Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 418
Filtrar
1.
Rev Med Suisse ; 16(678): 128-132, 2020 Jan 22.
Artigo em Francês | MEDLINE | ID: mdl-31967755

RESUMO

General internal medicine is particularly concerned by the shift from stationary to ambulatory care, a shift that unfortunately is more often discussed from an economic perspective than from the angle of evidence. This article presents the results of studies and reviews published in 2019 that investigated the effectiveness of ambulatory instead of stationary care.


Assuntos
Assistência Ambulatorial , Medicina Geral , Medicina Interna , Instituições de Assistência Ambulatorial , Medicina Geral/tendências , Humanos , Medicina Interna/tendências
2.
Artigo em Alemão | MEDLINE | ID: mdl-31420714

RESUMO

In Germany there is a threat of a shortage of junior general practitioners (GPs). One third of currently employed GPs are 60 years and older. Every year, 1700 GPs leave the profession, while only about 1350 new GP-specialist approvals are issued. The Advisory Council on the Assessment of Developments in the Health Care Sector estimates that there will be around 20,000 unmet replacement needs by 2025. By 2017, 2600 GP seats were already vacant.Based on the results of the KarMed study, this paper examines the questions as to how many residents intend to become general practitioners after graduation and how they develop during postgraduate training. Furthermore, the consequences of the increasing proportion of female physicians in primary care in terms of the possible volume of work will be investigated. Finally, measures that could reduce a possible personnel shortage are discussed.The attractiveness of general practice has increased considerably during residency over the last six years of observation. The preference for GP work is linked to parenthood. More female doctors strive for part-time work and an employment contract instead of a private practice. On this basis, it can be estimated that the volume of work performed by these female GPs will be half that of the traditional (male) working model in private practice.The forecasted numbers of new recruits are unlikely to be sufficient to cover the demand for GP care in Germany. Possible effective measures would be, for example, the introduction of a gatekeeper system, creation of multi-professional centers, a quota system for access to postgraduate training of specialists, a reformed national planning of GP supply in the country, and a shortening and flexibilization of postgraduate training for general practice.


Assuntos
Escolha da Profissão , Medicina Geral/tendências , Clínicos Gerais/provisão & distribução , Mão de Obra em Saúde , Internato e Residência , Certificação , Avaliação Educacional , Feminino , Alemanha , Humanos , Masculino , Prática Privada , Conselhos de Especialidade Profissional , Carga de Trabalho
5.
BMC Palliat Care ; 18(1): 51, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238934

RESUMO

BACKGROUND: Few studies have specifically assessed the scope, nature and challenges of palliative and end-of-life care in rural general practice. These knowledge gaps limit the development of evidence-based policies and services for patients in the last months of life. This study aimed to explore the perspectives of general practitioners (GPs) and other stakeholders on rural GPs' involvement and challenges in providing palliative and end-of-life care in regional Australia. METHODS: A qualitative study involving five focus groups with 26 GPs based in rural/regional Western Australia together with 15 individual telephone interviews with four GPs and 11 other stakeholders involved in end-of-life care across Australia. RESULTS: The rural GPs' central role in end-of-life care was recognized by the majority of participants but multiple challenges were also identified. Some challenges were comparable to those found in urban settings but others were more pronounced, including resource limitations and lack of training. Inappropriate payment models discouraged GPs' involvement in some aspects of end-of-life care, such as case conferences and home visits. Compared to GPs in urban settings, those in rural/regional communities often reported closer doctor-patient relationships and better care integration and collaboration. These positive aspects of care could be further developed to enhance service provision. Our study highlighted the importance of regular interactions with other professionals and patients in providing end-of-life care, but many GPs and other stakeholders found such interactions more challenging than the more "technical" aspects of care. CONCLUSIONS: Rural/regional GPs appear to be disproportionately affected by inappropriate payment models and limited resources, but may benefit from closer doctor-patient relationships and better care integration and collaboration relative to urban GPs. Systematic collection of empirical data on GP management at end-of-life is required to build on these strengths and address the challenges.


Assuntos
Medicina Geral/tendências , Clínicos Gerais/psicologia , População Rural , Assistência Terminal/métodos , Adulto , Atitude do Pessoal de Saúde , Feminino , Grupos Focais/métodos , Clínicos Gerais/tendências , Visita Domiciliar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Pesquisa Qualitativa , Assistência Terminal/tendências , Austrália Ocidental
6.
BMC Fam Pract ; 20(1): 68, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31113368

RESUMO

BACKGROUND: General practitioners (GPs) play a key role in securing and coordinating appropriate use of healthcare services, by providing primary and preventive healthcare and by acting as gatekeepers for secondary healthcare services. Historically, European GPs have reported high job satisfaction, attributed to high autonomy and good compatibility with family life. However, a trend of increasing workload in general practice has been seen in several European countries, including Norway, leading to recruitment problems and concerns about the well-being of both GPs and patients. This qualitative interview study with GPs and their co-workers aims to explore how they perceive and tackle their workload, and their experiences and reflections regarding explanations for and consequences of increased workload in Norwegian general practice. METHODS: We conducted seven focus groups and four individual interviews with GPs and their co-workers in seven GPs' offices in Mid-Norway: three in rural locations and four in urban locations. Our study population consisted of 21 female and 12 male participants; 23 were GPs and 10 were co-workers. The interviews were analysed using systematic text condensation. RESULTS: The analysis identified three main themes: (1) Heavy and increasing workload - more trend than fluctuation?; (2) Explanations for high workload; (3) Consequences of high workload. Our findings show that both GPs and their co-workers experience heavy and increasing workload. The suggested explanations varied considerably among the GPs, but the most commonly cited reasons were legislative changes, increased bureaucracy related to documentation and management of a practice, and changes in patients' expectations and help-seeking behaviour. Potential consequences were also perceived as varying, especially regarding consequences for patients and the healthcare system. The participants expressed concerns for the future, particularly in regards to GPs' health and motivation, as well as the recruitment of new GPs. CONCLUSIONS: This study found heavy and increasing workload in general practice in Norway. The explanations appear to be multi-faceted and many are difficult to reverse. The GPs expressed worries that they will not be able to provide the population with the expected care and services in the future.


Assuntos
Medicina Geral/tendências , Clínicos Gerais , Carga de Trabalho , Adulto , Idoso , Feminino , Grupos Focais , Humanos , Satisfação no Emprego , Masculino , Secretárias de Consultório Médico , Pessoa de Meia-Idade , Noruega , Enfermeiras e Enfermeiros , Pesquisa Qualitativa , População Rural , População Urbana , Adulto Jovem
15.
Int J Cardiol ; 278: 126-132, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30528621

RESUMO

BACKGROUND: The goal of this study was to analyze the impact of dronedarone on the risk of myocardial infarction and stroke in atrial fibrillation (AF) patients followed in general practices in Germany. METHODS: This study included patients who had received a first prescription of dronedarone, amiodarone, flecainide, propafenone, or sotalol in 1258 general and 62 cardiology practices between January 2010 and March 2017 (index date). The main outcomes of this study were the percentages of patients with myocardial infarction and stroke in the dronedarone group and in the group of individuals who had received other antiarrhythmic drugs within six years of the index date. Cox proportional regression models were used to estimate the relationship between dronedarone and myocardial infarction and stroke. RESULTS: This study included 3498 individuals who had received dronedarone and 17,724 individuals who had received other antiarrhythmic drugs. After six years of follow-up, 3.9% of patients who had received dronedarone and 5.2% of patients who had received other antiarrhythmic drugs had been diagnosed with myocardial infarction (log-rank p-value = 0.002). At the end of the follow-up period, 7.4% of individuals with dronedarone prescriptions and 8.3% of those who had been prescribed other antiarrhythmic drugs had been diagnosed with a stroke (log-rank p-value = 0.003). Dronedarone was associated with a significant decrease in the risk of developing myocardial infarction (HR = 0.78) and suffering a stroke (HR = 0.84) compared to other antiarrhythmics. CONCLUSIONS: In our study, dronedarone was associated with a lower risk of myocardial infarction and stroke in patients with AF compared to other antiarrhythmics.


Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Dronedarona/uso terapêutico , Medicina Geral/tendências , Infarto do Miocárdio/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Bases de Dados Factuais/tendências , Feminino , Seguimentos , Medicina Geral/métodos , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia
16.
Int J Cardiol ; 278: 267-272, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30578094

RESUMO

AIMS: With increasing age, physical inactivity and sedentary behaviour levels increase, as does cardiovascular disease (CVD) incidence. We investigate how device-measured sedentary behaviour and physical activity (PA) are related to CVD onset in men aged 70+; whether the total volume of activity is more important than pattern. METHODS AND RESULTS: Prospective population-based cohort study of men recruited from 24 UK General Practices in 1978-80. In 2010-12, 3137 survivors were invited to complete questionnaires and wear an Actigraph GT3x accelerometer for 7 days. PA intensity was categorised as sedentary, light and moderate to vigorous (MVPA). Men were followed up for Myocardial Infarction, stroke and heart failure (ICD9 410-414, 430-438 and 428) morbidity and mortality from 2010 to 12 to June 2016. Hazard Ratios (HRs) for incident Cardiovascular Disease (CVD) were estimated. 1528/3137 (49%) men had sufficient accelerometer data. 254 men with pre-existing CVD were excluded. Participants' mean age was 78.4 (range 71-92) years. After median 4.9 years follow-up, 122 first CVD events occurred in 1181 men (22.7/1000 person-years) with complete data. For each additional 30 min in sedentary behaviour, light PA,10 min in MVPA, or 1000 steps/day, HRs for CVD were 1.09(95%CI 1.00, 1.19), 0.94(0.85, 1.04), 0.88(0.81, 0.96) and 0.86(0.78 to 0.95) respectively, adjusted for measurement-related factors, socio-demographics, health behaviours and disability. HRs for accumulating 150 min/week MVPA in bouts ≥1 min and bouts ≥10 min were 0.47(0.32 to 0.69), and 0.49(0.25, 0.98). CONCLUSIONS: In older men, high volume of steps or MVPA rather than MVPA bouts was associated with reduced CVD risk.


Assuntos
Acelerometria/mortalidade , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Exercício/fisiologia , Comportamento Sedentário , Acelerometria/tendências , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Seguimentos , Medicina Geral/tendências , Humanos , Masculino , Mortalidade/tendências , Estudos Prospectivos , Inquéritos e Questionários , Reino Unido/epidemiologia
17.
Int J Cardiol ; 278: 14-21, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30309680

RESUMO

BACKGROUND: The aim of this study was to compare changes in health service utilization, preventive medical management, and cholesterol levels in patients without coronary artery disease (CAD) or with non-obstructive CAD as determined by coronary computed tomography angiography (CTA). METHODS: Single-center five-year observational registry-based cohort study of consecutive patients with chest pain undergoing coronary CTA with subsequent 12 months follow-up in general practice. RESULTS: We included 3032 patients with a normal test result (n = 2179) or a diagnosis of non-obstructive CAD (n = 853) by coronary CTA. Median age was 55 (interquartile range: 47-63) years and 44% were males. After coronary CTA, the probability of a decrease in consultations with general practitioner was higher in patients with no CAD compared to patients with non-obstructive CAD (adjusted OR = 0.81 [95% CI: 0.68-0.96], P = 0.016). Accordingly, patients with non-obstructive CAD more frequently received prescriptions on lipid-lowering medical therapy (adjusted OR = 4.50 [95% CI: 3.31-6.12], P < 0.001) than patients with no CAD after coronary CTA. In patients with non-obstructive CAD, mean total-cholesterol reduction was 0.51 (P < 0.001) compared to 0.13 mmol/L (P < 0.001) in patients without non-obstructive CAD. The relative reduction in low-density lipoprotein was 14% higher (P < 0.001) in patients with compared to patients without non-obstructive CAD after coronary CTA. CONCLUSIONS: Coronary CTA with subsequent follow-up in general practice has the potential to align health service utilization that prioritizes high-risk patients and facilitate optimized preventive management.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/prevenção & controle , Medicina Geral/métodos , Serviços Preventivos de Saúde/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Angiografia por Tomografia Computadorizada/tendências , Doença da Artéria Coronariana/epidemiologia , Dinamarca/epidemiologia , Feminino , Seguimentos , Medicina Geral/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/tendências , Sistema de Registros , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA