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1.
Rev Med Suisse ; 18(805): 2233-2235, 2022 11 23.
Article in French | MEDLINE | ID: covidwho-2164877
2.
BMC Prim Care ; 23(1): 289, 2022 11 19.
Article in English | MEDLINE | ID: covidwho-2139153

ABSTRACT

OBJECTIVES: Remote consultations were common in general practice during the COVID-19 pandemic. This approach may have affected access to GP care for people with low socio-economic status: this group has a high prevalence of chronic conditions and a higher mortality rate due to COVID-19. This study explores the association of sociodemographic and health factors with the decision to contact a GP practice, and care utilisation, among patients in low-income neighbourhoods in the Netherlands. DESIGN: Cross-sectional survey study. SETTING: General practice in low-income neighbourhoods in the Netherlands. PARTICIPANTS: Patients from low-income neighbourhoods were selected from fourteen general practices on the basis of ethnic background, chronic disease or health literacy. Participants were stratified according to categories of these background characteristics to obtain equal numbers per category. A total of 213 surveys were retained for analysis. MAIN OUTCOME MEASURES: Need for GP contact, decision to contact a GP practice, and GP service utilisation. RESULTS: Forty-five percent (N = 88) of the participants experienced health problems for which they wished to consult their GP at the start of the outbreak of COVID-19. A majority of them (81%) had contact with a GP service. The need to contact the GP was significantly associated with financial difficulties (OR 2.20 CI (1.10 to 4.39)). An interaction effect was found of health literacy with concerns about COVID-19 with in respondents with low health literacy a significant association between concerns about COVID-19 and a need for a GP appointment (OR 5.33 CI (2.09 to 13.59)) and absence of a significant association in the higher health literacy group (OR 1.14 CI (0.51 to 2.56)) . Moreover, 56% (N = 74) of the participants received remote care at least one time during the first wave of COVID-19. Female participants used remote care more often (OR 3.22 CI (1.57 to 6.59)) and participants aged 50 and over used remote care less often (OR 0.46 CI (0.21 to 0.97)). CONCLUSION: Many patients in low-income neighbourhoods were able to consult a GP, often remotely. However from the equity perspective, access to GP care should be safeguarded for patients with health problems, financial difficulties and low health literacy because of their greater need to consult a GP during times of crisis.


Subject(s)
COVID-19 , Health Services Accessibility , Telemedicine , Aged , Female , Humans , Middle Aged , COVID-19/epidemiology , Cross-Sectional Studies , Demography , Pandemics , Poverty , Residence Characteristics , General Practice
3.
BMJ Open ; 12(11): e064375, 2022 Nov 28.
Article in English | MEDLINE | ID: covidwho-2137766

ABSTRACT

OBJECTIVES: Implementing support and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. This study examined parents'/caregivers' experiences and perceptions about a digital developmental surveillance pathway for autism, the autism surveillance pathway (ASP), and usual care, the surveillance as usual (SaU) pathway, in the primary healthcare general practice setting. DESIGN: This qualitative study involves using a convenience selection process of the full sample of parents/caregivers that participated in the main programme, 'General Practice Surveillance for Autism', a cluster-randomised controlled trial study. All interviews were audio-recorded, transcribed and coded using NVivo V.12 software. An inductive thematic interpretive approach was adopted and data were analysed thematically. PARTICIPANTS: Twelve parents/caregivers of children with or without a developmental condition/autism (who participated in the main programme) in South Western Sydney and Melbourne were interviewed. SETTINGS: All interviews were completed over the phone. RESULTS: There were seven major themes and 20 subthemes that included positive experiences, such as pre-existing patient-doctor relationships and their perceptions on the importance of knowing and accessing early support/services. Barriers or challenges experienced while using the SaU pathway included long waiting periods, poor communication and lack of action plans, complexity associated with navigating the healthcare system and lack of understanding by general practitioners (GPs). Common suggestions for improvement included greater awareness/education for parents/carers and the availability of accessible resources on child development for parents/caregivers. CONCLUSION: The findings support the use of digital screening tools for developmental surveillance, including for autism, using opportunistic contacts in the general practice setting. TRIAL REGISTRATION NUMBER: ANZCTR (ACTRN12619001200178).


Subject(s)
Autistic Disorder , General Practice , Child , Humans , Autistic Disorder/diagnosis , Australia/epidemiology , Qualitative Research , Parents
4.
Rev Med Suisse ; 18(805): 2201-2205, 2022 Nov 23.
Article in French | MEDLINE | ID: covidwho-2146918

ABSTRACT

From June 1 to 3, 2022, Lausanne held the spring congress of the Swiss Society of General Internal Medicine: "Changes and Opportunities". In this article, chief residents in internal medicine at CHUV summarize presentations they attended. Internal general medicine is established in french-speaking Switzerland as a transversal specialty, which is reflected in this synthesis with very varied subjects. In thromboembolic disease, the duration of anticoagulation is now based on risk of recurrence. The thrombotic microangiopathy benefit nowadays from targeted therapy which improve diseases' outcomes. The new anti-viral therapy against SARS-CoV-2 (nirmatrelvir/ritonavir) is associated with numerous drug interactions. Finally, professors from Switzerland and abroad give their advices for scientific writing and academic career initiation.


Du 1er au 3 juin 2022 se tenait à Lausanne le congrès de printemps de la Société suisse de médecine interne : « Changes & Opportunities ¼. Les chefs de clinique du Service de médecine interne du CHUV vous proposent ici des résumés de quelques présentations. Cette synthèse aborde des sujets très variés reflétant la transversalité de la médecine interne générale. La durée d'anticoagulation de la maladie thromboembolique s'articule selon le risque de récidive. Les microangiopathies thrombotiques bénéficient de thérapies ciblées, qui améliorent leur pronostic. Le n­ouveau traitement antiviral contre le SARS-CoV-2 (nirmatrelvir/ritonavir) induit de multiples interactions médicamenteuses. Et pour finir, quelques conseils pour la rédaction d'un article scientifique et l'initiation d'une carrière académique.


Subject(s)
COVID-19 , General Practice , Humans , SARS-CoV-2 , Internal Medicine , Ethnicity
5.
Int J Environ Res Public Health ; 19(22)2022 Nov 20.
Article in English | MEDLINE | ID: covidwho-2116057

ABSTRACT

The COVID-19 pandemic has had a large and varying impact on primary care. This paper studies changes in the tasks of general practitioners (GPs) and associated staff during the COVID-19 pandemic. Data from the PRICOV-19 study of 5093 GPs in 38 countries were used. We constructed a scale for task changes and performed multilevel analyses. The scale was reliable at both GP and country level. Clustering of task changes at country level was considerable (25%). During the pandemic, staff members were more involved in giving information and recommendations to patients contacting the practice by phone, and they were more involved in triage. GPs took on additional responsibilities and were more involved in reaching out to patients. Problems due to staff absence, when dealt with internally, were related to more task changes. Task changes were larger in practices employing a wider range of professional groups. Whilst GPs were happy with the task changes in practices with more changes, they also felt the need for further training. A higher-than-average proportion of elderly people and people with a chronic condition in the practice were related to task changes. The number of infections in a country during the first wave of the pandemic was related to task changes. Other characteristics at country level were not associated with task changes. Future research on the sustainability of task changes after the pandemic is needed.


Subject(s)
COVID-19 , General Practice , Humans , Aged , COVID-19/epidemiology , Pandemics , Workforce , Primary Health Care
6.
Aust J Gen Pract ; 51(10): 793-797, 2022 10.
Article in English | MEDLINE | ID: covidwho-2111595

ABSTRACT

BACKGROUND AND OBJECTIVES: Vaccine uptake in older Australians is suboptimal. This exploratory study aims to establish the associations of opportunistic older person immunisation in general practice registrars' practice. METHOD: This study was a cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. Univariate and multivariable regressions explored associations between vaccine recommendations and patient, registrar, practice and consultation factors. RESULTS: A total of 2839 registrars provided data on 74,436 consultations. Associations of lower odds of immunisation included Aboriginal and Torres Strait Islander peoples (odds ratio [OR] 0.69; 95% confidence interval [CI]: 0.50, 0.96), rural/remote practice location (OR 0.75; 95% CI: 0.58, 0.98, compared with major cities) and in areas of greater relative socioeconomic disadvantage (OR per decile 1.03; 95% CI: 1.01, 1.05). Patients new to the practice (OR 2.46; 95% CI: 2.06, 2.94), or to the registrar (2.02; 95% CI: 1.87, 2.18) had higher odds of receiving an immunisation. DISCUSSION: Our findings suggest that general practice registrars may be proactively facilitating immunisation in new patients, but that inequities in vaccination persist.


Subject(s)
COVID-19 , General Practice , Aged , Australia , Cross-Sectional Studies , General Practice/education , Humans , Immunization , Referral and Consultation , Vaccination
7.
Br J Gen Pract ; 72(725): e907-e915, 2022 12.
Article in English | MEDLINE | ID: covidwho-2081799

ABSTRACT

BACKGROUND: Following a large-scale, pandemic-driven shift to remote consulting in UK general practice in 2020, 2021 saw a partial return to in-person consultations. This occurred in the context of extreme workload pressures because of backlogs, staff shortages, and task shifting. AIM: To study media depictions of remote consultations in UK general practice at a time of system stress. DESIGN AND SETTING: Thematic analysis of national newspaper articles about remote GP consultations from two time periods: 13-26 May 2021, following an NHS England letter, and 14-27 October 2021, following a government-backed directive, both stipulating a return to in-person consulting. METHOD: Articles were identified through, and retrieved from, LexisNexis. A coding system of themes and narrative devices was developed iteratively to inform data analysis. RESULTS: In total, 25 articles reported on the letter and 75 on the directive. Newspaper coverage of remote consulting was strikingly negative. The right-leaning press in particular praised the return to in-person consultations, depicting remote care as creating access barriers and compromising safety. Two newspapers led national campaigns pressuring the government to require GPs to offer in-person consultations. GPs were quoted as reluctant to return to an 'in-person by default' service (as it would further pressurise a system already close to breaking point). CONCLUSION: Remote consultations have become associated in the media with poor practice. Some newspapers were actively leading the 'war' on general practice rather than merely reporting on it. Proactive dialogue between practitioners and the media might help minimise polarisation and improve perceptions around general practice.


Subject(s)
General Practice , Remote Consultation , Humans , Family Practice , Workload , England
8.
BMJ Open ; 12(10): e063179, 2022 10 27.
Article in English | MEDLINE | ID: covidwho-2088813

ABSTRACT

OBJECTIVES: Telehealth has emerged as a viable and safe mode of care delivery in Australia during the COVID-19 pandemic. However, electronic general practice data reveal differences in uptake and consultation mode, which we hypothesise may be due to potential barriers impacting on quality of care. We aimed to identify the benefits and barriers of telehealth use in general practice, using an 'Action Research' approach involving general practitioners (GPs) and general practice stakeholders. DESIGN: Qualitative focus group performed within a broader Action Research methodology. SETTING: A focus group was held in August 2021, with general practice participants from Victoria, Australia. PARTICIPANTS: The study consisted of a purposive sample of 11 participants, including GPs (n=4), representatives from three primary health networks (n=4) and data custodian representatives (n=3) who were part of a project stakeholder group guided by an Action Research approach. METHODS: Semistructured interview questions were used to guide focus group discussions via videoconference, which were recorded and transcribed verbatim for analysis. The transcript was analysed using an inductive thematic approach. RESULTS: Emerging themes included evolution of telehealth, barriers to telehealth (privacy, eligibility, technology, quality of care, sociodemographic and residential aged care barriers) and benefits of telehealth (practice, quality of care, sociodemographic and residential aged care benefits). CONCLUSION: The findings highlight a range of barriers to telehealth that impact general practice, but also provide justification for the continuation and development of telehealth. These results provide important context to support data-driven population-based findings on telehealth uptake. They also highlight areas of quality improvement for the enhancement of telehealth as a valuable tool for routine general practice patient care.


