What constitutes competence? That depends on the task

Strengthening general practice/family medicine in Europe-advice from professionals from 30 European countries

Background

Substantial variations are still to be found in the strength of general practice/family medicine (GP/FM) across Europe regarding governance, workforce competence and performance, as well as academic development and position. Governments are encouraged by the WHO to secure high quality primary health care to their population, a necessity for reaching the goal “Health for all”. The present study aimed at investigating the opinions of council members of the European Academy of Teachers in General Practice (EURACT) on necessary actions to strengthen the position of GP/FM in their country.

Methods

The study used a mixed methods exploratory sequential design. EURACT representatives from 32 European countries first participated in brain-storming on how to strengthen GP/FM in Europe. Later, representatives from 37 countries were asked to individually score the relevance of the proposed actions for their country on a 9-point Likert scale. They were also asked to evaluate the status of GP/FM in their country on four dimensions.

Results

Respondents from 30 European countries returned complete questionnaires. To build and secure GP/FM as an academic discipline comprising teaching and research was seen as essential, regardless the present status of GP/FM in the respective country. To build GP/FM as a specialty on the same level as other specialties was seen as important in countries where GP/FM held a strong or medium strong position. The importance of common learning objectives and a defined bibliography were stated by respondents from countries where GP/FM presently has a weak position.

Conclusions

In order to strengthen GP/FM throughout Europe, EURACT and other professional organizations must establish common goals and share expertise between countries. To influence decision makers through information on cost-effectiveness of a GP/FM-based health care system is also important.

What do patients bring up in consultations? An observational study in general practice

OBJECTIVE

The main aim of the study was to investigate how many and what kind of problems patients present in consultations with their general practitioner (GP). A secondary aim was to explore patients' views on what is important in consultations.

DESIGN

Cross-sectional study including observation of unselected consultations with recording on a pre-designed scheme, and a brief questionnaire filled in by patients.

SETTING

Four general practices in Oslo, Norway.

SUBJECTS

A total of 201 patients in consultations and 177 patients waiting to see their GP.

MAIN OUTCOME MEASURES

Number and characteristics of problems raised by patients, and whether the problems were handled by GPs during the ongoing consultation. Patients' expectations for the consultation.

RESULTS

The mean number of problems raised was 2.6 (range 1-16), and when appointments for acute conditions were excluded, the mean number was 3.3. Somatic problems comprised about half of all problems, and in more than one-quarter of consultations a mental health issue was presented. Female sex and increasing age predicted an increasing number of problems raised. In one-quarter of encounters four or more problems were presented. The vast majority of problems were dealt with by the GPs during the ongoing consultation. "That I am able to address all the problems I have" was rated as highly important by patients.

CONCLUSION

GPs deal with multiple and unrelated problems in daily consultations, which is highly valued by patients. Management of concurrent problems in brief encounters demands training and adequate working conditions, in order to sustain this core value of general practice.

The association between erectile dysfunction, depressive symptoms and testosterone levels among middle-aged men

Aims: The aim of this study was to investigate the association between erectile dysfunction and depressive symptoms and testosterone levels among middle-aged men at the community level. Methods: The study population consisted of 614 men born in 1945 and living in the city of Oulu, Finland. Erectile dysfunction was assessed by the erectile function domain of the International Index of Erectile Function questionnaire and depressive symptoms by the Beck Depression Inventory. Blood samples were collected to measure testosterone and sex hormone-binding globulin level. Results: After adjusting for confounders, erectile dysfunction was statistically significantly associated with depressive symptoms (risk ratio (RR) 1.66, 95% confidence interval (95% CI) 1.29–2.15), as well as with obesity (RR 1.72, 95% CI 1.12–2.62). Neither total nor free testosterone level was associated with erectile dysfunction among our study group. Conclusions: Depressive symptoms rather than testosterone levels should be taken into consideration while treating middle-aged men with erectile problems at the community level.

Challenges in managing elderly people with diabetes in primary care settings in Norway

OBJECTIVE

To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings.

DESIGN

Focus-group interviews.

SUBJECTS AND SETTING

Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32-59 years with clinical experience ranging from 1.5 to 38 years.

RESULTS

Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines.

CONCLUSION

Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging.