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1.
Br J Gen Pract ; 73(727): e133-e140, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36702582

RESUMO

BACKGROUND: General practice plays a critical role in the prevention, diagnosis, management, and survivorship care of patients with cancer. Mapping research outputs over time provides valuable insights into the evolving role of general practice in cancer care. AIM: To describe and compare the distribution of cancer in general practice research publications by country, cancer type, area of the cancer continuum, author sex, and journal impact factor. DESIGN AND SETTING: A bibliometric analysis using a systematic approach to identify publications. METHOD: MEDLINE and Embase databases were searched for studies published between 2013 and 2019, which reported on cancer in general practice. Included studies were mapped to the cancer continuum framework. Descriptive statistics were used to present data from the included studies. RESULTS: A total of 2798 publications were included from 714 journals, spanning 79 countries. The publication rate remained stable over this period. Overall, the US produced the most publications (n = 886, 31.7%), although, per general population capita, Denmark produced nearly 10 times more publications than the US (20.0 publications per million compared with 2.7 publications per million). Research across the cancer continuum varied by country, but, overall, most studies focused on cancer screening, diagnosis, and survivorship. More than half of included studies used observational study designs (n = 1523, 54.4%). Females made up 66.5% (n = 1304) of first authors, but only 47.0% (n = 927) of last authors. CONCLUSION: Cancer in general practice is a stable field where research is predominantly observational. There is geographical variation in the focus of cancer in general practice research, which may reflect different priorities and levels of investment between countries. Overall, these results support future consideration of how to improve under-represented research areas and the design, conduct, and translation of interventional research.


Assuntos
Pesquisa Biomédica , Medicina Geral , Neoplasias , Humanos , Bibliometria , Fator de Impacto de Revistas , Medicina de Família e Comunidade , Neoplasias/diagnóstico
3.
Br J Gen Pract ; 73(727): 83, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36702603
4.
Br J Gen Pract ; 73(727): e124-e132, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36702608

RESUMO

BACKGROUND: People with advanced cancer frequently use the GP out-of-hours (GPOOH) service. Considerable amounts of routine GPOOH data are uncoded. Therefore, these data are omitted from existing healthcare datasets. AIM: To conduct a free-text analysis of a GPOOH dataset, to identify reasons for attendance and care delivered through GPOOH to people with advanced cancer. DESIGN AND SETTING: An analysis of a GPOOH healthcare dataset was undertaken. It contained all coded and free- text information for 5749 attendances from a cohort of 2443 people who died from cancer in Tayside, Scotland, from 2013-2015. METHOD: Random sampling methods selected 575 consultations for free-text analysis. Each consultation was analysed by two independent reviewers to determine the following: assigned presenting complaints; key and additional palliative care symptoms recorded in free text; evidence of anticipatory care planning; and free-text recording of dispensed medications. Inter-rater reliability concordance was established through Kappa testing. RESULTS: More than half of all coded reasons for attendance (n = 293; 51.0%) were 'other' or 'missing'. Free-text analysis demonstrated that nearly half (n = 284; 49.4%) of GPOOH attendances by people with advanced cancer were for pain or palliative care. More than half of GPOOH attendances (n = 325; 56.5%) recorded at least one key or additional palliative care symptom in free text, with the commonest being breathlessness, vomiting, cough, and nausea. Anticipatory care planning was poorly recorded in both coded and uncoded records. Uncoded medications were dispensed in more than one- quarter of GPOOH consultations. CONCLUSION: GPOOH delivers a substantial amount of pain management and palliative care, much of which is uncoded. Therefore, it is unrecognised and under-reported in existing large healthcare data analyses.


Assuntos
Plantão Médico , Medicina Geral , Neoplasias , Humanos , Reprodutibilidade dos Testes , Neoplasias/epidemiologia , Neoplasias/terapia , Medicina de Família e Comunidade
5.
BMC Med Educ ; 23(1): 65, 2023 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-36703159

RESUMO

BACKGROUND: The Recorded Consultation Assessment (RCA) was developed rapidly during the COVID-19 pandemic to replace the Clinical Skills Assessment (CSA) for UK general practice licensing. Our aim was to evaluate examiner perceptions of the RCA. METHODS: We employed a cross-sectional design using a questionnaire survey of RCA examiners with attitudinal (relating to examiners thoughts and perceptions of the RCA) and free text response options. We conducted statistical descriptive and factor analysis of quantitative data with qualitative thematic analysis of free text responses. RESULTS: Overall, 182 of 260 (70%) examiners completed the questionnaire. Responders felt that consultations submitted were representative of the work of a typical GP during the pandemic and provided a good sample across the curriculum. They were also generally positive about the logistic, advisory and other support provided as well as the digital platform. Despite responders generally agreeing there was sufficient information available in video or audio consultations to judge candidates' data gathering, clinical management, and interpersonal skills, they were less confident about their ability to make judgments of candidates' performance compared with the CSA. The qualitative analysis of free text responses detailed the problems of case selection and content, explained examiners' difficulties when making judgments, and detailed the generally positive views about support, training and information technology. Responders also provided helpful recommendations for improving the assessment. CONCLUSION: The RCA was considered by examiners to be feasible and broadly acceptable, although they experienced challenges from candidate case selection, case content and judgments leading to suggested areas for improvement.


Assuntos
COVID-19 , Medicina Geral , Humanos , Estudos Transversais , Pandemias , Avaliação Educacional , Educação de Pós-Graduação em Medicina , Medicina Geral/educação , Competência Clínica , Encaminhamento e Consulta
6.
BMC Prim Care ; 24(1): 23, 2023 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-36670354

RESUMO

BACKGROUND: Electronic clinical decision support tools (eCDS) are increasingly available to assist General Practitioners (GP) with the diagnosis and management of a range of health conditions. It is unclear whether the use of eCDS tools has an impact on GP workload. This scoping review aimed to identify the available evidence on the use of eCDS tools by health professionals in general practice in relation to their impact on workload and workflow. METHODS: A scoping review was carried out using the Arksey and O'Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched in 2019, and updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Double screening was completed by two reviewers, and data extracted from included articles were analysed. RESULTS: The search resulted in 5,594 references, leading to 95 full articles, referring to 87 studies, after screening. Of these, 36 studies were based in the USA, 21 in the UK and 11 in Australia. A further 18 originated from Canada or Europe, with the remaining studies conducted in New Zealand, South Africa and Malaysia. Studies examined the use of eCDS tools and reported some findings related to their impact on workload, including on consultation duration. Most studies were qualitative and exploratory in nature, reporting health professionals' subjective perceptions of consultation duration as opposed to objectively-measured time spent using tools or consultation durations. Other workload-related findings included impacts on cognitive workload, "workflow" and dialogue with patients, and clinicians' experience of "alert fatigue". CONCLUSIONS: The published literature on the impact of eCDS tools in general practice showed that limited efforts have focused on investigating the impact of such tools on workload and workflow. To gain an understanding of this area, further research, including quantitative measurement of consultation durations, would be useful to inform the future design and implementation of eCDS tools.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Medicina Geral , Clínicos Gerais , Humanos , Medicina de Família e Comunidade , Encaminhamento e Consulta , Carga de Trabalho , Fluxo de Trabalho
7.
BMC Prim Care ; 24(1): 13, 2023 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-36641488

RESUMO

BACKGROUND: Musculoskeletal disorders (MSD) are multifactorial requiring multidisciplinary treatment including physiotherapy. General practitioners (GP) have a central role in managing MSDs and mostly solicit physiotherapists accounting for 76.1% of physiotherapy referrals in France. Patient, physician, and contextual factors, including healthcare accessibility, can influence physiotherapy referral rates. OBJECTIVE: To identify patient, physician, and contextual factors associated with physiotherapy referral in adult patients with MSDs in general practice. METHODS: This study is based on the 2011/2012 French cross-sectional ECOGEN study. Analyses included working-age patients consulting their GP for any MSD. Physiotherapy referral was assessed initially, then adjusted multilevel logistic model analysis of patient, physician, geographical area-related factors associated with these referrals was performed. RESULTS: Among the 2305 patients included, 456 (19.8%) were referred to a physiotherapist. Following multilevel multivariate analyses, physiotherapist referral was more frequent for female patients (OR 1.28; 95% CI [1.03, 1.59]) with spinal (OR 1.47; 95% CI [1.18, 1.83]) and upper limb disorders (OR 1.66; 95% CI [1.20, 2.29]), and less frequent for patients ≥ 50 years (OR 0.69; 95% CI [0.52, 0.91]), living in deprived geographical areas (OR 0.60; 95% CI [0.40, 0.90]). GPs referred to a physiotherapist less frequently if they were ≥ 50 years (OR 0.50; 95% CI [0.39, 0.63]), had a high number of annual consultations, or were practicing in semi-urban area in a multidisciplinary team. CONCLUSION: This multilevel analysis identifies factors associated with physiotherapy referral for patients with MSDs, including living in deprived geographical areas. This constitutes an original contribution towards addressing healthcare disparities.


Assuntos
Medicina Geral , Clínicos Gerais , Doenças Musculoesqueléticas , Fisioterapeutas , Humanos , Adulto , Feminino , Estudos Transversais , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/epidemiologia , Doenças Musculoesqueléticas/terapia , Encaminhamento e Consulta , Atenção Primária à Saúde
8.
BMC Prim Care ; 24(1): 14, 2023 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-36641467

RESUMO

BACKGROUND: Artificial intelligence (AI) is increasingly used to support general practice in the early detection of disease and treatment recommendations. However, AI systems aimed at alleviating time-consuming administrative tasks currently appear limited. This scoping review thus aims to summarize the research that has been carried out in methods of machine learning applied to the support and automation of administrative tasks in general practice. METHODS: Databases covering the fields of health care and engineering sciences (PubMed, Embase, CINAHL with full text, Cochrane Library, Scopus, and IEEE Xplore) were searched. Screening for eligible studies was completed using Covidence, and data was extracted along nine research-based attributes concerning general practice, administrative tasks, and machine learning. The search and screening processes were completed during the period of April to June 2022. RESULTS: 1439 records were identified and 1158 were screened for eligibility criteria. A total of 12 studies were included. The extracted attributes indicate that most studies concern various scheduling tasks using supervised machine learning methods with relatively low general practitioner (GP) involvement. Importantly, four studies employed the latest available machine learning methods and the data used frequently varied in terms of setting, type, and availability. CONCLUSION: The limited field of research developing in the application of machine learning to administrative tasks in general practice indicates that there is a great need and high potential for such methods. However, there is currently a lack of research likely due to the unavailability of open-source data and a prioritization of diagnostic-based tasks. Future research would benefit from open-source data, cutting-edge methods of machine learning, and clearly stated GP involvement, so that improved and replicable scientific research can be done.


Assuntos
Inteligência Artificial , Medicina Geral , Medicina de Família e Comunidade , Automação , Aprendizado de Máquina
9.
BMC Prim Care ; 24(1): 22, 2023 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-36653772

RESUMO

BACKGROUND: Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which research and data are used routinely in clinical practice to facilitate system improvement. This study aimed to establish which elements of the learning health system were being realised within a university-based general practice and determine acceptability from staff to embrace further the transition towards a learning health system. METHODS: Semi-structured interviews were conducted with practice staff, including clinical and administrative staff, to determine the current state of the learning health system in the practice. An embedded researcher was placed within the general practice on a part-time basis to investigate the learning health system model. Interviews were transcribed and thematically analysed based on the National Academy of Medicine's framework of learning health systems. RESULTS: In total, 32 (91%) practice staff were interviewed, comprising general practitioners (n = 15), nurses (n = 3), administrative staff (n = 13), and a psychologist (n = 1). Participants indicated that the practice was operating with several characteristics of a learning health system (e.g., emphasising science and informatics; focusing on patient-clinician partnerships; applying incentives; supporting a continuous learning culture; and establishing structures and governance for learning). These measures were supported by the university-based setting, and resultant culture of learning. Nevertheless, there were areas of the practice where the learning health system could be strengthened, specifically relating to the use of patient data and informatics. Staff generally expressed willingness to engage with the process of strengthening the learning health system within their practice. CONCLUSION: Although the idea of a learning health system has been gaining traction in recent years, there are comparatively few empirical studies presented in the literature. This research presents a case study of a general practice that is operating as a learning health system and highlights the utility of using the learning health system framework.


Assuntos
Medicina Geral , Clínicos Gerais , Sistema de Aprendizagem em Saúde , Humanos , Pesquisa Qualitativa , Atenção Primária à Saúde
10.
Trials ; 24(1): 7, 2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36597136

RESUMO

BACKGROUND: Social, emotional and behavioural problems in early childhood are associated with increased risk for a wide range of poor outcomes associated with substantial cost and impact on society as a whole. Some of these problems are rooted in the early mother-infant relationship and might be prevented. In Denmark, primary health care has a central role in preventive care during pregnancy and the first years of the child's life and general practice provides opportunities to promote a healthy mother-infant relationship in early parenthood. OBJECTIVE: In the context of standardised antenatal and child development assessments focused on psychosocial wellbeing, we examine the impact of a complex intervention designed to improve maternal mentalisation skills, involving training of general practice clinicians and signposting towards a web-based resource. Joint main outcomes are child socio-emotional and language development at age 30 months measured by parentally reported questionnaires (Communicative Development Inventory and Strengths and Difficulties Questionnaire). METHODS: The study is a cluster-randomised controlled trial based in general practices in the Capital Region and the Zealand Region of Denmark. Seventy practices were included. Practices were randomised by a computer algorithm in a ratio of 1:1 to intervention or control groups. Each practice was asked to recruit up to 30 women consecutively at their first scheduled antenatal assessment. Clinicians in both groups received one day of training in preventive antenatal and child development consultations with added focus on parental psychosocial well-being, social support, and parent-child interaction. These preventive consultations delivered in both trial arms require enhanced data recording about psychosocial factors. In intervention clinics, clinicians were asked to signpost a web page at three scheduled antenatal consultations and at four scheduled consultations when the child is 5 weeks, 5 months, 1 and 2 years. DISCUSSION: We hypothesise that the intervention will increase mothers' ability to be sensitive to their child's mental state to an extent that improves the child's language and mental state at 30 months of age measured by parent-reported questionnaires. TRIAL REGISTRATION: ClinicalTrials.gov NCT04129359. Registered on Oct 16 2019.


Assuntos
Desenvolvimento Infantil , Medicina Geral , Lactente , Humanos , Feminino , Pré-Escolar , Gravidez , Mães/psicologia , Pais , Internet , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36627231

RESUMO

PURPOSE: The purpose of this paper is to determine which factors are associated with 6,065 patient presentations with non-life-threatening urgent conditions (NLTUCs) to an after-hours general practice, an urgent care clinic (UCC) and an emergency department (ED) on Sundays in Southeast Queensland (Qld). DESIGN/METHODOLOGY/APPROACH: A retrospective, comparative and observational study was conducted involving the auditing of medical records of patients with NLTUCs consulting three medical services between 0,800 and 1,700 h, on Sundays, over a one-year period. The study was limited to 6,065 patients. FINDINGS: There were statistically significant differences in choice of location according to age, number of postcodes from the patient's residence, time of the day, season, patient presentations for infection and injury, non-infectious, non-injurious conditions of the circulatory, gastrointestinal and genitourinary systems, and need for imaging, pathology, plastering/back-slab application, splinting and wound closure. Older adults were more likely to be admitted to the hospital and Ed Short Stay Unit, compared with other age groups. RESEARCH LIMITATIONS/IMPLICATIONS: Based on international models of UCC healthcare systems in United Kingdom (UK), USA and New Zealand (NZ) and the results of this study, it is recommended that UCCs in Australia have extended hours, walk-in availability, access to on-site radiology, ability to treat fractures and wounds and staffing by medical practitioners able to manage these conditions. Recommendations also include setting a national standard for UCC operation (National Urgent Care Centre Accreditation, 2018; NHS, 2020; RNZCUC, 2015) and requirements for vocational registration for medical practitioners (National Urgent Care Centre Accreditation, 2018; RNZCUC, 2015; The Royal College of Surgeons of Edinburgh, 2021a, b). PRACTICAL IMPLICATIONS: This study has highlighted three key areas for future research: first, research involving general practitioners (GPs), emergency physicians, urgent care physicians, nurse practitioners, urgent care pharmacists and paramedics could help to predict the type of patients more accurately, patient presentations and associated comorbidities that might be encouraged to attend or be diverted to Urgent Care Clinics. Second, larger studies of more facilities and more patients could improve the accuracy and generalisability of the findings. Lastly, studies of public health messaging need to be undertaken to determine how best to encourage patients with NLTUCs (especially infections and injuries) to present to UCCs. SOCIAL IMPLICATIONS: The Urgent Care Clinic model has existed in developed countries since 1973. The adoption of this model in Australia close to a patient's home, open extended hours and with onsite radiology could provide a community option, to ED, for NLTUCs (especially patient presentations with infections and injuries). ORIGINALITY/VALUE: This study reviewed three types of medical facilities for the management of NLTUCs. They were an after-hours general practice, an urgent care clinic and an emergency department. This study found that the patient choice of destination depends on the ability of the service to manage their NLTUCs, patient age, type of condition, postcodes lived away from the facility, availability of testing and provision of consumables. This study also provides recommendations for the development of an urgent care healthcare system in Australia based on international models and includes requirements for extended hours, walk-in availability, radiology on-site, national standard and national requirements for vocational registration for medical professionals.


Assuntos
Medicina Geral , Clínicos Gerais , Humanos , Idoso , Estudos Retrospectivos , Serviço Hospitalar de Emergência , Instituições de Assistência Ambulatorial
12.
PLoS One ; 18(1): e0279542, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36602972

RESUMO

BACKGROUND: Care engagement or active patient involvement in healthcare contributes to the quality of primary care, but organisational preconditions in routine practice need to be aligned. A Maturity Matrix for Care Engagement to assess and discuss these preconditions in the general practice team was developed and tested on feasibility and acceptability in general practice. METHODS AND FINDINGS: A systematic user-centred approach was applied, starting with a scoping literature search to describe the domains on the horizontal axis of the maturity matrix. The domains and growing steps (vertical axis) were refined by patients (n = 16) and general practice staff (n = 11) in three focus group discussions and reviewed by six experts (local facilitators and scientists). Seven domains could be distinguished: Personalised Care, Shared Decision Making, Self-Management, Patient as Partner, Supportive Means, Patient Environment, and Teamwork among Healthcare Professionals. The growing steps described three to six activities per domain (n = 32 in total) that contribute to care engagement. Local facilitators implemented the tool in two general practice teams according to a user guide, starting with a two-hour kick-off meeting on care engagement. In the next step, practitioners, nurses and assistants in each practice indicated their score on the domains individually. The scores were discussed in the facilitated practice meeting which was aimed at SMART improvement plans. Feasibility and acceptability were assessed in interviews showing that the tool was well received by the pilot practices, although the practice assistants had difficulties scoring some of the activities as they did not always relate to their daily work. An assessment after three months showed changes in practice organisation towards increased care engagement. CONCLUSIONS: The maturity matrix on care engagement is a tool to identify the organisational practice maturity for care engagement. Suggested adaptations must be implemented before large-scale testing.


Assuntos
Medicina Geral , Humanos , Grupos Focais , Pessoal de Saúde , Medicina de Família e Comunidade , Atenção Primária à Saúde
13.
Fam Med ; 55(1): 3-11, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36656881

RESUMO

BACKGROUND:  The COVID-19 pandemic restricted the availability of face-to-face primary care visits. This rapidly increased the proportion of primary care patient-clinician visits conducted virtually and asynchronously (remote consultations via video, telephone, and web-based text/email), altering the educational environment for medical students. Our study explored the impact of the increased proportion of primary care visits conducted virtually and asynchronously, on medical students' self-reported interest in pursuing a career in general (family) practice. METHODS:  We conducted a cross-sectional survey study of medical students at six universities within England and Wales to explore the impact of the increased proportion of primary care visits conducted virtually and asynchronously on medical students' interest in pursuing a career in general practice. RESULTS:  One hundred fifty-four medical students were recruited between December 2020 and May 2021; 79 (51%) of the participants reported being less interested in pursuing a career in general practice as a result of the increased proportion of virtual and asynchronous primary care visits during the COVID-19 pandemic. This increased to 104 (68%) of the participants reporting being less interested should primary care visits continue to be delivered virtually or asynchronously by default. Analysis of open-ended survey questions identified a poorer educational experience, concerns regarding the impact on patient care, an isolated working environment and technological challenges as key negative themes. CONCLUSIONS:  Sociable, supportive working and learning environments and offering equitable care are important motivators for the future workforce. There is a need to develop robust training and assessment in patient-clinician virtual visits and asynchronous communication and to integrate this into curricula.


Assuntos
COVID-19 , Medicina Geral , Estudantes de Medicina , Humanos , Estudos Transversais , Pandemias , Escolha da Profissão
14.
PLoS One ; 18(1): e0279554, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36689416

RESUMO

This study aims to compare the effectiveness of Hybrid and Pure problem-based learning (PBL) in teaching clinical reasoning skills to medical students. The study sample consisted of 99 medical students participating in a clerkship rotation at the Department of General Medicine, Chiba University Hospital. They were randomly assigned to Hybrid PBL (intervention group, n = 52) or Pure PBL group (control group, n = 47). The quantitative outcomes were measured with the students' perceived competence in PBL, satisfaction with sessions, and self-evaluation of competency in clinical reasoning. The qualitative component consisted of a content analysis on the benefits of learning clinical reasoning using Hybrid PBL. There was no significant difference between intervention and control groups in the five students' perceived competence and satisfaction with sessions. In two-way repeated measure analysis of variance, self-evaluation of competency in clinical reasoning was significantly improved in the intervention group in "recalling appropriate differential diagnosis from patient's chief complaint" (F(1,97) = 5.295, p = 0.024) and "practicing the appropriate clinical reasoning process" (F(1,97) = 4.016, p = 0.038). According to multiple comparisons, the scores of "recalling appropriate history, physical examination, and tests on clinical hypothesis generation" (F(1,97) = 6.796, p = 0.011), "verbalizing and reflecting appropriately on own mistakes," (F(1,97) = 4.352, p = 0.040) "selecting keywords from the whole aspect of the patient," (F(1,97) = 5.607, p = 0.020) and "examining the patient while visualizing his/her daily life" (F(1,97) = 7.120, p = 0.009) were significantly higher in the control group. In the content analysis, 13 advantage categories of Hybrid PBL were extracted. In the subcategories, "acquisition of knowledge" was the most frequent subcategory, followed by "leading the discussion," "smooth discussion," "getting feedback," "timely feedback," and "supporting the clinical reasoning process." Hybrid PBL can help acquire practical knowledge and deepen understanding of clinical reasoning, whereas Pure PBL can improve several important skills such as verbalizing and reflecting on one's own errors and selecting appropriate keywords from the whole aspect of the patient.


Assuntos
Medicina Geral , Estudantes de Medicina , Humanos , Feminino , Masculino , Aprendizagem Baseada em Problemas/métodos , Resolução de Problemas , Aprendizagem
16.
Subst Abuse Treat Prev Policy ; 18(1): 5, 2023 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-36641441

RESUMO

BACKGROUND: This study identified patient profiles in terms of their quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes based on frequent emergency department (ED) use, hospitalization, and death from medical causes. METHODS: A cohort of 18,215 patients with substance-related disorders (SRD) recruited in addiction treatment centers was investigated using Quebec (Canada) health administrative databases. A latent class analysis was produced, identifying three profiles of quality of outpatient care use, while multinomial and logistic regressions tested associations with patient characteristics and adverse outcomes, respectively. RESULTS: Profile 1 patients (47% of the sample), labeled "Low outpatient service users", received low quality of care. They were mainly younger, materially and socially deprived men, some with a criminal history. They had more recent SRD, mainly polysubstance, and less mental disorders (MD) and chronic physical illnesses than other Profiles. Profile 2 patients (36%), labeled "Moderate outpatient service users", received high continuity and intensity of care by general practitioners (GP), while the diversity and regularity in their overall quality of outpatient service was moderate. Compared with Profile 1, they  were older, less likely to be unemployed or to live in semi-urban areas, and most had common MD and chronic physical illnesses. Profile 3 patients (17%), labeled "High outpatient service users", received more intensive psychiatric care and higher quality of outpatient care than other Profiles. Most Profile 3 patients lived alone or were single parents, and fewer lived in rural areas or had a history of homelessness, versus Profile 1 patients. They were strongly affected by MD, mostly serious MD and personality disorders. Compared with Profile 1, Profile 3 had more frequent ED use and hospitalizations, followed by Profile 2. No differences in death rates emerged among the profiles. CONCLUSIONS: Frequent ED use and hospitalization were strongly related to patient clinical and sociodemographic profiles, and the quality of outpatient services received to the severity of their conditions. Outreach strategies more responsive to patient needs may include motivational interventions and prevention of risky behaviors for Profile 1 patients, collaborative GP-psychiatrist care for Profile 2 patients, and GP care and intensive specialized treatment for Profile 3 patients.


Assuntos
Assistência Ambulatorial , Aceitação pelo Paciente de Cuidados de Saúde , Determinantes Sociais da Saúde , Fatores Sociodemográficos , Transtornos Relacionados ao Uso de Substâncias , Humanos , Masculino , Assistência Ambulatorial/normas , Assistência Ambulatorial/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Quebeque/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Transtornos Relacionados ao Uso de Substâncias/terapia , Determinantes Sociais da Saúde/estatística & dados numéricos , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos
17.
BMC Med Educ ; 23(1): 47, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36670391

RESUMO

OBJECTIVE(S): To identify if gender and parenting factors are associated with burnout in Australian general practice (GP) registrars. DESIGN: Cross sectional study. The main outcome measure was the Maslach Burnout Inventory, included as part of the GPRA (General Practice Registrars Australia) biannual online survey. PARTICIPANTS: GP registrars, 2019 cohort, undertaking fellowship training in Australia. RESULTS: In 2019 a total of 366 GP registrars completed the online survey. Over 75% of registrars experienced moderate to high levels of burnout (emotional exhaustion scale). Several demographic factors were associated with an increased risk for reporting higher levels of burnout. Increasing age was associated with lower levels of personal accomplishment (P-value < 0.01), being female was associated with higher levels of emotional exhaustion (p-value < 0.001) and increasing numbers of children were associated with lower levels of burnout, independent of hours worked (p-value < 0.001). CONCLUSION: This study suggests that being a parent is associated with a reduced risk of burnout, irrespective of hours worked. However, being female and increased age were associated with increased levels of burnout. With increasing numbers of females entering medical training, and the decreasing desirability of general practice training, this paper reviews the complexities around parenting during training and associations with burnout. There is a need to examine this interaction further to understand the causation for these findings, and to ensure appropriate policies, opportunities and workplace supports are developed to ensure GP training is optimised to attract and support the next generation.


Assuntos
Esgotamento Profissional , Medicina Geral , Criança , Humanos , Feminino , Masculino , Estudos Transversais , Austrália/epidemiologia , Medicina Geral/educação , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Pessoal de Saúde/educação , Inquéritos e Questionários
18.
BMJ Open ; 13(1): e066793, 2023 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-36720571

RESUMO

OBJECTIVES: There is a broad call for change towards 'new era' quality systems in healthcare, in which the focus lies on learning and improving. A promising way to establish this in general practice care is to combine audit and feedback with peer group discussion. However, it is not known what different stakeholders think of this type of quality improvement. The aim of this research was to explore the opinions of different stakeholders in general practice on peer discussion of audit and feedback and on its opportunities and risks. Second, their thoughts on transparency versus accountability, regarding this system, were studied. DESIGN: An exploratory qualitative study within a constructivist paradigm. Semistructured interviews and focus group discussions were held and coded using thematic analysis. Included stakeholders were general practitioners (GP), patients, professional organisations and insurance companies. SETTING: General practice in the Netherlands. PARTICIPANTS: 22 participants were purposively sampled for eight interviews and two focus group discussions. RESULTS: Three main opportunities of peer discussion of audit and feedback were identified: deeper levels of reflection on data, adding context to numbers and more ownership; and three main risks: handling of unwilling colleagues, lacking a safe group and the necessity of patient involvement. An additional theme concerned disagreement on the amount of transparency to be offered: insurance companies and patients advocated for complete transparency on data and improvement of outcomes, while GPs and professional organisations urged to restrict transparency to giving insight into the process. CONCLUSIONS: Peer discussion of audit and feedback could be part of a change movement, towards a quality system based on learning and trust, that is initiated by the profession. Creating a safe learning environment and involving patients is key herein. Caution is needed when complete transparency is asked, since it could jeopardise practitioners' reflection and learning in safety.


Assuntos
Medicina Geral , Melhoria de Qualidade , Humanos , Retroalimentação , Aprendizagem , Grupo Associado
20.
BMJ Open ; 13(1): e062389, 2023 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-36604124

RESUMO

OBJECTIVES: To investigate the usefulness of using automated appointment check-in screens to collect brief research data from patients, prior to their general practice consultation. DESIGN: A descriptive, cross-sectional study. SETTING: Nine general practices in the West Midlands, UK. Recruitment commenced in Autumn 2018 and was concluded by 31 March 2019. PARTICIPANTS: All patients aged 18 years and above, self-completing an automated check-in screen prior to their general practice consultation, were invited to participate during a 3-week recruitment period. PRIMARY AND SECONDARY OUTCOME MEASURES: The response rate to the use of the automated check-in screen as a research data collection tool was the primary outcome measure. Secondary outcomes included responses to the two research questions and an assessment of impact of check-in completion on general practice operationalisation RESULTS: Over 85% (n=9274) of patients self-completing an automated check-in screen participated in the Automated Check-in Data Collection Study (61.0% (n=5653) women, mean age 55.1 years (range 18-98 years, SD=18.5)). 96.2% (n=8922) of participants answered a 'clinical' research question, reporting the degree of bodily pain experienced during the past 4 weeks: 32.9% (n=2937) experienced no pain, 28.1% (n=2507) very mild or mild pain and 39.0% (n=3478) moderate, severe or very severe pain. 89.3% (n=8285) of participants answered a 'non-clinical' research question on contact regarding future research studies: 46.9% (n=3889) of participants responded 'Yes, I'd be happy for you to contact me about research of relevance to me'. CONCLUSIONS: Using automated check-in facilities to integrate research into routine general practice is a potentially useful way to collect brief research data from patients. With the COVID-19 pandemic initiating an extensive digital transformation in society, now is an ideal time to build on these opportunities and investigate alternative, innovative ways to collect research data. TRIAL REGISTRATION NUMBER: ISRCTN82531292.


Assuntos
COVID-19 , Medicina Geral , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Pandemias , COVID-19/diagnóstico , Inglaterra , Coleta de Dados
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