Welcome to the 26th WONCA Europe Virtual Conference Programme Scheduling

Abstract Body

Background

Extensive use of antibiotics and antimicrobial resistance is a major concern globally. In Norway, 82% of antibiotics is prescribed in primary care and one in four prescriptions are issued for the treatment of urinary tract infections (UTI). This study investigated time trends in antibiotic treatment following consultations for UTI in primary care.

Methods

Registry-based study using linked data on all patient consultations for cystitis and pyelonephritis in general practice and out-of-hours (OOH) services, and all dispensed prescriptions of antibiotics in Norway, 2006-2015.

Results

Of the 2,426,643 UTI consultations, 94.5% were for cystitis and 5.5% for pyelonephritis; 79.4 % were conducted in general practice and 20.6% in OOH services. From 2006 to 2015, annual numbers of cystitis and pyelonephritis consultations increased by 33.9% and 14.0%. Proportion of UTI consultations resulting in antibiotic prescription increased gradually for cystitis (36.6% to 65.7%) and pyelonephritis (35.3% to 50.7%). Cystitis was mainly treated with pivmecillinam (53.9%), and trimethoprim (20.8%) and pyelonephritis with pivmecillinam (43.0%), ciprofloxacin (20.5%) and sulfamethoxazole-trimethoprim (16.3%). For cystitis, the use of pivmecillinam increased the most (46.1% to 56.6%), and for pyelonephritis, the use of sulfamethoxazole-trimethoprim (11.4% to 25.5%) and ciprofloxacin (from 18.2% to 23.1%).

Conclusions

During the 10-year study period there was a considerable increase in UTI consultations resulting in antibiotic treatment. Treatment trend for pyelonephritis was characterized by more use of broader-spectrum antibiotics. These trends, indicative of enduring changes in consultation and treatment patterns for UTIs, will have implications for future antibiotic stewardship measures and policy.

Abstract Body

Background

In 2019, Dutch organisations for general practitioners formulated a joint vision on quality policy in general practice. This vision focuses on “Learning together”, representing a paradigm shift from a more traditional ‘checklist’ quality policy towards one that focusses on teamwise professional development based on sharing and reflection/groupwise learning.

The Dutch College of GPs (NHG) would like to start a conversation on ‘Quality of care in practice’ with colleagues within Europe, in addition to the participance in WONCA-interest group ‘EQUIP’ and the attribution to position papers on quality and safety subjects.

Aim and learning objectives

An interactive workshop offers an ideal opportunity to start a conversation with our colleagues throughout Europe.

Through discussions, exchange of experiences and sharing best practices about quality policy, we may develop new ideas and educate ourselves.

Methods

Questions that we address during the workshop:

- What means ‘quality policy in practice’ to you and your co-workers?

- How do you get yourself and your team motivated to work on quality policy in your general practice?

- How do you approach the slogan ‘Learning together and improving together’ in quality policy?

Results and conclusions

The workshop gives new insights and different approaches in working and learning together on quality policy in practice. We hope to initiate new actions on sharing knowledge between countries regarding the new vision on quality policy in general practice.

Working on quality starts when your patient begins his “journey” through the practice. A general practice should be accessible for every patient. Only authorised and competent staff members should be working in general practices, general practitioners use guidelines for patient care and patient safety and patient experience should be considered. Working on quality relates to all facets in a healthy general practice!

Abstract Body

Background

The 1996 US Institute of Medicine report, Primary Care: America's Health in a New Era, summarized the evidence for primary care’s beneficial effects and a definition commonly used since. The Astana Declaration inspired a new National Academies’ primary care study revisiting its understanding of primary care. The report planning committee included WONCA and global UHC/PHC representatives.

This report’s underlying charge is to advise on how to strengthen primary care services in the US, especially for underserved populations, and to inform primary care systems around the world.

Aim and learning objectives

The workshop aims are to introduce WONCA Europe to the primary care study, to look for areas of alignment with global UHC/PHC efforts and to learn how PHC efforts and policies could support US goals.

