المؤلفون: Yin Y; Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China., Chu X; Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China., Han X; Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China., Cao Y; Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China., Di H; Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China., Zhang Y; Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China., Zeng X; Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China. zxjpumch@126.com.

المصدر: BMC family practice [BMC Fam Pract] 2021 Jan 11; Vol. 22 (1), pp. 18. Date of Electronic Publication: 2021 Jan 11.

نوع المنشور: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

مواضيع طبية MeSH: Career Choice* , Qualitative Research*, COVID-19/*epidemiology , Education, Medical/*methods , General Practice/*education , General Practitioners/*psychology, Adult ; China ; Female ; Humans ; Male ; Pandemics ; SARS-CoV-2 ; Workload/statistics & numerical data ; Young Adult

مستخلص: Background: The coronavirus disease 2019 (COVID-19) has been a worldwide public health emergency that has put great pressure on medical workers and the medical system. General Practitioners (GPs) played an important role in controlling the epidemic, and GP trainees also took an active part in this approach. This study was to explore Chinese GP trainees' career perspectives after COVID-19.
Methods: We conducted a qualitative research study which included 12 GP trainees from three teaching hospitals in China. Semi-structured telephone interviews were conducted. Grounded theory and thematic analysis were used to code the data and identify categories and factors.
Results: Eleven participants chose to continue a GP career after COVID-19, and nearly half of the participants strengthened their determination to dedicate themselves to this career. Only one participant decided to change the career choice because of interest in another specialty. Four main themes influencing GP trainees' perceptions of career development after COVID-19 emerged from the interviews: changes of GPs' work content in COVID-19, challenges of being a GP, psychological changes of the career, how to provide better primary care. Although some negative psychological changes existed, most of participants were inspired by role models and medical colleagues. They had more in-depth understanding of GPs' role and responsibility during COVID-19, and exhibited intensions for self-improvement in career development, especially in public health education and self-protection in preventing infectious diseases. In addition, the wide use of telemedicine provided a new work way for GP trainees. However, challenges, such as increased workloads, low income, lack of resources in primary medical institutions, and distrust of GPs are faced by trainees during the outbreak.
Conclusions: Overall, no substantial changes were seen in the career choice of GP trainees after COVID-19 outbreak. However, they were inspired and had an in-depth understanding about the GP's work and responsibility during an epidemic. Owing to the challenges faced by the GPs, measures are needed to improve the GP education and work environment in the training phase.

المؤلفون: Noonan M; Department of Nursing and Midwifery, Faculty of Education & Health Sciences, Health Sciences Building, University of Limerick, Limerick, Ireland. Maria.noonan@ul.ie., Doody O; Department of Nursing and Midwifery, Faculty of Education & Health Sciences, Health Sciences Building, University of Limerick, Limerick, Ireland., O'Regan A; Graduate Entry Medical School, Faculty of Education & Health Sciences, University of Limerick, Limerick, Ireland., Jomeen J; Faculty of Health and Social Care, University of Hull, Hull, UK., Galvin R; School of Allied Health, Faculty of Education & Health Sciences, Health Sciences Building, University of Limerick, Limerick, Ireland.

المصدر: BMC family practice [BMC Fam Pract] 2018 Dec 13; Vol. 19 (1), pp. 196. Date of Electronic Publication: 2018 Dec 13.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

مواضيع طبية MeSH: Attitude of Health Personnel* , Mental Health* , Qualitative Research*, General Practice/*standards , General Practitioners/*standards , Mental Disorders/*diagnosis , Perinatal Care/*standards, Female ; Humans ; Incidence ; Ireland/epidemiology ; Male ; Mental Disorders/epidemiology ; Pregnancy ; Retrospective Studies

