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Bayot M, Boone A, Godderis L, Lenoir AL. Multidimensional factors of burnout in general practice: a cross sectional survey. BJGP Open 2024; 8:BJGPO.2023.0171. [PMID: 38253400 PMCID: PMC11300977 DOI: 10.3399/bjgpo.2023.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND GPs are particularly vulnerable to job burnout. Tailored prevention and intervention strategies are needed. AIM To investigate organisational, interpersonal, and individual factors contributing to exhaustion and disengagement at work among GPs. DESIGN & SETTING We conducted a cross-sectional study in a sample of Belgian GPs. METHOD A total of 358 doctors (73% females, 301 with complete data) completed an online anonymous questionnaire assessing job burnout, psychosocial characteristics of the work environment, perceived social support in the private domain, emotional competence, and self-compassion. RESULTS GPs reported moderate levels of exhaustion and disengagement. Regression models showed that included factors jointly explained 69% of the variance in exhaustion and 63% in disengagement. Exhaustion was significantly predicted by female sex (β effect size = -0.1), high perceived emotional demands (β = 0.19), as well as low self-compassion (β = -0.14) and low emotional competence (β = 0.09). Disengagement was significantly predicted by low seniority (β = -0.12) and limited opportunities for development (β = -0.16). Both exhaustion and disengagement were predicted by low perceived quality of work (β = -0.19 and -0.14, respectively), meaning of work (β = -0.17 and -0.31, respectively), and role clarity (β = 0.09 and 0.12, respectively), as well as high perceived work-life conflict (β = 0.46 and 0.21, respectively). Moreover, GPs working in a multidisciplinary group reported lower levels of exhaustion and disengagement than those working in a monodisciplinary group or a solo practice, and this difference was associated with factors such as work-life conflict. CONCLUSION Organisational, interpersonal, and intrapersonal factors interact to predict a substantial part of burnout in general practice. The most significant risk factors were perceived work-life conflict and poor meaning of work. Policymakers should work to support more sustainable practices based on the specific needs and constraints reported by GPs.
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Affiliation(s)
- Marie Bayot
- Department of Clinical Sciences, Université de Liège, Liège, Belgium
| | - Anke Boone
- Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lode Godderis
- Centre for Environment and Health, Katholieke Universiteit Leuven, Leuven, Belgium
- Idewe, External Service for Prevention and Protection at Work, Heverlee, Belgium
| | - Anne-Laure Lenoir
- Department of Clinical Sciences, Université de Liège, Liège, Belgium
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Fisher G, Saba M, Dammery G, Ellis LA, Churruca K, Mahadeva J, Foo D, Wilcock S, Braithwaite J. Barriers and facilitators to learning health systems in primary care: a framework analysis. BMJ Health Care Inform 2024; 31:e100946. [PMID: 38909995 PMCID: PMC11328652 DOI: 10.1136/bmjhci-2023-100946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/01/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND The learning health system (LHS) concept is a potential solution to the challenges currently faced by primary care. There are few descriptions of the barriers and facilitators to achieving an LHS in general practice, and even fewer that are underpinned by implementation science. This study aimed to describe the barriers and facilitators to achieving an LHS in primary care and provide practical recommendations for general practices on their journey towards an LHS. METHODS This study is a secondary data analysis from a qualitative investigation of an LHS in a university-based general practice in Sydney, Australia. A framework analysis was conducted using transcripts from semistructured interviews with clinic staff. Data were coded according to the theoretical domains framework, and then to an LHS framework. RESULTS 91% (n=32) of practice staff were interviewed, comprising general practitioners (n=15), practice nurses (n=3), administrative staff (n=13) and a psychologist. Participants reported that the practice alignment with LHS principles was influenced by many behavioural determinants, some of which were applicable to healthcare in general, for example, some staff lacked knowledge about practice policies and skills in using software. However, many were specific to the general practice environment, for example, the environmental context of general practice meant that administrative staff were an integral part of the LHS, particularly in facilitating partnerships with patients. CONCLUSIONS The LHS journey in general practice is influenced by several factors. Mapping the LHS domains in relation to the theoretical domains framework can be used to generate a roadmap to hasten the journey towards LHS in primary care settings.
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Affiliation(s)
- Georgia Fisher
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Maree Saba
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
| | - Janani Mahadeva
- MQ Health General Practice, Macquarie University, Sydney, New South Wales, Australia
| | - Darran Foo
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
- MQ Health General Practice, Macquarie University, Sydney, New South Wales, Australia
| | - Simon Wilcock
- MQ Health General Practice, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
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Lyu C, Cao Z, Jiao Z. Changes in Chinese college students' mobile phone addiction over recent decade: The perspective of cross-temporal meta-analysis. Heliyon 2024; 10:e32327. [PMID: 38947462 PMCID: PMC11214489 DOI: 10.1016/j.heliyon.2024.e32327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/23/2024] [Accepted: 06/02/2024] [Indexed: 07/02/2024] Open
Abstract
In recent years, with the rapid advancement of Internet technology and the impact of the COVID-19 pandemic, mobile phones have been used more frequently, the development trend of mobile phone addiction among Chinese college students is a concern to society. This cross-temporal meta-analysis provides compelling evidence of the rising trend of mobile phone addiction in Chinese college students based on data from 42 independent studies (Sample Size = 49,544) over the past decade (2013-2022), and discuss the three important rising periods. Furthermore, extended research has revealed correlated factors of mobile phone addiction among Chinese college students, including gender, anxiety, depression, loneliness, stress, well-being, social support, and resilience. Additionally, the study identified the National internet penetration rate and the National GDP index as significant predictors of mobile phone addiction in Chinese college students. These findings not only reveal the changing trends of mobile phone addiction among Chinese college students, but also enrich the understanding of mobile phone addiction among this population and provide a reference for improving mobile phone addiction among in the future.
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Affiliation(s)
- Chunwei Lyu
- School of Educational Studies, Universiti Sains Malaysia, Penang, Malaysia
| | - Zixuan Cao
- Institute of Heath Management and Policy, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Zun Jiao
- City Graduate School, City University of Malaysia, Petaling Jaya, Malaysia
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Tajki AV, Miroševič Š, Gomezelj MC, Bunc KT, Van Poel E, Willems S, Klemenc-Ketiš Z. Well-being of family physicians during COVID-19 pandemic in Slovenia. BMC PRIMARY CARE 2024; 24:289. [PMID: 38822251 PMCID: PMC11143559 DOI: 10.1186/s12875-024-02416-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/30/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, family physicians (FPs) served as the the initial point of contact for patients potentially infected with the virus, necessitating frequent updates to treatment protocols. However, practices also faced organizational challenges in providing care to other patients who also needed their medical attention. The pressure on FPs increased and affected their well-being. The international PRICOV-19 study, titled "Primary care in times of COVID-19 pandemic," investigated how FPs functioned during the COVID-19 pandemic. This article examines the correlation between various organizational and structural COVID-19-related variables and the well-being of FPs in Slovenia. METHODS Between October 2020 and January 2021, we conducted an online cross-sectional survey. The questionnaire was distributed to 1040 Slovenian FPs and 218 family medicine (FM) trainees. Part of the questionnaire assessed the cooperation and well-being of FPs. The Mayo Clinic Well-being Index was used for the assessment. FP's well-being was also assessed descriptively by asking open-ended questions about maintaining mental health during the pandemic. Potential factors associated with FPs' well-being were identified using a multivariate linear regression method. RESULTS The final sample comprised 191 participants (response rate 14.1%). The mean value ± standard deviation of the Mayo Well-being Index was 3.3 ± 2.6 points. The FPs with the poorest well-being had 5-15 years of work experience and worked in a practice where work could not be distributed in the absence of a co-worker without compromising the well-being of colleagues. Physical activity was identified as the most common method of maintaining mental health among FPs. CONCLUSIONS The results of the study suggest that targeted interventions are needed to support FPs mid-career, increase resilience in practice, promote strong team dynamics, and prioritise physical activity in healthcare. Addressing these aspects can contribute to the well-being of individual FPs and the overall health of the healthcare workers.
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Affiliation(s)
- Alina Verdnik Tajki
- Maribor Community Health Centre, Maribor, Slovenia.
- Ljubljana Community Health Centre, Ljubljana, Slovenia.
| | - Špela Miroševič
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Cvetko Gomezelj
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
- Piran Community Health Centre, Piran, Slovenia
| | - Ksenija Tušek Bunc
- Maribor Community Health Centre, Maribor, Slovenia
- Department of Family Medicine, University of Maribor, Maribor, Slovenia
| | - Esther Van Poel
- Department of Public Health and Primary care, Ghent Univesity, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary care, Ghent Univesity, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Zalika Klemenc-Ketiš
- Ljubljana Community Health Centre, Ljubljana, Slovenia
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, University of Maribor, Maribor, Slovenia
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Jiao Z, Chen Y, Lyu C. Factors correlated with personal growth initiative among college students: A meta-analysis. Heliyon 2024; 10:e28518. [PMID: 38689971 PMCID: PMC11059555 DOI: 10.1016/j.heliyon.2024.e28518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/03/2024] [Accepted: 03/20/2024] [Indexed: 05/02/2024] Open
Abstract
In higher education, Personal growth initiative (PGI) has been the focus of attention, personal growth initiative is a fundamental mechanism for individual advancement, equipping college students with the resilience to navigate obstacles and bolstering self-enhancement. The present study comprehensively synthesizes existing research on the factors correlated with personal growth initiative among collegiate populations, aims to identify all correlated factors of college students' personal growth initiative, and the level of correlation. A systematic search was conducted through Scopus, Web of Science, PubMed, JSTOR, PsycINFO, ScienceDirect, and Wiley Online Library, as well as manually search in Google Schalor, spanning to collate research on college students' personal growth initiative. Quantitative synthesis was performed using STATA 17, while sensitivity was tested using a change effect model approach and publication bias was assessed employing Egger's test. After applying the Bonferroni correction, this study found that 18 factors were significantly positively correlated with college students' personal growth initiative, including 4 high-level correlated factors, 10 medium-level correlated factors, and 4 low-level correlated factors, as well as 4 factors were significantly negatively correlated, including 1 medium-level correlated factor and 3 low-level correlated factors. These findings offer valuable insights into personal growth initiative among college students, and the reference for educators and institutional leaders aiming to foster personal growth initiative for college student self-development.
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Affiliation(s)
- Zun Jiao
- Department of Literature, Qingdao Film Academy, Qingdao, China
| | - You Chen
- School of Housing, Building & Planning, Universiti Sains Malaysia, Penang, Malaysia
| | - Chunwei Lyu
- School of Educational Studies, Universiti Sains Malaysia, Penang, Malaysia
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Anderson H, Scantlebury A, Galdas P, Adamson J. The well-being of nurses working in general practice during the COVID-19 pandemic: A qualitative study (The GenCo Study). J Adv Nurs 2024; 80:1574-1591. [PMID: 37902132 DOI: 10.1111/jan.15919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/12/2023] [Accepted: 10/15/2023] [Indexed: 10/31/2023]
Abstract
AIM Exploration of experiences of nurses working in general practice during the COVID-19 pandemic to evaluate the impact on nurses' professional well-being. DESIGN An exploratory qualitative study comprised of case studies of three general practice sites in England and a nationwide interview study of nurses working in general practice and nurse leaders. The study was funded by The General Nursing Council for England and Wales Trust. University of York ethics approval (HSRGC/2021/458/I) and Health Research Authority approval was obtained (IRAS: 30353, Protocol number: R23982, Ref 21/HRA/5132, CPMS: 51834). METHODS Forty participants took part. Case site data consisted of interviews/focus groups and national data consisted of semi-structured interviews. Data collection took place between April and August 2022. Analysis was underpinned by West et al.'s The courage of compassion. Supporting nurses and midwives to deliver high-quality care, The King's fund, 2020 ABC framework of nurses' core work well-being needs. FINDINGS The majority of participants experienced challenges to their professional well-being contributed to by lack of recognition, feeling undervalued and lack of involvement in higher-level decision-making. Some participants displayed burnout and stress. Structural and cultural issues contributed to this and many experiences pre-dated, but were exacerbated by, the COVID-19 pandemic. CONCLUSIONS By mapping findings to the ABC framework, we highlight the impact of the COVID-19 pandemic on the well-being of nurses working in general practice and contributing workplace factors. The issues identified have implications for retention and for the future of nursing in general practice. The study highlights how this professional group can be supported in the future. IMPACT The study contributes to our understanding of the experiences of nurses working in general practice during the COVID-19 pandemic and beyond. Findings have implications for this skilled and experienced workforce, for retention of nurses in general practice, the sustainability of the profession more broadly and care quality and patient safety. REPORTING METHOD Standards for Reporting Qualitative Research (O'Brien et al. in Journal of the Association of American Medical Colleges, 89(9), 1245-1251, 2014). PATIENT OR PUBLIC CONTRIBUTION As this was a workforce study there was no patient or public contribution.
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Affiliation(s)
- Helen Anderson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Paul Galdas
- Department of Health Sciences, University of York, York, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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7
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Frajerman A, Deflesselle E, Colle R, Corruble E, Costemale-Lacoste JF. [Burnout, anxiety, insomnia and depressive symptoms among French outpatient physicians in the second wave of COVID-19: Comparison between general practitioners and specialists]. L'ENCEPHALE 2024; 50:192-199. [PMID: 37121809 PMCID: PMC10076503 DOI: 10.1016/j.encep.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 01/10/2023] [Accepted: 01/31/2023] [Indexed: 04/08/2023]
Abstract
INTRODUCTION The 2019 coronavirus (COVID-19) pandemic has caused a public health crisis worldwide. Concerns have been expressed about the rapid deterioration of mental health among primary care physicians among whom burnout already had a high prevalence prior to the pandemic. However, there is little data on private doctors during the pandemic. France experienced a second wave with a second lockdown. We aimed to assess and compare physicians' burnout, anxiety and depression symptoms and insomnia between general practitioners (GP) and all other private specialists during the second Covid-19 wave. METHODS We conducted an online survey of private practitioners registered on Doctolib® (n=32,655), the interface software most used by private practitioners for booking medical appointments in France. Doctors were invited by email to complete an online survey in November 2020. Inclusions were closed on 1st December. The 2nd lockdown lasted from 30th October to 15th December 2020. We used the Copenhagen Burnout Inventory (CBI) to assess burnout syndrome. A mean score of>50 in at least one subscale defined burnout. The Hospital Anxiety and Depression Scale assessed anxiety and depression symptoms. We used two cut-offs, 8 (>7) and 11 (>10), as both are validated in the ability to find cases. The Insomnia Severity Index (ISI) measures sleep-related complaints among physicians (cut-off >7). To link variations in the psychological scales to the COVID-19 pandemic, one of the items asked explicitly whether participants considered that "the COVID-19 epidemic we are currently experiencing is a source of excess stress, psychological suffering or burnout". Approval for this study was obtained from the local institutional review board of the University of Paris-Saclay, France. The questionnaires were collected anonymously. Statistical significance was tested using the chi-square test and student's t-test to compare the prevalence between GPs and other specialities. Subsequently, logistic regression models were run for statistically significant associations. RESULTS 1992 physicians replied, a response rate of 12.8% of those who received the invitation email. Among them, 79.4% suffered from psychological distress (symptoms of anxiety or depression or burnout), of which 71.3% suffered from burnout, 26.7% from depressive symptoms, 58.9% from anxiety symptoms and 45.8% from insomnia. There was no difference in gender between GPs and specialists, but there was an age difference (P<0.001). GPs had a higher prevalence of burnout (OR=1.33 CI95 [1.09;1.63]) and took more psychotropic drugs (1.38 CI95 [1.05;1.81]). They were also more likely to perceive their stress as work-related (OR=1.50 CI95 [1.23;1.81]) or COVID-19-related (OR=1.43 CI95 [1.16;1.77]). CONCLUSION Our study is the first to assess the mental health of private practitioners in the second wave in association with COVID-19 stress. Firstly, GPs who provide primary care have a significantly higher burnout rate than other doctors. Secondly, COVID-19 stress is associated with more significant psychological distress. Thirdly, almost 80% of the private doctors surveyed suffer from psychological pain, and 71% suffer from burnout. This study has strengths and limitations. Firstly, this study assesses mental health and stress related to its COVID-19 association. Second, this is the largest population of private physicians during the COVID-19 pandemic. The low response rate is the main limit of this study. The alarming rates of psychological distress among private doctors and, in particular, GPs should lead to intervention to help doctors reduce stress, burnout and other mental disorders. This study gives a picture of the situation during the second wave and the lock-in, and we need to be cautious with the next waves.
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Affiliation(s)
- Ariel Frajerman
- MOODS Team, Inserm, CESP, université Paris-Saclay, faculté de médecine Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Service hospitalo-universitaire de psychiatrie de Bicêtre, Mood Center Paris Saclay, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris-Saclay, 94275 Paris, France; Inserm U1266-GDR 3557, institut de psychiatrie et neurosciences de Paris, institut de Psychiatrie, Paris, France; Université Paris Cité, Paris, France.
| | - Eric Deflesselle
- MOODS Team, Inserm, CESP, université Paris-Saclay, faculté de médecine Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Département de médecine générale, université Paris-Saclay, faculté de médecine Paris-Saclay, 94275 Le Kremlin-Bicêtre, France
| | - Romain Colle
- MOODS Team, Inserm, CESP, université Paris-Saclay, faculté de médecine Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Service hospitalo-universitaire de psychiatrie de Bicêtre, Mood Center Paris Saclay, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris-Saclay, 94275 Paris, France
| | - Emmanuelle Corruble
- MOODS Team, Inserm, CESP, université Paris-Saclay, faculté de médecine Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Service hospitalo-universitaire de psychiatrie de Bicêtre, Mood Center Paris Saclay, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris-Saclay, 94275 Paris, France
| | - Jean-François Costemale-Lacoste
- MOODS Team, Inserm, CESP, université Paris-Saclay, faculté de médecine Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Centre hospitalier le Vinatier, Bron, France; Union régionale des professionnels de santé libéraux, Auvergne Rhône-Alpes, France
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Abrams R, Jones B, Campbell J, de Lusignan S, Peckham S, Gage H. The effect of general practice team composition and climate on staff and patient experiences: a systematic review. BJGP Open 2024; 8:BJGPO.2023.0111. [PMID: 37827584 PMCID: PMC11169989 DOI: 10.3399/bjgpo.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Recent policy initiatives seeking to address the workforce crisis in general practice have promoted greater multidisciplinarity. Evidence is lacking on how changes in staffing and the relational climate in practice teams affect the experiences of staff and patients. AIM To synthesise evidence on how the composition of the practice workforce and team climate affect staff job satisfaction and burnout, and the processes and quality of care for patients. DESIGN & SETTING A systematic literature review of international evidence. METHOD Four different searches were carried out using MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science. Evidence from English language articles from 2012-2022 was identified, with no restriction on study design. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and data were synthesised thematically. RESULTS In total, 11 studies in primary healthcare settings were included, 10 from US integrated healthcare systems, one from Canada. Findings indicated that when teams are understaffed and work environments are stressful, patient care and staff wellbeing suffer. However, a good relational climate can buffer against burnout and protect patient care quality in situations of high workload. Good team dynamics and stable team membership are important for patient care coordination and job satisfaction. Female physicians are at greater risk of burnout. CONCLUSION Evidence regarding team composition and team climate in relation to staff and patient outcomes in general practice remains limited. Challenges exist when drawing conclusions across different team compositions and definitions of team climate. Further research is needed to explore the conditions that generate a 'good' climate.
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Affiliation(s)
- Ruth Abrams
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Bridget Jones
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - John Campbell
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Heather Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
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9
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Küppers L, Göbel J, Aretz B, Rieger MA, Weltermann B. Associations between COVID-19 Pandemic-Related Overtime, Perceived Chronic Stress and Burnout Symptoms in German General Practitioners and Practice Personnel-A Prospective Study. Healthcare (Basel) 2024; 12:479. [PMID: 38391854 PMCID: PMC10888352 DOI: 10.3390/healthcare12040479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The mental burdens of general practitioners (GPs) and practice assistants (PrAs) during the COVID-19 pandemic are well investigated. Work-related conditions like overtime are known to contribute to perceived chronic stress and burnout symptoms. However, there is limited evidence regarding the specific mechanisms, which link pandemic-related overtime, chronic stress and burnout symptoms. This study used data from the IMPROVEjob trial to improve psychological well-being in general practice personnel. METHODS This prospective study with 226 German GPs and PrAs used the baseline (pre-pandemic: October 2019 to March 2020) and follow-up data (pandemic: October 2020 to April 2021) of the IMPROVEjob trial. Overtime was self-reported as hours above the regular work time. Perceived chronic stress was assessed using the Trier Inventory for the Assessment of Chronic Stress Screening Scale (TICS-SSCS), while burnout symptoms were evaluated using a short version of the Maslach Burnout Inventory (MBI). A mediation analysis investigated the differences of the three main variables between pre-pandemic and pandemic periods. RESULTS Burnout symptoms increased significantly from baseline to follow-up (p = 0.003). Overtime correlated positively with burnout symptoms (Total Effect: 0.13; 95% CI: 0.03, 0.23). Decomposition of the total effect revealed a significant indirect effect over perceived chronic stress (0.11; 95% CI: 0.06, 0.18) and no significant direct effect (0.02; 95% CI: -0.08, 0.12), indicating a full mediation. CONCLUSION In this large longitudinal study, pandemic-related overtime led to significantly higher levels of burnout symptoms, linked by a pathway through perceived chronic stress. Future prevention strategies need to aim at reducing the likelihood of overtime to ensure the mental well-being of practice personnel.
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Affiliation(s)
- Lucas Küppers
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian Göbel
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Benjamin Aretz
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, 72074 Tuebingen, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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10
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Hickman K. Unmasking delays: bridging the gap in timely lung cancer diagnosis for UK primary care. Thorax 2024; 79:195. [PMID: 38195645 DOI: 10.1136/thorax-2023-220739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/11/2024]
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van der Feltz-Cornelis CM, Sweetman J, Lee W, Doherty AM, Dineen P, Meinlschmidt G, Vitinius F, Fazekas C, Huber CG, Schaefert R, Stein B. Determinants of workload-related clinician stress levels in general hospital consultation liaison psychiatry services during the COVID-19 pandemic in England and Ireland. Short report. J Psychosom Res 2024; 177:111584. [PMID: 38181547 DOI: 10.1016/j.jpsychores.2023.111584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/18/2023] [Accepted: 12/24/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE To explore workload-related stress levels experienced by consultation liaison psychiatry (CLP) staff in England and Ireland, and factors relevant to such a burden, during the COVID-19 pandemic. METHODS Data were obtained for England and Ireland from a European survey among CLP services in general hospitals spread via CLP networks (11th June - 3rd October 2021). The heads of respective CLP services in general hospitals responded on behalf of each service, on 100 CLP hospital staff in total. DEPENDENT VARIABLE workload-related stress levels in CLP services due to COVID-19 (0-10 point scale). INDEPENDENT VARIABLES hospital size, CLP service size, degree of hospital involvement in COVID-19-related care, and the number of support options available to hospital staff. Spearman's rho correlation analyses were performed. RESULTS There was a significant association between the hospital's involvement in COVID-19-related care and workload-related stress levels as reported by CLP staff: r(22) = 0.41, p = 0.045, R2 = 0.17. There were no significant associations between workload-related stress levels and other variables including staff support (p = 0.74). CONCLUSION Our findings suggest that perceived workload-related stress levels of CLP staff during the COVID-19 pandemic can be an indicator of COVID-19 involvement of the hospitals. Staff support seemed not to alleviate work stress in the context of the pandemic. Healthcare policies should improve working conditions for CLP hospital staff that play an essential role from a population health perspective. Rigorous measures may be needed to ensure mental healthcare provision remains tenable and sustainable in the long term.
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Affiliation(s)
- Christina M van der Feltz-Cornelis
- Department of Health Sciences, University of York, York, United Kingdom; Hull York Medical School, University of York, York, United Kingdom; Institute of Health Informatics, University College London, London, United Kingdom.
| | - Jennifer Sweetman
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Anne M Doherty
- Mater Misericordiae University Hospital, Dublin, Ireland; University College Dublin, Dublin, Ireland
| | - Peter Dineen
- Department of Psychiatry & Neurobehavioural Science, University College Cork, Cork, Ireland; Cork University Hospital, Cork, Ireland
| | - Gunther Meinlschmidt
- University of Basel and University Hospital Basel, Department of Digital and Blended Psychosomatics and Psychotherapy, Psychosomatic Medicine, Basel, Switzerland; Department of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University (IPU), Berlin, Germany
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital and University of Cologne, Cologne, Germany; Department of Psychosomatic Medicine, Robert-Bosch Hospital Stuttgart, Stuttgart, Germany
| | - Christian Fazekas
- Medical University of Graz, Department of Psychiatry, Psychosomatics and Psychotherapy, Division of Medical Psychology, Psychosomatics and Psychotherapy, Graz, Austria
| | - Christian G Huber
- University of Basel, Department of Psychiatry (UPK), Basel, Switzerland
| | - Rainer Schaefert
- University of Basel and University Hospital Basel, Department of Psychosomatic Medicine, Basel, Switzerland
| | - Barbara Stein
- Nuremberg General Hospital, Paracelsus Medical Private University, Nuremberg, Germany
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Lescure DLA, Erdem Ö, Nieboer D, Huijser van Reenen N, Tjon-A-Tsien AML, van Oorschot W, Brouwer R, Vos MC, van der Velden AW, Richardus JH, Voeten HACM. Communication training for general practitioners aimed at improving antibiotic prescribing: a controlled before-after study in multicultural Dutch cities. Front Med (Lausanne) 2024; 11:1279704. [PMID: 38323031 PMCID: PMC10844435 DOI: 10.3389/fmed.2024.1279704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024] Open
Abstract
IntroductionSuboptimal doctor-patient communication drives inappropriate prescribing of antibiotics. We evaluated a communication intervention for general practitioners (GPs) in multicultural Dutch cities to improve antibiotic prescribing for respiratory tract infections (RTI).MethodsThis was a non-randomized controlled before-after study. The study period was pre-intervention November 2019 – April 2020 and post-intervention November 2021 – April 2022. The intervention consisted of a live training (organized between September and November 2021), an E-learning, and patient material on antibiotics and antibiotic resistance in multiple languages. The primary outcome was the absolute number of prescribed antibiotic courses indicated for RTIs per GP; the secondary outcome was all prescribed antibiotics per GP. We compared the post-intervention differences in the mean number of prescribed antibiotics between the intervention (N = 25) and the control group (N = 110) by using an analysis of covariance (ANCOVA) test, while adjusting for the pre-intervention number of prescribed antibiotics. Additionally, intervention GPs rated the training and their knowledge and skills before the intervention and 3 months thereafter.ResultsThere was no statistically significant difference in the mean number of prescribed antibiotics for RTI between the intervention and the control group, nor for mean number of overall prescribed antibiotics. The intervention GPs rated the usefulness of the training for daily practice a 7.3 (on a scale from 1–10) and there was a statistically significant difference between pre- and post-intervention on four out of nine items related to knowledge and skills.DiscussionThere was no change in GPs prescription behavior between the intervention and control group. However, GPs found the intervention useful and showed some improvement on self-rated knowledge and communication skills.
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Affiliation(s)
- Dominique L. A. Lescure
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, Netherlands
| | - Özcan Erdem
- Department of Research and Business Intelligence, Municipality of Rotterdam, Rotterdam, Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Aimée M. L. Tjon-A-Tsien
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, Netherlands
| | | | - Rob Brouwer
- Health Centre Levinas, Pharmacy Ramleh, Rotterdam, Netherlands
| | - Margreet C. Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Alike W. van der Velden
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Hélène A. C. M. Voeten
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, Netherlands
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13
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Abrams R, Blake S. UK general practice service delivery research priorities: an adapted James Lind Alliance approach. Br J Gen Pract 2024; 74:e9-e16. [PMID: 38154946 PMCID: PMC10755998 DOI: 10.3399/bjgp.2023.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/10/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND General practice is in a state of crisis in a number of countries. In the UK, a range of measures have been introduced to address the situation, including innovations such as practice networks, multidisciplinary roles, and digital technologies. However, identifying what still needs fixing could benefit from more evidence, particularly in relation to day-to-day service delivery. AIM To identify the general practice workforce's top 10 research priorities to improve service delivery. DESIGN AND SETTING This priority-setting study used an adapted James Lind Alliance methodology and involved staff working in general practice across the UK. METHOD The study comprised four phases: an online qualitative survey issued to the general practice workforce (clinical and non-clinical groups); thematic analysis of free-text responses; generation of indicative research questions; and the undertaking of ranking exercises with responders of the original survey. An online workshop was held with participants at the final stage of prioritisation. RESULTS In total, 93 staff completed a survey in Phase 1, from which 20 themes were categorised and developed into research questions. Twenty- two staff responded to the first ranking activity and 11 took part in a second ranking activity to discuss themes that had a tied vote. The final top 10 research priorities were: volume of work; patient behaviour; consultations; employment pay and conditions; workload dumping and care of patients on waiting list; funding; overwhelming pressure; patient health education; complex patient needs; and interfaces with secondary care. However, there was no clear ranking of these 10 priorities; instead, they carried equal weight and were closely interconnected. CONCLUSION Applying a marginal-gains approach, by seeking to explore all 10 priorities simultaneously as opposed to concentrating on one area at a time, may provide more noticeable improvements overall. Systems-based approaches that take account of the marked role that context has may be a particularly useful lens for future research.
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Affiliation(s)
- Ruth Abrams
- School of Health Sciences, University of Surrey, Guildford
| | - Sharon Blake
- School of Health Sciences, University of Surrey, Guildford
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14
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Anderson A, Douglass T, Hobson-West P. Researching childhood vaccine hesitancy in the wake of COVID-19. Vaccine X 2024; 16:100450. [PMID: 38318231 PMCID: PMC10839437 DOI: 10.1016/j.jvacx.2024.100450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
The COVID-19 pandemic has had a seismic effect on public healthcare, vaccine production, and on society. However, the pandemic has also had a methodological impact on social researchers, including those seeking to better understand vaccine hesitancy in relation to childhood vaccines. In this short communication, we describe the challenging experience of recruiting and conducting qualitative interviews with UK healthcare professionals and vaccine hesitant parents in early 2022. We also explore the way in which the context of COVID influenced our data analysis. Finally, we make recommendations for how researchers, including those using qualitative or quantitative methods, might learn from our experiences, as the complex and delicate relationship between society and vaccines continues to evolve in the wake of the pandemic.
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Affiliation(s)
- Alistair Anderson
- School of Sociology and Social Policy, University of Nottingham, NottinghamNG7 2RD, United Kingdom
| | - Tom Douglass
- Department of Social Work and Social Care, University of Birmingham, BirminghamB15 2TT, United Kingdom
| | - Pru Hobson-West
- School of Sociology and Social Policy, University of Nottingham, NottinghamNG7 2RD, United Kingdom
- School of Veterinary Medicine and Science, University of Nottingham, LeicestershireLE12 5RD, United Kingdom
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15
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Månsson Sandberg H, Landstad BJ, Tjulin Å, Brulin E. COVID-19- related work, managerial factors and exhaustion among general practitioners in Sweden: a cross-sectional study. BMC PRIMARY CARE 2023; 24:269. [PMID: 38087223 PMCID: PMC10717449 DOI: 10.1186/s12875-023-02228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION A significant number of international studies show that general practitioners (GPs) suffered from burnout when working during the COVID-19 pandemic. A Swedish study found that more than 16% of GPs had exhaustion in spring 2021. Exhaustion can be regarded as an initial stage of burnout. A knowledge gap remains on GPs´ working conditions, the impact of management during the pandemic and how it was associated with exhaustion. This study aims to explore the association between severe symptoms of exhaustion and COVID-19 pandemic-related work and managerial factors among Swedish GPs and whether managerial factors have an impact on the association between exhaustion and COVID-19-related work factors. METHODS Cross-sectional data was drawn from the Longitudinal Occupational Health survey in Health Care Sweden (LOHHCS), which included a representative sample of practicing doctors in Sweden. The sample consisted of 6699 doctors with a response rate of 41.2%. This study constitutes a sample of doctors who reported working in primary care facilities at the time of data collection, i.e. 1013 GPs. The Burnout Assessment Tool (BAT) was used to assess severe symptoms of exhaustion. Questions were also asked about pandemic-related work and managerial factors. The data was analysed using descriptive statistics and multivariate logistic regression to identify the association between exhaustion, work and managerial factors. RESULTS The multivariate analysis showed that GPs who managed COVID-19 patients were about twice as likely to report severe symptoms of exhaustion. Further, GPs who reported that management was unsupportive, provided unsatisfactory working conditions and unsatisfactory policies for patient prioritisation were between two and four times more likely to report severe symptoms of exhaustion. CONCLUSIONS COVID-19-related work and managerial factors had a significant impact on the mental health of GPs. Furthermore, the potentially protective effect that satisfactory management actions had on mental health was limited. In the aftermath of the COVID-19 pandemic and in preparation for future major crises that have a high impact on healthcare, there is a need to investigate the measures that can be taken to enable GPs to carry out their work, while maintaining their wellbeing.
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Affiliation(s)
- Helena Månsson Sandberg
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
- Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Bodil J Landstad
- Faculty of Human Sciences, Mid Sweden University, Östersund, Sweden
- Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden
| | - Åsa Tjulin
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Emma Brulin
- Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
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16
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Biddle GJ, Thomas N, Edwardson CL, Clemes SA, Daley AJ. Burnout, psychological wellbeing, and musculoskeletal complaints in UK GPs: an observational study. BJGP Open 2023; 7:BJGPO.2023.0007. [PMID: 37474254 PMCID: PMC11176677 DOI: 10.3399/bjgpo.2023.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/14/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Healthcare systems are under unprecedented pressure. GPs are crucial to the health of the population, yet their own health and wellbeing is often overlooked. AIM To investigate feelings of burnout, psychological wellbeing, and musculoskeletal complaints in GPs across the UK and to examine whether these health outcomes vary according to the time GPs spent sitting, their participation in physical activity each day, and the time spent working per day or week. DESIGN & SETTING Observational study involving GPs located across the UK. METHOD An online survey was emailed to working members of the Royal College of General Practitioners and shared on social media between October and December 2020. The survey included questions on burnout, psychological wellbeing, musculoskeletal complaints, sitting time, physical activity, and time spent working. Mean differences were examined for burnout, psychological wellbeing, and musculoskeletal complaints. RESULTS Data from 406 GPs showed a high level of burnout (35.5%) and musculoskeletal complaints (neck, shoulder and back: 81.8%; arms: 28.3%; and legs: 49.8%). Psychological wellbeing was low in 22.9% of GPs. Burnout was lower in GPs who met current physical activity guidelines, while psychological wellbeing was higher in those with >2 breaks in sitting per hour. Musculoskeletal complaints were higher in those spending >50% of sitting time in prolonged bouts (≥30 minutes). CONCLUSION A high proportion of GPs reported experiencing burnout and musculoskeletal complaints, but these health concerns were less evident in GPs who spent less time in prolonged sitting, took more breaks in sitting, and who were more physically active.
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Affiliation(s)
- Gregory Jh Biddle
- The Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Science, Loughborough University, Loughborough, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Nicholas Thomas
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Charlotte L Edwardson
- Research, Royal College of General Practitioners, London, UK
- Sedentary Behaviour and Health, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- Sedentary Behaviour and Health, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Stacy A Clemes
- School of Sport, Exercise and Health Science, Loughborough University, Loughborough, UK
| | - Amanda J Daley
- The Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Science, Loughborough University, Loughborough, UK
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17
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Golder S, Jefferson L, McHugh E, Essex H, Heathcote C, Castro Avila A, Dale V, Van Der Feltz-Cornelis C, Bloor K. General practitioners' wellbeing during the COVID-19 pandemic: Novel methods with social media data. Health Info Libr J 2023; 40:400-416. [PMID: 36416221 DOI: 10.1111/hir.12466] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/14/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND It is difficult to engage busy healthcare professionals in research. Yet during the COVID-19 pandemic, gaining their perspectives has never been more important. OBJECTIVE To explore social media data for insights into the wellbeing of UK General Practitioners (GPs) during the Covid-19 pandemic. METHODS We used a combination of search approaches to identify 381 practising UK NHS GPs on Twitter. Using a two stage social media analysis, we firstly searched for key themes from 91,034 retrieved tweets (before and during the pandemic). Following this we used qualitative content analysis to provide in-depth insights from 7145 tweets related to wellbeing. RESULTS Social media proved a useful tool to identify a cohort of UK GPs; following their tweets longitudinally to explore key themes and trends in issues related to GP wellbeing during the pandemic. These predominately related to support, resources and public perceptions and fluctuations were identified at key timepoints during the pandemic, all achieved without burdening busy GPs. CONCLUSION Social media data can be searched to identify a cohort of GPs to explore their wellbeing and changes over time.
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Affiliation(s)
- Su Golder
- Department of Health Sciences, University of York, York, UK
| | | | | | - Holly Essex
- Department of Health Sciences, University of York, York, UK
| | | | | | - Veronica Dale
- Department of Health Sciences, University of York, York, UK
| | | | - Karen Bloor
- Department of Health Sciences, University of York, York, UK
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18
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Stark S, Schaubroeck E, Kluge M, Burggraf L, Roos M, Borowski E, Van Poel E, Willems S, Kühlein T, Hueber S, Werner F. "The measures taken by the government overburdened the daily practice" - insights of the PRICOV-19 study on German general practitioners in times of COVID-19. BMC PRIMARY CARE 2023; 24:207. [PMID: 37821802 PMCID: PMC10568746 DOI: 10.1186/s12875-023-02115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/18/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The international study PRICOV-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on German general practitioners during the second wave of the COVID-19 pandemic. This paper addresses the following research questions: (1) How were changes in tasks on primary care and patient treatment perceived by GPs?, (2) What was the role of GPs during the pandemic, and how was their wellbeing?, (3) How did GPs perceive health policy measures?, and, (4) What influenced the attitudes of GPs on health policy measures? METHODS This study pursues a multi-country cross-sectional design. Data collection took place throughout Germany from 01.02. to 28.02.2021 with a quantitative online questionnaire consisting of 53 items. The questionnaire was analysed through descriptive and inferential analyses using correlation and multiple regression models. RESULTS The response rate was 20.4% (n = 349). The respondents were mainly GPs (59.6%) in single practices (62.5%) with a mean work experience of 15 to 20 years. GPs experienced a change in their work and practice organisation (80.3%). They felt a high responsibility (70.6%) and found their work has become more meaningful to them (76%). They also saw a lack of political support (75.2%) and that the measures taken by the government overburdened the daily practice (66.4%). Not many GPs were at risk of being distressed (53.4%) but rated the health policies rather negatively (60%). The multiple regression showed, the more GPs were exposed to risk of distress, the worse they assessed the government's measures. CONCLUSION GPs perceived their work as relevant and felt confident they could fulfil their tasks, but noticed that health policy initially hardly supported the outpatient sector. Health policies should increase their competence in relation to primary care, ensure its needs and consider an active inclusion of GPs in preparedness plans.
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Affiliation(s)
- Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Emmily Schaubroeck
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Marie Kluge
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Larissa Burggraf
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department for Sociology, University of Education, Schwäbisch Gmünd, Germany
| | - Marco Roos
- General Practice, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Eve Borowski
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Susann Hueber
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Felix Werner
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Yong FR, Naicker S, Uebel K, Agaliotis M, Chan C, Nguyen JDT, Pathirana T, Hawkey A, Vuong K. "We're trained to trust our patients": a qualitative study on the general practitioners' trust in patients for colorectal cancer shared care. Fam Pract 2023:cmad095. [PMID: 37797167 DOI: 10.1093/fampra/cmad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND In a therapeutic partnership, physicians rely on patients to describe their health conditions, join in shared decision-making, and engage with supported self-management activities. In shared care, the patient, primary care, and specialist services partner together using agreed processes and outputs for the patient to be placed at the centre of their care. However, few empirical studies have explored physicians' trust in patients and its implications for shared care models. AIM To explore trust in patients amongst general practitioners (GPs), and the impacts of trust on GPs' willingness to engage in new models of care, such as colorectal cancer shared care. METHODS GP participants were recruited through professional networks for semi-structured interviews. Transcripts were integrity checked, coded inductively, and themes developed iteratively. RESULTS Twenty-five interviews were analysed. Some GPs view trust as a responsibility of the physician and have a high propensity for trusting patients. For other GPs, trust in patients is developed over successive consultations based on patient characteristics such as honesty, reliability, and proactivity in self-care. GPs were more willing to engage in colorectal cancer shared care with patients with whom they have a developed, trusting relationship. CONCLUSIONS Trust plays a significant role in the patient's access to shared care. The implementation of shared care should consider the relational dynamics between the patient and health care providers.
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Affiliation(s)
- Faith R Yong
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Safe and Effective Medication Research Collaborative, School of Pharmacy, Faculty of Health and Behavioural Science, University of Queensland, Brisbane, Australia
- Westmead Institute of Medical Research, University of Sydney, Westmead, Australia
| | - Sundresan Naicker
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kerry Uebel
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Maria Agaliotis
- Australian Institute of Health Service Management, College of Business and Economics, University of Tasmania, Rozelle, Australia
| | - Christopher Chan
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - John D T Nguyen
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Thanya Pathirana
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Alexandra Hawkey
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
| | - Kylie Vuong
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Australia
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20
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Tunks A, Berry C, Strauss C, Nyikavaranda P, Ford E. Patients' perspectives of barriers and facilitators to accessing support through primary care for common mental health problems in England: A systematic review. J Affect Disord 2023; 338:329-340. [PMID: 37348656 DOI: 10.1016/j.jad.2023.06.035] [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: 01/31/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Common mental disorders (CMDs) are prevalent throughout the population. Psychological therapy is often sought via primary care; however, equitable access is not commonplace. This review aims to investigate the barriers and facilitators adults experiencing CMDs perceive when accessing evidence-based psychological treatment in England. METHODS A qualitative systematic review with meta-synthesis was conducted (PROSPERO CRD42020227039). Seven electronic databases were searched for papers from 2008 to October 2022. RESULTS Searches identified 30 studies from which three themes were developed with seven subthemes. Stigma and patients' perceptions and understandings of CMDs impacted their help-seeking decision-making and engagement with services. This meant that services were not used as a first resort for help-seeking. Upon reaching services, patients appeared to perceive primary care as not prioritising mental health problems, nor as being the place where they would be supported, particularly as healthcare professionals did not appear to know about CMDs and therapy was seen as difficult to access. The interaction between healthcare professional and patients was seen as pivotal to whether patients accessed support or not. LIMITATIONS The review is limited to research conducted within England. Additionally, it only explores access barriers prior to treatment experiences. CONCLUSION Knowledge, attitudinal, systemic and relational barriers and facilitators were identified. Future research should focus on developing stigma reduction initiatives. Clinical implications include provision of standardised training across primary care HCP (healthcare professionals).
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Affiliation(s)
- Alice Tunks
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
| | - Clio Berry
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
| | - Clara Strauss
- School of Psychology, University of Sussex, United Kingdom; Sussex Partnership NHS Foundation Trust, United Kingdom.
| | - Patrick Nyikavaranda
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
| | - Elizabeth Ford
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
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21
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Whitehead IO, Moffatt S, Warwick S, Spiers GF, Kunonga TP, Tang E, Hanratty B. Systematic review of the relationship between burn-out and spiritual health in doctors. BMJ Open 2023; 13:e068402. [PMID: 37553194 PMCID: PMC10414094 DOI: 10.1136/bmjopen-2022-068402] [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: 09/16/2022] [Accepted: 05/03/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE To investigate the relationship between burn-out and spiritual health among medical doctors. DESIGN Systematic literature review and narrative synthesis of cross-sectional studies. SETTING Any setting, worldwide. DATA SOURCES Five databases were searched from inception to March 2022, including Medline, Embase, PsycINFO, Scopus and Web of Science. ELIGIBILITY CRITERIA Any study design that involved medical doctors (and other healthcare staff if assessed alongside medical doctors), that measured (in any way) both burn-out (or similar) and spiritual health (or similar) medical doctors. DATA EXTRACTION AND SYNTHESIS All records were double screened. Data extraction was performed by one reviewer and a proportion (10%) checked by a second reviewer. Quality was assessed using the Appraisal of Cross-sectional Studies tool. Due to the heterogeneity of the included studies, a narrative review was undertaken without a meta-analysis. RESULTS Searches yielded 1049 studies. 40 studies met eligibility criteria and were included in this review. Low reported levels of spirituality were associated with high burn-out scores and vice versa. Religion was not significantly associated with lower levels of burn-out. Few studies reported statistically significant findings, few used validated spiritual scores and most were vulnerable to sampling bias. CONCLUSIONS Published research suggests that burn-out is linked to spiritual health in medical doctors but not to religion. Robust research is needed to confirm these findings and develop effective interventions. PROSPERO REGISTRATION NUMBER CRD42020200145.
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Affiliation(s)
| | - Suzanne Moffatt
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephanie Warwick
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gemma F Spiers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Eugene Tang
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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22
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Merrill AL, Stein SL, Chu JT, Sarode AL, McKinley SK, Parangi S, Donelan K, Palamara K. Do Resident Coaching Programs Benefit their Coaches? Impact of a Professional Development Coaching Program on The Coaches. World J Surg 2023; 47:1609-1616. [PMID: 36847851 PMCID: PMC9969939 DOI: 10.1007/s00268-023-06957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Coaching has been shown to decrease physician burnout; however, coachee outcomes have been the focus. We report the impact of coaching on women-identifying surgeons who participated as coaches in a 9-month virtual program. METHODS A coaching program was implemented in the Association of Women Surgeons (AWS) to determine the effects of coaching on well-being and burnout from 2018 to 2020. AWS members volunteered and completed training in professional development coaching. Pre- and post-study measures were assessed, and bivariate analysis performed based on burnout and professional fulfillment score. RESULTS Seventy-five coaches participated; 57 completed both pre- and post-study surveys. There were no significant changes in burnout or professional fulfillment including the Positive Emotion, Engagement, Relationship, Meaning, and Accomplishment scale, hardiness, self-valuation, coping, gratitude, or intolerance of uncertainty scores from baseline to post-survey. On bivariate analysis, hardiness was associated with lower burnout throughout the duration of the program. Coaches with lower burnout at the end of the program met with their coachee more frequently than coaches with higher burnout [mean (SD) 3.95(2.16) versus 2.35(2.13) p = 0.0099]. DISCUSSION Burnout and professional fulfillment demonstrated no change in women surgeons who participated as professional development coaches. Those with lower burnout and higher professional fulfillment at the end of the program were found to have higher hardiness, which may be worth future investigation. CONCLUSIONS Acquisition of coaching skills did not directly improve well-being in faculty who participated in a resident coaching program. Future studies would benefit from control groups and exploration of qualitative benefits of coaching.
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Affiliation(s)
- Andrea L Merrill
- Department of Surgery, Boston Medical Center, 820 Harrison Avenue, FGH Building- Suite 5005, Boston, MA, 02118, US.
| | - Sharon L Stein
- Department of Surgery, University Hospitals Cleveland, Cleveland, OH, US
- Association of Women Surgeons, Chicago, IL, US
| | - Jacqueline T Chu
- Department of Medicine, Massachusetts General Hospital, Boston, MA, US
| | - Anuja L Sarode
- Department of Surgery, University Hospitals Cleveland, Cleveland, OH, US
| | - Sophia K McKinley
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, US
| | - Sareh Parangi
- Association of Women Surgeons, Chicago, IL, US
- Department of Surgery, Massachusetts General Hospital, Boston, MA, US
| | - Karen Donelan
- Institute On Healthcare Systems, Heller School of Social Policy and Management, Brandeis University, Boston, MA, US
| | - Kerri Palamara
- Department of Medicine, Massachusetts General Hospital, Boston, MA, US
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23
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van Westen-Lagerweij NA, Willemsen MC, Croes EA, Chavannes NH, Meijer E. The delivery of Ask-Advise-Connect for smoking cessation in Dutch general practice during the COVID-19 pandemic: results of a pre-post implementation study. BMC Health Serv Res 2023; 23:654. [PMID: 37337250 DOI: 10.1186/s12913-023-09692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/13/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The Ask-Advise-Connect approach can help primary care providers to increase the number of smokers that attempt to quit smoking and enrol into cessation counselling. The approach has not yet been implemented in general practice in the Netherlands. The aim of this study was to investigate the influence of a comprehensive implementation strategy on the delivery of Ask-Advise-Connect for smoking cessation within Dutch general practice during the COVID-19 pandemic. METHODS A pre-post study was conducted between late 2020 and early 2022, and included 106 Dutch primary care providers (GPs, practice nurses and doctor's assistants). Participation lasted nine months: during the first three months participants delivered smoking cessation care as usual (pre-intervention); the implementation strategy came into effect after three months and participants were followed up for another six months (post-intervention). The implementation strategy consisted of two meetings in which participants were educated about Ask-Advise-Connect, made agreements on the implementation of Ask-Advise-Connect and reflected on these agreements. Participants also received online educational materials and a desk card as reminder. The changes in the proportions of 'Ask' and 'Advise' over time were modelled using linear mixed effects models. A descriptive analysis was conducted with regard to referrals to cessation counselling. RESULTS Participants provided consultations to 29,112 patients (both smokers and non-smokers). Results of the linear mixed effects model show that the proportion of patients that were asked about smoking ('Ask') significantly decreased in the first three months (pre-intervention), but slightly increased again after the implementation strategy came into effect (post-intervention). No significant change over time was found with regard to the proportion of patients advised to quit smoking ('Advise'). Descriptive statistics suggested that more participants proactively (vs. passively) referred patients to cessation counselling post-intervention ('Connect'). CONCLUSIONS The findings indicate that a comprehensive implementation strategy can support primary care providers in offering smoking cessation care to patients, even under stressful COVID-19 conditions. Additional implementation efforts are needed to increase the proportion of patients that receive a quit advice and proactive referral.
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Affiliation(s)
- Naomi A van Westen-Lagerweij
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725, 3500 AS, Utrecht, The Netherlands.
- Department of Health Promotion, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Marc C Willemsen
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725, 3500 AS, Utrecht, The Netherlands
- Department of Health Promotion, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Esther A Croes
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725, 3500 AS, Utrecht, The Netherlands
| | - Niels H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
- National eHealth Living Lab, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Eline Meijer
- Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
- National eHealth Living Lab, PO Box 9600, 2300 RC, Leiden, The Netherlands
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24
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Döpfmer S, Kuschick D, Toutaoui K, Riens B, Dierks M, Wolf F, Rost L, Krause M, Schulze D, Heintze C, Kümpel L. [Medical care in GP practices during the Covid-19 pandemic: A questionnaire-based survey among general practitioners and medical practice assistants asking for their opinion about changes, needs and burdens]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023:S1865-9217(23)00040-5. [PMID: 37169707 PMCID: PMC10168534 DOI: 10.1016/j.zefq.2023.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/20/2023] [Accepted: 03/14/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION The coronavirus pandemic did not only result in changes in the provision and utilization of health care services in general practice but also in an increased workload for physicians and medical practice assistants. The VeCo practice study retrospectively explores the experiences of both professional groups two years after the start of the pandemic. METHODS In March and April 2022, general practitioners and medical practice assistants in the three German federal states of Berlin, Brandenburg and Thuringia were asked to complete a paper-based questionnaire. RESULTS 657 general practitioners and 762 medical practice assistants completed the questionnaire. Both professional groups agreed to statements indicating a reduction in regular health care provisions. Nevertheless, 74% of the physicians and 82.9% of the medical practice assistants considered the health care provided to their patients during the pandemic as good. This was only possible through considerable additional effort and stress. While more than half of both groups reported that work was still enjoyable, three quarters of both groups stated that the challenges arising from the pandemic outstripped their capacity. Both groups would like to receive more recognition from society (medical practice assistants 93.2%, general practitioners 85.3%) and from their patients (87.7% and 69.9%, respectively). DISCUSSION General practitioners and medical practice assistants reduced regular health care provision but were still able to maintain a good quality of care for their patients during the pandemic. It became clear that more appreciation and adequate financial compensation are necessary to ensure long-term sustainability of GP care. CONCLUSION The subjective view of general practitioners and medical practice assistants on their health care provision shows that appreciation and adequate financial renumeration, particularly when working under most difficult conditions, are necessary to increase the attractiveness of a career in general practice, for both physicians and medical practice assistants.
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Affiliation(s)
- Susanne Döpfmer
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - Doreen Kuschick
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Kahina Toutaoui
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Burgi Riens
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Marius Dierks
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Florian Wolf
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Liliana Rost
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Markus Krause
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Daniel Schulze
- Institut für Biometrie und Klinische Epidemiologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Christoph Heintze
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Lisa Kümpel
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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25
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Teggart K, Neil-Sztramko SE, Nadarajah A, Wang A, Moore C, Carter N, Adams J, Jain K, Petrie P, Alshaikhahmed A, Yugendranag S, Ganann R. Effectiveness of system navigation programs linking primary care with community-based health and social services: a systematic review. BMC Health Serv Res 2023; 23:450. [PMID: 37158878 PMCID: PMC10165767 DOI: 10.1186/s12913-023-09424-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Fragmented delivery of health and social services can impact access to high-quality, person-centred care. The goal of system navigation is to reduce barriers to healthcare access and improve the quality of care. However, the effectiveness of system navigation remains largely unknown. This systematic review aims to identify the effectiveness of system navigation programs linking primary care with community-based health and social services to improve patient, caregiver, and health system outcomes. METHODS Building on a previous scoping review, PsychInfo, EMBASE, CINAHL, MEDLINE, and Cochrane Clinical Trials Registry were searched for intervention studies published between January 2013 and August 2020. Eligible studies included system navigation or social prescription programs for adults, based in primary care settings. Two independent reviewers completed study selection, critical appraisal, and data extraction. RESULTS Twenty-one studies were included; studies had generally low to moderate risk of bias. System navigation models were lay person-led (n = 10), health professional-led (n = 4), team-based (n = 6), or self-navigation with lay support as needed (n = 1). Evidence from three studies (low risk of bias) suggests that team-based system navigation may result in slightly more appropriate health service utilization compared to baseline or usual care. Evidence from four studies (moderate risk of bias) suggests that either lay person-led or health professional-led system navigation models may improve patient experiences with quality of care compared to usual care. It is unclear whether system navigation models may improve patient-related outcomes (e.g., health-related quality of life, health behaviours). The evidence is very uncertain about the effect of system navigation programs on caregiver, cost-related, or social care outcomes. CONCLUSIONS There is variation in findings across system navigation models linking primary care with community-based health and social services. Team-based system navigation may result in slight improvements in health service utilization. Further research is needed to determine the effects on caregiver and cost-related outcomes.
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Affiliation(s)
- Kylie Teggart
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Abbira Nadarajah
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Amy Wang
- Department of Family Medicine, University of Alberta, 5-16 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Caroline Moore
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Nancy Carter
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Janet Adams
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Kamal Jain
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Penelope Petrie
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Aref Alshaikhahmed
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Shreya Yugendranag
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Rebecca Ganann
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada.
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Lasalvia A, Bodini L, D’Astore C, Gomez F, Pesarin A, Imperadore G, Bonetto C. The Impact of COVID-19 Pandemic on Psychiatric Rehabilitation in Residential Facilities: Perspectives of Staff and Residents. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2023:1-15. [PMID: 37360914 PMCID: PMC10123581 DOI: 10.1007/s40737-023-00343-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/05/2023] [Indexed: 06/28/2023]
Abstract
The coronavirus pandemic imposed significant changes in the care of patients in psychiatric residential facilities, especially during lockdown periods. The aim of this study was to assess the impact of the pandemic on patients and staff of psychiatric residential facilities (RFs). This cross-sectional survey was conducted between 30 June and 30 July 2021 and involved 31 RFs located in the province of Verona (Italy). In total, 170 staff members and 272 residents participated in this study. Staff showing clinically significant symptoms of anxiety, depression and burnout were, respectively, 7.7%, 14.2% and 6%. Staff were concerned about the risk that COVID-19 infection might spread among residents (67.6%) and that residents could not receive an acceptable service due to service reconfiguration because of the pandemic (50.3%). Residents found it very unpleasant not to be permitted to attend family members (85.3%), and not to be allowed to engage in outdoor activities due to the restrictions (84%). Both staff and residents agree that the main problematic areas for the residents was the interdiction to meet family members or friends and the interdiction to outdoor activities, whereas problems related to the COVID-19 infection were considered by the staff members as more frequently problematic than reported by residents. The COVID-19 pandemic had a significant impact on the rehabilitation care and recovery journeys of the residents of psychiatric RFs. Therefore, sustained, and careful attention is needed to ensure that the rehabilitation needs of people with severe mental disorders are not neglected in time of pandemics. Supplementary Information The online version contains supplementary material available at 10.1007/s40737-023-00343-6.
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Affiliation(s)
- Antonio Lasalvia
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) Di Verona, Policlinico “G.B. Rossi”, P.le Scuro, 10, 37134 Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Luca Bodini
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Camilla D’Astore
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) Di Verona, Policlinico “G.B. Rossi”, P.le Scuro, 10, 37134 Verona, Italy
| | - Francesca Gomez
- Department of Mental Health, ULSS 9 Scaligera, Verona, Italy
| | - Alessia Pesarin
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Chiara Bonetto
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Wilding S, Wighton S, West R, Conner M, O'Connor DB. A randomised controlled trial of volitional and motivational interventions to improve cervical cancer screening uptake. Soc Sci Med 2023; 322:115800. [PMID: 36858020 DOI: 10.1016/j.socscimed.2023.115800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/18/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Cervical cancer is the fourth most common cancer to occur in women worldwide. In the UK, the NHS cervical screening programme invites eligible individuals to take part in screening every 3-5 years. At present, around 70% of individuals attend screening when invited. The present study aimed to test the effectiveness of a volitional and a motivational intervention alone and in combination on screening uptake at 16-week follow up. METHODS 14,536 participants were recruited from the list of eligible participants invited for screening in Yorkshire, Humber and the North East regions of England in December 2021. They were randomised to a social norm-based motivational intervention (SNA); implementation intention-based Volitional Help Sheet (VHS); combined intervention (SNA + VHS); or treatment as usual control. The primary outcome was screening uptake measured via patient screening records at 16 weeks. RESULTS Of the 14,466 participants with eligible data for analysis, 5793 (40.0%) attended for cervical cancer screening in the 16 weeks after the intervention mailing. Both age and deprivation influenced screening uptake, with lower uptake in the youngest individuals and those from more deprived areas. Compared to control, there was no evidence of any benefit from the VHS implementation intervention alone (Adj.OR = 0.99, 95% CI 0.90 to 1.10), the SNA motivational intervention alone (Adj.OR = 0.89; 95% CI: 0.80 to 0.99), or the combined intervention (Adj.OR = 0.96, 95% CI 0.86 to 1.06). CONCLUSION The study did not support any benefit of either VHS or SNA interventions alone or in combination on cervical cancer screening uptake. It did demonstrate alarmingly low levels of screening uptake at 16 weeks which were well below the average rate. Future research needs to urgently investigate and understand the barriers to uptake following on from the COVID-19 pandemic.
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Affiliation(s)
- Sarah Wilding
- School of Psychology, University of Leeds, Leeds, UK
| | - Sarah Wighton
- NHS England and NHS Improvement (North East & Yorkshire), UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK.
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Bower M, Smout S, Donohoe-Bales A, O’Dean S, Teesson L, Boyle J, Lim D, Nguyen A, Calear AL, Batterham PJ, Gournay K, Teesson M. A hidden pandemic? An umbrella review of global evidence on mental health in the time of COVID-19. Front Psychiatry 2023; 14:1107560. [PMID: 36970258 PMCID: PMC10032377 DOI: 10.3389/fpsyt.2023.1107560] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/17/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundThe mental health impacts of the COVID-19 pandemic remain a public health concern. High quality synthesis of extensive global literature is needed to quantify this impact and identify factors associated with adverse outcomes.MethodsWe conducted a rigorous umbrella review with meta-review and present (a) pooled prevalence of probable depression, anxiety, stress, psychological distress, and post-traumatic stress, (b) standardised mean difference in probable depression and anxiety pre-versus-during the pandemic period, and (c) comprehensive narrative synthesis of factors associated with poorer outcomes. Databases searched included Scopus, Embase, PsycINFO, and MEDLINE dated to March 2022. Eligibility criteria included systematic reviews and/or meta-analyses, published post-November 2019, reporting data in English on mental health outcomes during the COVID-19 pandemic.FindingsThree hundred and thirty-eight systematic reviews were included, 158 of which incorporated meta-analyses. Meta-review prevalence of anxiety symptoms ranged from 24.4% (95%CI: 18–31%, I2: 99.98%) for general populations to 41.1% (95%CI: 23–61%, I2: 99.65%) in vulnerable populations. Prevalence of depressive symptoms ranged from 22.9% (95%CI: 17–30%, I2: 99.99%) for general populations to 32.5% (95%CI: 17–52%, I2: 99.35) in vulnerable populations. Prevalence of stress, psychological distress and PTSD/PTSS symptoms were 39.1% (95%CI: 34–44%; I2: 99.91%), 44.2% (95%CI: 32–58%; I2: 99.95%), and 18.8% (95%CI: 15–23%; I2: 99.87%), respectively. Meta-review comparing pre-COVID-19 to during COVID-19 prevalence of probable depression and probable anxiety revealed standard mean differences of 0.20 (95%CI = 0.07–0.33) and 0.29 (95%CI = 0.12–0.45), respectively.ConclusionThis is the first meta-review to synthesise the longitudinal mental health impacts of the pandemic. Findings show that probable depression and anxiety were significantly higher than pre-COVID-19, and provide some evidence that that adolescents, pregnant and postpartum people, and those hospitalised with COVID-19 experienced heightened adverse mental health. Policymakers can modify future pandemic responses accordingly to mitigate the impact of such measures on public mental health.
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Affiliation(s)
- Marlee Bower
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Marlee Bower,
| | - Scarlett Smout
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Scarlett Smout,
| | - Amarina Donohoe-Bales
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Siobhan O’Dean
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Lily Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Julia Boyle
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Denise Lim
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Andre Nguyen
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Alison L. Calear
- Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia
| | - Philip J. Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia
| | - Kevin Gournay
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Jefferson L, Heathcote C, Bloor K. General practitioner well-being during the COVID-19 pandemic: a qualitative interview study. BMJ Open 2023; 13:e061531. [PMID: 36813497 PMCID: PMC9950583 DOI: 10.1136/bmjopen-2022-061531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic presented new challenges for general practitioners' (GPs') mental health and well-being, with growing international evidence of its negative impact. While there has been a wide UK commentary on this topic, research evidence from a UK setting is lacking. This study sought to explore the lived experience of UK GPs during COVID-19, and the pandemic's impact on their psychological well-being. DESIGN AND SETTING In-depth qualitative interviews, conducted remotely by telephone or video call, with UK National Health Service GPs. PARTICIPANTS GPs were sampled purposively across three career stages (early career, established and late career or retired GPs) with variation in other key demographics. A comprehensive recruitment strategy used multiple channels. Data were analysed thematically using Framework Analysis. RESULTS We interviewed 40 GPs; most described generally negative sentiment and many displayed signs of psychological distress and burnout. Causes of stress and anxiety related to personal risk, workload, practice changes, public perceptions and leadership, team working and wider collaboration and personal challenges. GPs described potential facilitators of their well-being, including sources of support and plans to reduce clinical hours or change career path, and some described the pandemic as offering a catalyst for positive change. CONCLUSIONS A range of factors detrimentally affected the well-being of GPs during the pandemic and we highlight the potential impact of this on workforce retention and quality of care. As the pandemic progresses and general practice faces continued challenges, urgent policy measures are now needed.
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Affiliation(s)
- Laura Jefferson
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Claire Heathcote
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Karen Bloor
- Department of Health Sciences, University of York, York, North Yorkshire, UK
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Burnout and Turnover Intention in Critical Care Professionals During the COVID-19 Pandemic in Japan: A Cross-sectional Survey. Ann Am Thorac Soc 2023; 20:262-268. [PMID: 36122173 PMCID: PMC9989855 DOI: 10.1513/annalsats.202201-029oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Rationale: The prevalence of burnout among critical care professionals during the coronavirus disease (COVID-19) pandemic varies in different countries. Objectives: To investigate the prevalence of burnout and turnover intention in Japanese critical care professionals in March 2021. Methods: This cross-sectional study used a web-based survey of Japanese critical care professionals working in 15 intensive care units in 15 prefectures. Burnout was measured using the Mini Z 2.0 Survey. Intention to leave (turnover intention) was assessed by survey. Resilience was measured using the Brief Resilience Scale (Japanese version). Demographics and personal and workplace characteristics were also collected. Results: Of 1,205 critical care professionals approached, 936 (77.6%) completed the survey. Among these, 24.3%, 20.6%, and 14.2% reported symptoms of burnout, depression, and anxiety, respectively. A total of 157 respondents (16.8%) reported turnover intention. On multivariate analysis, higher resilience scores (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.84-0.95; and OR, 0.94; 95% CI, 0.91-0.96) and perceived support from the hospital (OR, 0.64; 95% CI, 0.44-0.93; and OR, 0.54; 95% CI, 0.40-0.73) were associated with a lower odds of burnout and turnover intention, respectively. Conclusions: Approximately 24% and 17% of the Japanese critical care professionals surveyed had symptoms of burnout and turnover intention from critical care, respectively, during the COVID-19 pandemic. Such professionals require organizational support to cultivate both individual and organizational resilience to reduce burnout and turnover intention.
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Sattar R, Heyhoe J, O'Hara D, Wijeratne D, Lawton R. Caring in a crisis: Understanding the stressors and uplifts for National Health Service frontline staff through the lens of clinical psychologists. Stress Health 2023; 39:103-114. [PMID: 35650379 DOI: 10.1002/smi.3168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 02/07/2023]
Abstract
The unprecedented public health crisis of the Covid-19 pandemic resulted in a significant challenge to the delivery of healthcare that has rarely been experienced before. The stress already faced by healthcare staff working in the National Health Service (NHS) has been further exacerbated during Covid-19, putting them at risk of adverse mental health outcomes. Through the lens of clinical psychologists who had provided support to frontline healthcare staff during the Covid-19 pandemic, this study aimed to better understand the stressors and uplifts healthcare staff experienced during Covid-19, the impact of these on the wellbeing of staff and patient care, and to examine the support needed to deal with the impact of a crisis. A qualitative study design using a combination of diaries followed by semi-structured interviews was utilised. Data was analysed using thematic analysis. The following five themes represented the stressors and uplifts experienced by NHS frontline healthcare staff during Covid-19, the impact on staff wellbeing and patient care: facing change; risks of working in the NHS environment; transcending the negatives; challenging professional values and haunted by patient deaths. The findings also highlight the importance of providing psychological support and suggest the need to continue to provide this support service to help NHS staff manage through subsequent waves of the pandemic. These findings can contribute towards both the management of the current Covid-19 pandemic and other similar crises in the future.
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Affiliation(s)
- Raabia Sattar
- Bradford Institute for Health Research, Bradford, West Yorkshire, UK
| | - Jane Heyhoe
- Bradford Institute for Health Research, Bradford, West Yorkshire, UK
| | - Daniel O'Hara
- Neuropsychology Department, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | | | - Rebecca Lawton
- Bradford Institute for Health Research, Bradford, West Yorkshire, UK.,School of Psychology, University of Leeds, Leeds, UK
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COVID-19 Continues to Burden General Practitioners: Impact on Workload, Provision of Care, and Intention to Leave. Healthcare (Basel) 2023; 11:healthcare11030320. [PMID: 36766895 PMCID: PMC9914234 DOI: 10.3390/healthcare11030320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
General practitioners (GPs), already in a profession with a high workload, have been at the frontline of providing COVID-19-related healthcare in addition to routine care. Our study examined the impact of pandemic-related consultations and changes in practice organization on GPs' current workload and provision of healthcare in summer 2021 (May 2021-July 2021) and early 2022 (January 2022-February 2022). In total, 143 German GPs participated in an online survey in the summer of 2021. Of these, 51 GPs participated in the follow-up survey in 2022. Most GPs perceived an increase in consultation frequency, consultation times, and workload since the pandemic outbreak. Increased consultation times were related to the reduced provision of medical care to other patients with chronic diseases. More SARS-CoV-2 vaccination consultations were associated with reduced home visits, acute consultation times, and cancer screenings. A quarter of GPs considered leaving their job. Pandemic-related bureaucracy, restricted access to therapy and rehabilitation services specialized on COVID-19, unreliable vaccine deliveries, mandatory telematics-infrastructure implementation, and frequent changes in official regulations were the main reasons reported for dissatisfaction. Our results provide insights into how the pandemic continues to burden GPs' work routines and how better working conditions in times of high demand could be achieved in future pandemics.
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Valjarevic S, Radaljac D, Jovanovic MB, Miladinovic N. Late diagnosis of a submandibular gland carcinoma in Covid-19 pandemic. Med Leg J 2023:258172221141252. [PMID: 36655332 DOI: 10.1177/00258172221141252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The Covid-19 pandemic has created exceptional challenges for patients and medical care systems. Among many factors influencing postponed cancer diagnosis, mask-wearing created difficulties in initial diagnosis of head and neck tumours. This report features a patient who had been covering a submandibular tumour under a surgical mask for more than 6 months. He visited his general practitioner due to a significant weight loss, but he neither took his mask off, nor was he asked to do so. When he reported to our emergency room, we noticed a massive ulcerous mass in the right submandibular region. Histological examination confirmed primary squamocellular carcinoma of submandibular salivary gland. During the Covid-19 pandemic, significant clinical observations may be missed if a surgical mask or respirator are not removed during examination with the potential for increased incidence of medical malpractice claims.
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Affiliation(s)
- Svetlana Valjarevic
- Department of Otorhinolaryngology with Maxillofacial Surgery, Clinical Hospital Center "Zemun", Belgrade, Serbia
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Dejan Radaljac
- Department of Otorhinolaryngology with Maxillofacial Surgery, Clinical Hospital Center "Zemun", Belgrade, Serbia
| | - Milan B Jovanovic
- Department of Otorhinolaryngology with Maxillofacial Surgery, Clinical Hospital Center "Zemun", Belgrade, Serbia
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Nenad Miladinovic
- Department of Clinical Pathology, Clinical Hospital Center "Zemun", Belgrade
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Muacevic A, Adler JR. The Impact of COVID-19 on Primary Care: A Scoping Review. Cureus 2023; 15:e33241. [PMID: 36618499 PMCID: PMC9815485 DOI: 10.7759/cureus.33241] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
The COVID-19 pandemic had a severe impact on various aspects of everyday life, including healthcare provision. The aim of the scoping review was to collate, summarize, and discuss this literature, in light of the impact COVID-19 had on Primary care. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) four-stage process framework for reporting was followed. A total of 31 studies were included in this review. Based upon our review we found COVID-19 pandemic on Primary Care, has made significant effects on 1) service redesign, 2) long-term illness care provision, 3) healthcare staff well-being and 4) the post-pandemic future of Primary Care. The COVID-19 outbreak has demonstrated, how a pandemic can drastically change the process of healthcare provision within the community, as evidenced by the change in consultation styles with patients, the impact on the physical and mental wellbeing of health workers, a shift from isolated practice to teamwork, as well as the ability of healthcare workers to seek prompt help with their health. Studies have demonstrated progress in knowledge and experience gained by healthcare workers when tackling COVID-19, and how these can be implemented in possible future pandemics affecting Primary Care, however, further research is required within this sphere.
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Foo D, Mahadeva J, Lopez F, Ellis LA, Churruca K, Dammery G, Willcock S, Braithwaite J. High-performing primary care: reinvigorating general practice as a learning health system. Br J Gen Pract 2023; 73:8-9. [PMID: 36543545 PMCID: PMC9799353 DOI: 10.3399/bjgp23x731505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Darran Foo
- Conjoint Lecturer, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales
| | - Janani Mahadeva
- Conjoint Senior Lecturer, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales
| | - Francisco Lopez
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science; National Health and Medical Research Council (NHMRC) Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales
| | - Kate Churruca
- NHMRC Leadership Fellow, Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science; NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales
| | - Simon Willcock
- Wellbeing and Diagnostics, MQ Health; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science; NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales
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van Gelder M, van Veldhoven M, van de Voorde K. Wellbeing in line managers during mandatory working from home: How work and personal factors combine. Front Psychol 2022; 13:1041902. [PMID: 36591035 PMCID: PMC9800035 DOI: 10.3389/fpsyg.2022.1041902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
The pandemic, particularly the aspect of forced working from home, has had a major impact on the workforce. Previous studies show that line managers have also experienced severe mental strain during this period. Since it is expected that hybrid working will be more the new normal than the exception in future, this study further examined line managers' work-related wellbeing in terms of engagement and exhaustion. Following the job characteristics model (JCM), we explore the mediating role of meaningful work between workplace innovation before the pandemic and line managers' work-related wellbeing during forced working from home. The underlying idea is that organizations that already adopted workplace innovation practices before the pandemic, give teams and employees more control, thus allowing a more meaningful role for line managers, which positively impacts line managers' work-related wellbeing during the pandemic. In addition, building upon Job Demands-Resources (JD-R) Theory and the role of personal resources therein, we explore digital leadership skills and work-life segmentation preference as moderators between meaningful work and work-related wellbeing. Our findings show that workplace innovation is positively associated with engagement via its effect on meaningful work, but not associated with exhaustion. Second, we found that work-life segmentation preference amplifies the relation between meaningful work and engagement (positive link) as well as exhaustion (negative link). This indicates that line managers with a high work-life segmentation preference who have a low score on meaningful work, experience less engagement and more exhaustion than line managers with a high score on meaningful work when working from home. No support was found for the moderation of digital leadership skills in the relationship between meaningful work, engagement, and exhaustion. Based on these results, we discuss implications for research and we provide practice recommendations.
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Whitehead IO, Moffatt S, Jagger C, Hanratty B. A national study of burnout and spiritual health in UK general practitioners during the COVID-19 pandemic. PLoS One 2022; 17:e0276739. [PMID: 36322555 PMCID: PMC9629610 DOI: 10.1371/journal.pone.0276739] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To quantify the burnout and spiritual health of general practitioners (GPs) in the United Kingdom (UK) who worked during the Covid-19 Pandemic. DESIGN Online survey, April/May 2021, distributed via emails to general practices, Clinical Commissioning Groups (CCGs), Health boards, Clinical Research Networks, professional groups, social media GP groups and networks. SETTING United Kingdom. PARTICIPANTS 1318 GPs who had worked in the National Health Service (NHS) during the COVID-19 pandemic (March 2020 -May 2021). MAIN OUTCOME MEASURES Burnout scores, measured by the Maslach Burnout Inventory (MBI) for Medical Personnel; spiritual health, measured using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, Non-Illness (FACIT-SP-NI). RESULTS 19% of surveyed GPs were at the highest risk for burnout, using accepted MBI 'cut off' levels. There was no evidence of a difference in burnout by gender, ethnicity, or length of service. GP burnout was associated with GP spiritual health, regardless of identification with a religion. GPs with low spiritual health were five times more likely to be in the highest risk group for burnout. CONCLUSIONS Burnout is at crisis levels amongst GPs in the UK NHS. A comprehensive response is required, identifying protective and precipitating factors for burnout. The potentially protective impact of spiritual health merits further investigation.
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Affiliation(s)
- Ishbel Orla Whitehead
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Suzanne Moffatt
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Carol Jagger
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Barbara Hanratty
- Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
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Parajuli DR, Ullah S, McGrail M, McLachlan CS, Isaac V. Work-related, socio-cultural, and personal factors associated with locus of control among Australian general practitioners. J Psychiatr Res 2022; 155:589-595. [PMID: 36206603 DOI: 10.1016/j.jpsychires.2022.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/29/2022] [Accepted: 09/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Locus of control (LoC) is a social cognition, that relates to the level of self-control that people have over their personal environment that influences their life. In this context, LoC is frequently associated with work-related behavioral outcomes, ranging from job attitudes, career behaviors, stress, and burnout. OBJECTIVE To investigate the association between LoC, and work-related behavioral factors, socio-cultural factors, and personal factors among Australian General Practitioners (GPs). METHODS This study utilized data from the 2010 Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors. Locus of control (LoC) was measured by a 7-point Likert scale based on Pearlin-Schooler Mastery/Self-efficacy 7-item Scale. Higher score indicated lower internal LoC. Multivariate linear regression model was performed to determine the independent predictors of LoC. RESULTS Of 3,664 GP participants, LoC did not differ by gender. Poor/fair self-rated health, working in urban location, running a stressful practice, poor balance of professional and personal commitments, poor support network, financial circumstances after retirement, and perception of unrealistic expectation by patients were significant predictors for a lower Internal LoC in a multivariate linear regression model. Adjusted R2 explained 22.4% of variation in predicting the LoC in our models. CONCLUSIONS LoC of Australian GPs is negatively affected by poor work-life balance, inadequate support, and unrealistic patient expectation. These work-place specific factors could be targeted by interventions to improve GPs wellbeing.
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Affiliation(s)
- Daya Ram Parajuli
- Flinders Rural and Remote Health, College of Medicine and Public Health, Flinders University, Ral Ral Avenue, Renmark, Australia
| | - Shahid Ullah
- Flinders Rural and Remote Health, College of Medicine and Public Health, Flinders University, Ral Ral Avenue, Renmark, Australia
| | - Matthew McGrail
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Australia
| | - Craig S McLachlan
- Health Vertical, Centre for Healthy Futures, Torrens University, Sydney, NSW, Australia
| | - Vivian Isaac
- Flinders Rural and Remote Health, College of Medicine and Public Health, Flinders University, Ral Ral Avenue, Renmark, Australia.
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Eghosa-Aimufua O, Boam A, Webb KL, Browne J. 'I felt forced to find an alternative': a qualitative analysis of women medical educators' narratives of career transitions. BMJ Open 2022; 12:e059009. [PMID: 36109028 PMCID: PMC9478840 DOI: 10.1136/bmjopen-2021-059009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES While institutional and systemic attempts to increase women's participation in medical education have enabled increasing numbers to enter the field and achieve more senior positions, little is known about lived experiences of female clinical educators. Women clinicians are more likely to change careers and work less than full time. This study focuses on women medical educators' narratives of career change, with the aim of exploring the interplay between factors affecting career decision-making, career trajectory and professional development. METHODS: We employed narrative enquiry approaches to two data sources (55 written accounts of turning points; 9 semistructured interviews reflecting on periods of career transition). Through analysing themes within each dataset before comparing and contrasting datasets simultaneously, we identified three areas of inconsistency and tension. RESULTS Participants reported feeling both drawn and pushed into medical education. Some respondents reported that they were compelled by circumstances to enter medical education. Participants' narratives were ambiguous regarding personal and professional identities. Additionally, participants asserted their position as autonomous agents while acknowledging their powerlessness when encountering organisational, social and cultural expectations limiting the ability to make independent choices. Even where primary decisions to pursue medical education were positive and motivated by interest, subsequent disappointments and challenges led some participants to doubt their choices. CONCLUSIONS Career advancement in medical education may involve women taking significant personal or career sacrifices, partly due to the continued existence of a medical culture allowing men to dominate senior ranks. Women medical educators achieving satisfying senior roles in the field may harbour lingering regret and resentment at the personal and career costs.
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Affiliation(s)
| | - Alicia Boam
- School of Medicine, Cardiff University, Cardiff, UK
| | | | - Julie Browne
- Centre for Medical Education, Cardiff University, Cardiff, UK
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Talbot A, Lee C, Ryan S, Roberts N, Mahtani KR, Albury C. Experiences of treatment-resistant mental health conditions in primary care: a systematic review and thematic synthesis. BMC PRIMARY CARE 2022; 23:207. [PMID: 35971077 PMCID: PMC9380292 DOI: 10.1186/s12875-022-01819-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/02/2022] [Indexed: 11/11/2022]
Abstract
Background Most adults fail to achieve remission from common mental health conditions based on pharmacological treatment in primary care alone. There is no data synthesising the reasons. This review addresses this gap through a systematic review and thematic synthesis to understand adults’ experiences using primary care for treatment-resistant mental health conditions (TRMHCs). We use the results to produce patient-driven recommendations for better support in primary care. Methods Eight databases were searched from inception to December 2020 for qualitative studies reporting research on people’s experience with TRMHCs in primary care. We included the following common mental health conditions defined by NICE: anxiety, depression, panic disorder, post-traumatic stress, and obsessive-compulsive disorder. Two reviewers independently screened studies. Eligible studies were analysed using an aggregative thematic synthesis. Results Eleven studies of 4456 were eligible. From these eleven studies, 4 descriptive themes were developed to describe a cycle of care that people with TRMHCs experienced in primary care. In the first stage, people preferred to self-manage their mental health and reported barriers that prevented them from seeing a GP (e.g., stigma). People felt it necessary to see their GP only when reaching a crisis point. In the second stage, people were usually prescribed antidepressants, but were sceptical about any benefits they had to their mental health. In the third stage, people self-managed their mental health (e.g., by adjusting antidepressant dosage). The fourth stage described the reoccurrence of mental health and need to see a GP again. The high-order theme, ‘breaking the cycle,’ described how this cycle could be broken (e.g., continuity of care). Conclusions People with TRMHCs and GPs could break the cycle of care by having a conversation about what to do when antidepressants fail to work. This conversation could include replacing antidepressants with psychological interventions like talking therapy or mindfulness.
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Li J, Zhao N, Zhang H, Yang H, Yang J. Roles and Challenges for Village Doctors in COVID-19 Pandemic Prevention and Control in Rural Beijing, China: A Qualitative Study. Front Public Health 2022; 10:888374. [PMID: 35844871 PMCID: PMC9277090 DOI: 10.3389/fpubh.2022.888374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Rural areas in China are more vulnerable to COVID-19 pandemic than urban areas, due to their far fewer health care resources. Village doctors, as rural grassroots health workers in China, have been actively engaged in the pandemic prevention and control. This study aims to describe the roles of village doctors in rural China, and the challenges they have faced during the prevention and control of the COVID-19 pandemic. Setting This study was conducted in three towns in Huairou District, Beijing, China. Design We carried out semi-structured interviews with 75 key informants. All the interviews were audio-recorded and transcribed verbatim. We employed thematic analysis to define themes and sub-themes from the qualitative data. Results We reported four themes. First, the village doctor guided the village committee to carry out decontamination, monitored home-isolated residents, and disseminated knowledge on prevention of the COVID-19 pandemic during the rural pandemic prevention and control. Second, they took pandemic prevention measures in village clinics, distributed pandemic prevention materials, and undertook pre-screening triage. Third, village doctors provided basic medical care, including treatment of common diseases as well as the purchase and delivery of medicines to villagers. Fourth, village doctors faced difficulties and challenges, such as inadequate medical skills, aging staff structure, and lack of pandemic prevention materials. Conclusions Despite many difficulties and challenges, village doctors have actively participated in rural pandemic prevention and control, and made outstanding contributions to curbing spread of COVID-19 pandemic in rural areas. Village doctors provide basic health care while participating in various non-medical tasks.
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Affiliation(s)
- Jin Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Ning Zhao
- School of Public Health, Capital Medical University, Beijing, China
| | - Haiyan Zhang
- Department of Health Education, Beijing Huairou Hospital of University of Chinese Academy of Sciences, Beijing, China
| | - Hui Yang
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jia Yang
- School of Public Health, Capital Medical University, Beijing, China
- *Correspondence: Jia Yang
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Collins C, Clays E, Van Poel E, Cholewa J, Tripkovic K, Nessler K, de Rouffignac S, Šantrić Milićević M, Bukumiric Z, Adler L, Ponsar C, Murauskiene L, Ožvačić Adžić Z, Windak A, Asenova R, Willems S. Distress and Wellbeing among General Practitioners in 33 Countries during COVID-19: Results from the Cross-Sectional PRICOV-19 Study to Inform Health System Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5675. [PMID: 35565070 PMCID: PMC9101443 DOI: 10.3390/ijerph19095675] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022]
Abstract
Emerging literature is highlighting the huge toll of the COVID-19 pandemic on frontline health workers. However, prior to the crisis, the wellbeing of this group was already of concern. The aim of this paper is to describe the frequency of distress and wellbeing, measured by the expanded 9-item Mayo Clinic Wellbeing Index (eWBI), among general practitioners/family physicians during the COVID-19 pandemic and to identify levers to mitigate the risk of distress. Data were collected by means of an online self-reported questionnaire among GP practices. Statistical analysis was performed using SPSS software using Version 7 of the database, which consisted of the cleaned data of 33 countries available as of 3 November 2021. Data from 3711 respondents were included. eWBI scores ranged from -2 to 9, with a median of 3. Using a cutoff of ≥2, 64.5% of respondents were considered at risk of distress. GPs with less experience, in smaller practices, and with more vulnerable patient populations were at a higher risk of distress. Significant differences in wellbeing scores were noted between countries. Collaboration from other practices and perception of having adequate governmental support were significant protective factors for distress. It is necessary to address practice- and system-level organizational factors in order to enhance wellbeing and support primary care physicians.
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Affiliation(s)
- Claire Collins
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium; (E.C.); (E.V.P.); (S.W.)
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium; (E.C.); (E.V.P.); (S.W.)
| | - Joanna Cholewa
- Institute of Health and Society, Catholic University of Louvain, 1348 Louvain-la-Neuve, Belgium; (J.C.); (S.d.R.); (C.P.)
| | - Katica Tripkovic
- City Institute of Public Health Belgrade, 11000 Belgrade, Serbia;
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland; (K.N.); (A.W.)
| | - Ségolène de Rouffignac
- Institute of Health and Society, Catholic University of Louvain, 1348 Louvain-la-Neuve, Belgium; (J.C.); (S.d.R.); (C.P.)
| | | | - Zoran Bukumiric
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.Š.M.); (Z.B.)
| | - Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Cécile Ponsar
- Institute of Health and Society, Catholic University of Louvain, 1348 Louvain-la-Neuve, Belgium; (J.C.); (S.d.R.); (C.P.)
| | - Liubove Murauskiene
- Public Health Department, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania;
| | - Zlata Ožvačić Adžić
- Department of Family Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland; (K.N.); (A.W.)
| | - Radost Asenova
- Department of General Practice, Medical University Plovdiv, 4003 Plovdiv, Bulgaria;
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium; (E.C.); (E.V.P.); (S.W.)
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Affiliation(s)
| | - Mike Holmes
- Haxby Group, York; Chair, Nimbuscare, York; Chair, Trustee Board, Royal College of General Practitioners, London; Honorary Professor, Department of Health Sciences, University of York, York
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Abstract
Many aspects of wellbeing have been studied in the context of the COVID-19 pandemic. However, studies that measure a comprehensive, multi-faceted conceptualization of wellbeing are rare. Using a broad conceptualization of wellbeing, based on the Organisation for Economic Co-operation and Development (OECD) wellbeing indicators and a theoretical model of wellbeing developed previously, this study empirically assesses the wellbeing effects of COVID-19 in Israel. A representative sample of the adult population in Israel was surveyed and structural equation modeling (SEM) was used to analyze the impacts of the pandemic on a number of wellbeing indicators. Relationships among indicators were also analyzed. The study’s findings highlight the importance of social interactions, economics, mental health, and leisure on wellbeing. The study can be used by policymakers to fully understand the impact of various COVID-19 response policies on the wellbeing of the population.
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