Silver service : 25 years of activities by the Malta College of Family Doctors (1990-2015)

The Malta College of Family Doctors is an autonomous academic institution that was formally set up in 1990 with the object to encourage, foster and maintain the highest possible standards in family medicine in Malta, and to sustain and improve the professional qualifications of members of the medical profession in Malta who are engaged in family medicine.peer-reviewe

Lifestyle, prevention, change & support : the views & attitudes of patients in Maltese family practice

Introduction: General practitioners (GPs) are advised to consider their patients' views and attitudes in order to facilitate the success of preventive and health promotion interventions. This study explored patients’ views and beliefs about the importance of lifestyle and preventive interventions, and assessed their readiness to make lifestyle changes and to receive support from GPs. Methodology: Ten Maltese GP practices participated in a cross-sectional survey conducted by the European Network for Prevention and Health Promotion in Family Medicine/General Practice across 22 European countries during 2008-9. From each practice, 40 consecutive patients stratified by gender and age (10 males and 10 females aged 30-49 years, and 10 males and 10 females aged 50-70 years) were asked to complete a purposely- designed and piloted questionnaire. Results: Seventy-seven per cent of smokers, ~60% of unhealthy eaters, inadequate exercisers and those with abnormal weight, but only 11% of excessive drinkers thought they needed to improve their unhealthy lifestyles. Thirteen per cent of smokers, 30% of excessive drinkers, and ~50% of patients with problems of diet, exercise and weight were confident they would succeed. Sixty per cent of patients with diet, exercise and weight problems, 50% of smokers and just 8% of excessive drinkers would have liked GPs’ support. Conclusion: GPs and healthcare professionals need to discuss risky lifestyles with patients to help them personalise such risks, and should offer their support to those wishing to change so as to improve their confidence and chances of success. Such discussion and support are especially important for excessive drinkers.peer-reviewe

Family doctors and health promotion : do we practise what we preach?

Introduction: A survey on `Attitudes and Knowledge of General Practitioners (GPs) in Prevention and Health Promotion' was carried out in 2000 by EUROPREV (European Network for Prevention and Health Promotion in General Practice / Family Medicine). Method: All local general practitioners (GPs) known to the Malta College of Family Doctors were mailed a questionnaire to elicit beliefs and attitudes in practice, possible barriers in implementing preventive activities, and their personal health behaviour. Results: The response rate was 50% (156 replies out of 313). A difference was found between GPs' beliefs that certain preventive and health promotion activities should be done and their actually doing them in clinical practice. Forty-nine percent found some or great difficulty in carrying out such activities, mainly due to heavy workload and lack of time, problems in patients' accessibility to these activities, and patients' doubts about their effectiveness. Discrepancies were revealed between GPs' health promotion beliefs and their own personal behaviour. Discussion: As this study is based on GPs' self-reporting of activities, more objective evidence is needed through audit of properly-kept medical records. A practical protocol of health promotion activities needs to be devised for, and distributed to, family doctors. Health promotion activities may be facilitated by reduction of doctors' workload through patient registration and an appointment system. As doctors seem to prefer ordering investigations to giving verbal advice, other healthcare professionals could provide the latter. GPs should set an example to their patients by adopting a healthy lifestyle to reinforce their advice regarding health promotion.peer-reviewe

It’s time we made smoking history! Tobacco control in Malta : the present and the future

Tobacco products have no safe level of consumption. They are the only legal consumer products that cause ill health and premature death when used exactly as the manufacturer intends. Unless concerted action is taken quickly, 250 million of today’s children will die prematurely from an avoidable cause -tobacco use. The above declarations are not the author’s, but statements of the World Health Organisation (WHO). This article is a brief overview of tobacco control in Malta regarding the present situation and plans for the future, and is based on the following WHO Ten-Point Programme for Successful Tobacco Control.peer-reviewe

Malta’s specialist training programme in family medicine : a pre-implementation evaluation

