Palliative care in Bulgarian general practice

Background. GPs in Bulgaria provide basic care to people with advanced disease; there is no legislative framework for palliative care. The aim of the study was to investigate the activities of the GPs involving patients who need palliative care. Material and methods. The 42 GPs followed up a total of 211 patients, meeting the diagnostic criteria for inclusion. A form was developed for the purposes of the study, reflecting the activities during the 625 consultation. The subjective opinion of the patient was also registered. The statistical processing of data was made by a SPSS 17. Results. The patients above 60 years of age predominated. The ratio by gender was balanced. The distribution by diagnostic criteria was: oncological disease (87/41.28 ± 3.38%); chronic heart failure (CHF) (65/30.80 ± 3.17%); chronic obstructive pulmonary disease (COPD) (20/9.47 ± 2.01%) and combinations (39/18,48 ± 2,67%). No significance was found between the referrals and the social and diagnostic characteristics. Weak correlations were found between the lower level of education, the lower social status, COPD patients and the greater frequency of home visits. Principal symptoms in our study were pain and fatigue. Discrepancy between the evaluations of patients and GPs was found regarding the ones that are subjective. In cases of oncological diseases the diagnosis and prognosis, were discussed more frequently with the relatives. Conclusion. Within the framework of their general obligations, GPs perform activities characteristic of palliative care. The investigation of these activities and the analysis of the results can serve as a first step in the formation of structured palliative care in our country. Adv. Pall. Med. 2011; 10, 1: 17–22Background. GPs in Bulgaria provide basic care to people with advanced disease; there is no legislative framework for palliative care. The aim of the study was to investigate the activities of the GPs involving patients who need palliative care. Material and methods. The 42 GPs followed up a total of 211 patients, meeting the diagnostic criteria for inclusion. A form was developed for the purposes of the study, reflecting the activities during the 625 consultation. The subjective opinion of the patient was also registered. The statistical processing of data was made by a SPSS 17. Results. The patients above 60 years of age predominated. The ratio by gender was balanced. The distribution by diagnostic criteria was: oncological disease (87/41.28 ± 3.38%); chronic heart failure (CHF) (65/30.80 ± 3.17%); chronic obstructive pulmonary disease (COPD) (20/9.47 ± 2.01%) and combinations (39/18,48 ± 2,67%). No significance was found between the referrals and the social and diagnostic characteristics. Weak correlations were found between the lower level of education, the lower social status, COPD patients and the greater frequency of home visits. Principal symptoms in our study were pain and fatigue. Discrepancy between the evaluations of patients and GPs was found regarding the ones that are subjective. In cases of oncological diseases the diagnosis and prognosis, were discussed more frequently with the relatives. Conclusion. Within the framework of their general obligations, GPs perform activities characteristic of palliative care. The investigation of these activities and the analysis of the results can serve as a first step in the formation of structured palliative care in our country. Adv. Pall. Med. 2011; 10, 1: 17–2

Opieka paliatywna w podstawowej opiece zdrowotnej w Bułgarii

Wstęp. W Bułgarii podstawową opiekę zdrowotną osobom poważnie chorym zapewniają lekarze pierwszego kontaktu (POZ). W chwili obecnej brakuje regulacji prawnych dotyczących opieki paliatywnej. Celem niniejszej pracy była analiza tych działań lekarzy POZ, które dotyczą pacjentów wymagających opieki paliatywnej. Materiał i metody. Grupę 211 pacjentów spełniających kryteria diagnostyczne wymagane do włączenia do badania obserwowało 42 lekarzy POZ. Na potrzeby badania opracowano specjalny formularz, odzwierciedlający czynności wykonane podczas 625 konsultacji lekarskich. W formularzu ujęto również subiektywną ocenę pacjentów. Statystyczną analizę danych wykonano za pomocą oprogramowania SPSS 17. Wyniki. W grupie badanych przeważali pacjenci w wieku powyżej 60 lat. Rozkład według płci był zrównoważony. Podział według kryteriów diagnostycznych przedstawiał się następująco: choroba nowotworowa (87 — 41,28 ± 3,38%); przewlekła niewydolność serca (CHF) (65 — 30,80 ± 3,17%); przewlekła obturacyjna choroba płuc (POChP) (20 — 9,47 ± 2,01%) oraz choroby stanowiące połączenia wyżej wymienionych (39 — 18,48 ± 2,67%). Nie stwierdzono istotnych zależności pomiędzy liczbą wystawionych skierowań a diagnozą i statusem socjalnym pacjenta. Wykazano nieznaczną współzależność między niższym poziomem wykształcenia, niższym statusem socjalnym, obecnością POChP a większą częstością wizyt domowych. Ból i zmęczenie były podstawowymi objawami zaobserwowanymi w niniejszym badaniu. Rozbieżność w ocenach pacjentów i lekarzy POZ dotyczyła objawów subiektywnych. W przypadku chorób nowotworowych diagnoza i rokowania były omawiane częściej z członkami rodziny pacjenta. Wnioski. W ramach swoich podstawowych obowiązków lekarze POZ wykonywali czynności związane z opieką paliatywną. Zbadanie tych czynności oraz analiza wyników mogą posłużyć jako pierwszy krok w uzyskaniu informacji na temat strukturalnej opieki paliatywnej w Bułgarii. Medycyna Paliatywna w Praktyce 2011; 5, 2: 54–5

What factors empower general practitioners for early cancer diagnosis? A 20-country European Delphi Study

Funding Information: The publication of the article in OA mode was financially supported by HEAL-Link. Publisher Copyright: © The Author(s), 2022.Background: Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses. Aim: To identify the factors that affect European GPs' empowerment in making an early diagnosis of cancer. Methods: This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale. The final list of statements indicated those that were considered by consensus to be the most relevant. Results: In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs' working conditions. Statements relating to training, skills and working efficiency were not considered priority areas. Conclusion: GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis.publishersversionPeer reviewe

What factors empower general practitioners for early cancer diagnosis? A 20-country European Delphi Study.

BACKGROUND Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses. AIM To identify the factors that affect European GPs' empowerment in making an early diagnosis of cancer. METHODS This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale.The final list of statements indicated those that were considered by consensus to be the most relevant. RESULTS In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs' working conditions. Statements relating to training, skills and working efficiency were not considered priority areas. CONCLUSION GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis

Exploring dementia management attitudes in primary care: a key informant survey to primary care physicians in 25 European countries

Background: Strategies for the involvement of primary care in the management of patients with presumed or diagnosed dementia are heterogeneous across Europe. We wanted to explore attitudes of primary care physicians (PCPs) when managing dementia: (i) the most popular cognitive tests, (ii) who had the right to initiate or continue cholinesterase inhibitor or memantine treatment, and (iii) the relationship between the permissiveness of these rules/guidelines and PCP's approach in the dementia investigations and assessment. Methods: Key informant survey. Setting: Primary care practices across 25 European countries. Subjects: Four hundred forty-five PCPs responded to a self-administered questionnaire. Two-step cluster analysis was performed using characteristics of the informants and the responses to the survey. Main outcome measures: Two by two contingency tables with odds ratios and 95 confidence intervals were used to assess the association between categorical variables. A multinomial logistic regression model was used to assess the association of multiple variables (age class, gender, and perceived prescription rules) with the PCPs' attitude of "trying to establish a diagnosis of dementia on their own". Results: Discrepancies between rules/guidelines and attitudes to dementia management was found in many countries. There was a strong association between the authorization to prescribe dementia drugs and pursuing dementia diagnostic work-up (odds ratio, 3.45; 95 CI 2.28-5.23). Conclusions: Differing regulations about who does what in dementia management seemed to affect PCP's engagement in dementia investigations and assessment. PCPs who were allowed to prescribe dementia drugs also claimed higher engagement in dementia work-up than PCPs who were not allowed to prescribe

Why do European primary care physicians sometimes not think of, or act on, a possible cancer diagnosis? : A qualitative study

Funding The Swedish application for ethical approval was funded by the Jämtland Cancer and Nursing Foundation. The study had no other external fundingPeer reviewedPostprin

Unburdening dementia a basic social process grounded theory – based on a primary care physician survey from 25 countries

OBJECTIVE: To explore dementia management from a primary care physician perspective.DESIGN: One-page seven-item multiple choice questionnaire; free text space for every item; final narrative question of a dementia case story. Inductive explorative grounded theory analysis. Derived results in cluster analyses. Appropriateness of dementia drugs assessed by tertiary care specialist.SETTING: Twenty-five European General Practice Research Network member countries.SUBJECTS: Four hundred and forty-five key informant primary care physician respondents of which 106 presented 155 case stories.MAIN OUTCOME MEASURES: Processes and typologies of dementia management. Proportion of case stories with drug treatment and treatment according to guidelines.RESULTS: Unburdening dementia - a basic social process - explained physicians' dementia management according to a grounded theory analysis using both qualitative and quantitative data. Unburdening starts with Recognizing the dementia burden by Burden Identification and Burden Assessment followed by Burden Relief. Drugs to relieve the dementia burden were reported for 130 of 155 patients; acetylcholinesterase inhibitors or memantine treatment in 89 of 155 patients - 60% appropriate according to guidelines and 40% outside of guidelines. More Central and Northern primary care physicians were allowed to prescribe, and more were engaged in dementia management than Eastern and Mediterranean physicians according to cluster analyses. Physicians typically identified and assessed the dementia burden and then tried to relieve it, commonly by drug prescriptions, but also by community health and home help services, mentioned in more than half of the case stories.CONCLUSIONS: Primary care physician dementia management was explained by an Unburdening process with the goal to relieve the dementia burden, mainly by drugs often prescribed outside of guideline indications. Implications: Unique data about dementia management by European primary care physicians to inform appropriate stakeholders. Key points Dementia as a syndrome of cognitive and functional decline and behavioural and psychological symptoms causes a tremendous burden on patients, their families, and society. •We found that a basic social process of Unburdening dementia explained dementia management according to case stories and survey comments from primary care physicians in 25 countries. •First, Burden Recognition by Identification and Assessment and then Burden Relief - often by drugs. •Prescribing physicians repeatedly broadened guideline indications for dementia drugs. The more physicians were allowed to prescribe dementia drugs, the more they were responsible for the dementia work-up. Our study provides unique data about dementia management in European primary care for the benefit of national and international stakeholders

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

UNLABELLED: 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

WONCA Europe position statement on the redefinition of fatty liver disease

Family doctors and general practitioners (GPs) are the frontline in the management of fatty liver disease. With its high prevalence and strong association with other conditions commonly treated in primary care, the voice of family doctors and GPs has an important role in informing the discussion on the redefinition of fatty liver disease. Primary care uptake of any proposed name will be hampered if there is not enough involvement of this important group in the process

Distress and wellbeing among general practitioners during COVID 19 results from the cross sectional PRICOV 19 study.

Background: Emerging literature from all around the world 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. Burnout is the most extreme form of this lack of wellbeing and its symptoms not only have a direct impact on the physician, but also on patients. Some studies have shown that, among physicians who report experiencing at least some signs of burnout, family medicine and emergency medicine physicians are among those at highest risk. Research questions: To describe the frequency of distress and wellbeing, measured by the Mayo Clinic Wellbeing index, among general practitioners and family physicians during the COVID-19 pandemic and to identify some of the key levers that could potentially mitigate the risk of distress. Method: Data were collected by means of an online self-reported questionnaire among GP practices. Statistical analysis was performed using SPSS software on Version 7 of the database, which was the version consisting of the cleaned data of 33 countries available as of November 3rd, 2021. Results: Data from 3,711 was incuded. MCWI scores ranged from -2 to 9 with a mean of 2.7 and median of 3. Using a cut off of ≥2, 64.5% of respondents are considered at risk. GPs with less experience, in smaller practices, and with more vulnerable patient populations are at a higher risk of distress. Collaboration from other practices and adequate governmental support are significant protective factors for distress. Conclusions: While individual factors are important, it is necessary to address practice and system-level organizational factors in order to enhance wellbeing and support primary care physicians