Helen Salisbury: Practising in the dark

After careful screening to exclude coronavirus symptoms we invite some patients into the practice to be examined. With longstanding patients I hope that this will be just a brief interruption to our normal relationship, but when I haven't previously met the patient it poses a significant challenge to building a rapport. In the past week the number of new patients reporting coronavirus symptoms has fallen, as has the death rate at our local hospital.

A critique of clinical economy: reassessing value and care during covid-19—an essay by Eric Reinhart and Daniel Brauner

For decades, American medical practice has been organised around billing codes, with severe consequences for patient care and physician morale. The interruption of routine clinic visits owing to covid-19 presents an opportunity to reconsider the guiding principles of clinical care, write Eric Reinhart and Daniel Brauner

Will the COVID-19 cloud change pediatric medicine forever?

With the United States still in the throes of a pandemic, nearly 400 pediatric health care providers share their struggles in getting patients back to the office, advocating for a COVID-19 vaccine, and working their way toward optimism in the face of the biggest health care challenge of their lives. [...]although the reasons around the pessimism remained the same in both 2013 and 2019 (insufficient time with patients, inadequate reimbursement, and health care reform), this year-no surprise-the top reason was concerns about adequately treating patients with COVID-19 and multisystem inflammatory syndrome in children (MIS-C). In 2019, when asked what the top 2 challenges to their practice were, 45% of health care providers said transitioning to electronic health records (EHRs) and dealing with insurance (42%) were the greatest obstacles.

PP07.004 End-of-life treatment preference discussions between older people and their physician before and during the COVID-19 pandemic

BackgroundCOVID-19 could lead to hospitalisation and ICU admission, especially in older adults. Therefore, during the pandemic, it became more important to discuss wishes and preferences, such as older peoples' desire for intensive treatment in a hospital in acute situations, or not. This study explores 1) what percentage of Dutch older people aged 75 and over discussed Advance Care Planning (ACP) topics with a physician during the first months of the COVID-19 pandemic and 2) whether this was different in these people before the COVID-19 pandemic.MethodsData of two ancillary data collections of the Longitudinal Aging Study Amsterdam (LASA) were used: the LASA 75 PLUS study and the LASA COVID-19 study. The cross-sectional part of this study consisted of N=428 people aged 75 years and older who completed the LASA COVID-19 questionnaire (first objective). The longitudinal sample consisted of 219 people aged 75 years and older who had data on both the LASA 75 PLUS Study and the LASA COVID-19 study (second objective).ResultsMost older adults had thought about ACP topics during COVID-19 (76,4%), and a minority had also discussed ACP topics with a physician (20.3%). Thinking about ACP topics increased during COVID-19 compared to before COVID-19 in a sample with measurements on both timeframes (82,5% vs 68,0%). People who discussed ACP with others were more likely to discuss ACP with a physician.ConclusionOlder people do think about ACP topics, which is an important first step in ACP, and this has increased during COVID-19. However, discussing ACP topics with a physician is still not that common. General practitioners could therefore take the initiative in broaching the subject of ACP. This can for instance be done by organizing information meetings.

A practical guide to statistics for general practice

EVIDENCE-BASED MEDICINE is a well-established part of general practice in Australia.1 Understanding research is embedded within the current curriculum of The Royal Australian College of General Practitioners (RACGP), with the ability to discuss 'scientific and statistical information' for clinical decisions listed as a required skillset for general practitioners (GPs).2 In the past few years, the COVID-19 pandemic has further highlighted that interpreting epidemiology and statistics is not only relevant for GP academics, but is also an integral part of clinical care.3 For example, GPs are often the first point of contact for patients asking about the evidence for masks, diagnostic accuracy of COVID-19 tests, vaccine efficacy and effectiveness of new antiviral treatments. In clinical practice, framing a research question, conducting a database search and critical appraisal of the selected paper are key first steps in interpreting and using research evidence.

Celebrating 60 years of general practice training programs in Australia

Over the years, training for general practice has undergone several iterations, with profession-led training starting this year.2 Yet, the mission is essentially unchanged and follows the lead of the RACGP through acknowledging that the patient is at the centre of care, supported in the first instance by their regular GP to provide patient-centred, comprehensive, high-quality, continuous, coordinated, and accessible care.3 This year also heralds the arrival of a new triennium of continuing professional development (CPD) standards for Australian GPs. With that in mind, AJGP will now publish the answers to the clinical challenge in the following issue, to ensure that all current and aspiring GPs, regardless of location and circumstances, may benefit from this program. GPs continue to be the most common health professional seen by the Australian public, with 84% having at least one consultation each year, rising to 95% for those with a chronic disease,5 leading us full circle to the RACGP mission, which places patients at the forefront.

Education for primary health care in Africa.

No abstract available.

Initiating advance care planning in New South Wales general practices using a structured conversation guide

There is variation in ACP terminology and legislation of ACDs between different jurisdictions within Australia.4 General practice is the ideal setting for ACP discussions, and evidence supports patient preference for initiation of ACP while they are still healthy in the community.5-7 The Royal Australian College of General Practitioners (RACGP) recommends that general practitioners (GPs) discuss ACP as part of routine care for older patients during the annual 75 years and over health assessment.8 The COVID-19 pandemic highlighted the need for GPs to have these conversations, and there have been calls for ACP to be an integral part of pandemic health planning responses.9 Evaluating the prevalence of ACP conversations is difficult, with most studies focusing on the more tangible assessment of ACD completion. Some barriers to GPs initiating ACP include difficulties in defining the right moment to discuss the topic, a perceived lack of knowledge in the ACP process and concern regarding the potential time-consuming nature of ACP discussions.11'12 Strategies to increase initiation of ACP in general practice have focused on workshops and communication skills training for GPs and general practice nurses (GPNs), which are time and resource intensive.13-15 Some studies have shown that discussion guides and question prompt lists can improve the frequency of ACP discussions with patients, but these have been limited to palliative care settings.16-18 Most doctors believe it is their responsibility to initiate these discussions but struggle with timing.19 More evidence is needed to understand how to help GPs facilitate these conversations in a way that is acceptable and meaningful for older patients and their families. [...]it's the family that's really going to make the decision. [Female GP, FG 1.1] Some GPs preferred to focus on clinical decisions such as cardiopulmonary resuscitation (CPR) as the main subject of the conversation, while others preferred to broaden the discussion to general healthcare goals.

P3-1 Medical digital transformation after COVID-19: industry 4.0 and healthcare

The once-in-a-century pandemic has changed the world in many ways. In the U.S., which suffered the most damage, people were forced to use non-contact medical care, especially in the medical field, and as a result, various medical devices and services using digital technology became a MUST HAVE and spread rapidly. Now that the corona disaster is over, we are not going back to the pre-corona state, but rather, a hybrid of virtual and physical medicine is being developed. For example, telemedicine accounts for more than 50% of family physicians' practice, and U.S. health insurance authorities actively promote day surgery. In addition, the concepts of Virtual Hospital and Medical Home are being introduced to provide hospital inpatient care at home and will be reimbursed by the U.S. health insurance authorities in the fall of 2021. In this way, digital medical transformation using digital technology is advancing rapidly, necessitated by the Corona disaster, and the fourth industrial revolution is taking place in both name and reality. In this article, I would like to introduce the current status of digital technology in the U.S. medical industry.

"There's nothing like a good crisis for innovation": a qualitative study of family physicians' experiences with virtual care during the COVID-19 pandemic.

BACKGROUND: Prior to the pandemic, Canada lagged behind other Organisation for Economic Cooperation and Development countries in the uptake of virtual care. The onset of COVID-19, however, resulted in a near-universal shift to virtual primary care to minimise exposure risks. As jurisdictions enter a pandemic recovery phase, the balance between virtual and in-person visits is reverting, though it is unlikely to return to pre-pandemic levels. Our objective was to explore Canadian family physicians' perspectives on the rapid move to virtual care during the COVID-19 pandemic, to inform both future pandemic planning for primary care and the optimal integration of virtual care into the broader primary care context beyond the pandemic. METHODS: We conducted semi-structured interviews with 68 family physicians from four regions in Canada between October 2020 and June 2021. We used a purposeful, maximum variation sampling approach, continuing recruitment in each region until we reached saturation. Interviews with family physicians explored their roles and experiences during the pandemic, and the facilitators and barriers they encountered in continuing to support their patients through the pandemic. Interviews were audio-recorded, transcribed, and thematically analysed for recurrent themes. RESULTS: We identified three prominent themes throughout participants' reflections on implementing virtual care: implementation and evolution of virtual modalities during the pandemic; facilitators and barriers to implementing virtual care; and virtual care in the future. While some family physicians had prior experience conducting remote assessments, most had to implement and adapt to virtual care abruptly as provinces limited in-person visits to essential and urgent care. As the pandemic progressed, initial forays into video-based consultations were frequently replaced by phone-based visits, while physicians also rebalanced the ratio of virtual to in-person visits. Medical record systems with integrated capacity for virtual visits, billing codes, supportive clinic teams, and longitudinal relationships with patients were facilitators in this rapid transition for family physicians, while the absence of these factors often posed barriers. CONCLUSION: Despite varied experiences and preferences related to virtual primary care, physicians felt that virtual visits should continue to be available beyond the pandemic but require clearer regulation and guidelines for its appropriate future use.

A Qualitative Study of Rural and Remote Australian General Practitioners' Involvement in High-Acuity Patients.

This study aimed to understand the experiences, barriers, and facilitators of rural general practitioners' involvement with high-acuity patients. Semi-structured interviews with rural general practitioners in South Australia who had experience delivering high-acuity care were audio-recorded, transcribed verbatim, and analyzed through content and thematic approaches incorporating Potter and Brough's capacity-building framework. Eighteen interviews were conducted. Barriers identified include the inability to avoid high-acuity work in rural and remote areas, pressure to handle complex presentations, lack of appropriate resources, lack of mental health support for clinicians, and impacts on social life. Enablers included a commitment to community, comradery in rural medicine, training, and experience. We concluded that general practitioners are a vital pillar of rural health service delivery and are inevitably involved in disaster and emergency response. While the involvement of rural general practitioners with high-acuity patients is complex, this study suggested that with the appropriate system, structure and role supports, rural general practitioners could be better empowered to manage high-acuity caseloads locally.

Characteristics and Health Care Use of Patients Attending Virtual Walk-in Clinics in Ontario, Canada: Cross-sectional Analysis.

BACKGROUND: Funding changes in response to the COVID-19 pandemic supported the growth of direct-to-consumer virtual walk-in clinics in several countries. Little is known about patients who attend virtual walk-in clinics or how these clinics contribute to care continuity and subsequent health care use. OBJECTIVE: The objective of the present study was to describe the characteristics and measure the health care use of patients who attended virtual walk-in clinics compared to the general population and a subset that received any virtual family physician visit. METHODS: This was a retrospective, cross-sectional study in Ontario, Canada. Patients who had received a family physician visit at 1 of 13 selected virtual walk-in clinics from April 1 to December 31, 2020, were compared to Ontario residents who had any virtual family physician visit. The main outcome was postvisit health care use. RESULTS: Virtual walk-in patients (n=132,168) had fewer comorbidities and lower previous health care use than Ontarians with any virtual family physician visit. Virtual walk-in patients were also less likely to have a subsequent in-person visit with the same physician (309/132,168, 0.2% vs 704,759/6,412,304, 11%; standardized mean difference [SMD] 0.48), more likely to have a subsequent virtual visit (40,030/132,168, 30.3% vs 1,403,778/6,412,304, 21.9%; SMD 0.19), and twice as likely to have an emergency department visit within 30 days (11,003/132,168, 8.3% vs 262,509/6,412,304, 4.1%; SMD 0.18), an effect that persisted after adjustment and across urban/rural resident groups. CONCLUSIONS: Compared to Ontarians attending any family physician virtual visit, virtual walk-in patients were less likely to have a subsequent in-person physician visit and were more likely to visit the emergency department. These findings will inform policy makers aiming to ensure the integration of virtual visits with longitudinal primary care.

The experiences and thoughts of Turkish family physicians about COVID-19 pandemic: A qualitative study.

BACKGROUND: Efforts to contain the SARS-CoV-2 virus would fall short without strong primary health care. OBJECTIVES: In this study, we aimed to determine the experiences, views and suggestions of family physicians regarding their roles, primary care health systems' preparedness and the challenges/needs for a better organisation during the pandemic via in-depth exploration. METHODS: Twenty-one family physicians working in different cities of Turkey participated in semi-structured interviews between 15/08/2020-21/01/2021. Convenience sampling was used. We did this qualitative study through interviews by telephone. Participants were asked seven open-ended questions. Thematic analysis was used, which included reading the transcript, identifying significant phrases and formulating meanings and validating meanings through research team discussions to reach consensus, identifying themes. RESULTS: Ten of the participants were female and the average age of the participants was 39.5 (SD = 10.5) years. Twelve of the family physicians are specialists in family medicine. Four themes were identified: role of primary care in the pandemic, pandemic preparedness of primary care, challenges of working in primary care centres during the COVID-19 pandemics, and approaches to future pandemics. CONCLUSION: Our study showed that, despite unprepared primary care and undefined roles of family physicians in pandemic planning, family physicians played a significant role in pandemic management.

Burnout, Depression, Anxiety, and Stress among Family Physicians in Kansas: 18 Months into the COVID-19 Pandemic

Introduction: Given the significant turmoil during the COVID-19 pandemic, the authors evaluated burnout and other types of emotional distress experienced by family physicians in Kansas during the second year of the pandemic. The authors compared findings of this study to a similar study conducted 3 months into the pandemic. Method(s): A cross-sectional online survey of 272 actively practicing family physicians in Kansas was conducted from September 15 to October 18, 2021. A 34-item questionnaire was used to measure the physicians' levels of burnout, personal depression, anxiety, and stress. A mixed method approach was used to collect, analyze, and interpret the data. Descriptive statistics, Mann-Whitney U test/independent samples t-test, v2, adjusted odds ratio, and immersion-crystallization methods were used to analyze the data. Result(s): The response rate was 48.9% (n = 133). In aggregate, 69.2% of respondents reported at least 1 manifestation of professional burnout in 2021 compared with 50.4% in 2020;P <= .01). The 2021 respondents were at higher odds of experiencing burnout compared with 2020 respondents (aOR = 1.86;95% CI, 1.00 to 3.57;P = .046). The respondents who reported at least 1 manifestation of professional burnout were more likely to screen positive for depression (aOR = 1.87;95% CI, 1.31-2.66;P <= .01), report higher levels of anxiety (aOR = 1.53;95% CI, 1.04-2.24;P = .013), and higher levels of stress (aOR = 1.39;95% CI, 1.17-1.66;P <= .001). Conclusion(s): As the COVID-19 pandemic continued, there are significant and worsening rates of professional burnout and other forms of emotional distress among family physicians. These findings suggest timely need for appropriate psychological supports. Copyright © 2022 American Board of Family Medicine. All rights reserved.

Burnout in primary healthcare physicians and nurses in Turkey during COVID-19 pandemic.

BACKGROUND: Due to additional responsibilities and uncertainties during the COVID-19 pandemic, primary healthcare (PHC) workers are at increased risk of burnout. AIM: To determine and compare the burnout levels and related factors in PHC nurses and family physicians (FPs) during the COVID-19 pandemic. METHODS: An online survey was delivered to PHC workers. Non-random sampling method was used. To evaluate burnout, the Maslach Burnout Inventory was used, which investigates burnout in three categories: emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). Multivariate linear regression was used to analyze factors associated with burnout for FPs and nurses separately. FINDINGS: Among the participants, 55.7% were nurses, the mean age was 42.34. FPs and nurses experienced similar levels of burnout in terms of EE. Family physicians had higher levels of low PA and DP. Based on the results of the multivariate analysis, while higher EE levels were significantly associated with unequal distribution of workload and communication problems within the Family Health Center for physicians, the unequal distribution of PPE, lack of appreciation by patients or colleagues and restrictions on work-related rights were relevant factors for nurses. Lack of appreciation and restrictions of the rights were associated with increased DP scores in both groups. Unequal distribution of workload was also associated with reduced PA among FPs. CONCLUSION: PHC physicians and nurses are affected by burnout in different ways under the conditions of the COVID-19 pandemic based on gender, socioeconomic status and working conditions. To protect the mental health of PHC workers in the next public health emergency, clarification in the organization of services, empowering PHC workers in emergency risk communication and provision of timely, adequate and free PPE is essential. It is also crucial to ensure the rights of health workers through macro policy changes especially during emergencies.

Living and working in rural healthcare during the COVID-19 pandemic: a qualitative study of rural family physicians' lived experiences.

BACKGROUND: The COVID-19 pandemic has been pervasive in its impact on all aspects of Canadian society. Along with its pervasiveness, the disease provided unprecedented complexity to the Canadian healthcare infrastructure, eliciting varying responses from the afflicted healthcare systems in Canada. However, insights into the various parameters and complexities endured by Canadian rural physicians and rural healthcare institutions during the pandemic have been scarce. OBJECTIVE: This paper explores the conditions and complexity of living and working of Rural Family Physicians (RFPs) in rural healthcare in Canada during the pandemic. METHODS: Community-based participatory research was utilized as a collaborative and partnership approach, equitably engaged community members in all aspects of research, ranging from designing the research question to analyzing data. Participants of this study include RFPs with at least one year of experience working in rural Canada. Data were collected through telephone interviews and analyzed according to the six-phase guide for the data's inductive thematic analysis. Data collection halted upon saturation. RESULTS: Five significant compiled categories reflect the lived experiences of Rural Family Physicians. 1- virtual care as a challenge or forward progress; 2- canceling in-person visits and interrupting the routine; 3- shortage of health care providers and supporting staff; 4-ongoing coping process with the pandemic guidelines; 5-COVID-19 combat fatigue. DISCUSSION: The inception of COVID-19 has significantly impacted rural physicians across several interconnected issues. This study illuminates the lesser-known effects of the COVID-19 pandemic, which heavily impacts rural healthcare.

