cometadata/datacite-titles-descriptions-related-identifiers huggingface dataset:
DOI: 10.6084/m9.figshare.14587978.v1
title: Drug interactions detected by a computer-assisted prescription system in primary care patients in Spain: MULTIPAP study

description: Drug interactions increase the risk of treatment failure, intoxication, hospital admissions, consultations and mortality. Computer-assisted prescription systems can help to detect interactions. To describe the drug–drug interaction (DDI) and drug–disease interaction (DdI) prevalence identified by a computer-assisted prescription system in patients with multimorbidity and polypharmacy. Factors associated with clinically relevant interactions were analysed. Observational, descriptive, cross-sectional study in primary health care centres was undertaken in Spain. The sample included 593 patients aged 65–74 years with multimorbidity and polypharmacy participating in the MULTIPAP Study, recruited from November 2016 to January 2017. Drug interactions were identified by a computer-assisted prescription system. Descriptive, bivariate, and multivariate analyses with logistic regression models and robust estimators were performed. Half (50.1% (95% CI 46.1–54.1)) of the patients had at least one relevant DDI and 23.9% (95% CI 18.9–25.6) presented with a DdI. Non-opioid–central nervous system depressant drug combinations and benzodiazepine–opioid drug combinations were the two most common clinically relevant interactions (10.8% and 5.9%, respectively). Factors associated with DDI were the use of more than 10 drugs (OR 11.86; 95% CI 6.92–20.33) and having anxiety/depressive disorder (OR 1.98; 95% CI 1.31–2.98). Protective factors against DDI were hypertension (OR 0.62; 95% CI 0.41–0.94), diabetes (OR 0.57; 95% CI 0.40–0.82), and ischaemic heart disease (OR 0.43; 95% CI 0.25–0.74). Drug interactions are prevalent in patients aged 65–74 years with multimorbidity and polypharmacy. The clinically relevant DDI frequency is low. The number of prescriptions taken is the most relevant factor associated with presenting a clinically relevant DDI.
DOI: 10.6084/m9.figshare.15090155.v1
title: Task shifting in primary care to tackle healthcare worker shortages: An umbrella review

description: Task shifting is an approach to help address the shortage of healthcare workers through reallocating human resources but its impact on primary care is unclear. To provide an overview of reviews describing task shifts from physicians to allied healthcare workers in primary care and its impact on clinical outcomes. Six electronic databases were searched up to 15 December 2020, to identify reviews describing task shifting in primary care. Two reviewers independently screened the references for relevant studies, extracted the data and assessed the methodological quality of included reviews using AMSTAR-2. Twenty-one reviews that described task shifting in primary care were included. Task shifted include provision of care for people with chronic conditions, medication prescribing, and health education. We found that task shifting could potentially improve several health outcomes such as blood pressure, HbA1c, and mental health while achieving cost savings. Key elements for successful implementation of task shifting include collaboration among all parties, a system for coordinated care, provider empowerment, patient preference, shared decision making, training and competency, supportive organisation system, clear process outcome, and financing. Evidence suggests that allied healthcare workers such as pharmacists and nurses can potentially undertake substantially expanded roles to support physicians in primary care in response to the changing health service demand. Tasks include providing care to patients, independent prescribing, counselling and education, with comparable quality of care.
DOI: 10.6084/m9.figshare.15124534.v1
title: Predictors for mortality due to acute exacerbation of COPD in primary care: Derivation of a clinical prediction rule in a multicentre cohort study

description: In primary care (PC), 80% of the acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are treated. However, no predictive model has been derived or validated for use in PC to help general practitioners make decisions about these patients. To derive a clinical prediction rule for mortality from any cause 30 days after the last PC visit. Between December 2013 and November 2014, we performed a cohort study with people aged 40 and over who were treated for AECOPD in 148 health centres in Spain. We recorded demographic variables, past medical history, signs, and symptoms of the patients and derived a logistic regression model. In the analysis, 1,696 cases of AECOPD were included and 17 patients (1%) died during follow-up. A clinical prediction rule was derived based on the exacerbations suffered in the last 12 months, age, and heart rate, displaying an area under the receiver operating characteristic curve of 0.792 (95% confidence interval, 0.692–0.891) and good calibration. This rule stratifies patients into three categories of risk and suggests to the physician a different action for each category: managing low-risk patients in PC, referring high-risk patients to hospitals and taking other criteria into account for decision-making in patients with moderate risk. These findings suggest that it is possible to accurately estimate the risk of death due to AECOPD without complex devices. Future studies on external validation and impact assessment are needed before this prediction rule may be used in clinical practice.
DOI: 10.6084/m9.figshare.14579481
title: Future-proofing the primary care workforce: A qualitative study of home visits by emergency care practitioners in the UK

