Abstract
Background
Cardiovascular diseases (CVD) caused 17.9 million deaths worldwide in 2016, being the world’s leading cause of death. Prevention of CVD in high-income countries is expensive and ...fails to reach the population at risk. In low-income countries, it is under-developed. The SPICES project implements a community-based program to improve CVD prevention in 3 European countries and 2 Sub-Saharan countries, based on using community champions to effect behavioural changes. In France, the project operates in “Pays Centre Ouest Bretagne” (COB) which is the Central West Brittany area, and a vulnerable, rural setting. The aim of this study is to assess this innovative prevention strategy versus brief advice.
Methods
A two-step RCT hybrid type 1 implementation study will first of all screen a population using the Non-Laboratory INTERHEART Score (NL-IHRS) and will involve health-care students at public events in the COB area until 1000 participants have been recruited. Second, a RCT will be carried out. The research team will contact each participant with an intermediate NL-IHRS in order to include them. Participants will be over 18 years of age and work or live in the COB area. Participants will be equally randomised in two groups. The intervention group will receive brief advice plus behavioural change guidance carried out by community champions. The control group will receive brief advice only. The main objective for the RCT is to assess a difference of at least 15% in the NL-IHRS between the two groups after 24 months. The primary outcome will be analysed with intention to treat. Secondary outcomes for the RCT will be assessed using validated questionnaires: the WHOQOL-BREF, the DASH Q questionnaire, the IPAQ-short; smoking level will be assessed according to the NL-IHRS scoring system; a modified self-declared alcohol consumption questionnaire has been developed and gauges will be used to assess BMI. The implementation strategy will use mixed methods: qualitative research methods and quantitative epidemiological studies.
Discussion
A difference in the mean NL-IHRS of 15% will provide an argument in favour of reorganising prevention policies. A substantial change would favour relocating primary prevention from healthcare professionals to lay people and the community.
Trial registration
Clinical Trials
NCT03886064
- the study was recorded on
ClinicalTrials.gov
, the 22nd of March 2019.
Premature ejaculation (PE) is the most common sexual dysfunction among men. According to patients, the general practitioner (GP) is the appropriate professional with whom to discuss this issue. ...However, few patients receive the medical help needed because GPs find it difficult to talk to their patients about sex. A previous qualitative study provided six strategies described by GPs who had tackled the topic during consultation. A pilot study showed that using one of these strategies after a training course led to an increase in the rate of consultations where the topic was raised: an increase from 6.6 to 30.8%. The aim of this study is to compare whether training in communication skills with these six strategies is more effective than usual care on the incidence of patients bringing up the topic of PE with their GP.
A cluster randomised controlled trial, stratified over four areas comparing an intervention group, which will receive the six strategies training session, and a control group, which ensures routine medical care. The primary outcome is to investigate the efficacy of a training in communication skills directed towards this pathology, compared with usual care procedures, on the incidence of patients bringing up the topic of PE with their GP. The secondary objective relates to the variation in the quality of life of patients after having recently addressed the topic of PE. Quality of life will be evaluated using the SF-12 health scale, with scoring filled in by the patient immediately after the consultation and 4 weeks later. The patients suffering from PE will be identified if their score is higher than 9 on the Premature Ejaculation Diagnostic Tool filled in 4 weeks after the consultation. The number of patients necessary to highlight a significant difference between the two groups from 5 to 20% is 101. Therefore, a total of 600 patients is expected, 300 in each arm (40 GPs, 15 patients per GP; risk α = 5%; power = 90%; intra-cluster correlation coefficient ρ = 0.2; Hawthorne effect = 15%; lost-to-follow-up rates for GPs = 10% and for patients = 20%).
The implication for practice is the improvement in the quality of patient-centred care within a topic area which encompasses almost 30% of male sex-related complaints.
ClinicalTrials.gov, ID: NCT02378779 . Registered on 3 February 2015.
Multimorbidity, according to the World Health Organization, exists when there are two or more chronic conditions in one patient. This definition seems inaccurate for the holistic approach to Family ...Medicine (FM) and long-term care. To avoid this pitfall the European General Practitioners Research Network (EGPRN) designed a comprehensive definition of multimorbidity using a systematic literature review.
To translate that English definition into European languages and to validate the semantic, conceptual and cultural homogeneity of the translations for further research.
Forward translation of the EGPRN's definition of multimorbidity followed by a Delphi consensus procedure assessment, a backward translation and a cultural check with all teams to ensure the homogeneity of the translations in their national context. Consensus was defined as 70% of the scores being higher than 6. Delphi rounds were repeated in each country until a consensus was reached.
229 European medical expert FPs participated in the study. Ten consensual translations of the EGPRN comprehensive definition of multimorbidity were achieved.
A comprehensive definition of multimorbidity is now available in English and ten European languages for further collaborative research in FM and long-term care.
The European General Practitioners Research Network (EGPRN) designed and validated a comprehensive definition of multimorbidity using a systematic literature review and qualitative research ...throughout Europe. This definition was tested as a model to assess death or acute hospitalization in multimorbid outpatients.
To assess which criteria in the EGPRN concept of multimorbidity could detect outpatients at risk of death or acute hospitalization in a primary care cohort at a 6-month follow-up and to assess whether a large scale cohort with FPs would be feasible.
Family Physicians included a random sample of multimorbid patients who attended appointments in their offices from July to December 2014. Inclusion criteria were those of the EGPRN definition of Multimorbidity. Exclusion criteria were patients under legal protection and those unable to complete the 2-year follow-up. Statistical analysis was undertaken with uni- and multivariate analysis at a 6-month follow-up using a combination of approaches including both automatic classification and expert decision making. A Multiple Correspondence Analysis (MCA) completed the process with a projection of illustrative variables. A logistic regression was finally performed in order to identify and quantify risk factors for decompensation.
19 FPs participated in the study. 96 patients were analyzed. 3 different clusters were identified. MCA showed the central function of psychosocial factors and peaceful versus conflictual relationships with relatives in all clusters. While taking into account the limit of a small cohort, age, frequency of family physician visits and extent of family difficulties were the factors which predicted death or acute hospitalization.
A large scale cohort seems feasible in primary care. A sense of alarm should be triggered to prevent death or acute hospitalization in multimorbid older outpatients who have frequent family physician visits and who experience family difficulties.
Quality of care remains a priority issue and is correlated with patient experience. Measuring multidimensional patient primary care experiences in multiprofessional clinics requires a robust ...instrument. Although many exist, little is known about their quality.
To identify patient perception instruments in multiprofessional primary care and evaluate their quality.
Systematic review using Medline, Pascal, PsycINFO, Google Scholar, Cochrane, Scopus, and CAIRN. Eligible articles developed, evaluated, or validated 1 or more self-assessment instruments. The instruments had to measure primary care delivery, patient primary care experiences and assess at least 3 quality-of-care dimensions. The COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist was used to assess methodological quality of included studies. Instrument measurement properties were appraised using 3 possible quality scores. Data were combined to provide best-evidence synthesis based on the number of studies, their methodological quality, measurement property appraisal, and result consistency. Subscales used to capture patient primary care experiences were extracted and grouped into the 9 Institute of Medicine dimensions.
Twenty-nine articles were found. The included instruments captured many subscales illustrating the diverse conceptualization of patient primary care experiences. No included instrument demonstrated adequate validity and the lack of scientific methodology for assessing reliability made interpreting validity questionable. No study evaluated instrument responsiveness.
Numerous patient self-assessment instruments were identified capturing a wide range of patient experiences, but their measurement properties were weak. Research is required to develop and validate a generic instrument for assessing quality of multiprofessional primary care.
Not applicable.
ObjectivesTo explore care experiences in multidisciplinary primary healthcare centres from the patients, carers and healthcare professionals perspectives.DesignThis qualitative study used ...face-to-face, in-depth interviews and focus groups. Patients with multimorbidity monitored by a General Practitioner (GP) and another professional from the health centre were recruited through purposive sampling and included with their carer. They were interviewed together while professionals were interviewed separately. Verbatims were coded with subsequent blind analysis, using an inductive approach, to find aspects and features. The constant comparative method highlighted data consistencies and variations.ParticipantsTwenty-six patients, 23 family carers and 57 healthcare professionals.SettingFive multidisciplinary primary healthcare centres, in France, between March 2017 and December 2018.ResultsThis unique study grouped perspectives into nine core quality of primary care aspects: having accessible, available, and varied care; feeling welcome and enjoying comfortable, well-equipped, and clean premises; having quality medicotechnical care (medical knowledge and technical skills); having a reliable GP; receiving appropriate care from healthcare professionals other than the GP; maintaining an efficient relationship with healthcare professionals; benefiting from organised and coordinated care; being an informed, supported and involved patient; having an informed, supported and involved carer. New areas of interest include the multidisciplinary nature of the centres, appreciation of other professionals within the centre, medicotechnical dimensions of care and the carer’s role in maintaining patient autonomy.ConclusionsThis is the first study to interview patients and carers alongside healthcare professionals. This enhanced knowledge improves understanding of these aspects and can guide implementation of evaluation tools that truly reflect patient and carer needs and enable an efficient experience in terms of quality. To address deficiencies in existing questionnaires, the new perspectives found will be added to former aspects to create a comprehensive quality of primary care evaluation tool.Trial registration numberNCT02934711, Results.
Background Cardiovascular diseases (CVD) caused 17.9 million deaths worldwide in 2016, being the world's leading cause of death. Prevention of CVD in high-income countries is expensive and fails to ...reach the population at risk. In low-income countries, it is under-developed. The SPICES project implements a community-based program to improve CVD prevention in 3 European countries and 2 Sub-Saharan countries, based on using community champions to effect behavioural changes. In France, the project operates in "Pays Centre Ouest Bretagne" (COB) which is the Central West Brittany area, and a vulnerable, rural setting. The aim of this study is to assess this innovative prevention strategy versus brief advice. Methods A two-step RCT hybrid type 1 implementation study will first of all screen a population using the Non-Laboratory INTERHEART Score (NL-IHRS) and will involve health-care students at public events in the COB area until 1000 participants have been recruited. Second, a RCT will be carried out. The research team will contact each participant with an intermediate NL-IHRS in order to include them. Participants will be over 18 years of age and work or live in the COB area. Participants will be equally randomised in two groups. The intervention group will receive brief advice plus behavioural change guidance carried out by community champions. The control group will receive brief advice only. The main objective for the RCT is to assess a difference of at least 15% in the NL-IHRS between the two groups after 24 months. The primary outcome will be analysed with intention to treat. Secondary outcomes for the RCT will be assessed using validated questionnaires: the WHOQOL-BREF, the DASH Q questionnaire, the IPAQ-short; smoking level will be assessed according to the NL-IHRS scoring system; a modified self-declared alcohol consumption questionnaire has been developed and gauges will be used to assess BMI. The implementation strategy will use mixed methods: qualitative research methods and quantitative epidemiological studies. Discussion A difference in the mean NL-IHRS of 15% will provide an argument in favour of reorganising prevention policies. A substantial change would favour relocating primary prevention from healthcare professionals to lay people and the community. Trial registration Clinical Trials NCT03886064 - the study was recorded on ClinicalTrials.gov, the 22nd of March 2019. Keywords: Primary prevention, Cardiovascular system, Community participation, Community health-care workers, Motivational interviewing
Background: Multimorbidity is a challenging concept for general practice. An EGPRN working group has published a comprehensive definition of the concept of multimorbidity. As multimorbidity could be ...a way to explore complexity in general practice, it was of importance to explore whether European general practitioners (GPs) recognize this concept and whether they would change it.
Objectives: To investigate whether European GPs recognize the EGPRN concept of multimorbidity and whether they would change it.
Methods: Focus group meetings and semi-structured interviews as data collection techniques with a purposive sample of practicing GPs from every country. Data collection continued until saturation was reached in every country. The analysis was undertaken using a grounded theory based method. In each national team, four independent researchers, working blind and pooling data, carried out the analysis. To ensure the internationalization of the data, an international team of 10 researchers pooled the axial and selective coding of all national teams to check the concept and highlight emerging themes.
Results: The maximal variation and saturation of the sample were reached in all countries with 211 selected GPs. The EGPRN definition was recognized in all countries. Two additional ideas emerged, the use of Wonca's core competencies of general practice, and the dynamics of the doctor-patient relationship for detecting and managing multimorbidity and patient's complexity.
Conclusion: European GPs recognized and enhanced the EGPRN concept of multimorbidity. These results open new perspectives regarding the management of complexity using the concept of multimorbidity in general practice.
Key Messages
European general practitioners recognize the EGPRN enhanced, comprehensive concept of multimorbidity.
They add the use of Wonca's core competencies and the patient-doctor relationship dynamics for detecting and managing multimorbidity.
The EGPRN concept of multimorbidity leads to new perspectives for the management of complexity.
Primary care organization is changing to improve the patient's care pathway and to cope with increasingly complex care requests. The multiple care and services required by multimorbid patients ...require multiple expertise and interprofessional coordination that coordinated practice could more easily provide. Despite the growth of these groups, there was still a lack of understanding of professionals’ motivation to set up in such groups and a lack of description about what was occurring in them.
To explore factors influencing the establishment of multi-professional groups, collaboration, and its durability over time.
Five qualitative studies involving semi-structured interviews and group interviews with health professionals working in multi-professional health offices were analysed using an open and inductive approach. Dynamics and types of work were compared and summarized. The results were displayed in a heuristic map.
Fifty-seven health professionals were interviewed in 57 individual interviews and 5 focus groups, covering 11 professions. The analysis of the 62 verbatims highlighted three main chronologically linked themes: the genesis of the multiprofessional group (levers and barriers to installation), the construction of the collaboration and its evolution (strengthening of the collaboration or shift towards colocation). Health professionals clarified the collaboration dynamics. They described their fears and motivations for installation, the elements influencing the transition from roommate to collaboration, and its durability over time.
The levers highlighted must be planned for and taught in order to support the development of groups in the field and lead to more general collaborative work in primary care.
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