Children in general practice: An exciting area for research. Reflections on the EGPRN meeting in Plovdiv,Bulgaria, May 2010

Abstract

The European General Practice Research Network organized an international research conference on ‘Children in General Practice’ in Plovdiv, Bulgaria, in May 2010. Two of the authors were keynote speakers at the workshop, tasked with summarizing the theme research presentations on each of the two days of the meeting. The theme of the meeting ‘Children in General Practice’ refers to the primary aim for timely and high quality health care for every child and the related general practitioners’ activities. The meeting was an important event, especially for young doctors and investigators from different countries, because they were informed of good practices from other European countries in preventive work with children. All participants shared and learned a lot of good ideas beyond the standards and quality management. Examples of ideas for new research questions that emerged were to study differences in routine check-ups during childhood between European countries; to study the effectiveness of advices given by GPs to (parents of) obese children; and to study adverse events of medication in general practice.

Conclusion: At a European level, the diversity of the ways health care systems deal with health problems in children is striking. We felt great enthusiasm to further develop this research area. Interested family doctors are invited to attend future conferences to develop collaborative research projects on this topic.     

Research using electronic patient records in general practice. The EGPRN meeting in Bertinoro,Italy, May 2009

Abstract

The European General Practice Research Network organized an international workshop on research using electronic patient records in Bertinoro, Italy, in May 2009. The authors were keynote speakers at the workshop, tasked with summarizing the theme research presentations on each of the two days of the meeting. The conference discussed the utility of capturing data in a way that can be appropriately analysed. In this application, the use of ICPC was repeatedly mentioned. Such research requires disciplined data entry and retrieval, and many times consistency in coding is a challenge, which may be met by definitions for coded classes. Quality of data is a concern in such research, and there were suggestions to involve the patients in improving the quality of their record. Clinicians are qualified to code data into electronic patient records accurately, capturing the fine nuances of the consultation. Income incentives, such as the Quality Outcomes Framework, run the risk of data distortion to improve financial gain. The role of all family doctors in research was emphasized, and the full potential of collecting data from family practice is practically achievable only through large databases collecting clinical records from every practice. EGPRN has dealt with this emerging theme in primary care research over the years. Interested family doctors are invited to attend future conferences to develop collaborative research projects using electronic patient records.     

Qualitative outcome assessment and research on chronic disease management in general practice. Highlights from a keynote lecture,EGPRN May 2011, Nice

At its 2011 conference in Nice, France, the European General Practice Research Network (EGPRN), considered the issue of Relevant Outcome Measures in General Practice Research into Chronic Diseases. This paper, which is adapted from a keynote lecture given during that conference, considers the role of qualitative outcome assessments in research. Such assessments have a great deal in common with the patient-centred approach of general practice as they can capture the overall state of a patient rather than capturing only certain aspects. Research suggests that patients can be categorized, based on qualitative outcome assessment, and over time might change category. This approach to assessment brings to our attention alternative ways of considering the future: future as currently being made or future as predictable, at least to some extent. Although general practice needs the evidence from research that predicts the future, it also needs to engage in research that seeks to understand patients as they make their future, and to understand the impact of clinical interventions on this process.     

Qualitative outcome assessment and research on chronic disease management in general practice. Highlights from a keynote lecture, EGPRN May 2011, Nice

At its 2011 conference in Nice, France, the European General Practice Research Network (EGPRN), considered the issue of Relevant Outcome Measures in General Practice Research into Chronic Diseases. This paper, which is adapted from a keynote lecture given during that conference, considers the role of qualitative outcome assessments in research. Such assessments have a great deal in common with the patient-centred approach of general practice as they can capture the overall state of a patient rather than capturing only certain aspects. Research suggests that patients can be categorized, based on qualitative outcome assessment, and over time might change category. This approach to assessment brings to our attention alternative ways of considering the future: future as currently being made or future as predictable, at least to some extent. Although general practice needs the evidence from research that predicts the future, it also needs to engage in research that seeks to understand patients as they make their future, and to understand the impact of clinical interventions on this process.     

Setting priorities and identifying barriers for general practice research in Europe. Results from an EGPRW meeting

BACKGROUND: In spring 2002, WONCA Europe, the European Society of General Practice/Family Medicine and its Network organizations reached consensus on a 'new' European definition of general practice. Subsequently, the European General Practice Research Workshop (EGPRW) started working on a European General Practice Research Agenda. This topic was addressed during the 2002 EGPRW autumn meeting. OBJECTIVE: Our aim was to explore the views of European general practice researchers on needs and priorities as well as barriers for general practice research in Europe. METHODS: In seven discussion groups, 43 general practice researchers from 18 European countries had to answer the following questions. (i) What major topics should be included in a research agenda for general practice in your country? (ii) What are the barriers to adequate implementation of general practice research in your country? Group answers were listed and subsequently categorized by two authors. RESULTS: Research on 'clinical issues' (common diseases, chronic diseases, etc.), including diagnostic strategies, was considered to be the core content of general practice research, with primary care-based morbidity registration essential for surveillance of disease, clinical research and teaching in general practice. There was also consensus on the need for research on education and teaching. 'Insufficient funding opportunities' was perceived to be the major barrier to the development of general practice research. CONCLUSIONS: These findings could be used as a basis for national checklists of 'content of' and 'conditions for' general practice research. European general practice research training programmes should be developed further.     

How to conduct research on overdiagnosis. A keynote paper from the EGPRN May 2016, Tel Aviv

Overdiagnosis is a growing problem worldwide. Overdiagnosis is the diagnosis of deviations, abnormalities, risk factors, and pathologies that in themselves would never cause symptoms (this applies only to risk factors and pathology), would never lead to morbidity, and would never be the cause of death. Overdiagnosis is often misinterpreted as overutilization or overtreatment. Overutilization, overtreatment, and overdiagnosis are interrelated but three distinct topics. Overutilization (establishment of standard practice that does not provide net benefit) does not have to lead to overdiagnosis or overtreatment, but the risk exists. Treatment of overdiagnosed conditions is one category of overtreatment. Another is when the best available evidence shows that the treatment has no beneficial effect. Overdiagnosis can be caused by overutilization and is nearly always followed by overtreatment. Treating an overdiagnosed condition cannot improve the patient’s prognosis, and therefore can only be harmful. At the individual level, we can never be sure if the person is overdiagnosed. However, experiences and thoughts of individuals who are most likely overdiagnosed can be explored in qualitative interviews, e.g. men with a small screening detected abdominal aortic aneurism. In longitudinal surveys, the degree and length of psychosocial consequences associated with overdiagnosis can be estimated. In high-quality RCTs, the magnitude of overdiagnosis can be quantified, and in cohort studies, we can find indications of overdiagnosis. Finally, we can conduct research about the consequences of overdiagnosis in at least eight different areas: financial strain, hassles/inconveniences, medical costs, opportunity costs, physical harms, psychological harms, societal costs and work-related costs.     

Motivation in medical education and patient communication. The EGPRN meeting in Zurich, Switzerland, October 2010

The European General Practice Research Network held an international research meeting on 'Motivation in medical education and patient communication' in Zürich, Switzerland, in October 2010. The two authors were keynote speakers, who introduced the theme from different angles and summarized and reflected on individual papers presented at the conference. The theme of the conference underlined the importance of communication in general practice and of motivation in medical education in particular. There were a variety of papers each addressing in its own way the topic of this meeting. We conclude that it is still uncommon to use psychological theories on motivation in research on motivation and patient communication in general practice/family medicine. Motivation and readiness to change are essential concepts in experimental health services research. Research designs increasingly follow the Framework for the Evaluation of Complex Interventions in Health Care as suggested by the British Medical Research Council. However, there are also difficulties related to classical experimental designs that have to be critically discussed.     

Motivation in medical education and patient communication. The EGPRN meeting in Zurich,Switzerland, October 2010

Abstract

The European General Practice Research Network held an international research meeting on ‘Motivation in medical education and patient communication’ in Zürich, Switzerland, in October 2010. The two authors were keynote speakers, who introduced the theme from different angles and summarized and reflected on individual papers presented at the conference. The theme of the conference underlined the importance of communication in general practice and of motivation in medical education in particular. There were a variety of papers each addressing in its own way the topic of this meeting. We conclude that it is still uncommon to use psychological theories on motivation in research on motivation and patient communication in general practice/family medicine. Motivation and readiness to change are essential concepts in experimental health services research. Research designs increasingly follow the Framework for the Evaluation of Complex Interventions in Health Care as suggested by the British Medical Research Council. However, there are also difficulties related to classical experimental designs that have to be critically discussed.     

A study on the basic epidemiological parameters of viral hepatitis a in the region of Plovdiv,Bulgaria

INTRODUCTION: Infection with hepatitis A virus is of great importance to public health. The disease has a worldwide occurrence due to inadequate sanitation and the variable seroprevalence rates in the community. OBJECTIVE: The present report investigates the epidemiological features of hepatitis A in the region of Plovdiv and outlines the most important epidemiological features of the disease. MATERIALS AND METHODS: In 1999 (a year with a lower hepatitis A prevalence) the basic epidemiological characteristics of the disease were studied: overall morbidity and mortality rates, age, sexual and seasonal distribution, and prevalence in rural and urban areas. The study was carried out in a cohort of 288 patients with hepatitis A admitted to the Clinic of Infectious Disease of the Medical University in Plovdiv. All patients were anti HAV IgM positive. Routine clinical, laboratory, epidemiological and statistical methods were used. Laboratory and serological tests were performed at the Center for Disease Control, Plovdiv and at the University Clinical Laboratory. RESULTS: Of 423 patients with acute viral hepatitis 288 (68.09%) had hepatitis A. In 1999 the morbidity rate for the region of Plovdiv was 49.55 per hundred thousand (intermediate). Disease prevalence was the highest in preschool and early school age as well as in the age groups 20-29 (84.67 per hundred thousand) and 30-39 (71.59 per hundred thousand). Urban residents accounted for 79.85% of the cases. The male/female ratio was 1:1. 82.25% of the preschool children did not attend day-care centers. History of contact with sources of infection was elicited from 17.01% of the patients. Disease rates peaked in October through December (maximum in October). CONCLUSIONS: Accumulated data could contribute to more effective disease control.     

Closing evidence gaps in general practice & family medicine. Selected Abstracts from the 92nd EGPRN Meeting – Virtual Conference, 30 April to 1 May 2021: All abstracts of the conference can be found at the EGPRN website https://www.egprn.org/page/conference-abstracts

Research in general practice covers the whole of medicine, including clinical and contextual issues. Defining the focus of research is, therefore, not easy. Knowledge and preferences of researchers and funding agencies may dominate above the real problems faced by patients and society. In addition, topic selection and prioritisation are often not coordinated, leading to duplication and research waste. A research agenda could help focus on the issues that matter most.In the Netherlands, we developed a national research agenda involving general practitioners (GPs), researchers, patients and other relevant stakeholders in healthcare. We reviewed knowledge gaps from 90 Dutch general practice guidelines and received input from 48 healthcare stakeholders to formulate research questions relevant for general practice. This resulted in a long list of 787 research questions. These were prioritised by practising GPs (n = 232) in an online survey and in an invitational conference, including GPs (n = 48) and representatives of other stakeholders in healthcare (n = 16). The prioritising procedure resulted in 24 top 10 lists of research questions categorised according to ICPC chapters and overarching themes such as person-centred care, eHealth, and organisation of care. An advisory board composed of general practice research departments representatives, the Dutch College of GPs, GP trainees, and patient organisations supported the whole process.The national research agenda provided an enormous boost in general practice research as well as in collaboration between research departments. A national general practice research programme has been launched to address the questions in the agenda. Collaboration instead of competition between research departments and institutes is encouraged within this programme. They are united in a national consortium supported by the Dutch College of GPs to facilitate collaboration between data registration networks and initiate large-scale multicentered trials.The Dutch general practice research agenda could be an example for other countries and international collaboration. Opportunities to collaborate within the EGPRN to set up an international research agenda are challenging. This could include cross-border themes such as infectious diseases, migrant care, and planetary health. A shared agenda could also increase the chances of obtaining European funding. It is time now for international collaboration in general practice research contributing to health that matters to all.

• Eur J Gen Pract. 2021; 27(1): 354–365.
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• Digital technologies: Opportunities and challenges for better, safer and more equitable primary care

2021; 27(1): 354–365. Published online 2021 Dec 13. doi: 10.1080/13814788.2021.2008352

Digital technologies: Opportunities and challenges for better, safer and more equitable primary care

Ana Luisa NevesAna Luisa NevesCenter for Health Technology and Services Research, University of Porto, Porto, PotugalFind articles by Ana Luisa NevesAuthor information Copyright and License information PMC DisclaimerCenter for Health Technology and Services Research, University of Porto, Porto, PotugalCONTACT moc.liamg@seven.asiul.anaPMC Copyright notice     

Challenges for clinical practice and research in family medicine in reducing the risk of chronic diseases. Notes on the EGPRN Spring Conference 2017 in Riga

Chronic diseases in most cases belong to the category of non-communicable diseases (NCDs), which are the main cause of mortality globally. Cardiovascular diseases, diabetes, chronic obstructive pulmonary disease and cancer are the four NCDs responsible for 82% of NCD deaths. Prevention of NCDs implies health promotion activities that encourage healthy lifestyle and limit the initial onset of chronic diseases. Prevention also includes early detection activities, such as screening at-risk populations, as well as strategies for appropriate management of existing diseases and related complications. Early intervention, reducing morbidity and mortality rates could be an appealing idea for patients, physicians and governmental institutions but could also cause harm. Healthcare is undergoing profound changes, and the role of technology in diagnostics and management of chronic diseases in primary healthcare (PHC) is increasing remarkably. However, studies show that the standards of care for chronic diseases and preventive care are met by less than 50%. We still lack clear standards for patients with multiple chronic diseases. The applicability of a single evidence-based guideline to multimorbid patients is limited and can be problematic. Well-designed PHC studies focusing on the impact of medical interventions on morbidity, mortality and quality of life in the fields of early diagnosis, early treatment and multimorbidity are still needed.     

Research challenges for family medicine in a changing Europe. Reflections afteran EGPRN conference on multimorbidity (Dubrovnik, 2009)

Introduction: In this background paper, we discuss the educational needs of family medicine teachers and trainers in the light of a EURACT (European Academy of Teachers in General Practice) project aimed at the development of a European framework for the professional development of general practice (GP) educators. Background: There is evidence that the ideal GP educator would benefit from systematic training in teaching skills. Although international literature indicates that such skills training should be in supervision, feedback, assessment and educational management, it is not clear if these needs vary between trainers who teach general practice in different settings and environments. Needs assessment: Recently EURACT, in collaboration with partners from five EU countries and Turkey, set up a project aimed at the development of a comprehensive ‘training the trainers’ programme. The project included a baseline survey of perceived educational needs and wants among both novice and expert European GP educators. The survey demonstrated that the educational needs of GP educators did not vary much in the content areas in which training was required throughout Europe but did vary in the level and depth of knowledge needed; this depended on their experience and level of expertise as teachers. Implications: Based on the information gathered and experience gained from previous EURACT courses, a Leonardo da Vinci project has developed and launched a comprehensive programme with courses at three levels of participant expertise, to address the personal learning needs of GP educators.     

Clinical information for research; the use of general practice databases.

General practice computers have been widely used in the United Kingdom for the last 10 years and there are over 30 different systems currently available. The commercially available databases are based on two of the most widely used systems--VAMP Medical and Meditel. These databases provide both longitudinal and cross-sectional data on between 1.8 and 4 million patients. Despite their availability only limited use has been made of them for epidemiological and health service research purposes. They are a unique source of population-based information and deserve to be better recognized. The advantages of general practice databases include the fact that they are population based with excellent prescribing data linked to diagnosis, age and gender. The problems are that their primary purpose is patient care and the database population is constantly changing, as well as the usual problems of bias and confounding that occur in any observational studies. The barriers to the use of general practice databases include the cost of access, the size of the databases and that they are not structured in a way that easily allows analysis. Proper utilization of these databases requires powerful computers, staff proficient in writing computer programs to facilitate analysis and epidemiologists skilled in their use. If these structural problems are overcome then the databases are an invaluable source of data for epidemiological studies.     

Development of an information source for patients and the public about general practice services: an action research study

OBJECTIVE: The publication of information about the performance of health-care providers is regarded as central to promoting greater accountability and empowering patients to exercise choice. The evidence suggests that the public is not very interested in accessing or using current sources of information. This study aimed to explore the information needs of patients in the context of UK primary care and to develop an information source about general practice services, designed to be usable by and useful to patients. DESIGN: An action research study making use of data from formal and informal interviews, focus groups, participant observation and document review. SETTING: The geographical areas covered by two Primary Care Trusts in the north of England and two Local Health Boards in south Wales. PARTICIPANTS: A partnership between 103 members of the public, general practice staff from 19 practices, NHS managers from four Primary Care Organizations and the research team. RESULTS: The public would like to know more about the quality and range of general practice services but current sources of information do not meet their needs. The public do not like league tables comparing the performance of practices and only a small number of people want to use comparative information to choose between practices. They seem to be more interested in the context and availability of services and the willingness of practices to improve, than in the practice's absolute or relative performance. They want to be clear about the source of the information so that they can make personal judgements about its veracity. Information is most likely to be useful if it adheres to the basic principles of cognitive science in terms of its structure, content and presentation format. Using these findings, paper and electronic prototype versions of a guide to general practice services have been developed. CONCLUSIONS: In order to maximize the potential use of performance information by the public it is necessary to move beyond provider-led and professionally constructed approaches to information provision and ensure that the public is actively involved in the development of information sources. Such involvement produces a different kind of information to that currently available to the public. The findings of this study have important implications for policy. Most importantly, it seems that the traditional consumerist model underlying a policy of making comparative performance information available to the public to enable them to exercise choice between primary care providers may not be appropriate. An alternative model of information provision, which recognizes the public's commitment to their practice and is integrated with 'soft' sources of knowledge is more likely to engage and be of use to the public.     

Distance as an influence on demand in general practice.

A survey of general practice in the London borough of Lambeth was analysed to discover how the distance from a patient's home to a medical facility affects the utilisation of that facility. It was shown that distance has a negative effect on utilisation for all population groups except men aged 15 to 64. The effect was especially marked for women, for the elderly, and for Social Classes III, IV, and V, which are the groups with highest utilisation rates. Some diagnostic groups singled out for analysis showed the same effect. These results are related to other studies and to an economic theory seeking to explain patterns of demand.     

Patient-centred interprofessional collaboration in primary care: challenges for clinical,educational and health services research. An EGPRN keynote paper

The theme ‘patient-centred interprofessional collaboration’ of the EGPRN conference in October 2012, captures in just three words important challenges for European primary care and its research agenda. Challenges for future research are formulated, in three domains: clinical, educational and health services research. Transferability of research, based upon advanced computational infrastructure, will facilitate a rapid learning health care system. In educational research, this includes the use of observational and reflexivity methods. Outcomes should be defined in terms of improvement of functional status and social participation rather than in terms of disease-specific outcomes. Partnership with all stakeholders, patients, GPs and their health care colleagues and students, can help in reducing avoidable waste in the production and reporting of research evidence.