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BMJ Open Sep 2023The implementation of outpatient training in primary care settings is an essential part of residency training for general practitioner (GP) residents. However, limited...
OBJECTIVES
The implementation of outpatient training in primary care settings is an essential part of residency training for general practitioner (GP) residents. However, limited research exists on their experiences and perceptions of this training. This study aimed to explore the experiences and perceptions of GP residents regarding outpatient training in primary care settings in China and provide insights and recommendations to enhance training quality.
DESIGN
A qualitative descriptive study employing in-depth interviews.
SETTING
Two community healthcare centres (CHCs) that implement outpatient training programmes for GP residents in Zhejiang Province, China.
PARTICIPANTS
In total, 20 GP residents affiliated with 14 CHCs and two hospitals across Zhejiang Province and Guizhou Province who had completed outpatient training in either CHC for over 1 month.
RESULTS
Of the 20 participants in this study, 11 (55%) were women, and the mean age was 28 years. GP residents completed the process of consultation, physical examination and therapy independently; subsequently, the community preceptors provided feedback based on their clinical performance and modelled their clinical skills. The benefits perceived by GP residents included improved clinical skills and confidence in practice, and they learned approaches to maintaining good relationships with patients. They preferred dealing with complex cases, discussions with peers and the indirect supervision of community preceptors in the training session. Residents recommended that measures be taken to improve the training quality regarding patient selection and recruitment, clinical skills in the training session, and assessment of clinical performance.
CONCLUSIONS
The outpatient training in primary care settings provides constructive opportunities for GP residents to improve their professional competencies. Although the current training sessions and the abilities of community preceptors largely satisfy the needs of GP residents, further research is needed to evaluate the effectiveness of training and explore approaches to improve its quality.
Topics: Humans; Female; Adult; Male; Outpatients; General Practitioners; Learning; China; Primary Health Care
PubMed: 37714679
DOI: 10.1136/bmjopen-2023-076821 -
Heliyon Oct 2023University-Industry collaboration as a driver of digital transformation ultimately depends on the engagement and relationship between individual academics and industry...
University-Industry collaboration as a driver of digital transformation ultimately depends on the engagement and relationship between individual academics and industry practitioners as partners in a trust relationship. This paper describes the personal ('lived') experiences of academics and industry practitioners. The types, benefits, and enablers of the collaboration were investigated during semi-structured face-to-face interviews with industry partners and academic staff from the Science, Technology, Engineering and Mathematics (STEM) unit at the University of Enterprise in Australia. The types of collaboration included research activities, sharing facilities and equipment, innovation and commercialisation, collaboration involving students projects, collaborative teaching and learning, and sharing facilities and equipment. The benefits of the collaboration include access to valuable resources, validation of work, learning and teaching opportunities, financial benefits, improved reputation and career progression. The enablers of collaboration have been clustered into institutional, output, framework, and relationship factors. In this paper we focus on relationship factors and institutional enablers such as stakeholder engagement. The research is represented in a UA-IP Collaboration Model indicating the types (what), benefits (why), and enablers (how) of academic-practitioner collaboration. Universities and businesses from a variety of industries can benefit from the results of the presented research.
PubMed: 37867890
DOI: 10.1016/j.heliyon.2023.e21017 -
Nursing Open Jul 2024To examine changes in advanced nurse practitioner (ANP) well-being, satisfaction and motivation over a four-year period. (Review)
Review
AIMS
To examine changes in advanced nurse practitioner (ANP) well-being, satisfaction and motivation over a four-year period.
DESIGN
Longitudinal Cohort study.
METHODS
Surveys were carried out each year from 2019 to 2022 with the same cohort of ANPs in the United Kingdom (UK). The survey consisted of demographics, questions on contemporary issues in advanced practice, National Health Service (NHS) staff survey questions and validated questionnaires. A core set of questions were asked every year with some changes in response to the COVID-19 pandemic.
RESULTS
Response rate ranged from 40% to 59% and appeared to be affected by COVID-19. Staff satisfaction with pay and the well-being score were stable throughout. Other questions on well-being, job satisfaction and motivation saw statistically significant reductions after 4 years. Open-ended questions about ongoing well-being concerns show participants are concerned about exhaustion levels caused by workload, staffing issues, abuse from patients and colleagues' mental health.
CONCLUSION
The findings highlight a decline in ANP well-being, job satisfaction and motivation post-COVID-19. Reasons for this, explored in the qualitative data, show that ANPs have faced extremely difficult working conditions. Urgent action is required to prevent a workforce retention crisis as many nursing staff are close to retirement and may not be motivated to remain in post.
IMPACT
This study has followed ANPs through the most challenging years the NHS has ever seen. Job satisfaction, motivation and enjoyment of the job all significantly reduced over time. In many areas, the ANP role has been used to fill medical workforce gaps, and this will become harder to do if ANPs are dissatisfied, disaffected and struggling with stress and burnout. Addressing these issues should be a priority for policymakers and managers.
PATIENT OR PUBLIC CONTRIBUTION
None as this study focussed on staff. Staff stakeholders involved in the design and conduct of the study.
Topics: Humans; Job Satisfaction; COVID-19; United Kingdom; Nurse Practitioners; Female; Male; Longitudinal Studies; Surveys and Questionnaires; Adult; Middle Aged; SARS-CoV-2; Motivation; Cohort Studies; State Medicine; Pandemics; Workload; Burnout, Professional
PubMed: 38940475
DOI: 10.1002/nop2.2218 -
Environmental Research Nov 2023Residing in areas with lower levels of air pollution and higher green space is beneficial to physical and mental health. We investigated associations of PM, tree cover...
Association of air pollution and green space with all-cause general practitioner and emergency room visits: A cross-sectional study of young people and adults living in Belgium.
BACKGROUND
Residing in areas with lower levels of air pollution and higher green space is beneficial to physical and mental health. We investigated associations of PM, tree cover and grass cover with in-hours and out-of-hours GP visits and ER visits, for young people and adults. We estimated potential cost savings of GP visits attributable to high PM.
METHODS
We linked individual-level health insurance claims data of 315,123 young people (10-24 years) and 885,988 adults (25-64 years) with census tract-level PM, tree cover and grass cover. Deploying negative binomial generalized linear mixed models, we estimated associations between quartile exposures and the three outcome measures.
RESULTS
For in-hours and out-of-hours GP visits, among young people as well as adults, statistically significant pairwise differences between quartiles suggested increasing beneficial effects with lower PM. The same outcomes were statistically significantly less frequent in quartiles with highest tree cover (>30.00%) compared to quartiles with lower tree cover, but otherwise pairwise differences were not statistically significant. These associations largely persisted in rural and urban areas. Among adults living in urban areas lower grass cover was associated with increased in-hours GP visits and ER visits. Assuming causality, reducing PM levels to the lowest quartile (4.91-7.49 μg/m³), among adults, 195,964 in-hours and 74,042 out-of-hours GP visits could be avoided annually. Among young people, 27,457 in-hours and 22,423 out-of-hours GP visits could be avoided annually. Nationally, this amounts to an annual potential cost saving of €43 million (€5.7 million in out-of-pocket payments and €37.2 million in compulsory health insurance).
CONCLUSION
Higher ambient PM and lower tree cover show associations with higher non-urgent and urgent medical care utilization. These findings confirm the importance of reducing air pollution and fostering green zones, and that such policies may contribute positively to economic growth.
Topics: Humans; Adult; Adolescent; Air Pollutants; Cross-Sectional Studies; Particulate Matter; Belgium; Parks, Recreational; General Practitioners; Environmental Exposure; Air Pollution; Emergency Service, Hospital
PubMed: 37481061
DOI: 10.1016/j.envres.2023.116713 -
BMJ Open Quality Oct 2023Potentially inappropriate medicine prescriptions and low-value diagnostic testing pose risks to patient safety and increases in health system costs. The aim of the... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Potentially inappropriate medicine prescriptions and low-value diagnostic testing pose risks to patient safety and increases in health system costs. The aim of the Clinical and Healthcare Improvement through My Health Record usage and Education in General Practice study was to evaluate a scalable online quality improvement intervention, integrating online education regarding a national shared electronic health record and rational prescribing, pathology and imaging ordering by Australian general practitioners (GPs).
METHODS
The study was a parallel three-arm randomised trial comprising a prescribing education arm, a pathology education arm and an imaging education arm. Currently practising GPs in Australia were eligible to participate and randomised on a 1:1:1 basis to the study arms after consenting. The response to the intervention in reducing potentially unnecessary medicine prescriptions and tests in each arm was assessed using the other two arms as controls. The primary outcome was the cost per 100 consultations of predefined medication prescriptions, pathology and radiology test ordering 6 months following the intervention, compared with 6 months prior. Outcomes were assessed on intention-to-treat and post hoc per-protocol bases using multilevel regression models, with the analysts blinded to allocation.
RESULTS
In total, 106 GPs were enrolled and randomised (prescribing n=35, pathology n=36, imaging n=35). Data were available for 97 GPs at the end of trial (prescribing n=33, pathology n=32, imaging n=32) with 44 fully completing the intervention. In intention-to-treat analysis, there were no significant differences in the rates of change in costs across the three arms. Per protocol, there was a statistically significant difference in the rate of change in pathology costs (p=0.03). In the pathology arm, the rate of increase in pathology costs was significantly lower by $A187 (95% CI -$A340, -$A33) than the prescribing arm, and non-significantly $A9 (95% CI -$A128, $A110) lower than the imaging arm.
DISCUSSION
This study provides some evidence for reductions in costs for low-value pathology test ordering in those that completed the relevant online education. The study experienced slow uptake and low completion of the education intervention during the COVID-19 pandemic. Changes were not significant for the primary endpoint, which included all participants. Improving completion rates and combining real-time feedback on prescribing or test ordering may increase the overall effectiveness of the intervention. Given the purely online delivery of the education, there is scope for upscaling the intervention, which may provide cost-effectiveness benefits.
TRIAL REGISTRATION NUMBER
ACTRN12620000010998.
Topics: Humans; General Practitioners; COVID-19; Education, Distance; Pandemics; Australia
PubMed: 37857521
DOI: 10.1136/bmjoq-2023-002351 -
Diabetes Therapy : Research, Treatment... Jul 2024Despite insulin being a lifesaving medication, insulin distress, insulin hesitancy, and insulin inertia remain oft-repeated themes in diabetes discourse. The current...
Despite insulin being a lifesaving medication, insulin distress, insulin hesitancy, and insulin inertia remain oft-repeated themes in diabetes discourse. The current model lists three issues: temperament, troublesomeness, and technicality, which contribute to insulin perceptions. Therapeutic patienteducation (TPE), value-added therapy (VAT), and medication counseling are concepts that assist in optimizing insulin perceptions. Insulin icodec is a basal insulin with a half-life of 196 h and a once-weekly or circaseptan frequency of administration. Insulin icodec reduces the frequency of basal insulin administration to one-seventh, which along with the lower requirement of glucose monitoring, reduces the burden of plastic and ancillary supply disposal. Because of its unique frequency of injection, insulin icodec usage requires appropriate counseling and education. This reader-friendly counseling guide helps practitioners offer VAT, as well as TPE while prescribing icodec and other insulins.
PubMed: 38743307
DOI: 10.1007/s13300-024-01600-y -
Journal of Professional Nursing :... 2023A diverse nursing workforce is key to addressing health disparities and moving the United States towards health equity. Building and sustaining a diverse nursing work...
A diverse nursing workforce is key to addressing health disparities and moving the United States towards health equity. Building and sustaining a diverse nursing work force requires close attention to admissions, including interviews. Bias in nursing school interviews has been documented, particularly impacting applicants from historically excluded groups (especially racial and ethnic minorities). With the pivot to remote interviews due to Covid 19, faculty and schools now need to consider bias in remote interviews. This article describes the implementation and outcomes of a faculty training to identify and mitigate bias in remote interviews.
Topics: Humans; United States; Nurse Practitioners; Schools, Nursing; Faculty
PubMed: 38042549
DOI: 10.1016/j.profnurs.2023.09.008 -
Australian Journal of General Practice Jun 2024General practitioners manage a significant proportion of inflammatory and neoplastic skin conditions on a daily basis. Various surgical techniques can be employed to aid...
BACKGROUND
General practitioners manage a significant proportion of inflammatory and neoplastic skin conditions on a daily basis. Various surgical techniques can be employed to aid in diagnosis, including punch biopsies, shave biopsy, shave excision, incisional biopsy, curettage and formal excision with closure. Requiring minimal equipment, shave procedures are quick to perform, produce good cosmetic outcomes and minimise costs.
OBJECTIVE
Our aim is to discuss shave procedures in detail and highlight the difference between shave biopsies and shave excisions, as well as the role they each have in diagnosing an array of benign, inflammatory and malignant skin conditions, including melanocytic lesions.
DISCUSSION
Shave procedures performed on suitable lesions by trained practitioners can be used for sampling or removing suspect lesions. Where the intent is complete removal, margin involvement is rare given good lesion selection and technique.
Topics: Humans; General Practice; Biopsy; Skin Diseases
PubMed: 38840380
DOI: 10.31128/AJGP-06-23-6872 -
Risk Management and Healthcare Policy 2023After 75 years of reformed practice, general practitioners (GPs) in the UK have transformed from health gatekeepers who simply provide medical decision-making such as...
After 75 years of reformed practice, general practitioners (GPs) in the UK have transformed from health gatekeepers who simply provide medical decision-making such as diagnostic and treatment services and referral services, to health agents who proactively provide more relevant health services such as immunizations, health monitoring and health management, etc. In order to discuss this transformation of the role of the general practitioner and the conditions for the evolution of the role, this study chose the documentary analysis method to provide a comprehensive overview of the legal and normative documents related to the general practitioner. Furthermore, this study uses a comparative analysis method to conclude the definition and role characteristics of GPs as health agents. This study summarises the general pattern of evolution of GPs into health agents. The transformation into a health agent relies on the interpersonal trust and rigorous institutional of society on the general practitioner system. The expansion of GPs' clientele and range of services, together with the motivation to proactively provide services, have combined to push for a "qualitative change" in the GP's role as health agent. The transformation of the role of the general practitioner to a health agent is a historical necessity. It responds to the evolution of society's understanding of health and the need for higher levels of health. Therefore, recognizing the role of GPs as health agents is important for optimizing the use of health care resources and improving the health of society by taking advantage of this role.
PubMed: 37750073
DOI: 10.2147/RMHP.S416934 -
JMIR Medical Education Jul 2023Supporting patients to live well by optimizing behavior is a core tenet of primary health care. General practitioners and practice nurses experience barriers in...
BACKGROUND
Supporting patients to live well by optimizing behavior is a core tenet of primary health care. General practitioners and practice nurses experience barriers in providing behavior change interventions to patients for lifestyle behaviors, including low self-efficacy in their ability to enact change. Web-based learning technologies are readily available for general practitioners and practice nurses; however, opportunities to upskill in behavior change are still limited. Understanding what influences general practitioners' and practice nurses' adoption of web-based learning is crucial to enhancing the quality and impact of behavior change interventions in primary health care.
OBJECTIVE
This study aimed to explore general practitioners' and practice nurses' perceptions regarding web-based learning to support patients with behavior change.
METHODS
A qualitative, cross-sectional design was used involving web-based, semistructured interviews with general practitioners and practice nurses in Queensland, Australia. The interviews were recorded and transcribed using the built-in Microsoft Teams transcription software. Inductive coding was used to generate codes from the interview data for thematic analysis.
RESULTS
In total, there were 11 participants in this study, including general practitioners (n=4) and practice nurses (n=7). Three themes emerged from the data analysis: (1) reflecting on the provider of the Healthy Lifestyles suite; (2) valuing the web-based learning content and presentation; and (3) experiencing barriers and facilitators to using the Healthy Lifestyles suite.
CONCLUSIONS
Provider reputation, awareness of availability, resources, content quality, usability, cost, and time influence adoption of web-based learning. Perceived quality is associated with culturally tailored information, resources, a balance of information and interactivity, plain language, user-friendly navigation, appealing visual presentation, communication examples, and simple models. Free web-based learning that features progress saving and module lengths of less than 2 hours alleviate perceived time and cost barriers. Learning providers may benefit by including these features in their future behavior change web-based learning for general practitioners and practice nurses.
PubMed: 37498657
DOI: 10.2196/45587