Introduction: As a result of Malta’s EU accession in 2004, family medicine was accepted as a speciality and the Malta College of Family Doctors prepared a Specialist Training Programme in Family Medicine. To facilitate its launch, potential GP trainers and trainees participated in its preimplementation evaluation. Method: Participants’ views were gathered quantitatively through a questionnaire using scales to rate closed statements regarding the programme and its sections. Qualitative openended questions also allowed them to highlight strengths and provide constructive feedback regarding any required improvements and perceived barriers. Results: Nearly half the questionnaires (27/58: 47%) were returned. Although the majority of participants evaluated the programme and its sections as specific, attainable, relevant and timed, only a minority agreed that they were easily measurable. The strengths mentioned most were the various methods of assessment (41%), experience in relevant hospital specialities (37%), and preparation and updating of trainers (30%). The improvements seen as most needed were the identification of resources (22%), the acquisition of competences (19%) and their assessment (19%). The main barriers identified were the use of trainees just as locums (41%), poor attitudes among the various stakeholders (37%) and difficulties in coordinating assessment methods (26%). Discussion: To assist the programme’s implementation, the development of a well-supervised curriculum is needed, supported by the resources necessary for the preparation and updating of motivated trainers and the acquisition by trainees of the required community and hospital competences and their objective assessment. While a post-course evaluation of specialist training in family medicine in Malta is merited, preimplementation evaluation is of use in preparing to implement postgraduate training.peer-reviewe

Are stop smoking services successful?: an evaluation of smoking cessation clinics in Malta

Introduction. Smoking cessation clinics in Malta have been organised by the Health Promotion Department in government primary health care centres on a regular basis since 1991. Aim. A research project was set up to evaluate the clinics' process, outcome and consequent cost-benefit. Methods. The qualitative procedure involved questionnaire completion and interpretation by a total of 40 clients who attended the last session of all clinics held during one year from October 1999. The quantitative method entailed measurement and analysis of participants' smoking status at the quit session, final session and following a six-month period. Results. The thirty participants (75% response rate) who completed the questionnaire spoke quite favourably of the clinic process. Of the 101 clients attending quit sessions, there were 27 quitters by the final session (giving an immediate success rate of 27%), and only ten were still not smoking at the six-month follow-up (long-term success rate of 10%). Discussion. The consequent savings to lung cancer treatment were conservatively estimated at Lm 3245 during the first year of diagnosed disease, more than five times the clinics' running costs over one year. Recommendations for service improvement include: · The integral use of pharmacotherapy and carbon monoxide monitoring; · The organisation of clinics on a more frequent basis, with follow-up support meetings; · The setting-up of state-of-the-art training for facilitators; · The introduction of an on-going quantitative and qualitative evaluation system; · The classification of nicotine addiction as a Schedule 5 disease to enable pharmacotherapy to be available free on prescription; and · Full support and funding of smoking cessation and other tobacco control services.peer-reviewe

Breaking the smoking habit in Malta

Between 1991 and 1996, under the auspices of the Department of Health Promotion, the author led 14 smoking-cessation clinics in Health Centres in Malta. In their application for attendance at these clinics, smokers were asked to complete a questionnaire on their smoking habits. This study discusses the answers to these 363 questionnaires with regard to knowledge of health effects of smoking (28% did not think they would be much healthier when quitting), nicotine addiction and desire to quit (87% felt dependent ’a lot’ on smoking while 94% believed in quitting with help), and the power of tobacco advertising (50% started smoking before 16 years of age) among this select group of smokers. Recommendations are made on the role of family doctors regarding the education of patients on the health effects of smoking, the provision of understanding and help to would-be quitters, and the lobby for an effective anti-tobacco-policy, including childhood education on tobacco, stronger health warnings, smoke-free public places, advertising bans and increased taxes on tobacco.peer-reviewe

Work-based assessment within Malta’s specialist training programme in family medicine

The Specialist Training Programme in Family Medicine (STPFM) – Malta was drawn up by the Malta College of Family Doctors in 2006, approved by Malta’s Specialist Accreditation Committee, and launched in 2007 by the Primary Health Care Department and the Malta College of Family Doctors. This article regarding the work-based assessment of specialist training in family medicine in Malta was prepared by consulting various local / international documents and publications that are related to general practice / family medicine and its teaching, appraisal and assessment. Assessment of family doctors should consider their actual performance of different tasks in diverse settings of daily practice; this is carried out on-site by direct observation of the practitioner at the work-place (work-based assessment) using different methods.peer-reviewe

A seven-year review (2011-17) of the work-based assessment component of Malta’s Specialist Training Programme in Family Medicine

Background: Work-based assessment (WBA) within Malta’s Specialist Training Programme in Family Medicine is recorded using the ‘One-to-One Appraisal’ form in the General Practitioner (GP) Trainee Educational ePortfolio. -- Objectives: The postgraduate training coordinators in family medicine review the above annually to see where the WBA is operating well and to identify where improvements are required. -- Method: The ‘One-to-One Appraisal’ involves the completion of a scoring system (selecting one score from ‘needs further development’: 1-2-3; ‘competent’: 4-5-6; and ‘excellent’: 7-8-9) for twelve competency areas. The educational portfolio is reviewed using objective requirements listed in the form ‘Review of the GP Trainee Educational Portfolio’. -- Results: The review of educational portfolios revealed commendable practices including detailed educational plans and case-logs, a general trend of adherence to time frames, and high attendance rates for group-teaching sessions. While One-to-One Appraisal documents were filled in satisfactorily, the issue of remarkably high average scoring was encountered. Moreover disparities were seen between scores and comments in some of the ‘GP trainee interim review by GP trainer’ forms. Deficiencies were outlined in clinical supervision time, mainly during family medicine government placements, while incomplete adherence to placement requirements was noticed. -- Conclusion: A significant amount of quality work was carried out by the GP trainees under their trainers’ supervision. Two main areas of improvement were however outlined – the need for refining the GP trainers’ score allocation and the importance of regular review of the portfolio by both trainees and trainers, with the prompt flagging of persisting unresolved issues to the training coordinators.peer-reviewe

Turning the winter of doctor discontent to summer : tackling GP needs in state primary care

Introduction: A study on job satisfaction among state General Practitioners (GPs) in Malta addressed the problem of the inadequate number of doctors within the government GP service. It investigated the hypothesis that this is due to poor job satisfaction, and allowed GPs to suggest other reasons and propose solutions. Method: A mixed methodology was used, with both quantitative (the Spector `Job Satisfaction Survey') and qualitative methods (3 open questions) in a questionnaire sent to current and former government GPs, followed by focus group/elite interviews. Results: 71 out of 136 questionnaires were returned, giving a 52% response rate. (a) Quantitative analysis: Job dissatisfaction was confirmed among health-centre doctors during 1998-2003. Taking significance as p<0.05, regression analysis revealed that doctors formerly working in health centres were significantly more dissatisfied than present ones (univariate p=0.033), and working part-time is significantly more satisfying than working full-time (univariate p=0.007, multiple p=0.039). (b) Qualitative analysis: 41% of GPs felt unappreciated, neglected and disrespected; 39% experienced job dissatisfaction, stress and depression; while 31% felt verbally and physically used, misused and abused. The top causes cited for the lack of government GPs were poor pay and ancillary benefits (70%), poor training prospects/ career progression (54%) and poor working conditions (46%). Discussion: As former state GPs during 1998-2002 were significantly more dissatisfied than those in employment in 2003, this corroborates the hypothesis that job dissatisfaction is associated with the shortage of government GPs. Direct solutions (enhanced remuneration/conditions and professional development) and indirect measures (organisational, management and educational initiatives to improve working arrangements) were proposed and discussed