Subject(s)
COVID-19 , General Practice , Telemedicine , Humans , Aged , COVID-19/epidemiology , Pandemics , Qualitative Research , Victoria
9.
Aust Health Rev ; 46(5): 595-604, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2087410

ABSTRACT

Objective The aim of this research was to explore the experiences of general practice in delivering Australia's coronavirus disease 2019 (COVID-19) vaccine, and the impact on practice finances and workforce. Methods Eighteen semi-structured interviews with owners and practice managers of general practices in Greater Sydney between June and August 2021 were conducted. Results Practices reported early enthusiasm for the vaccine rollout and engaged in large-scale staffing and infrastructure adaptations to manage increased vaccination workload. Although some practices reported increased income related to vaccination, nearly all reported increased costs. Lack of timely and transparent communication between primary care and policymakers was a major concern for practices. Conclusions The success of Australia's COVID-19 vaccine rollout relied on the goodwill of general practices. Participation in the COVID-19 vaccine rollout resulted in increased stress, increased administration workload, and reduced financial viability for many practices.


Subject(s)
COVID-19 , General Practice , Australia , COVID-19/prevention & control , COVID-19 Vaccines , Humans , Primary Health Care
10.
Br J Gen Pract ; 72(714): 40-41, 2022 01.
Article in English | MEDLINE | ID: covidwho-2084825
11.
Br J Gen Pract ; 72(724): e799-e808, 2022 11.
Article in English | MEDLINE | ID: covidwho-2080549

ABSTRACT

BACKGROUND: The COVID-19 pandemic has altered the provision of health care and expanded telehealth consultations. AIM: To study the effect of the COVID-19 pandemic on contact patterns in general practice, and to identify patient groups at risk of losing care. DESIGN AND SETTING: Register-based study of Danish general practice, including daytime and out-of-hours (OOH) services. METHOD: All individuals residing in Denmark from 1 January 2017 to 31 October 2020 were included. The incidence rate for six contact types in general practice and adjusted incidence rate ratio were calculated by comparing the incidence rate in the pandemic period with the adjusted expected incidence rate based on the incidence rate in the pre-pandemic period. RESULTS: The number of face-to-face in-clinic consultations declined during the lockdown in March 2020. A subsequent increase in the number of clinic consultations was observed, rising to a level above that of the pre-pandemic period; this increase resulted mainly from the introduction of telehealth consultations (that is, video and extended telephone). The number of daytime email consultations increased, whereas the number of daytime home visits decreased. Likewise, the number of OOH telephone consultations increased, whereas the number of OOH home visits and clinic consultations decreased. Consultation rates of patients who are vulnerable, that is, those with low education, old age, and comorbidity, were most adversely affected by the pandemic. The most adverse impact in OOH clinic consultations was seen for children aged 0-9 years. CONCLUSION: New methods are called for to ensure access to general practice for patients who are vulnerable during a pandemic. The potential of telehealth consultations should be further investigated.


Subject(s)
COVID-19 , General Practice , Telemedicine , Child , Humans , COVID-19/epidemiology , Pandemics , Communicable Disease Control , Family Practice
12.
Front Public Health ; 10: 937100, 2022.
Article in English | MEDLINE | ID: covidwho-2055090