مستخلص: Background: Identification of perinatal mental health problems and effective care for women who experience them are important considering the potentially serious impact that they may have on the wellbeing of the woman, her baby, family and wider society. General practitioners (GPs) play a central role in identifying and supporting women and this study aimed to explore GPs' experiences of caring for women with perinatal mental health problems in primary care. The results of this study may provide guidance to inform policy, practice, research and development of curriculum and continuous professional development resources.
Method: In-depth semi-structured interviews were undertaken between March and June 2017 with GPs (n = 10) affiliated with a University training programme for general practice in Ireland. Thematic data analysis was guided by Braun and Clarkes (2013) framework.
Results: Data were categorised into three themes with related subthemes: identification of perinatal mental health problems, decision making around perinatal mental health and preparation for a role in perinatal mental health. GPs described the multifaceted nature of their role in supporting women experiencing perinatal mental health issues and responding to complex psychological needs. Inbuilt tools on existing software programmes prompted GPs to ask questions relating to perinatal mental health. Limited access to referral options impacts on assessment and care of women. GPs desire further continuous professional development opportunities delivered in an online format and through monthly meetings and conference sessions.
Conclusions: GPs require access to culturally sensitive; community based perinatal mental health services, translation services and evidence based perinatal psychological interventions. A standardised curriculum on perinatal mental health for trainee GPs needs to be established to ensure consistency across primary care and GP education should incorporate rotations in community and psychiatry placements.

المؤلفون: Nash DM; ICES, London, Ontario, Canada. danielle.nash@lhsc.on.ca.; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. danielle.nash@lhsc.on.ca., Garg AX; ICES, London, Ontario, Canada.; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.; Department of Medicine, University of Western Ontario, London, Ontario, Canada.; The Ontario Renal Network, Toronto, Ontario, Canada., Brimble KS; The Ontario Renal Network, Toronto, Ontario, Canada.; Department of Medicine, McMaster University, Hamilton, Ontario, Canada., Markle-Reid M; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.; School of Nursing, McMaster University, Hamilton, Ontario, Canada.

المصدر: BMC family practice [BMC Fam Pract] 2018 Dec 10; Vol. 19 (1), pp. 192. Date of Electronic Publication: 2018 Dec 10.

نوع المنشور: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

مواضيع طبية MeSH: Decision Making* , Guideline Adherence* , Health Knowledge, Attitudes, Practice* , Qualitative Research*, Creatine/*blood , Renal Insufficiency, Chronic/*diagnosis, Adult ; Biomarkers/blood ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Ontario/epidemiology ; Renal Insufficiency, Chronic/blood ; Renal Insufficiency, Chronic/epidemiology

مستخلص: Background: Patients should receive follow-up serum creatinine tests after an initial abnormal result to diagnose chronic kidney disease. However, half of the time this fails to occur in primary care. We interviewed primary care providers to better understand their perceptions of enablers and barriers to following this guideline-recommended care.
Methods: We performed a qualitative descriptive study guided by the Theoretical Domains Framework (TDF), a framework for behavioural change. We used purposeful sampling to recruit primary care providers (physicians and nurse practitioners) based on provider and practice characteristics (rural, solo versus team practice, etc.) from Ontario, Canada. We completed one-on-one interviews with providers using a semi-structured and open-ended interview guide based on the 14 TDF domains. We alternated between data collection and analysis, where we used directed content analysis to identify frequent, important, and conflicting enablers and barriers.
Results: We completed 13 interviews with nine primary care physicians and four nurse practitioners. Nine themes related to the TDF emerged from the data: 1) environmental context and resources, 2) knowledge, 3) memory, attention, and decision processes, 4) beliefs about consequences, 5) goals, 6) social or professional role, 7) behavioural regulation, 8) skills, and 9) optimism. Within these themes, we identified 16 enablers and five barriers. Some enablers included, providers' knowledge on appropriate testing, their motivation to order these tests, and their use of tools and resources to help order follow-up serum creatinine tests. However, providers perceived some barriers including that ordering confirmatory laboratory tests for chronic kidney disease was not always a priority in regards to other care they wish to provide. Providers also noted that a perceived barrier is patients not going to the laboratory to complete the test.
Conclusions: We identified novel enablers and barriers to primary care providers completing guideline recommended repeat testing for the diagnosis of chronic kidney disease. Similar research is needed to understand the views of patients. These research findings can be used to inform strategies to improve the quality of care.

المؤلفون: Wichmann AB; Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands. Anne.Wichmann@radboudumc.nl., van Dam H; Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands., Thoonsen B; Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands., Boer TA; Section Ethics, University Kampen, Kampen, The Netherlands., Engels Y; Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands., Groenewoud AS; Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands.

