantitative data were collected. The data was analysed using systematic text condensation and descriptive statistics. Results: Of 1099 invited, 670 (61%) junior doctors completed the questionnaire. Qualitative data: junior doctors found educational environments and a feasible work-life balance were important. They valued patient-centred healthcare, doctor-patient relationships based on continuity, and the possibility of organizing their work in smaller, manageable units. Quantitative data: 90.8% stated that the set-up of Danish specialist-training programme positively influenced their choice of general practice as their specialty. Junior doctors (80.4%) found that their university curriculum had too little emphasis on general practice, 64.5% agreed that early basic postgraduate training in general practice had a high impact on their choice of general practice as their specialty. Conclusion: Several factors that might positively affect the choice of general practice were identified. These factors may hold the potential to guide recruitment strategies for general practice.


Assuntos
Escolha da Profissão , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Especialização/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Currículo , Dinamarca , Educação de Pós-Graduação em Medicina/métodos , Feminino , Grupos Focais , Medicina Geral/organização & administração , Clínicos Gerais/psicologia , Humanos , Masculino , Inquéritos e Questionários
11.
Aust N Z J Public Health ; 43(5): 464-469, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31268211

RESUMO

OBJECTIVE: Uptake of screening through the Australian National Bowel Cancer Screening Program remains low. General practice guidelines support the general practitioners' role to offer CRC screening. This study tests the effect that an intervention including point-of-care FOBT provision, printed screening advice and GP endorsement has on self-reported FOBT uptake. METHODS: A multisite, 1:1 parallel-arm, cluster-randomised controlled trial. Participants aged 50-74, at average risk of CRC and overdue for screening were recruited from four general practices in New South Wales, Australia, from September 2016 to May 2017. Self-report of FOBT up to eight weeks post baseline. RESULTS: A total of 336 participants consented to complete a baseline survey (64% consent rate), of which 123 were recruited into the trial (28 usual care days and 26 intervention days). Follow-up data was collected for 114 participants (65 usual care and 49 intervention). Those receiving the intervention had ten times greater odds of completing screening compared to usual care (39% vs. 6%; OR 10.24; 95%CI 2.9-36.6, p=0.0006). CONCLUSIONS: A multicomponent intervention delivered in general practice significantly increased self-reported FOBT uptake in those at average risk of CRC. Implications for public health: General practice interventions could serve as an important adjunct to the Australian National Bowel Cancer Screening Program to boost plateauing screening rates.


Assuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Programas de Rastreamento , Sangue Oculto , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Idoso , Austrália/epidemiologia , Neoplasias Colorretais/epidemiologia , Assistência à Saúde , Feminino , Medicina Geral , Humanos , Masculino , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , New South Wales , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
12.
Eur J Gen Pract ; 25(3): 136-142, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31272245

RESUMO

Background: Non-urgent care is an important factor responsible for rising healthcare costs and general practitioners (GPs) are known to be more cost-effective than emergency departments (EDs). Objectives: To understand the reasons why patients confronted with a medical problem perceived as urgent choose to consult either a GP or an ED. Methods: We conducted a qualitative study in Switzerland, using data collected between 2014 and 2015 through semi-structured interviews of adults with non-vital medical problems. Half were recruited after an ambulatory consultation in an ED, and half were patients who consulted their GP. The audio-recorded interviews were transcribed, coded, and analysed according to the constant comparative method. Results: The main reason given by patients who consulted their GP first was the quality of the relationship. The more meaningful the relationship, the more likely patients were to seek advice from their GP. One marker of a privileged relationship was GPs supplying their mobile phone number to the patient. The perceived nature of the complaint, for example, symptoms considered as life-threatening or severe pain, together with the expected waiting time in an ED were additional factors influencing the patients' choice. Conclusion: Our study showed that when patients are confronted with what they perceive as a medical emergency, the quality of the relationship with the GP, in particular the continuity of care provided, seem to be the major reasons why they consult their GP rather than an ED.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Relações Médico-Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Emergências/epidemiologia , Emergências/psicologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Suíça , Fatores de Tempo , Adulto Jovem
13.
Immun Inflamm Dis ; 7(3): 214-228, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31290265

RESUMO

BACKGROUND: Clinicians draw on instructional approaches when training patients with anaphylaxis to use adrenaline autoinjectors, but patient use is poor. Psychological barriers to these behaviours exist but are not considered routinely when training patients to use autoinjectors. Health Psychology principles suggest exploring these factors with patients could improve their autoinjector use. OBJECTIVE: To evaluate the impact of a 90-minute workshop training clinicians in strategies and techniques for exploring and responding to psychological barriers to autoinjector use with patients. Attendees' knowledge, confidence and likelihood of using the strategies were expected to improve. METHODS: Impact was evaluated using a longitudinal mixed-method design. Twenty-nine clinicians (general and specialist nurses, general practitioners, and pharmacists) supporting patients with anaphylaxis in UK hospitals and general practice attended. Self-rated knowledge, confidence, and likelihood of using the strategies taught were evaluated online 1 week before, 1 to 3, and 6 to 8 weeks after the workshop. Clinicians were invited for telephone interview after attending to explore qualitatively the workshop impact. RESULTS: χ2 analyses were significant in most cases (P < .05), with sustained (6-8 weeks) improvements in knowledge, confidence, and likelihood of using the strategies taught. Thematic analysis of interview data showed the workshop enhanced attendees' knowledge of the care pathway, understanding of patient's experience of anaphylaxis as psychological not purely physical, and altered their communication with this and other patient groups. However, interviewees perceived lack of time and organisational factors as barriers to using the strategies and techniques taught in clinical contexts. CONCLUSION: Training clinicians in psychologically informed strategies produce sustained improvements in their confidence and knowledge around patient autoinjector education, and their likelihood of using strategies in clinical practice. CLINICAL RELEVANCE: Exploring psychological barriers should be part of training patients with anaphylaxis in autoinjector use.


Assuntos
Anafilaxia/prevenção & controle , Educação Médica/métodos , Epinefrina/administração & dosagem , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Autoadministração/métodos , Inquéritos e Questionários , Adulto , Anafilaxia/tratamento farmacológico , Educação Médica/estatística & dados numéricos , Feminino , Clínicos Gerais/psicologia , Clínicos Gerais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras Clínicas/psicologia , Enfermeiras Clínicas/estatística & dados numéricos , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Médicos/psicologia , Médicos/estatística & dados numéricos , Autoadministração/estatística & dados numéricos , Vasoconstritores/administração & dosagem
14.
BMC Health Serv Res ; 19(1): 464, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286960

RESUMO

BACKGROUND: The healthcare systems in the western world have in recent years faced major challenges caused by demographic changes and altered patterns of diseases as well as political decisions influencing the organisation of healthcare provisions. General practitioners are encouraged to delegate more clinical tasks to their staff in order to respond to the changing circumstances. Nevertheless, the degree of task delegation varies substantially between general practices, and how these different degrees affect the quality of care for the patients is currently not known. Using chronic obstructive pulmonary disease (COPD) as our case scenario, the aim of the study was to investigate associations between degrees of task delegation in general practice and spirometry testing as a measure of quality of care. METHODS: We carried out a cross-sectional study comprising all general practices in Denmark and patients suffering from chronic obstructive pulmonary disease. General practitioners (GPs) were invited to participate in a survey investigating degrees of task delegation in their clinics. Data were linked to national registers on spirometry testing among patients with COPD. We investigated associations using multilevel mixed-effects logit models and adjusted for practice and patient characteristics. RESULTS: GPs from 895 practices with staff managing COPD-related tasks responded, and 61,223 COPD patients were linked to these practices. Hereof, 24,685 (40.3%) had a spirometry performed within a year. Patients had a statistically significant higher odds ratio (OR) of having an annual spirometry performed in practices with medium or maximal degrees of task delegation compared to practices with a minimal degree (OR = 1.27 and OR = 1.33, respectively). CONCLUSION: Delegating more complex tasks to practice staff implies that COPD-patients are more likely to be treated according to evidence-based recommendations on spirometry testing.


Assuntos
Medicina Geral/organização & administração , Clínicos Gerais/psicologia , Fidelidade a Diretrizes/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria/normas , Idoso , Estudos Transversais , Dinamarca , Feminino , Clínicos Gerais/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
15.
BMC Health Serv Res ; 19(1): 434, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31253160

RESUMO

BACKGROUND: Rising workload in general practice has been a recent cause for concern in several countries; this is also the case in Norway. Long working hours and heavy workload seem to affect recruitment and retention of regular general practitioners (RGPs). We investigated Norwegian RGPs' workload in terms of time used on patient-related office work, administrative work, municipality tasks and other professional activities in relation to RGPs, and gender, age, employment status and size of municipality. METHODS: In early 2018, an electronic survey was sent to all 4716 RGPs in Norway. In addition to demographic background, the RGP reported minutes per day used on various tasks in the RGP practice prospectively during 1 week. Working time also included additional tasks in the municipality, other professional work and on out-of-hours primary health care. Differences were analysed by chi square test, independent t-tests, and one-way ANOVA. RESULTS: Among 1876 RGPs (39.8%), the mean total working hours per week was 55.6, while the mean for regular number of working hours was 49.0 h weekly. Men worked 1.5 h more than women (49.7 vs. 48.2 h, p = 0.010). Self-employed RGPs work more than salaried RGPs (49.3 vs. 42.5 h, p < 0.001), and RGPs age 55-64 years worked more than RGPs at age 30-39 (51.1 vs. 47.3 h, p < 0.001). 54.1% of the regular working hours was used on face-to-face patient work. CONCLUSIONS: Norwegian RGPs have long working hours compared to recommended regular working hours in Norway, with small gender differences. Only half of the working time is used on face-to-face consultations. There seems to be a trend of increasing workload among Norwegian GPs, at the cost of direct patient contact. Further research should address identifying factors that can reduce long working hours.


Assuntos
Clínicos Gerais/psicologia , Atenção Primária à Saúde , Carga de Trabalho/estatística & dados numéricos , Adulto , Feminino , Clínicos Gerais/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Atenção Primária à Saúde/estatística & dados numéricos , Inquéritos e Questionários
16.
Geriatr Gerontol Int ; 19(8): 705-710, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31237101

RESUMO

AIM: The purpose of this study was to investigate whether transpersonal trust (TPT) moderates the relationship between chronic conditions and general practitioner (GP) visits among the oldest old in Germany. METHODS: The multicenter prospective cohort Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest old primary care patients (85+) (AgeQualiDe) was carried out. Individuals were recruited through GP offices at six study centers in Germany (follow-up wave 7). Primary care patients were aged ≥85 years (n = 861, mean age 89.0 years; range 85-100 years). The self-reported number of outpatient visits to the GP was used as the outcome measure. To explore religious and spiritual beliefs, the short form of the Transpersonal Trust scale was used. The presence or absence of 36 chronic conditions was recorded by the GP. RESULTS: Multiple Poisson regressions showed that GP visits were positively associated with the number of chronic conditions (incidence rate ratio 1.03, P < 0.05). TPT moderated the relationship between chronic conditions and GP visits (incidence rate ratio 1.01, P < 0.05). The association between chronic conditions and GP visits was significantly more pronounced when TPT was high. CONCLUSION: Our findings highlight the importance of TPT in the relationship between chronic conditions and GP visits. Future longitudinal studies are required to clarify this subject further. Geriatr Gerontol Int 2019; 19: 705-710.


Assuntos
Clínicos Gerais , Múltiplas Afecções Crônicas , Visita a Consultório Médico/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Qualidade de Vida , Espiritualidade , Confiança , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Clínicos Gerais/psicologia , Clínicos Gerais/estatística & dados numéricos , Alemanha , Serviços de Saúde para Idosos/estatística & dados numéricos , Humanos , Masculino , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/psicologia , Múltiplas Afecções Crônicas/terapia , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
17.
JMIR Mhealth Uhealth ; 7(6): e13199, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31199343

RESUMO

BACKGROUND: Mobile health (mHealth) apps can be prescribed as an effective self-management tool for patients. However, it is challenging for doctors to navigate 350,000 mHealth apps to find the right ones to recommend. Although medical professionals from many countries are using mHealth apps to varying degrees, current mHealth app use by Australian general practitioners (GPs) and the barriers and facilitators they encounter when integrating mHealth apps in their clinical practice have not been reported comprehensively. OBJECTIVE: The objectives of this study were to (1) evaluate current knowledge and use of mHealth apps by GPs in Australia, (2) determine the barriers and facilitators to their use of mHealth apps in consultations, and (3) explore potential solutions to the barriers. METHODS: We helped the Royal Australian College of General Practitioners (RACGP) to expand the mHealth section of their annual technology survey for 2017 based on the findings of our semistructured interviews with GPs to further explore barriers to using mHealth apps in clinical practice. The survey was distributed to the RACGP members nationwide between October 26 and December 3, 2017 using Qualtrics Web-based survey tool. RESULTS: A total of 1014 RACGP members responded (response rate 4.6% [1014/21,884], completion rate 61.2% [621/1014]). The median years practiced was 20.7 years. Two-thirds of the GPs used apps professionally in the forms of medical calculators and point-of-care references. A little over half of the GPs recommended apps for patients either daily (12.9%, 80/621), weekly (25.9%, 161/621), or monthly (13.4%, 83/621). Mindfulness and mental health apps were recommended most often (32.5%, 337/1036), followed by diet and nutrition (13.9%, 144/1036), exercise and fitness (12.7%, 132/1036), and women's health (10%, 104/1036) related apps. Knowledge and usage of evidence-based apps from the Handbook of Non-Drug Interventions were low. The prevailing barriers to app prescription were the lack of knowledge of effective apps (59.9%, 372/621) and the lack of trustworthy source to access them (15.5%, 96/621). GPs expressed their need for a list of safe and effective apps from a trustworthy source, such as the RACGP, to overcome these barriers. They reported a preference for online video training material or webinar to learn more about mHealth apps. CONCLUSIONS: Most GPs are using apps professionally but recommending apps to patients sparingly. The main barriers to app prescription were the lack of knowledge of effective apps and the lack of trustworthy source to access them. A curated compilation of effective mHealth apps or an app library specifically aimed at GPs and health professionals would help solve both barriers.


