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Tebartz van Elst H, Niehoff C, Steinhäuser J. Motives and modifying factors for giving or rejecting psychiatric diagnoses in general medicine and psychiatry - a qualitative interview study. BMC Psychiatry 2024; 24:461. [PMID: 38902699 PMCID: PMC11188242 DOI: 10.1186/s12888-024-05900-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 06/07/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND There is a discussion among general practitioners and psychiatrists regarding over-diagnosing versus under-reporting of psychiatric diagnoses. A deeper understanding of this topic is relevant for providing reasonable health care and for planning future studies. A crucial factor to understanding this discussion is the difference in the prevalence of a disease in each sector. One way to attain knowledge about such prevalences is the analysis of routine care data of the sector in question. However, diagnosis-related data might be modified by several additional influencing factors. AIMS This study aims to explore what kind of motives and modifying factors play a role for or against giving psychiatric diagnoses in psychiatric and general medical settings. METHODS Twenty-six semi-structured interviews were conducted with German physicians in the fields of general medicine and psychiatry. Interviews were analysed using content analysis. RESULTS The analysis revealed three major motivational categories for finding a diagnosis: (1) "objective matters" such as "categorisation for research"; (2) "functional and performance-related factors" such as "requirement for medication", "billing aspects" that go with certain diagnoses or "access to adequate care" and (3) "Individual factors" such as the "personality of a physician". Similarly, factors emerged that lead to not making psychiatric diagnoses like "fear of stigmatization among patients" or "detrimental insurance status with psychiatric diagnosis". Additionally participants mentioned other reasons for "not diagnosing a psychiatric diagnosis", such as "coding of other clinical pictures". CONCLUSION The diagnostic process is a complex phenomenon that goes far beyond the identification of medical findings. This insight should be considered when processing and interpreting secondary data for designing health care systems or designing a study.
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Affiliation(s)
- Hannah Tebartz van Elst
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Campus Lübeck, Germany.
| | - Claudia Niehoff
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Campus Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Campus Lübeck, Germany
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Cruvinel PVQ, Grosseman S. [In the final analysis, who is "problematic"? An integrative review of patients, physicians and problematic relationships]. CIENCIA & SAUDE COLETIVA 2023; 28:1685-1701. [PMID: 37255146 DOI: 10.1590/1413-81232023286.16812022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/09/2023] [Indexed: 06/01/2023] Open
Abstract
The scope of this study was to assess the literature on the characteristics of patients, physicians, and physician-patient relationships considered 'problematic.' An integrative review of primary studies published between January 1, 2016, and September 30, 2021, in Portuguese, English and Spanish was conducted, Of the 3,414 papers identified in the PubMed, Embase, Scopus and Lilacs databases, 19 were selected for qualitative analysis. Seven studies were carried out in Europe, eight in North America, two in South America and two in China, totaling 1,694 patients, 1,903 assistant physicians, 101 residents and 160 medical academics. Physicians and academics considered the following to be problematic: patients with clinical conditions such as psychosomatic and chronic illnesses; symptoms and complaints such as pain; powerful emotions; problems in obtaining and sharing information, in decision-making, in the adherence to the therapeutic plan and in their self-care; and some sociodemographic and vulnerability characteristics. Among other aspects, patients, or their relatives, considered physicians to be problematic when they did not listen to them or appear to care about their children, Teaching medical communication and systemic interventions are recommended to improve physician-patient relationships.
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Affiliation(s)
| | - Suely Grosseman
- Departamento de Pediatria, Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina. Hospital Universitário Polydoro Ernani de São Thiago, Campus Universitário, R. Professora Maria Flora Pausewang s/n, Trindade. 88036-800. Florianópolis SC Brasil.
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Tamura H, Shikino K, Sogai D, Yokokawa D, Uchida S, Li Y, Yanagita Y, Yamauchi Y, Kojima J, Ishizuka K, Tsukamoto T, Noda K, Uehara T, Imaizumi T, Kataoka H, Ikusaka M. Association Between Physician Empathy and Difficult Patient Encounters: a Cross-Sectional Study. J Gen Intern Med 2023; 38:1843-1847. [PMID: 36385409 PMCID: PMC10271945 DOI: 10.1007/s11606-022-07936-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Physicians frequently experience patients as difficult. Our study explores whether more empathetic physicians experience fewer patient encounters as difficult. OBJECTIVE To investigate the association between physician empathy and difficult patient encounters (DPEs). DESIGN Cross-sectional study. PARTICIPANTS Participants were 18 generalist physicians with 3-8 years of experience. The investigation was conducted from August-September 2018 and April-May 2019 at six healthcare facilities. MAIN MEASURES Based on the Jefferson Scale of Empathy (JSE) scores, we classified physicians into low and high empathy groups. The physicians completed the Difficult Doctor-Patient Relationship Questionnaire-10 (DDPRQ-10) after each patient visit. Scores ≥ 31 on the DDPRQ-10 indicated DPEs. We implemented multilevel mixed-effects logistic regression models to examine the association between physicians' empathy and DPE, adjusting for patient-level covariates (age, sex, history of mental disorders) and with physician-level clustering. KEY RESULTS The median JSE score was 114 (range: 96-126), and physicians with JSE scores 96-113 and 114-126 were assigned to low and high empathy groups, respectively (n = 8 and 10 each); 240 and 344 patients were examined by physicians in the low and high empathy groups, respectively. Among low empathy physicians, 23% of encounters were considered difficulty, compared to 11% among high empathy groups (OR: 0.37; 95% CI = 0.19-0.72, p = 0.004). JSE scores and DDPRQ-10 scores were negatively correlated (r = -0.22, p < 0.01). CONCLUSION Empathetic physicians were less likely to experience encounters as difficult. Empathy appears to be an important component of physician perception of encounter difficulty.
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Affiliation(s)
- Hiroki Tamura
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan.
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Daichi Sogai
- Department of General Medicine, Sanmu Medical Center, Chiba, Japan
| | - Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Shun Uchida
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Yu Li
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Yasutaka Yanagita
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Yosuke Yamauchi
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Jumpei Kojima
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Kosuke Ishizuka
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Tomoko Tsukamoto
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Kazukata Noda
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Takanori Uehara
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Takahiro Imaizumi
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hitomi Kataoka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
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Shikino K, Mito T, Ohira Y, Yokokawa D, Katsuyama Y, Ota T, Sato E, Hirose Y, Yamashita S, Suzuki S, Noda K, Uehara T, Ikusaka M. Frequency of Difficult Patient Encounters in a Japanese University Hospital and Community Hospitals: A Cross-sectional Study. Intern Med 2023; 62:533-537. [PMID: 35793958 PMCID: PMC10017258 DOI: 10.2169/internalmedicine.0085-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Difficult patient encounters (DPEs) are defined as encounters with patients causing strong negative feelings in physicians. In primary care settings, DPEs account for approximately 15% of visits among outpatients. To our knowledge, this is the first epidemiological study of DPEs in Japan. Methods We conducted a survey of 8 physicians (5.0±2 years of clinical experience) who examined first-visit patients ≥15 years old with clinical symptoms at the Department of General Medicine in Chiba University Hospital and 4 community hospitals over a 2-month period since December 2015. Materials We evaluated 10-Item Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) scores (DPE ≥31 points; non-DPE ≤30 points) and patient age, sex, and presence of psychological or social problems. Results The valid response rate was 98.9% (94/95) and 98.4% (189/192) in the university and community hospitals, respectively. The percentage of DPEs was 39.8% (37/93) and 15.0% (26/173) in the university and community hospitals, respectively; the percentage of DPEs was significantly higher at the university hospital than at the community hospitals (p<0.001). The proportion of patients with psychosocial problems was significantly higher in the DPE group than in the non-DPE group (93.7% vs. 40.4%, p<0.001). Conclusion Our findings were similar to those reported in primary care settings in other countries in community hospital outpatient and general internal medicine departments, where patients are mostly non-referrals, although the values were higher in university hospital general medicine departments, where patients were mostly referrals. Patients involved in DPEs have a high rate of psychological and social problems.
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Affiliation(s)
- Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Japan
- Department of Community-based Medical Education, Graduate School of Medicine, Chiba University, Japan
| | - Tsutomu Mito
- Department of General Medicine, Chiba University Hospital, Japan
| | - Yoshiyuki Ohira
- Department of General Medicine, Chiba University Hospital, Japan
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Japan
| | - Yota Katsuyama
- Department of General Medicine, Chiba University Hospital, Japan
- Department of Community-based Medical Education, Graduate School of Medicine, Chiba University, Japan
- Department of General Medicine, Sanmu Medical Center, Japan
| | - Takahiro Ota
- Department of General Medicine, Chiba University Hospital, Japan
| | - Eri Sato
- Department of General Medicine, Chiba University Hospital, Japan
| | - Yuta Hirose
- Department of General Medicine, Chiba University Hospital, Japan
| | - Shiho Yamashita
- Department of General Medicine, Chiba University Hospital, Japan
| | - Shingo Suzuki
- Department of General Medicine, Chiba University Hospital, Japan
- Department of Internal Medicine, Chiba Central Medical Center, Japan
| | - Kazutaka Noda
- Department of General Medicine, Chiba University Hospital, Japan
| | - Takanori Uehara
- Department of General Medicine, Chiba University Hospital, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Japan
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Werdecker L, Esch T. Happiness in General Practice: Results of a Qualitative Study Among Physicians and Practice Assistants. ZFA. ZEITSCHRIFT FUR ALLGEMEINMEDIZIN 2022; 98:24-29. [PMID: 37252060 PMCID: PMC10211298 DOI: 10.53180/zfa.2022.0024-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/23/2021] [Indexed: 05/31/2023]
Abstract
Background Well-being of health care professionals is becoming more and more important. Research often focuses on deficits and health impairments. Therefore, the aim of this study was to investigate what contributes to the sense of happiness among family physicians and practice assistants. Methods Between April and October 2018, we conducted semi-structured interviews and observations with family physicians and practice assistants in North Rhine-Westphalia. The analyses followed the content-structuring, qualitative content analysis according to Kuckartz supported by the software NVivo. Results We observed in five practices and interviewed eleven family physicians and 15 practice assistants. The core topics were teamwork, relationship to patients, local roots, patient-practice-fit and effectiveness of work. Conclusions The results indicate conditions conducive to happiness. The findings may inform the development of targed-group-specific behavioural interventions (happiness training) for family physicians and practice assistants. In particular, the team and the relationship to patients should to be addressed.
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Affiliation(s)
- Lena Werdecker
- Institut für Integrative Gesundheitsversorgung und Gesundheitsförderung, Universität Witten/Herdecke, Deutschland
| | - Tobias Esch
- Institut für Integrative Gesundheitsversorgung und Gesundheitsförderung, Universität Witten/Herdecke, Deutschland
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Werdecker L, Esch T. Burnout, satisfaction and happiness among German general practitioners (GPs): A cross-sectional survey on health resources and stressors. PLoS One 2021; 16:e0253447. [PMID: 34143849 PMCID: PMC8213182 DOI: 10.1371/journal.pone.0253447] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 06/02/2021] [Indexed: 12/21/2022] Open
Abstract
Well-being is a major issue among health care professionals, especially physicians. Less job satisfaction and impaired health can have an impact on health care quality. Our aim was to examine the association of stressors (illegitimate tasks) and health related resources (work-related sense of coherence; recovery experience) with life satisfaction, happiness, job satisfaction and burnout among German general practitioners (GPs). We conducted a cross-sectional survey among general medical practices in Germany. Main outcome measures were life satisfaction, happiness (Subjective Happiness Scale), job satisfaction (Work Satisfaction Scale) and burnout (Copenhagen Burnout Inventory). 548 GPs from across Germany participated (53.6% males, 45.6% females; mostly representative of German GPs). One third (35.2%) of the participants reported a high prevalence of personal, and one quarter (26.5%) indicated a high prevalence of work-related burnout symptoms. Illegitimate tasks are negatively associated with life and job satisfaction and are positively associated with personal, work-related and patient-related burnout among GPs. Work-SoC and recovery experience are positively associated with life satisfaction, happiness, and job satisfaction and are negatively associated with personal, work-related and patient-related burnout. Female physicians have a higher job satisfaction than male physicians. Being female and working as an employed physician is associated with a higher prevalence of personal burnout symptoms. GPs working in a group practice are happier and more satisfied with their job than GPs in single practices. Personal, work-related and patient-related burnout symptoms are stronger in GPs working in a single practice than in GPs in group practices. Our results highlight that Work-SoC, recovery experience and illegitimate tasks are important for creating work-related well-being among GPs. Introducing health promotion activities which aim to strengthen recovery experience and Work-SoC, as well as interventions to restructure tasks, may increase life satisfaction, happiness, and job satisfaction and reduce burnout symptoms in this health care profession.
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Affiliation(s)
- Lena Werdecker
- Institute for Integrative Health Care and Health Promotion, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- * E-mail:
| | - Tobias Esch
- Institute for Integrative Health Care and Health Promotion, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Tsarouha E, Preiser C, Weltermann B, Junne F, Seifried-Dübon T, Stuber F, Hartmann S, Wittich A, Rieger MA, Rind E. Work-Related Psychosocial Demands and Resources in General Practice Teams in Germany. A Team-Based Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197114. [PMID: 32998397 PMCID: PMC7579545 DOI: 10.3390/ijerph17197114] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022]
Abstract
General practices are established microenterprises in Germany providing a variety of preventive and therapeutic health care services and procedures in a challenging working environment. For example, general practice teams are confronted increasingly with work-related demands, which have been associated with poor psychological and physical outcomes. It is therefore important to gain a better understanding of issues related to occupational health and safety for personnel working in the primary care setting. This study aims to gain an in-depth understanding of psychosocial demands and resources in the primary care setting. We applied an ethnographic design, comprising a combination of participating observations, individual interviews with general practitioners (GPs) (N = 6), and focus group discussion with practice assistants and administrative staff (N = 19) in five general practices in Germany. A grounded theory approach was applied to analyze all data. Our results identified psychosocial demands and resources exemplified mainly along two typical tasks in GP practices: the issuing of medical prescriptions and blood sampling. Main psychosocial demands included factors related to work content and tasks, organization of work, and the working environment. For example, daily routines across all practices were characterized by a very high work intensity including disturbances, interruptions, delegation, and the division of labor between GPs and practice staff. Work-related resources comprised the staff’s influence on aspects related to work organization and social support. The triangulation of methods and data formats allowed the disclosure of interconnectedness between these factors. Although work processes in general practices are complex and required to comply with legal regulations, there are opportunities for practice owners and practice teams to establish working procedures in ways that reduce psychosocial risks and strengthen work-related resources.
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Affiliation(s)
- Elena Tsarouha
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
| | - Christine Preiser
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
- Centre for Public Health and Health Services Research, Core Facility for Health Services Research, University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, Faculty of Medicine, University Hospital Bonn, Venusberg-Campus. 1, 53127 Bonn, Germany;
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany; (F.J.); (T.S.-D.); (F.S.)
| | - Tanja Seifried-Dübon
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany; (F.J.); (T.S.-D.); (F.S.)
| | - Felicitas Stuber
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany; (F.J.); (T.S.-D.); (F.S.)
| | - Sigrid Hartmann
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
| | - Andrea Wittich
- Occupational Psychologist and Psychotherapist, Tuebingen, Germany;
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
| | - Esther Rind
- Institute of Occupational and Social Medicine and Health Services Research, Faculty of Medicine, University Hospital Tuebingen, Wilhelmstr. 27, 72074 Tuebingen, Germany; (E.T.); (C.P.); (S.H.); (M.A.R.)
- Correspondence:
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Schmid GL, Kühnast B, Heise M, Deutsch T, Frese T. Ultrasonography in assessing suspected bone fractures: a cross-sectional survey amongst German general practitioners. BMC FAMILY PRACTICE 2020; 21:9. [PMID: 31931750 PMCID: PMC6958739 DOI: 10.1186/s12875-020-1078-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/03/2020] [Indexed: 11/24/2022]
Abstract
Background Over the last two decades, ultrasonography (US) has been shown to be an accurate tool for the diagnosis of suspected bone fractures; however, the integration of this application of US into routine care and outpatient settings needs to be explored. In this study, we surveyed German general practitioners (GPs) to assess their knowledge, attitudes, and utilization of US for the diagnosis of suspected fractures. Methods Notification of the study, a self-designed questionnaire, and a reminder were mailed to 600 randomly selected GPs in Saxony and Saxony-Anhalt. Results The response rate was 47.7% (n = 286), and respondents did not differ from the population of all GPs in respect to sex and practice type. Among GPs surveyed, 48.6% used an US device in their practice. On average, GPs diagnosed six patients with suspected fractures per month, yet only 39.3% knew about the possibility of ultrasonographic fracture diagnosis, and only 4.3% of GPs using US applied it for this purpose. Among participants, 71.9% believed that US is inferior to conventional X-rays for the diagnosis of bony injuries. Users of US were better informed of and more commonly used US for fracture diagnosis compared to non-users. Conclusion The need to rule out possible fractures frequently arises in general practice, and US devices are broadly available. Further efforts are needed to improve the knowledge and attitudes of GPs regarding the accuracy of US for fracture diagnosis. Multicenter controlled trials could explore the safety, usefulness, and effectiveness of this still seldom used diagnostic approach for suspected fractures.
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Affiliation(s)
- Gordian Lukas Schmid
- Department of General Practice, Medical Faculty of the University of Leipzig, Philipp-Rosenthal-Str. 55, Leipzig, 04103, Deutschland. .,Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
| | - Beatrice Kühnast
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Marcus Heise
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Tobias Deutsch
- Department of General Practice, Medical Faculty of the University of Leipzig, Philipp-Rosenthal-Str. 55, Leipzig, 04103, Deutschland
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Flägel K, Galler B, Steinhäuser J, Götz K. [The "National Aeronautics and Space Administration-Task Load Index" (NASA-TLX) - an instrument for measuring consultation workload within general practice: evaluation of psychometric properties]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2019; 147-148:90-96. [PMID: 31759889 DOI: 10.1016/j.zefq.2019.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 09/23/2019] [Accepted: 10/23/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aims of the study were the translation and a first reflection of the psychometric properties of the Aeronautics and Space Administration-Task Load Index (NASA-TLX), a multidimensional instrument to measure workload in general practice. METHODS During April and September 2015, the NASA-TLX was translated and evaluated. For this purpose, a questionnaire composed of the NASA-TLX items and others items related to demographic data, was developed. Postgraduate family medicine trainees and family physicians were then asked to assess patient consultations by applying the questionnaire. The psychometric properties of the NASA-TLX were identified using explorative and confirmatory factor analysis. Reliability was assessed using Cronbach's α. RESULTS Overall, 16 participants completed 769 surveys after a single patient consultation. The highest average was observed for the item 'mental demand' (mean 6.9 ± 5.4), followed by the item 'effort' (mean 6.6 ± 5.5). Factor analysis revealed a one-factor solution with an explained variance of 56.9 %. The German version of NASA-TLX demonstrated a high internal consistency (Cronbach's α = 0.84). Confirmatory factor analysis showed that there was an acceptable consistency between the expected unidimensional structure and the data. CONCLUSIONS The German version of NASA-TLX provides preliminary indications of psychometric properties and presents an important tool to evaluate family physicians' workload in direct patient contact.
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Affiliation(s)
- Kristina Flägel
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, 23562 Lübeck, Deutschland.
| | - Britta Galler
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, 23562 Lübeck, Deutschland.
| | - Jost Steinhäuser
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, 23562 Lübeck, Deutschland
| | - Katja Götz
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, 23562 Lübeck, Deutschland.
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Pentzek M, Santos S, Wollny A, Gummersbach E, Herber OR, In der Schmitten J, Icks A, Abholz HH, Wilm S. Which patients with type 2 diabetes mellitus are perceived as 'difficult' by general practitioners? Prim Care Diabetes 2019; 13:353-359. [PMID: 30685382 DOI: 10.1016/j.pcd.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/02/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
AIMS To find factors that are associated with a general practitioner's (GP's) subjective impression of a patient being 'difficult' within a sample of patients with type 2 diabetes mellitus (T2DM). METHODS Secondary cross-sectional analysis of a cohort of GP patients with T2DM. GP questionnaire on clinical data and GPs' subjective ratings of patient attributes (including 'patient difficulty'). Patient questionnaire on sociodemographics and illness perceptions. Bivariate and multivariate analyses, adjusted for cluster-effect of GP practice. RESULTS Data from 314 patients from 49 GPs could be analysed. Independent associations with higher GP-rated difficulty were found for (odds ratio; 95% confidence interval): male patients from male GPs (1.27; 1.06-1.53), unmarried men (1.25; 1.04-1.51), men with non-German nationality (1.80; 1.24-2.61), patients perceiving more problems with diabetes (1.17; 1.04-1.30), patients with higher BMI (1.01; 1.00-1.02) and HbA1c values (1.06; 1.02-1.10), patients being perceived by the GP as less adherent (1.34; 1.22-1.46) and less health-literate (1.19; 1.04-1.35). CONCLUSIONS The impact of patients' gender and illness perception yield new insights into GP-perceived complexity of care. Culturally and gender-sensitive communication techniques for adapting health care goals to patients' problems (rather than norm values) may alleviate GPs' work.
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Affiliation(s)
- Michael Pentzek
- Institute of General Practice (ifam), Medical Faculty, Heinrich-Heine University Düsseldorf, Werdener Str. 4, 40227 Düsseldorf, Germany.
| | - Sara Santos
- Institute of General Practice (ifam), Medical Faculty, Heinrich-Heine University Düsseldorf, Werdener Str. 4, 40227 Düsseldorf, Germany.
| | - Anja Wollny
- Institute of General Practice, University Medical Center Rostock, Doberaner Straße 142, 18057 Rostock, Germany.
| | - Elisabeth Gummersbach
- Institute of General Practice (ifam), Medical Faculty, Heinrich-Heine University Düsseldorf, Werdener Str. 4, 40227 Düsseldorf, Germany.
| | - Oliver Rudolf Herber
- Institute of General Practice (ifam), Medical Faculty, Heinrich-Heine University Düsseldorf, Werdener Str. 4, 40227 Düsseldorf, Germany.
| | - Jürgen In der Schmitten
- Institute of General Practice (ifam), Medical Faculty, Heinrich-Heine University Düsseldorf, Werdener Str. 4, 40227 Düsseldorf, Germany.
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany.
| | - Heinz-Harald Abholz
- Institute of General Practice (ifam), Medical Faculty, Heinrich-Heine University Düsseldorf, Werdener Str. 4, 40227 Düsseldorf, Germany.
| | - Stefan Wilm
- Institute of General Practice (ifam), Medical Faculty, Heinrich-Heine University Düsseldorf, Werdener Str. 4, 40227 Düsseldorf, Germany.
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