VACCINATIONS FOR LIFE: THE JOURNAL OF THE HEALTH VISITORS' ASSOCIATION

It's important that vaccines are given on time for the best protection, but if clients miss a vaccine for themselves or their child, they should contact their GP to catch up. However, Covid vaccinations have not been included here. Some vaccines are only available on the NHS for groups of people who need extra protection. These include at-risk babies and children and people with underlying health conditions.

Virtual family physician care during COVID-19: a mixed methods study using health administrative data and qualitative interviews.

BACKGROUND: The onset of the COVID-19 pandemic necessitated a rapid shift in primary health care from predominantly in-person to high volumes of virtual care. The pandemic afforded the opportunity to conduct a deep regional examination of virtual care by family physicians in London and Middlesex County, Ontario, Canada that would inform the foundation for virtual care in our region post-pandemic. OBJECTIVES: (1) to determine volumes of in-person and virtual family physicians visits and characteristics of the family physicians and patients using them during the early COVID-19 pandemic; (2) to determine how virtual visit volumes changed over the pandemic, compared to in-person; and (3) to explore family physicians' experience in virtual visit adoption and implementation. METHODS: We conducted a concurrent mixed-methods study of family physicians from March to October 2020. The quantitative component examined mean weekly number of total, in-person and virtual visits using health administrative data. Differences in outcomes according to physician and practice characteristics for pandemic periods were compared to pre-pandemic. The qualitative study employed Constructivist Grounded Theory, conducting semi-structured family physicians interviews; analyzing data iteratively using constant comparative analysis. We mapped themes from the qualitative analysis to quantitative findings. RESULTS: Initial volumes of patients decreased, driven by fewer in-person visits. Virtual visit volumes increased dramatically; family physicians described using telephone almost entirely. Rural family physicians reported video connectivity issues. By early second wave, total family physician visit volume returned to pre-pandemic volumes. In-person visits increased substantially; family physicians reported this happened because previously scarce personal protective equipment became available. Patients seen during the pandemic were older, sicker, and more materially deprived. CONCLUSION: These results can inform the future of virtual family physician care including the importance of continued virtual care compensation, the need for equitable family physician payment models, and the need to attend to equity for vulnerable patients. Given the move to virtual care was primarily a move to telephone care, the modality of care delivery that is acceptable to both family physicians and their patients must be considered.

A cross sectional study to assess the psychological impact of covid 19 on family medicine specialists and residents in Kerala.

Aim: To study the psychological impacts of COVID-19 on family physicians and residents in Kerala. Objectives: 1. To evaluate mental health outcomes among family physicians and residents in Kerala involved in the COVID-19 response. 2. To quantify the symptoms of depression, anxiety, and stress. 3. To assess the potential risk factors associated with the symptoms of anxiety, depression, or stress. Background: Health care professionals dealing with COVID-19 are under increased work pressure and experience high rates of anxiety and depression. This is even more in family physicians as they are the frontline workers and may contract the disease themselves. So, it is imperative to assess and grade the psychological impact of COVID-19 on family physicians. Methodology: The study population included 80% of the family physicians and residents working in Kerala. This is a cross-sectional survey conducted in the month of January 2021 with the help of a predesigned and pretested questionnaire. Sample size: 120. Depression and anxiety were measured using a 14-item Hospital Anxiety and Depression Scale (HADS: 0-21). Stress was computed using Perceived Stress Scale. The data were analyzed statistically by Chi-square and simple proportions. Results: A total of 80% were directly involved in treating/dealing COVID-19 patients. A total of 55.83% had an economic impact due to COVID-19. A total of 95% agreed to be anxious about spreading the disease to people at home. The increased stress was mostly attributed to change in social habits/lifestyles. Residents had a higher PSS score compared to temporary and permanent employees. Compared to other age groups, borderline or abnormal depression scale was seen in the age group of 31-40 years and 21-30 years. Compared to males, more proportion of females had anxiety and depression scores. Conclusions: It is imperative that we evaluate the psychological impact of COVID-19 on family physicians in order to ensure their mental wellbeing and better productivity.