A study on the attitudes of foundation doctors in Malta towards general practice and their experience while working in the specialty

Introduction: A substantial number of Foundation year (FY) doctors have a three month rotation in family medicine at the health centres in Malta. The aim of the study was to understand the factors that influence FY doctors’ attitudes towards general practice (GP) and the potential reasons why these doctors would choose a career in GP. Method: This consisted of a cross-sectional questionnaire study carried out with FY doctors in Malta. The online server Google Forms was used to collect data and manage the questionnaires. Data was extracted to Excel 2010 with which it was analysed. Results: Over the one-year study period 61 FY doctors had a GP rotation. The questionnaire response rate was 54%. For 72.7% of respondents, choosing a rotation in GP had been a priority; of these, 88% would consider a career in GP but it was the preferred career choice for only 50%. Sixty-nine point six per cent of doctors gave a very positive rating (more than 7 out of 10) of their experience at health centres, and 78.8% experienced a positive change in attitude towards the specialty of family medicine after this rotation. The rotation was rated as having the greatest influence on career choice. Quality of life was the most popular factor attracting doctors to GP. Lack of respect towards general practitioners and the challenge of managing clinical uncertainty with patients in family medicine were the two main factors which discouraged doctors from such a career. Conclusion: General practice is a popular specialty in Malta and the Foundation rotation in GP was found to be one of the main factors influencing career choice. In view of this, it should be ensured that during the rotation doctors get a complete experience of general practice, which is a true reflection of what the specialty entails.peer-reviewe

A review of certain recent advances in primary health care

A strong primary health care system is the keystone of health care and helps patients manage their health conditions in the community, whilst also providing disease prevention services. Primary care is a continuously evolving specialty, with recent exciting innovations, aiming to improve all aspects of care and to meet people’s needs and expectations. A search for articles focusing on the specific aspects of recent advances in primary health care was done using internet search engines. Articles were selected from primary and secondary literature sources, which included original research articles, review articles and other epidemiological studies. Recent advances in information technology, services and access, dealing with multimorbidity, academic family medicine, equity and outcome measures have all made an impact on the primary health care system and on meeting the ever-increasing challenges of modern society. Primary health care is of extreme importance in having an efficient and effective health care system. As primary health care improves with recent advances, a positive effect is seen on the population’s health, cost savings and health care disparities.peer-reviewe

A brief evaluation of care at a diabetic clinic in a primary health care centre

Introduction Type 2 diabetes is one of the commonest chronic conditions in Malta posing a major health burden as a result of the complications that may arise. Evaluating patient management and comparing them to standard guidelines such as those set by the International Diabetes Federation (IDF) is an important step in improving care. Objective The study aimed to assess whether the practice at the diabetic clinic in Mosta Health Centre is in line with IDF targets for glycosylated haemoglobin (HbA1c), lipid profile and urinary albumin/creatinine ratio (ACR). Method All patients who attended the diabetic clinic in November and December 2016 were included. For each, data was collected for investigations done retrospectively from the Information Clinical Manager system over the year preceding their appointment. Data collected included age, gender, HbA1c values, lipid profile readings and ACR values. Adherence to guidelines was calculated and significant trends were reported. Results The study involved 515 patients, of which 55.5% were males and 44.5% females. The majority were of the older age group (48.3% being older than 70 years). Results for each investigation considered are as follows: For HbA1c, 99.2% of patients had this test taken, with 89.1% having a second reading and 53.2% having a third reading over the year preceding the appointment. There was a statistical difference of HbA1c levels between males and females. Of all HbA1c values taken in this study 45.7% adhered to the IDF standards. For ACR, 55% of the total had a measurement. Of these, 69.6% were within normal limits. Of the 30.4% abnormal results, only 5.7% had the test repeated twice over 4 months. In this study 97.5% had at least a single lipid profile taken over the previous year. Of these, 88.4% had triglyceride levels 1 mmol/l. Similar values were obtained for the 52.2% of patients who had two lipid profile readings and for the 17.3% of patients who had three readings over the year prior to appointment. Conclusion Most investigations were done as per IDF standards but there is still room for improvement. Adhering to guidelines is important and this may be improved by raising awareness of these guidelines among general practitioners. Development of local guidelines would be ideal.peer-reviewe

Blood investigation results at a primary health care centre in Malta : a brief evaluation

Background This evaluation was based at Mosta Health Centre with a particular focus on the blood investigation results clinic. Objectives To get a clinical profile of the patients being seen at the clinic, to assess whether risk assessment tools are being used in the management of dyslipidaemia and to evaluate patient feedback about the clinic. Method This consisted of a cross-sectional observational study carried out over a five-week period between the end of October and the end of November 2017. Data was collected retrospectively immediately after completion of the clinic on three random days every week. Data collection was divided into two lists of patients – those who attended and those who failed to attend their appointment. A patient questionnaire was also handed to patients to fill in after attending their appointment. Data was inputted in Excel 2010 and analysed using Statistical Package for Social Sciences (SPSS) 22. Results A total of 181 patients had a registered appointment at the blood investigation results clinic during the period of data collection. Seventy-five per cent of these patients attended for their appointment, with 62.2% being females. Routine blood investigations were taken in 80.7% of patients, thyroid function tests in 71.9% and glycosylated haemoglobin in 31.9%. Fourteen point eight per cent of patients had tumour markers booked, and a significant association was found between gender and whether tumour markers were ordered. A risk assessment tool was used in only 21% of the patients seen at the clinic for a lipid profile result, with the majority of General Practitioners (GPs) using the QRISK®2 cardiovascular disease calculator. Seventy eight patient satisfaction questionnaires were filled in during the period of data collection, and the percentage of patients who gave a very positive response (>8) for questions 1, 2 and 3 was 92%, 89% and 97% respectively. Conclusion Patient attendance at the blood investigation results clinic at Mosta Health Centre during the period under review was reasonably good, and patients were overall satisfied by the service provided. Tumour markers were found to be ordered more frequently in male patients, due to the common request for the PSA test. Risk assessment tools were used by GPs in only 14% of the total number of patients seen at the clinic, and the QRISK®2 cardiovascular disease calculator was the most commonly used tool.peer-reviewe

Patient attendance at a primary health care centre in Malta : a cross-sectional observational study

Introduction The aim of the study was to describe the reason for consultation of patients attending the General Practitioner (GP) service at a major local health centre and also to get a clinical profile of the patients making use of such health service. This study is based in the publiclyfunded primary health system in Malta and focuses on Mosta Health Centre. Methodology This was a cross-sectional observational study carried out in January 2017. Only the patients seen in the GP clinics were included. All six authors are practicing GPs. All the patients that the authors encountered in the GP clinics were included in the study. The fact that all authors work in different shifts and days allowed for a broad and random inclusion of patients. Patients attending out-ofhours and in weekends were also included. A pilot oneweek period of data collection was carried out. Thereafter, all six authors had an Excel spreadsheet uploaded on the work computer system in the GP consulting rooms, so that patient data was inputted in real-time at the end of each consultation. Data was inputted in Excel 2010 and analysed using the Statistical Package for the Social Sciences (SPSS) 22. Results A total of 820 patients were included in the study. 51.8% of patients were females, whilst 74.8% of patients were born in Malta. 50.2% of patients raised more than one issue during a single consultation, whilst the most common co-morbidity noted was hypertension. The most common reasons for consultation were related to the respiratory and musculoskeletal systems. Various significant associations were observed, most importantly being between the time of attendance and number of issues brought up during a consultation; between being born in Malta and number of issues brought up during a consultation; and between age and number of issues brought up during a single consultation. Conclusion This study involved 820 patients attending Mosta Health Centre over a one-month period during winter 2017. During a single episode of care (visit), Maltese nationals consult for a greater number of issues. In addition, they have a greater number of co-morbidities than non-Maltese nationals. People attending between 08.00 and 17.00 hours tend to present with a greater number of issues for management. Suggestions for service development have been put forward in the discussion. Ideally, such studies should be conducted independently in different health centres given the notable differences in the catchment areas, and during different months of the year.peer-reviewe

The Journal of the Malta College of Family Doctors A review of certain recent advances in primary health care

aBstraCt Background A strong primary health care system is the keystone of health care and helps patients manage their health conditions in the community, whilst also providing disease prevention services. Primary care is a continuously evolving specialty, with recent exciting innovations, aiming to improve all aspects of care and to meet people's needs and expectations. Method A search for articles focusing on the specific aspects of recent advances in primary health care was done using internet search engines. Articles were selected from primary and secondary literature sources, which included original research articles, review articles and other epidemiological studies