Assuntos
Clínicos Gerais/psicologia , Aplicativos Móveis/normas , Adulto , Idoso , Austrália , Feminino , Clínicos Gerais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Inquéritos e Questionários , Telemedicina/normas , Telemedicina/estatística & dados numéricos , Interface Usuário-Computador
18.
Assist Inferm Ric ; 38(2): 66-76, 2019.
Artigo em Italiano | MEDLINE | ID: mdl-31241052

RESUMO

. The team-based care models in primary care: General Practitioners' perspectives on nurses' role. INTRODUCTION: In the last decade in Italy, different team-based primary care models have been developed that involve the collaboration of General Practitioners (GPs) with other professionals, such as nurses. AIMS: To investigate the GPs attitude towards the role and levels of autonomy of nurses in the primary care settings. METHODS: A two-phase exploratory study was performed: 1) a focus group with a purposeful sample of 12 GPs was conducted to identify the potential patients-clients/problems and activities that might be assigned to nurses; 2) a questionnaire was developed to analyze the levels of autonomy GPs assigned to nurses for different patients-clients/problems and activities. The questionnaire was administered to a convenience sample of 45 GPs, who were also interviewed to explain their choices. RESULTS: GPs recognized autonomy to nurses in the assessment, monitoring and education on lifestyles, prevention of falls, malnutrition and compliance with treatments; in performing technical and organizational activities. They believed necessary supervision or providing indications to nurses in the management of chronic patients, especially in the assessment of signs and symptoms of deterioration, in monitoring and follow-up and partly on the contents of health education. Finally, GPs felt responsible of the management of pluri-pathological and unstable patients, such as heart failure patients, due to their highly unpredictable and rapid deterioration. CONCLUSIONS: GPs expressed a positive attitude towards the role of nurses in the primary care setting, which varied depending on patients' instability and clinical complexity.


Assuntos
Clínicos Gerais/estatística & dados numéricos , Papel do Profissional de Enfermagem , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Idoso , Atitude do Pessoal de Saúde , Feminino , Grupos Focais , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Autonomia Profissional , Inquéritos e Questionários
19.
BMC Health Serv Res ; 19(1): 403, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221215

RESUMO

BACKGROUND: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. METHODS: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. RESULTS: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. CONCLUSIONS: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02757781 . Registered on 25 April 2016.


Assuntos
Atitude do Pessoal de Saúde , Educação a Distância/métodos , Clínicos Gerais/psicologia , Enfermeiras e Enfermeiros/psicologia , Atenção Primária à Saúde , Adulto , Doença Crônica , Estudos de Viabilidade , Feminino , Clínicos Gerais/estatística & dados numéricos , Humanos , Aprendizagem , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Participação do Paciente , Projetos Piloto , Pesquisa Qualitativa
20.
PLoS One ; 14(5): e0217225, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31120959

RESUMO

BACKGROUND: General Practitioners (GPs) play a key role in the healthcare trajectory of patients. If the patient experiences problems that are typically non-life-threatening, such as the symptoms of post-intensive-care syndrome, the GP will be the first healthcare professional they consult. The primary aim of this study is to gain insight in the frequency of GP consultations during the year before hospital admission and the year after discharge for ICU survivors and a matched control group from the general population. The secondary aim of this study is to gain insight into differences between subgroups of the ICU population with respect to the frequency of GP consultations. METHODS: We conducted a retrospective cohort study, combining a national health insurance claims database and a national quality registry for ICUs. Clinical data of patients admitted to an ICU in 2013 were enriched with claims data from the years 2012, 2013 and 2014. Poisson regression was used to assess the differences in frequency of GP consultations between the ICU population and the control group. RESULTS: ICU patients have more consultations with GPs during the year before and after admission than individuals in the control group. In the last four weeks before admission, ICU patients have 3.58 (CI 3.37; 3.80) times more GP consultations than the control group, and during the first four weeks after discharge they have 4.98 (CI 4.74; 5.23) times more GP consultations. In the year after hospital discharge ICU survivors have an increased GP consultation rate compared to the year before their hospital admission. CONCLUSIONS: Close to hospital admission and shortly after hospital discharge, the frequency of GP consultations substantially increases in the population of ICU survivors. Even a year after hospital discharge, ICU survivors have increased GP consultation rates. Therefore, GPs should be well informed about the problems ICU patients suffer after discharge, in order to provide suitable follow-up care.


Assuntos
Clínicos Gerais/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Qualidade de Vida , Encaminhamento e Consulta/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Alta do Paciente , Relações Médico-Paciente , Estudos Retrospectivos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA