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1.
BMJ Open ; 10(12): e042119, 2020 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-33268433

RESUMO

OBJECTIVES: To describe how general practitioners (GPs) adapted their practices to secure and maintain access to care in the epidemic phase. A secondary objective was to explore if GPs' individual characteristics and type of practice determined their adaptation. DESIGN: Observational study using an online questionnaire. Organisational changes were measured by a main question and detailed in two specific outcomes. To identify which GPs' characteristics impacted organisational changes, successive multivariate logistic modelling was performed. First, we identified the GPs' characteristics related to organisational changes with a univariate analysis. Then, we tested the adjusted associations between this variable and the following GPs' characteristics: age, gender and type of practice. SETTING: The questionnaire was administered online between 14 March and 21 March 2020. Practitioners were recruited by email using the contact lists of different French scientific GP societies. PARTICIPANTS: The target population was GPs currently practising in France (n=46 056). We obtained a total of 7481 responses. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome: Proportion of GPs who adapted their practice. Secondary outcome: GPs' characteristics related to organisational changes. RESULTS: Among the 7481 responses, 5425 were complete and were analysed. 3849 GPs (70.9%) changed their activity, 3605 GPs (66.5%) increased remote consultations and 2315 GPs (42.7%) created a specific pathway for probable patients with COVID-19. Among the 3849 GPs (70.9%) who changed their practice, 3306 (91.7%) gave more answers by phone, 996 (27.6%) by email and 1105 (30.7%) increased the use of video consultations. GPs working in multi-professional group practices were more likely to have changed their activity since the beginning of the epidemic wave than GPs working in mono-professional group or single medical practices (adjusted OR: 1.32, 95% CI 1.12 to 1.56, p=0.001). CONCLUSIONS: French GPs adapted their practices regarding access to care for patients in the context of the COVID-19 epidemic. This adaptation was higher in multi-professional group practices.


Assuntos
/terapia , Medicina Geral/organização & administração , Clínicos Gerais/estatística & dados numéricos , Padrões de Prática Médica , Adulto , Animais , Atitude do Pessoal de Saúde , Feminino , França , Clínicos Gerais/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Inquéritos e Questionários
4.
Aust J Gen Pract ; 49(11): 745-751, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33123716

RESUMO

METHOD: A national cross-sectional online survey of Australian general practitioners was conducted in April and May 2020, with 572 respondents. RESULTS: The COVID-19 pandemic in Australia has resulted in major changes to general practice business models. Most practices have experienced increased workload and reduced income. DISCUSSION: Australian general practices have undertaken major innovation and realignment to respond to staff safety and patient care challenges during the COVID-19 pandemic. Increased administration, reduced billable time, managing staffing and pivoting to telehealth service provision have negatively affected practice viability. Major sources of information for general practice are primary care-specific, but many practices turn to colleagues for support and resources.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus , Medicina Geral , Pandemias , Pneumonia Viral , Gestão de Riscos , Atitude do Pessoal de Saúde , Austrália/epidemiologia , Betacoronavirus , Defesa Civil/normas , Defesa Civil/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Medicina Geral/organização & administração , Medicina Geral/tendências , Clínicos Gerais , Pesquisas sobre Serviços de Saúde , Humanos , Mortalidade , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gestão de Riscos/organização & administração , Gestão de Riscos/tendências , Telemedicina/estatística & dados numéricos
5.
N Z Med J ; 133(1523): 65-75, 2020 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-33032304

RESUMO

AIMS: To investigate changes in general practice consultation patterns in response to reduced face-to-face patient contact during the COVID-19 pandemic. METHODS: A retrospective before and after case notes review study of one urban general practice to investigate patient contact in the first two weeks of New Zealand general practices' COVID-19 response in 2020, compared to the same period in 2019. RESULTS: Twenty percent of patients had contact with the practice in both samples, with similar proportions by age, gender, ethnicity, deprivation and presence of multimorbidity or mental health diagnoses. Similar numbers of acute illness, accident-related and prevention patient contacts occurred in both samples, with more long-term condition-related contact in 2020. While 70% of patient contacts were face-to-face in 2019, 21% were face-to-face in 2020. Most acute illness, accident-related and long-term condition-related contacts were able to be provided through virtual means, but most prevention-related contacts were face-to-face. CONCLUSIONS: This single practice study showed total patient contact was similar over both sample periods, but most contact in 2020 was virtual. Further longitudinal multi-practice studies to confirm these findings and describe future consultation patterns are needed to inform general practice service delivery post-COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Medicina Geral/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Encaminhamento e Consulta/organização & administração , População Urbana/estatística & dados numéricos , Adulto , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Nova Zelândia , Satisfação do Paciente , Pneumonia Viral/epidemiologia , Estudos Retrospectivos
6.
Eur J Public Health ; 30(Suppl_4): iv12-iv17, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32875316

RESUMO

Rural areas have problems in attracting and retaining primary care workforce. This might have consequences for the existing workforce. We studied whether general practitioners (GPs) in rural practices differ by age, sex, practice population and workload from those in less rural locations and whether their practices differ in resources and service profiles. We used data from 2 studies: QUALICOPC study collected data from 34 countries, including 7183 GPs in 2011, and Profiles of General Practice in Europe study collected data from 32 countries among 7895 GPs in 1993. Data were analyzed using multilevel analysis. Results show that the share of female GPs has increased in rural areas but is still lower than in urban areas. In rural areas, GPs work more hours and provide more medical procedures to their patients. Apart from these differences between locations, overall ageing of the GP population is evident. Higher workload in rural areas may be related to increased demand for care. Rural practices seem to cope by offering a broad range of services, such as medical procedures. Dedicated human resource policies for rural areas are required with a view to an ageing GP population, to the individual preferences and needs of the GPs, and to decreasing attractiveness of rural areas.


Assuntos
Assistência à Saúde/organização & administração , Medicina Geral/organização & administração , Clínicos Gerais/provisão & distribução , Mão de Obra em Saúde/estatística & dados numéricos , Área de Atuação Profissional , Adulto , Estudos Transversais , Assistência à Saúde/estatística & dados numéricos , Europa (Continente) , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Saúde da População Rural , População Rural , Inquéritos e Questionários , Saúde da População Urbana , População Urbana , Carga de Trabalho
7.
Eur J Public Health ; 30(Suppl_4): iv36-iv38, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32894291

RESUMO

This short report aims to investigate the association between teamwork and burnout among general practitioners (GPs). A two-stage survey was conducted. In stage one, validated self-report measures of burnout and teamwork were completed by 50 GPs across 12 general practices in Greater Manchester, UK. In stage two, staff members across 3 of the 12 general practices (GPs, nursing staff, managers and admin staff) responded to free text questions about teamwork (n = 20). The results of the stage one survey showed that teamwork in GPs was significantly negatively associated with the emotional exhaustion (r = -0.326, P < 0.05) and depersonalization (r = -0.421, P < 0.01) domains of the burnout measure and significantly positively associated with the personal accomplishment (r = 0.296, P < 0.05) domain. Free text responses in stage two were assigned into three themes: (i) addressing organizational barriers which might threaten teamwork, (ii) promoting the view of teamwork as a shared responsibility among all staff members of the general practice and (iii) implementing improvement strategies which can be embedded in the busy environment of general practices. GPs and other staff members of general practices valued the importance of teamwork for boosting their morale and mitigating burnout. Future research should focus on designing and embedding brief teamwork improvement strategies in general practices.


Assuntos
Esgotamento Profissional/prevenção & controle , Medicina Geral/organização & administração , Clínicos Gerais/psicologia , Satisfação no Emprego , Equipe de Assistência ao Paciente , Adulto , Esgotamento Profissional/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Autorrelato , Inquéritos e Questionários , Reino Unido
9.
Aust Health Rev ; 44(5): 733-736, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32878685

RESUMO

The COVID-19 pandemic has resulted in multiple changes in the delivery of general practice services. In response to the threat of the pandemic and in order to keep their businesses safe and viable, general practices have rapidly moved to new models of care, embraced Medicare-funded telehealth and responded to uncertain availability of personal protective equipment with innovation. These changes have shown the adaptability of general practice, helped keep patients and practice staff safe, and undoubtedly reduced community transmission and mortality. The pandemic, and the response to it, has emphasised the potential dangers of existing fragmentation within the Australian health system, and is affecting the viability of general practice. These impacts on primary care highlight the need for improved integration of health services, should inform future pandemic planning, and guide the development of Australia's long-term national health plan.


Assuntos
Infecções por Coronavirus/diagnóstico , Diagnóstico Precoce , Medicina Geral/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Atenção Primária à Saúde/organização & administração , Medicina Estatal/organização & administração , Telemedicina/organização & administração , Austrália , Betacoronavirus/patogenicidade , Medicina Geral/métodos , Medicina Geral/estatística & dados numéricos , Humanos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Telemedicina/métodos
12.
Aust Health Rev ; 44(5): 737-740, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32853536

RESUMO

In March 2020, the Australian Government added new temporary telehealth services to the Medicare Benefits Schedule (MBS) to reduce the risk of patient-patient and patient-clinician transmission of the 2019 coronavirus (COVID-19). Here, the MBS statistics for general practitioner activity and the associated costs are described; a small increase in both activity and costs for the new MBS telehealth items were observed. The opportunities for future research and policy implications are also discussed.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Medicina Geral/organização & administração , Medicina Geral/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Telemedicina/organização & administração , Austrália , Betacoronavirus/patogenicidade , Medicina Geral/métodos , Humanos , Telemedicina/métodos , Telemedicina/estatística & dados numéricos
14.
PLoS One ; 15(8): e0237629, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790804

RESUMO

BACKGROUND: During the COVID-19 pandemic, general practitioners worldwide re-organise care in very different ways because of the lack of evidence-based protocols. OBJECTIVE: This paper describes the organisation and the characteristics of consultations in Belgian out-of-hours primary care during five weekends at the peak of a COVID-19 outbreak and compares it to a similar period in 2019. METHODS: Real-time observational study using pseudonymised routine clinical data extracted out of reports from home visits, telephone- and physical consultations (iCAREdata). Nine general practice cooperatives (GPCs) participated covering a population of 1 513 523. RESULTS: All GPCs rapidly re-organised care in order to handle the outbreak and provide a safe working environment. The average consultation rate was 222 per 100 000 citizens per weekend. These consultations were handled by telephone alone in 40% (N = 6293). A diagnosis at risk of COVID-19 was registered in 6692 (43%) consultations,. Out of 5311 physical consultations, 1460 were at risk of COVID-19 of which 443 (30%) did not receive prior telephone consultation to estimate this risk. Compared to 2019, the workload initially increased due to telephone consultations but afterwards declined drastically. The physical consultation rate declined by 45% with a marked decline in diagnoses unrelated to COVID-19. CONCLUSIONS: General practitioners can rapidly re-organise out-of-hours care to handle patient flows during a COVID-19 outbreak. Forty percent of the out-of-hours primary care contacts are handled by telephone consultations alone. We recommend to give a telephone consultation to all patients and not to rely on call takers to differentiate between infectious and regular care. The demand for physical consultations declined drastically provoking questions about patient's safety for care unrelated to COVID-19.


Assuntos
Plantão Médico/organização & administração , Betacoronavirus , Infecções por Coronavirus/terapia , Medicina Geral/organização & administração , Pneumonia Viral/terapia , Atenção Primária à Saúde/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bélgica/epidemiologia , Criança , Infecções por Coronavirus/virologia , Feminino , Clínicos Gerais , Visita Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Segurança do Paciente , Pneumonia Viral/virologia , Consulta Remota/métodos , Carga de Trabalho , Adulto Jovem
16.
JMIR Public Health Surveill ; 6(3): e19773, 2020 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-32484782

RESUMO

BACKGROUND: Routinely recorded primary care data have been used for many years by sentinel networks for surveillance. More recently, real world data have been used for a wider range of research projects to support rapid, inexpensive clinical trials. Because the partial national lockdown in the United Kingdom due to the coronavirus disease (COVID-19) pandemic has resulted in decreasing community disease incidence, much larger numbers of general practices are needed to deliver effective COVID-19 surveillance and contribute to in-pandemic clinical trials. OBJECTIVE: The aim of this protocol is to describe the rapid design and development of the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) and its first two platforms. The Surveillance Platform will provide extended primary care surveillance, while the Trials Platform is a streamlined clinical trials platform that will be integrated into routine primary care practice. METHODS: We will apply the FAIR (Findable, Accessible, Interoperable, and Reusable) metadata principles to a new, integrated digital health hub that will extract routinely collected general practice electronic health data for use in clinical trials and provide enhanced communicable disease surveillance. The hub will be findable through membership in Health Data Research UK and European metadata repositories. Accessibility through an online application system will provide access to study-ready data sets or developed custom data sets. Interoperability will be facilitated by fixed linkage to other key sources such as Hospital Episodes Statistics and the Office of National Statistics using pseudonymized data. All semantic descriptors (ie, ontologies) and code used for analysis will be made available to accelerate analyses. We will also make data available using common data models, starting with the US Food and Drug Administration Sentinel and Observational Medical Outcomes Partnership approaches, to facilitate international studies. The Surveillance Platform will provide access to data for health protection and promotion work as authorized through agreements between Oxford, the Royal College of General Practitioners, and Public Health England. All studies using the Trials Platform will go through appropriate ethical and other regulatory approval processes. RESULTS: The hub will be a bottom-up, professionally led network that will provide benefits for member practices, our health service, and the population served. Data will only be used for SQUIRE (surveillance, quality improvement, research, and education) purposes. We have already received positive responses from practices, and the number of practices in the network has doubled to over 1150 since February 2020. COVID-19 surveillance has resulted in tripling of the number of virology sites to 293 (target 300), which has aided the collection of the largest ever weekly total of surveillance swabs in the United Kingdom as well as over 3000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology samples. Practices are recruiting to the PRINCIPLE (Platform Randomised trial of INterventions against COVID-19 In older PeopLE) trial, and these participants will be followed up through ORCHID. These initial outputs demonstrate the feasibility of ORCHID to provide an extended national digital health hub. CONCLUSIONS: ORCHID will provide equitable and innovative use of big data through a professionally led national primary care network and the application of FAIR principles. The secure data hub will host routinely collected general practice data linked to other key health care repositories for clinical trials and support enhanced in situ surveillance without always requiring large volume data extracts. ORCHID will support rapid data extraction, analysis, and dissemination with the aim of improving future research and development in general practice to positively impact patient care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/19773.


Assuntos
Ensaios Clínicos como Assunto , Infecções por Coronavirus/epidemiologia , Medicina Geral/organização & administração , Sistemas Computadorizados de Registros Médicos , Pneumonia Viral/epidemiologia , Vigilância em Saúde Pública , Humanos , Pandemias , Atenção Primária à Saúde/organização & administração , Sociedades Médicas , Reino Unido/epidemiologia
17.
BMJ Open ; 10(6): e039674, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32554730

RESUMO

OBJECTIVES: The current COVID-19 pandemic, as well as the measures taken to control it, have a profound impact on healthcare. This study was set up to gain insights into the consequences of the COVID-19 outbreak on the core competencies of general practice, as they are experienced by general practitioners (GPs) on the frontline. DESIGN, SETTING, PARTICIPANTS: We performed a descriptive study using semistructured interviews with 132 GPs in Flanders, using a topic list based on the WONCA definition of core competencies in general practice. Data were analysed qualitatively using framework analysis. RESULTS: Changes in practice management and in consultation strategies were quickly adopted. There was a major switch towards telephone triage and consults, for covid-related as well as for non-covid related problems. Patient-centred care is still a major objective. Clinical decision-making is largely focused on respiratory assessment and triage, and GPs feel that acute care is compromised, both by their own changed focus and by the fact that patients consult less frequently for non-covid problems. Chronic care is mostly postponed, and this will have consequences that will extend and become visible after the corona crisis. Through the holistic eyes of primary care, the current outbreak-as well as the measures taken to control it-will have a profound impact on psychological and socioeconomic well-being. This impact is already visible in vulnerable people and will continue to become clear in the medium and long terms. GPs think that they are at high risk of getting infected. Dropping out and being unable to contribute their part or becoming virus transmitters are reported to be greater concerns than getting ill themselves. CONCLUSIONS: The current times have a profound impact on the core competences of primary care. Although the vast increase in patients soliciting medical help and the necessary separate covid and non-covid flows have been dealt with, GPs are worried about the continuity of regular care and the consequences of the anticovid measures. These may become a threat for the general health of the population and for the provision of primary healthcare in the near and distant future.


Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/terapia , Clínicos Gerais/psicologia , Pneumonia Viral/terapia , Atenção Primária à Saúde/organização & administração , Adulto , Bélgica , Infecções por Coronavirus/psicologia , Gerenciamento Clínico , Feminino , Medicina Geral/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/psicologia , Padrões de Prática Médica/normas , Pesquisa Qualitativa
19.
BMC Health Serv Res ; 20(1): 431, 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32423485

RESUMO

BACKGROUND: In England, since 2015, there has been a formal drive to integrate pharmacists into general practice as a new healthcare service. Research efforts have offered insights into how general practice-based professionals and patients view the service, however, they took no account of community pharmacy teams' opinions. There have been anecdotal statements about opposition from community pharmacies to the service, due to fears of losing business. The aim of the current study was to identify the experiences and perceptions of community pharmacy teams regarding pharmacists' presence in general practice. METHODS: The National Health Service Choices website was used to identify community pharmacies within a radius of two miles from eight West London general practices. The search resulted in 104 community pharmacies which were all contacted via telephone. Pharmacy staff who verbally expressed their interest to participate were then provided with the study's documents. Qualitative, face-to-face, semi-structured interviews were conducted inside the pharmacy from which each participant was recruited. Interviews lasted 30 to 45 min and were audio-recorded. Audio-recordings were transcribed verbatim and transcripts analysed thematically. RESULTS: Forty-eight community pharmacy staff participated. Four themes were discerned: awareness ("I knew that [pharmacists] have already been implemented [in general practice] but I haven't really followed it … where does the pharmacist role come?"); interactions ("I'm just so pleased that there's a pharmacist professional in the general practice … because we speak the same language!"); patient care ("if I was a patient knowing that there is a general practitioner and a pharmacist [in general practice], I would … think 'nothing can go wrong at the moment'"); and funding challenges ("if general practices take on the extra responsibility of stop smoking or flu vaccination campaigns … financially, this would affect this pharmacy"). CONCLUSIONS: The current study revealed the perceived impact of general practice-based pharmacists on community pharmacies would be improved communication between pharmacies and practices. Findings will inform policy so that any future framing of pharmacists' presence in general practice considers the needs of community pharmacies.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Medicina Geral/organização & administração , Farmacêuticos/psicologia , Inglaterra , Humanos , Pesquisa Qualitativa
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