المصدر: BMC family practice [BMC Fam Pract] 2018 Nov 28; Vol. 19 (1), pp. 184. Date of Electronic Publication: 2018 Nov 28.

نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

مواضيع طبية MeSH: Attitude of Health Personnel* , Communication* , Physician-Patient Relations* , Qualitative Research*, Advance Care Planning/*organization & administration , General Practitioners/*standards , Palliative Care/*organization & administration, Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Practice Patterns, Physicians' ; Young Adult

مستخلص: Background: Although it is often recommended that general practitioners (GPs) initiate advance care planning (ACP), little is known about their experiences with ACP. This study aimed to identify GP experiences when conducting ACP conversations with palliative patients, and what factors influence these experiences.
Methods: Dutch GPs (N = 17) who had participated in a training on timely ACP were interviewed. Data from these interviews were analysed using direct content analysis.
Results: Four themes were identified: ACP and society, the GP's perceived role in ACP, initiating ACP and tailor-made ACP. ACP was regarded as a 'hot topic'. At the same time, a tendency towards a society in which death is not a natural part of life was recognized, making it difficult to start ACP discussions. Interviewees perceived having ACP discussions as a typical GP task. They found initiating and timing ACP easier with proactive patients, e.g. who are anxious of losing capacity, and much more challenging when it concerned patients with COPD or heart failure. Patients still being treated in hospital posed another difficulty, because they often times are not open to discussion. Furthermore, interviewees emphasized that taking into account changing wishes and the fact that not everything can be anticipated, is of the utmost importance. Moreover, when patients are not open to ACP, at a certain point it should be granted that choosing not to know, for example about where things are going or what possible ways of care planning might be, is also a form of autonomy.
Conclusions: ACP currently is a hot topic, which has favourable as well as unfavourable effects. As GPs experience difficulties in initiating ACP if patients are being treated in the hospital, future research could focus on a multidisciplinary ACP approach and the role of medical specialists in ACP. Furthermore, when starting ACP with palliative patients, we recommend starting with current issues. In doing so, a start can be made with future issues kept in view. Although the tension between ACP's focus on the patient's direction and the right not to know can be difficult, ACP has to be tailored to each individual patient.

المؤلفون: Hackett J; Martin House Research Centre, Social Policy Research Unit, University of York, York, YO10 5DD, UK. julia.hackett@york.ac.uk., Ziegler L; Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK., Godfrey M; Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK., Foy R; Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK., Bennett MI; Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK.

المصدر: BMC family practice [BMC Fam Pract] 2018 Nov 20; Vol. 19 (1), pp. 177. Date of Electronic Publication: 2018 Nov 20.

نوع المنشور: Journal Article; Multicenter Study; Observational Study; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

مواضيع طبية MeSH: Qualitative Research*, Delivery of Health Care/*methods , Neoplasms/*therapy , Palliative Care/*organization & administration, Humans ; Morbidity/trends ; Neoplasms/epidemiology ; United Kingdom/epidemiology

مستخلص: Background: Primary health care teams are key to the delivery of care for patients with advanced cancer during the last year of life. The Gold Standards Framework is proposed as a mechanism for coordinating and guiding identification, assessment, and support. There are still considerable variations in practice despite its introduction. The aim of this qualitative study is to improve understanding of variations in practice through exploring the perspectives and experiences of members of primary health care teams involved in the care of patients with advanced cancer.
Methods: Qualitative, semi-structured interviews, focus groups, and non-participatory observations involving 67 members of primary health care teams providing palliative care. Data were analysed using a grounded theory approach.
Results: We identified distinct differences in the drivers and barriers of community advanced cancer care coordination, which relate to identification and management, and access to effective pain management, and go some way to understanding variations in practice. These include proactive identification processes, time and resource pressures, unclear roles and responsibilities, poor multidisciplinary working, and inflexible models for referral and prescribing. These provide valuable insight into how professionals work together and independently within an infrastructure that can both support and hinder the provision of effective community palliative care.
Conclusions: Whilst the GSF is a guide for good practice, alone it is not a mechanism for change. Rather it provides a framework for describing quality of practice that was already occurring. Consequently, there will continue to be variations in practice.

المؤلفون: Chew-Graham CA; Research Institute, Primary Care and Health Sciences, Keele University, Newcastle, Staffs, ST5 5BG, UK. c.a.chew-graham@keele.ac.uk., Shepherd T; Research Institute, Primary Care and Health Sciences, Keele University, Newcastle, Staffs, ST5 5BG, UK., Burroughs H; Research Institute, Primary Care and Health Sciences, Keele University, Newcastle, Staffs, ST5 5BG, UK., Dixon K; Research Institute, Primary Care and Health Sciences, Keele University, Newcastle, Staffs, ST5 5BG, UK., Kessler D; Centre for Academic Primary Care, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK.

المصدر: BMC family practice [BMC Fam Pract] 2018 Dec 14; Vol. 19 (1), pp. 197. Date of Electronic Publication: 2018 Dec 14.

نوع المنشور: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

مواضيع طبية MeSH: Qualitative Research*, Antidepressive Agents/*therapeutic use , Depression/*drug therapy , General Practice/*standards , General Practitioners/*standards , Medication Adherence/*statistics & numerical data, Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Surveys and Questionnaires

مستخلص: Background: Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease. The number of prescriptions for antidepressants has risen dramatically in recent years yet up to 50% of patients who are treated for depression with antidepressants do not report feeling better as a result of treatment, and do not show the desired improvement on depression measures. We report a qualitative study embedded in a trial of second antidepressant for people who had not responded to one antidepressant, exploring the acceptability of a combination of antidepressants from the perspectives of both patients and practitioners, together with experiences of participating in a clinical trial.
Methods: A qualitative study embedded in a randomized controlled trial investigating the effectiveness and cost-effectiveness of combining mirtazapine with Serotonin-Noradrenaline Reuptake Inhibitor (SNRI) or Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants versus SNRI or SSRI therapy alone (the MIR trial). 59 interviews were conducted with people who declined to participate in the trial, people who completed the study and people who withdrew from the intervention, and 16 general practitioners.
Results: Across the data-sets, four main themes were identified: the hard work of managing depression, uncertainties over the value of a second antidepressant, help-seeking at a point of crisis, and attainment and maintenance of a hard-won equilibrium.
Conclusions: Exploring reasons for declining to participate in a trial of a second antidepressant in people who had not responded to one antidepressant suggests that people who are already taking one antidepressant may be reluctant to take a second, being wary of possible side-effects, but also being unconvinced of the logic behind such a combination. In addition, people describe being in a state of equilibrium and reluctant to make a change, reflecting that this equilibrium is 'hard-won' and they are unwilling to risk disturbing this. This makes some people reluctant to enrol in a clinical trial. Understanding a patient's view on medication is important for GPs when discussing antidepressants.
Trial Registration: MIR Trial Registration: ISRCTN 06653773 .

المؤلفون: Westland H; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, HP Str. 6.131, PO 85500, 3508, GA, Utrecht, The Netherlands. H.Westland@umcutrecht.nl., Koop Y; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands., Schröder CD; Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands., Schuurmans MJ; Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Slabbers P; Department of Acute Psychiatry, Psychiatric Center GGZ Central, Amersfoort, The Netherlands., Trappenburg JCA; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, HP Str. 6.131, PO 85500, 3508, GA, Utrecht, The Netherlands., Vervoort SCJM; Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.

المصدر: BMC family practice [BMC Fam Pract] 2018 Dec 12; Vol. 19 (1), pp. 194. Date of Electronic Publication: 2018 Dec 12.

نوع المنشور: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

مواضيع طبية MeSH: Attitude of Health Personnel* , Qualitative Research*, Behavior Therapy/*methods , Cardiovascular Diseases/*nursing , Exercise/*physiology , Primary Health Care/*methods , Self-Management/*methods, Adult ; Cardiovascular Diseases/physiopathology ; Cardiovascular Diseases/psychology ; Feasibility Studies ; Female ; Follow-Up Studies ; Health Behavior ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Reduction Behavior ; Time Factors ; Treatment Outcome ; Young Adult

مستخلص: Background: Self-management support is widely accepted for the management of chronic conditions. Self-management often requires behaviour change in patients, in which primary care nurses play a pivotal role. To support patients in changing their behaviour, the structured behaviour change Activate intervention was developed. This intervention aims to enhance physical activity in patients at risk for cardiovascular disease in primary care as well as to enhance nurses' role in supporting these patients. This study aimed to evaluate nurses' perceptions towards the delivery and feasibility of the Activate intervention.
Methods: A qualitative study nested within a cluster-randomised controlled trial using semistructured interviews was conducted and thematically analysed. Fourteen nurses who delivered the Activate intervention participated.
Results: Three key themes emerged concerning nurses' perceptions of delivering the intervention: nurses' engagement towards delivering the intervention; acquiring knowledge and skills; and dealing with adherence to the consultation structure. Three key themes were identified concerning the feasibility of the intervention: expectations towards the use of the intervention in routine practice; perceptions towards the feasibility of the training programme; and enabling personal development.
Conclusions: Delivering a behaviour change intervention is challenged by the complexity of changing nurses' consultation style, including acquiring corresponding knowledge and skills. The findings have increased the understanding of the effectiveness of the Activate trial and will guide the development and evaluation of future behaviour change interventions delivered by nurses in primary care.
Trial Registration: ClinicalTrials.gov NCT02725203 .

المؤلفون: Mitsuyama T; Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan., Son D; Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. sondtky@gmail.com., Eto M; Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.

المصدر: BMC family practice [BMC Fam Pract] 2018 Nov 29; Vol. 19 (1), pp. 186. Date of Electronic Publication: 2018 Nov 29.

نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

مواضيع طبية MeSH: Clinical Competence* , Qualitative Research* , Rural Population* , Urban Population*, Community Health Services/*organization & administration , General Practitioners/*standards , Physicians, Family/*standards, Adult ; Female ; Humans ; Japan ; Male ; Primary Health Care/standards ; Retrospective Studies

مستخلص: Background: The medical practice of general practitioners/family physicians in urban areas differs from that in rural areas, accounting for the difference in specific competencies. However, variations in competencies in community healthcare required for general practitioners/family physicians in urban areas compared with those in rural areas have not yet been fully clarified. Thus, this study aimed to elucidate the competencies required for general practitioners/family physicians, especially in those characteristic to urban areas, and compare them with those in non-urban/rural areas.
Methods: A qualitative study with individual interviews and qualitative data analysis was conducted. Participants were selected by purposive sampling, and 10 general practitioners/family physicians with clinical experience of ≥7 y after graduation and ≥ 1 y in both urban and non-urban (rural) areas in Japan were recruited. Additionally, semi-structured individual interviews in a private room around the workplace of the interviewee between September 2014 and September 2016 were conducted. For data collection, interview transcripts were analyzed according to the "Steps for Coding and Theorization" method, a sequential and thematic qualitative data analysis technique and data analysis since March 2018.
Results: We interviewed 10 general practitioners/family physicians of Japan and extracted 10 themes as competencies characteristic to general practitioners/family physicians in urban areas. In addition to the known competencies on urban underserved care, we newly clarified the competencies of the ability to integrate divided care and ability to coordinate and collaborate with various medical care and welfare professionals in urban areas.
Conclusion: This study was one of the few studies describing the characteristic competencies of urban general practitioners. In summary, a competency necessary for general practitioners in urban areas is to understand the urban context and provide contextual care suitable for urban areas. In the modern age, where urban population concentration is progressing and the interest in urban health is rising, our study will give certain suggestions for primary care education and practice necessary for urban areas.

المؤلفون: Moult A; Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. a.moult@keele.ac.uk., Burroughs H; Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK., Kingstone T; Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.; South Staffordshire and Shropshire NHS Foundation Trust, Stafford, ST16 3SR, UK., Chew-Graham CA; Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.; West Midlands Collaboration for Leadership in Applied Health Research and Care, West Midlands, UK.

المصدر: BMC family practice [BMC Fam Pract] 2018 Nov 29; Vol. 19 (1), pp. 185. Date of Electronic Publication: 2018 Nov 29.

نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

مواضيع طبية MeSH: Communication* , Internet* , Qualitative Research*, Anxiety Disorders/*therapy , General Practitioners/*standards , Self-Management/*methods, Aged ; Aged, 80 and over ; Anxiety Disorders/epidemiology ; England/epidemiology ; Female ; Humans ; Male ; Prevalence

مستخلص: Background: Anxiety and depression are common in older adults, but often under-recognised by GPs. Rather than perceiving themselves as suffering from anxiety or depression, older adults are more likely to self-identify as experiencing low mood, stress or distress. Older people may also feel responsible for managing their own mood problems. The Internet has the potential to support the self-management of distress through accessing health information or social support.
Methods: This study was approved by Keele University's ethical review panel. Older adults who self-identified as experiencing distress were recruited from community groups in the West Midlands, England. To generate data, 'think-aloud' methods (including storyboards and an extract from an online forum) were embedded within semi-structured interviews. Thematic analysis, incorporating constant comparison methods, were used for data analysis.
Results: Data saturation was achieved after 18 interviews. All participants reported having access to the Internet, but only a few described using the Internet to obtain general information or to conduct online purchases. Most participants described barriers to Internet use which included: a lack of interest, knowledge and confidence, a fear of technology and no trust in social media sites. Facilitators of Internet use included family encouragement and attending community groups which taught computer use. Female participants reported valuing the social contact provided by attending such groups. The Internet was seen as a source of health information once a GP had diagnosed a physical problem, but was not considered a source of information about distress or mood problems. Participants did not use the Internet to access social support and described a preference for face-to-face communication.
Conclusions: GPs need to understand how an individual patient utilises the Internet. GPs should explore the self-management strategies already employed by older adults experiencing distress and understand that directing these older people to online support might not be acceptable. Encouraging distressed older adults to attend computer group classes might be useful as this permits face-to-face social contact, and may help to facilitate Internet use in the future.

المؤلفون: Gordon I; Faculty of Health Sciences and Wellbeing, University of Sunderland, City Campus Chester Road, Sunderland, SR1 3SD, UK. I.Gordon@sunderland.ac.uk., Ling J; Faculty of Health Sciences and Wellbeing, University of Sunderland, City Campus Chester Road, Sunderland, SR1 3SD, UK., Robinson L; Newcastle University Institute for Ageing and Institute for Health & Society, Newcastle University, Newcastle upon Tyne, NE4 5PL, England., Hayes C; Faculty of Health Sciences and Wellbeing, University of Sunderland, City Campus Chester Road, Sunderland, SR1 3SD, UK., Crosland A; Faculty of Health Sciences and Wellbeing, University of Sunderland, City Campus Chester Road, Sunderland, SR1 3SD, UK.

المصدر: BMC family practice [BMC Fam Pract] 2018 Nov 03; Vol. 19 (1), pp. 173. Date of Electronic Publication: 2018 Nov 03.

نوع المنشور: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

مواضيع طبية MeSH: Attitude of Health Personnel* , Qualitative Research*, Depression/*diagnosis , Primary Health Care/*methods, Aged ; Communication ; Depression/psychology ; Female ; Humans ; Male

مستخلص: Background: Older people can struggle with revealing their depression to GPs and verbalising preferences regarding its management. This contributes to problems for GPs in both detecting and managing depression in primary care. The aim of this study was to explore older people's accounts of how they talk about depression and possible symptoms to improve communication about depression when seeing GPs.
Methods: Adopting a qualitative Interpretivist methodological approach, semi-structured interviews were conducted by IG based on the principles of grounded theory and situational analysis. GPs working in north east England recruited patients aged over 65 with depression. Data analysis was carried out with a process of constant comparison, and categories were developed via open and axial coding and situational maps. There were three levels of analysis; the first developed open codes which informed the second level of analysis where the typology was developed from axial codes. The typology derived from second level analysis only is presented here as older people's views are rarely reported in isolation.
Results: From the sixteen interviews with older people, it was evident that there were differences in how they understood and accepted their depression and that this influenced what they shared or withheld in their narratives. A typology showing three categories of older people was identified: those who appeared to talk about their depression freely yet struggled to accept aspects of it (Superficial Accepter), those who consolidated their ideas about depression aloud (Striving to Understand) and those who shared minimal detail about their depression and viewed it as part of them rather than a treatable condition (Unable to Articulate). The central finding was that older people's acceptance and understanding of their depression guided their depression narratives.
Conclusions: This study identified differences between older people in ways they understand, accept and share their depression. Recognising that their depression narratives can change and listening for patterns in what older people share or withhold may help GPs in facilitating communication to better understand the patient when they need to implement alternative approaches to patient management.