description: Broadening the skill-mix in general practice is advocated to build resilience into the primary care workforce. However, there is little understanding of how extended-scope practitioners from different disciplines, such as paramedicine and nursing, embed into roles traditionally ascribed to general practitioners (GPs). This study sought to explore patients' and professionals' experiences of a primary care home visiting service delivered by emergency care practitioners (ECPs), in place of GPs; to determine positive impacts/unintended consequences and establish whether interdisciplinary working was achieved. Three practices in England piloted an ECP (extended-scope practitioners with a paramedic or nursing background) home visiting service (November 2018–March 2019). Following the pilot, focus groups were conducted with each of the three primary healthcare teams (14 participants, including eight GPs), and one with ECPs (five participants) and nine individual patient interviews. Data were analysed using a modified framework approach. The impact of ECP home visiting on GP workload and patient care was perceived as positive by patients, GPs and ECPs. Initial preconceptions of GPs and patients about the ECP role and expertise, and reservations about the appropriacy of ECPs for home visiting, were perceived to have been overcome by the expertise and interpersonal skills of ECPs. Fostering a culture of collaboration between ECPs and GPs was instrumental to remodelling professional boundaries at the practice level. Broadening the skill-mix to incorporate extended-scope practitioners such as ECPs, to deliver primary care home visiting, presents an opportunity to increase resilience in the general practice workforce.
DOI: 10.6084/m9.figshare.17013673.v1
title: Barriers to losing weight for women attending group visits in primary care: A qualitative exploration using in-depth interviews

description: Despite the accumulated evidence suggesting the positive aspects of using group visits in obesity, the number of qualitative studies that examine why and how the effects occur at an individual level is limited. This qualitative study aimed to explore the experiences and perspectives of women who participated in group visits and had different weight loss outcomes in the programme. Purposive maximum variation sampling was performed. Data collection and analysis were performed iteratively, and the data saturation method was used as a guideline for sample size. All participants who completed the group visits were approached, and finally, 20 individuals were included in the study. Semi-structured in-depth interviews were audio-recorded, transcribed verbatim, and analysed thematically using a phenomenological approach. The mean age of the individuals was 38.5 ± 9.8 years, the education level ranged from incomplete-high school to university degree, and the weight changes were between +4.1% and −17.1%. Two main themes emerged from the thematic analysis revealing barriers: weight stigma (two sub-themes: internal and external stigma) and traumatic life events (three sub-themes: ‘loss of relatives,’ ‘childhood traumas,’ and ‘conflicting intimate partner relationships’). Considering the barriers to weight loss efforts in this study, these issues need to be explicitly investigated before and during the group visits in addition to weight loss practices and behavioural changes.
DOI: 10.6084/m9.figshare.21347619
title: Appendix_The gendered dimension of fighting corruption.docx.pdf

description: The following document includes documents that were used for an article. The goal of the paper is a feminist critique of the transnational discourse of gender policies in the particular case of policy proposals against corruption. To this end, we first introduce some main insights from our theoretical frame drawing from feminist critique in the international relations (IR) discipline before introducing the state of the art on the topic of gender in development and critically engaging with some of the most problematic assumptions related to this strategy. Critical frame analysis proves a fruitful tool for our analysis as it helps examine stereotypical framing. Combined with the Gender Equality Policy in Practice (GEPP) approach, through two case studies from Ghana and Indonesia, we demonstrate that one-size-fits-all approaches to empowering women and tackling corruption are unlikely to succeed and that different frames of the gendered dimension of corruption exist in different policy areas.
DOI: 10.6084/m9.figshare.14535566.v1
title: Health seeking behaviour among Lebanese population: A highlight on seeking care from pharmacists

description: Understanding health-seeking behaviour could significantly reduce the impact of illness on patients’ lives. Fragmentation of the Lebanese healthcare system and presence of variability in socio-economic factors have affected some aspects of the Lebanese population’s overall health seeking behaviour. One of these aspects is seeking diagnosis from pharmacists, which is prohibited by the Lebanese law but reinforced by the absence of supervision of concerned authorities. This study aimed to assess the Lebanese population’s knowledge, attitude, and practice towards seeking health care from pharmacists, exploring particularly the practice of seeking diagnosis from pharmacists. A cross-sectional study was conducted by surveying a convenient sample of 493 participants across the eight governorates of Lebanon between July and October 2016. A self-administered questionnaire was used. Questions assessed the health care seeking behaviour of the participants. Two-thirds of the study participants (63.9%) did not have a general practitioner whom they visit regularly. Nearly half of the participants (48.9%) reported seeking diagnosis from pharmacists. Noteworthy, seeking diagnosis from pharmacists’ behaviour declined significantly with having a general practitioner visited regularly. More than half of participants (59.5%) believed that dealing with emergencies is among the pharmacists’ duties. In addition, 62.8% perceived that pharmacists are ‘often/always’ capable of managing common complaints. Our study showed that a significant proportion of the Lebanese population seek a diagnosis from pharmacists and a significant proportion of them have a misconception about the role of pharmacists in the Lebanese healthcare system.
DOI: 10.6084/m9.figshare.17040423
title: Management of symptomatic patients with suspected mild-moderate COVID-19 in general practice. What was published within the first year of the pandemic? A scoping review

description: Most COVID-19 patients experience a mild course of the disease and can be managed in general practice. However, in the early pandemic, most research was conducted in secondary care. This scoping review aimed to identify original research published within the first year of the pandemic relevant to general practice regarding symptomatic, non-hospitalised patients with mild to moderate COVID-19 disease to provide an overview of published research. PubMed was searched for studies written in English, Swedish, Danish, or Norwegian published before 1 April 2021. Two authors screened all titles and abstracts and identified full texts. We screened 1303 titles and abstracts and retrieved 128 full texts. An additional 44 full-texts were obtained from references. After full-text reading, 79 articles were included, six of which were conducted in general practice, 20 in the community, 42 in hospitals, and 11 in other settings. Therapy and harm were investigated in randomised controlled trials in 11 out of 17 studies; the diagnosis was investigated using a diagnostic accuracy design in four out of 26 studies and prognosis in prospective studies in 10 out of 21 studies. The remaining 15 studies had other research questions. Although general practitioners in most countries must have been involved in managing patients with COVID-19, little research has been published from general practice during the first year of the pandemic. General practice research environments must be able to respond quickly in case of future pandemics.
DOI: 10.6084/m9.figshare.14791832
title: Exploring the diverse career trajectories of general practice graduates in the French-speaking part of Belgium: An interview study

description: Several European countries face a shortage of general practitioners (GPs), in part due to GP attrition. Most studies of GP attrition have focussed on why GPs decide to leave. Yet understanding why GPs decide to remain may also elicit potential interventions to reduce attrition. This study examined GP graduates’ career trajectories and underlying decisions to elucidate the factors influencing GP attrition. We conducted semi-structured interviews of early to mid-career general practice graduates having completed training in Belgian French-speaking universities between 1999 and 2013. We sampled participants from three categories: full-time GPs, part-time GPs, no longer working as GPs. We analysed each participant’s career trajectory and broke it down into major phases. We performed thematic analysis of the factors influencing participants’ trajectories. We compared and contrasted trajectories to develop a typology of career trajectories. We identified six types of career trajectories: ‘stable’ (never considered leaving general practice), ‘reaffirmed’ (had considered leaving but made substantial changes whilst remaining), ‘reactional reorientations’ (had left to escape the challenges of general practice), ‘inspired reorientations’ (had left to pursue a different job), ‘reorientations out of loyalty’ (had never wanted to practice as GPs and had remained true to their original professional aspirations) and ‘mobiles’ (valued change and did not want to set-up practice). Reasons GPs leave the profession are multiple. The typology that emerged indicates that only some of the career trajectories would benefit from interventions to reduce attrition such as improving working conditions and providing psychological support for GPs.
DOI: 10.6084/m9.figshare.15067523
title: The diversity of opinion among general practitioners regarding the threat and measures against COVID-19 – Cross-sectional survey

description: After the ‘first wave’ in spring 2020, opinions regarding the threat and measures against COVID-19 seemed to vary among German general practitioners (GPs). To systematically investigate opinions and to identify subgroups of GPs sharing similar views. A questionnaire was sent to all 210 practices accredited for undergraduate teaching of family medicine at the Medical Faculty of the Technical University of Munich. Questions addressed personal opinions regarding risks, dilemmas, restrictions and their relaxation associated with COVID-19, and personal fears, symptoms of depression and anxiety. Patterns of strong opinions (‘archetypes’) were identified using archetypal analysis, a statistical method seeking extremal points in the multidimensional data. One hundred and sixty-one GPs sent back a questionnaire (response rate 77%); 143 (68%) with complete data for all 38 relevant variables could be included in the analysis. We identified four archetypes with subgroups of GPs tending in the direction of these archetypes: a small group of ‘Sceptics’ (<i>n</i> = 12/8%) considering threats of COVID-19 as overrated and measures taken as exaggerated; ‘Hardliners’ (<i>n</i> = 34/24%) considering threats high and supporting strong measures; ‘Balancers’ (<i>n</i> = 77/54%) who also rated the threats high but were more critical about potentially impairing the quality of life of elderly people and children; and ‘Anxious’ GPs (<i>n</i> = 20/14%) tending to report more fear, depressive and anxiety symptoms. Among the participants in this survey, opinions regarding the threat and the measures taken against COVID-19 during the ‘first wave’ in Germany in spring 2020 varied greatly.
DOI: 10.6084/m9.figshare.15124534
title: Predictors for mortality due to acute exacerbation of COPD in primary care: Derivation of a clinical prediction rule in a multicentre cohort study

description: In primary care (PC), 80% of the acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are treated. However, no predictive model has been derived or validated for use in PC to help general practitioners make decisions about these patients. To derive a clinical prediction rule for mortality from any cause 30 days after the last PC visit. Between December 2013 and November 2014, we performed a cohort study with people aged 40 and over who were treated for AECOPD in 148 health centres in Spain. We recorded demographic variables, past medical history, signs, and symptoms of the patients and derived a logistic regression model. In the analysis, 1,696 cases of AECOPD were included and 17 patients (1%) died during follow-up. A clinical prediction rule was derived based on the exacerbations suffered in the last 12 months, age, and heart rate, displaying an area under the receiver operating characteristic curve of 0.792 (95% confidence interval, 0.692–0.891) and good calibration. This rule stratifies patients into three categories of risk and suggests to the physician a different action for each category: managing low-risk patients in PC, referring high-risk patients to hospitals and taking other criteria into account for decision-making in patients with moderate risk. These findings suggest that it is possible to accurately estimate the risk of death due to AECOPD without complex devices. Future studies on external validation and impact assessment are needed before this prediction rule may be used in clinical practice.
DOI: 10.6084/m9.figshare.15090155
title: Task shifting in primary care to tackle healthcare worker shortages: An umbrella review

description: Task shifting is an approach to help address the shortage of healthcare workers through reallocating human resources but its impact on primary care is unclear. To provide an overview of reviews describing task shifts from physicians to allied healthcare workers in primary care and its impact on clinical outcomes. Six electronic databases were searched up to 15 December 2020, to identify reviews describing task shifting in primary care. Two reviewers independently screened the references for relevant studies, extracted the data and assessed the methodological quality of included reviews using AMSTAR-2. Twenty-one reviews that described task shifting in primary care were included. Task shifted include provision of care for people with chronic conditions, medication prescribing, and health education. We found that task shifting could potentially improve several health outcomes such as blood pressure, HbA1c, and mental health while achieving cost savings. Key elements for successful implementation of task shifting include collaboration among all parties, a system for coordinated care, provider empowerment, patient preference, shared decision making, training and competency, supportive organisation system, clear process outcome, and financing. Evidence suggests that allied healthcare workers such as pharmacists and nurses can potentially undertake substantially expanded roles to support physicians in primary care in response to the changing health service demand. Tasks include providing care to patients, independent prescribing, counselling and education, with comparable quality of care.
DOI: 10.6084/m9.figshare.15067523.v1
title: The diversity of opinion among general practitioners regarding the threat and measures against COVID-19 – Cross-sectional survey

description: After the ‘first wave’ in spring 2020, opinions regarding the threat and measures against COVID-19 seemed to vary among German general practitioners (GPs). To systematically investigate opinions and to identify subgroups of GPs sharing similar views. A questionnaire was sent to all 210 practices accredited for undergraduate teaching of family medicine at the Medical Faculty of the Technical University of Munich. Questions addressed personal opinions regarding risks, dilemmas, restrictions and their relaxation associated with COVID-19, and personal fears, symptoms of depression and anxiety. Patterns of strong opinions (‘archetypes’) were identified using archetypal analysis, a statistical method seeking extremal points in the multidimensional data. One hundred and sixty-one GPs sent back a questionnaire (response rate 77%); 143 (68%) with complete data for all 38 relevant variables could be included in the analysis. We identified four archetypes with subgroups of GPs tending in the direction of these archetypes: a small group of ‘Sceptics’ (<i>n</i> = 12/8%) considering threats of COVID-19 as overrated and measures taken as exaggerated; ‘Hardliners’ (<i>n</i> = 34/24%) considering threats high and supporting strong measures; ‘Balancers’ (<i>n</i> = 77/54%) who also rated the threats high but were more critical about potentially impairing the quality of life of elderly people and children; and ‘Anxious’ GPs (<i>n</i> = 20/14%) tending to report more fear, depressive and anxiety symptoms. Among the participants in this survey, opinions regarding the threat and the measures taken against COVID-19 during the ‘first wave’ in Germany in spring 2020 varied greatly.