ABSTRACT

Independent from initial severity, many patients develop persistent symptoms after infection with SARS-CoV-2, described as long COVID syndrome. Most of these patients are treated by general practitioners (GPs). As evidence-based treatment recommendations are still sparse, GPs must make their therapy decisions under uncertainty. We investigated (1) the most frequently observed long COVID symptoms in general practices and (2) GPs' applied treatment and rehabilitation plans for these symptoms. In total, 143 German GPs participated in an online-based survey between 05/2021 and 07/2021. We found that each GP practice was treating on average 12 patients with long COVID symptoms. Most frequently seen symptoms were fatigue and reduced performance. Current therapy options were rated as poor and loss of smell and taste, fatigue, or lack of concentration were perceived to be especially difficult to treat. The use of drug and non-drug therapies and specialist referrals focused primarily on physiological and less on psychosomatic/psychological rehabilitation and followed guidelines of similar conditions. Our results provide first insights into how GPs approach a newly emerging condition in the absence of guidelines, evidence-based recommendations, or approved therapies, and might inform about GP preparedness in future pandemics. Our results also emphasize a gap between the current knowledge of the long COVID manifestation and knowledge about effective rehabilitation.


Subject(s)
COVID-19 , General Practice , COVID-19/complications , COVID-19/therapy , Fatigue , Humans , SARS-CoV-2
13.
BMC Prim Care ; 23(1): 254, 2022 09 27.
Article in English | MEDLINE | ID: covidwho-2053866

ABSTRACT

BACKGROUND: Most COVID-19 patients with severe symptoms are treated in hospitals. General practices are responsible for assessing most ambulatory patients. However, they face several challenges managing COVID-19 patients, and those with non-COVID-19 conditions. In April of 2020, we designed a software tool for the structured surveillance of high-risk home-quarantined COVID-19 patients in general practice (CovidCare) including several telephone monitorings, in order to support general practices and early identification of severe courses. This study presents the qualitative results of a mixed-methods process evaluation study on CovidCare. METHODS: In a qualitative process evaluation study conducted between March and May 2021, we explored the perspectives of seven general practitioners (GPs) and twelve VERAHs (medical care assistants with special training) on CovidCare using semi-structured interviews based on the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance). We used deductive qualitative content analysis employing the RE-AIM framework to assess the utilisation and implementation of CovidCare. RESULTS: Overall, most health care professionals were satisfied with CovidCare. They highlighted 1) a good orientation for the management of COVID-19 patients, especially due to a high level of uncertainty at the beginning of the pandemic, 2) the possibility to gain new knowledge, and 3) the structured data collection as facilitators for the implementation of CovidCare. Moreover, CovidCare reduced the workload for GPs while some VERAHs perceived a higher workload as they were responsible for large parts of the CovidCare management. However, CovidCare positively affected the VERAHs' job satisfaction as most patients provided positive feedback and felt less anxious about coping with their disease. Previous experience with the software and an easy integration into daily practice were considered to be crucial utilisation drivers. Time and personnel resources were identified as major barriers. To further improve CovidCare, participants suggested a less comprehensive version of CovidCare, the expansion of inclusion criteria as well as an app for the patients' self-management. CONCLUSION: The COVID-19 surveillance and care tool for COVID-19 patients with increased risk was perceived as useful by GPs and VERAHs. Supportive remote health care tools such as CovidCare are a viable means to maintain comprehensive and continuous health care during a pandemic and may strengthen the primary care system. TRIAL REGISTRATION: German Clinical Trials Register DRKS00022054 ; date of registration: 02/06/2020.


Subject(s)
COVID-19 , General Practice , General Practitioners , COVID-19/epidemiology , Family Practice , Humans , Qualitative Research
14.
Prim Health Care Res Dev ; 23: e61, 2022 09 29.
Article in English | MEDLINE | ID: covidwho-2050231

ABSTRACT

BACKGROUND: The deployment of (Trainee) Associate Psychological Practitioners (T/APPs) to deliver brief psychological interventions focusing on preventing mental health deterioration and promoting emotional wellbeing in General Practice settings is a novel development in the North West of England. As the need and demand for psychological practitioners increases, new workforce supply routes are required to meet this growth. AIMS: To evaluate the clinical impact and efficacy of the mental health prevention and promotion service, provided by the T/APPs and the acceptability of the role from the perspective of the workforce and the role to T/APPs, patients and services. METHODS: A mixed-methods design was used. To evaluate clinical outcomes, patients completed measures of wellbeing (WEMWBS), depression (PHQ-9), anxiety (GAD-7) and resilience (BRS) at the first session, final session and at a 4-6 week follow-up. Paired-samples t-tests were conducted comparing scores from session 1 and session 4, and session 1 and follow-up for each of the four outcome measures. To evaluate acceptability, questionnaires were sent to General Practice staff, T/APPs and patients to gather qualitative and quantitative feedback on their views of the T/APP role. Quantitative responses were collated and summarised. Qualitative responses were analysed using inductive summative content analysis to identify themes. RESULTS: T-test analysis revealed clinically and statistically significant reductions in depression and anxiety and elevations in wellbeing and resiliency between session 1 and session 4, and at follow-up. Moderate-large effect sizes were recorded. Acceptability of the T/APP role was established across General Practice staff, T/APPs and patients. Content analysis revealed two main themes: positive feedback and constructive feedback. Positive sub-themes included accessibility of support, type of support, patient benefit and primary care network benefit. Constructive sub-themes included integration of the role and limitations to the support. CONCLUSIONS: The introduction of T/APPs into General Practice settings to deliver brief mental health prevention and promotion interventions is both clinically effective and acceptable to patients, General Practice staff and psychology graduates.


Subject(s)
General Practice , Mental Health , England , Humans , Surveys and Questionnaires
15.
PLoS One ; 17(9): e0274560, 2022.
Article in English | MEDLINE | ID: covidwho-2039420

ABSTRACT

INTRODUCTION: Medication errors are an important cause of morbidity and mortality. The pharmacist-led IT-based intervention to reduce clinically important medication errors (PINCER) has demonstrated improvements in primary care medication safety, and whilst now the subject of national roll-out its optimal and sustainable use across health contexts has not been fully explored. As part of a qualitative evaluation we aimed to identify factors influencing successful adoption, embedding and sustainable use of PINCER across primary care settings in England, UK. METHODS: Semi-structured face-to-face or telephone interviews, including follow-up interviews and an online survey were conducted with professionals knowledgeable of PINCER. Interview recruitment targeted four early adopter regions; the survey was distributed nationally. Initial data analysis was inductive, followed by analysis using a coding framework. A deductive matrix approach was taken to map the framework to the Normalisation Process Theory (NPT). Themes were then identified. RESULTS: Fifty participants were interviewed, 18 participated in a follow-up interview. Eighty-one general practices and three Clinical Commissioning Groups completed the survey. Four themes were identified and interpreted within the relevant NPT construct: Awareness & Perceptions (Coherence), Receptivity to PINCER (Cognitive Participation), Engagement [Collective Action] and Reflections & Adaptations (Reflexive Monitoring). Variability was identified in how PINCER awareness was raised and how staff worked to operationalise the intervention. Facilitators for use included stakeholder investment, favourable evidence, inclusion in policy, incentives, fit with individual and organisational goals and positive experiences. Barriers included lack of understanding, capacity concerns, operational difficulties and the impact of COVID-19. System changes such as adding alerts on clinical systems were indicative of embedding and continued use. CONCLUSIONS: The NPT helped understand motives behind engagement and the barriers and facilitators towards sustainable use. Optimising troubleshooting support and encouraging establishments to adopt an inclusive approach to intervention adoption and utilisation could help accelerate uptake and help establish ongoing sustainable use.


Subject(s)
COVID-19 , General Practice , England , Humans , Medication Errors , Pharmacists
16.
BMJ Open ; 12(9): e061513, 2022 09 19.
Article in English | MEDLINE | ID: covidwho-2038308

ABSTRACT

OBJECTIVES: General practitioners (GPs) and their staff have been at the frontline of the SARS-CoV-2 pandemic in Australia. However, their experiences of responding to and managing the risks of viral transmission within their facilities are poorly described. The aim of this study was to describe the experiences, and infection prevention and control (IPC) strategies adopted by general practices, including enablers of and challenges to implementation, to contribute to our understanding of the pandemic response in this critical sector. DESIGN: Semistructured interviews were conducted in person, by telephone or online video conferencing software, between November 2020 and August 2021. PARTICIPANTS: Twenty general practice personnel working in New South Wales, Australia, including nine GPs, one general practice registrar, four registered nurses, one nurse practitioner, two practice managers and two receptionists. RESULTS: Participants described implementing wide-ranging repertoires of IPC strategies-including telehealth, screening of patients and staff, altered clinic layouts and portable outdoor shelters, in addition to appropriate use of personal protective equipment (PPE)-to manage the demands of the SARS-CoV-2 pandemic. Strategies were proactive, influenced by the varied contexts of different practices and the needs and preferences of individual GPs as well as responsive to local, state and national requirements, which changed frequently as the pandemic evolved. CONCLUSIONS: Using the 'hierarchy of controls' as a framework for analysis, we found that the different strategies adopted in general practice often functioned in concert with one another. Most strategies, particularly administrative and PPE controls, were subjected to human variability and so were less reliable from a human factors perspective. However, our findings highlight the creativity, resilience and resourcefulness of general practice staff in developing, implementing and adapting their IPC strategies amidst constantly changing pandemic conditions.


Subject(s)
COVID-19 , General Practice , Australia/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Pandemics/prevention & control , Qualitative Research , SARS-CoV-2
17.
Aust J Gen Pract ; 51(9): 696-702, 2022 09.
Article in English | MEDLINE | ID: covidwho-2026512

ABSTRACT

BACKGROUND AND OBJECTIVES: There is growing evidence regarding the effectiveness of registrar training through video cameras, which has relevance for quality supervision during times of crises such as the global COVID-19 pandemic. METHOD: Interviews were conducted in 2012 with supervisors, registrars and patients evaluating video camera use for tele-supervision across six rural sites in Gippsland, Australia. Thematic analysis was employed in 2013 - and re-examined in 2021 in light of the global COVID-19 pandemic - to explore user experience with video technology. RESULTS: Participants identified advantages of video supervision addressing distance and temporal issues, also emphasising quality supervision and education. Challenges included patient confidentiality, internet stability and loss of serendipitous 'corridor conversations'. DISCUSSION: Remote supervision is no longer simply an issue for rural and remote training. During crises such as a global pandemic, tele-supervision becomes the purview of all. There are distinct merits and limitations in adopting video technology, warranting consideration of individual training contexts. These findings can help inform remote supervision via video in varied milieu.


Subject(s)
COVID-19 , General Practice , Rural Health Services , Family Practice , General Practice/education , Humans , Pandemics/prevention & control
18.
PLoS One ; 17(9): e0273212, 2022.
Article in English | MEDLINE | ID: covidwho-2021907

ABSTRACT

INTRODUCTION: General practitioners (GP) increasingly face the challenge of meeting the complex care needs of multi-morbid patients. Previous studies show that GP practices would like support from other institutions in advising on social aspects of care for multi-morbid patients. Already existing counselling services, like community care points, are not sufficiently known by both GPs and patients. The aim of COMPASS II is to investigate the feasibility of cooperation between GP practices and community care points. METHODS AND ANALYSIS: During the intervention, GPs send eligible multi-morbid patients with social care needs to a community care point. The community care points report the consultation results back to the GPs. In preparation for the intervention, in a moderated process, GP practices meet with the community care points to agree on information exchange. The primary outcome is the feasibility of the cooperation: Questionnaires will be sent to GPs, medical practice assistances and community care point personnel (focus: practicality, acceptability). Data will be collected on frequency and reasons for GP-initiated consultations at community care points (focus: demand). Qualitative interviews will be conducted with all participating groups (focus: acceptability, satisfaction). The secondary outcome is the assessment of changes in health-related quality of life, social support and satisfaction with care: participating patients complete a questionnaire before and three to six months after their counselling. The results of the study will be incorporated into a manual in which the experiences of the cooperation will be made available to other GP practices and community care points. DISCUSSION: In COMPASS II, GP practices establish cooperation with community care points. The latter are already existing institutions that provide independent and free advice on social matters. By using an existing institution, the established cooperation and experiences from the study can be used beyond the end of the study. TRIAL REGISTRATION: The trial is registered with DRKS-ID: DRKS00023798, Coordination of Medical Professions Aiming at Sustainable Support II.


Subject(s)
General Practice , General Practitioners , Feasibility Studies , Humans , Quality of Life , Surveys and Questionnaires
19.
BMC Prim Care ; 23(1): 230, 2022 09 09.
Article in English | MEDLINE | ID: covidwho-2021243

ABSTRACT

INTRODUCTION: The significance of the role of receptionists during the recent shift to remote triage has been widely recognised and they will have a significant role to play in UK general practice as it continues to cope with a huge increase in demand exacerbated by the COVID-19 pandemic. To maximise their contribution, it is important the social and occupational characteristics of the modern receptionist are understood, alongside their attitudes towards the role and their perceptions of the support and training they receive . METHODS: We used convenience and cross-sectional sampling to survey the demographic characteristics of receptionists and various aspects of their role and responsibilities. This included the training received, specific tasks performed, job satisfaction, the importance of the role, and their interaction with clinical and non-clinical colleagues. We also captured data on the characteristics of their practice including the number of GPs and location. RESULTS: A total of 70 participants completed the survey (16 postal and 54 online responses) of whom the majority were white (97.2%), female (98.6%), and aged 40 and over (56.7%). The majority of the training focussed on customer service (72.9%), telephone (64.3%), and medical administration skills (58.6%). Just over a quarter had received training in basic triage (25.7%). A standard multiple regression model revealed that the strongest predictor of satisfaction was support from practice GPs (ß = .65, p <.001) there were also significant positive correlations between satisfaction and appreciation from GPs, r(68) = .609, p < .001. CONCLUSION: This study has provided a much-needed update on the demographics, duties, and job satisfaction of GP receptionists. The need for diversification of the workforce to reflect the range of primary care patients warrants consideration in light of continuing variation in access along lines of gender andethnicity. Training continues to focus on administrative duties not on the clinically relevant aspects of their role such as triage.


Subject(s)
COVID-19 , General Practice , Adult , COVID-19/epidemiology , Cross-Sectional Studies , Female , Humans , Middle Aged , Pandemics , Surveys and Questionnaires , Workforce
20.
J Med Internet Res ; 24(8): e37223, 2022 08 30.
Article in English | MEDLINE | ID: covidwho-2009805

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, video consultations became a common method of delivering care in general practice. To date, research has mostly studied acute or subacute care, thereby leaving a knowledge gap regarding the potential of using video consultations to manage chronic diseases. OBJECTIVE: This study aimed to examine general practitioners' technology acceptance of video consultations for the purpose of managing type 2 diabetes in general practice. METHODS: A web-based survey based on the technology acceptance model measuring 4 dimensions-perceived usefulness, perceived ease of use, attitude, and behavioral intention to use-was sent to all general practices (N=1678) in Denmark to elicit user perspectives. The data were analyzed using structural equation modeling. RESULTS: The survey sample comprised 425 general practitioners who were representative of the population. Structural equation modeling showed that 4 of the 5 hypotheses in the final research model were statistically significant (P<.001). Perceived ease of use had a positive influence on perceived usefulness and attitude. Attitude was positively influenced by perceived usefulness. Attitude had a positive influence on behavioral intention to use, although perceived usefulness did not. Goodness-of-fit indices showed acceptable fits for the structural equation modeling estimation. CONCLUSIONS: Perceived usefulness was the primary driver of general practitioners' positive attitude toward video consultations for type 2 diabetes care. The study suggests that to improve attitude and technology use, decision-makers should focus on improving usefulness, that is, how it can improve treatment and make it more effective and easier.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , General Practice , General Practitioners , Telemedicine , Cross-Sectional Studies , Denmark , Diabetes Mellitus, Type 2/therapy , Humans , Pandemics , Technology
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