Learning objectives:

To understand the reframed primary care definition

To discern which recommendations are supportive of global PHC goals

To recognize policy and governance restructuring that may be useful in a European context.

Methods and timetable

The report is a consensus committee included twenty multidisciplinary members supplemented by commissioned papers on payment, revelations of the COVID19 pandemic, and generalism. A patient perspective panel also offered guidance on what patients value in primary care. The study began January 2020 and will be released April 2021.

(Proposed) Results / Conclusions

The workshop will help identify how the National Academies’ report can be a bridge for US and global primary care interests.

Abstract Body

Background and purpose

This study explores the long-term care (LTC) reform in the Netherlands and its relation to the day-to-day integrated care for frail elderly people, from the perspective of general practitioners (GPs). We assessed GP perspectives regarding which elements of the LTC reform have promoted and hindered the provision of person-centred, integrated care for elderly people in the Netherlands.

Methods

We performed case studies conducted by semi-structured interviews, using the Healthy Alliances (HALL) framework as a framework for thematic analysis.

Results

GPs reported that the ideals of the LTC reform (self-reliance) were largely achievable and listed a number of positive effects, including increased healthcare professional engagement and the improved integration of the medical and social domains through the close involvement of social support teams. The reported negative implications were a lack of co-ordination in the implementation of the reforms by the municipality, insufficient funding for multidisciplinary team meetings and the reinforced fragmentation of home care. In particular, the implementation of the system reforms took place with little regard for the local context.

Conclusions

We suggest that the implementation of national care reforms should be aligned with factors operating at the micro level and make the following recommendations: use one central location for primary health and social services, integrate regional ICT structures to improve the exchange of patient information, and reduce fragmentation in home care.

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Primary care professionals (PCP) in Spain have a very low rate of reporting patient safety incidents (PSI). Care pressure and reporting burden are disincentives. Patients' complaints at primary care facilities regarding their care can be used as a source of PSI. The purpose is to analyze patient complaints (PC) in 4 health areas of Aragon Health Care Service (Spain) - covering 958,000 inhabitants- and identify those related to patient safety issues.

Methods: A simple random sampling was performed regarding all the claims issued in 2017 for primary care facilities. Total sample: 324 claims. Peer review was made with a checklist to identify PSI considering: sex and age of the patient, nature of PSI, professional involved, place of healthcare, severity, and avoidability of harm. Claims were reviewed by two researchers (kappa concordance test 0.94) and a third independent reviewer for disagreements. The three were family doctors.

Results: 24.3% (84/324) of claims are due to PSI. Family Doctors received 44.9% of claims. Among the PSI detected (84), 52.3% were due to problems in the healthcare process and 23.5% to coordination between care levels and waiting times. Regarding causal factors, 51 % involved diagnosis and 24.9 % management and communication issues. A total of 39/84 were PSI with harm of whom 4/84 (6%) were moderate and 2/84 serious harm. A total of 2.6% (1/39 PSI) were unavoidable while 97.4% (38/39 complaints with PSI) could have been avoided.

Conclusion: Patients' claims content PSI. The analysis and follow-up of claims regarding PSI can be considered as a source of information to improve PS in primary care.

Abstract Body

Background and purpose: Safety-netting advice (SNA) is ‘information shared with a patient or their carer designed to help them identify the need to seek further medical help if their condition fails to improve, changes, or if they have concerns about their health.’¹ We currently know very little about how UK general practitioners (GPs) document this information and what factors might influence whether SNA is recorded in the medical records or not.

Methods: Coding of existing dataset of video / audio recorded consultations and medical records for 295 adults with 516 problems seeing 23 UK GPs. Descriptive statistics and logistic regression models were used to test associations.

Results: SNA was given to patients in two-thirds of consultations (192/295) with regard to almost half of all problems discussed (242/516). SNA was documented in one-third (94/295) of consultations and for one-fifth of problems (105/506). Individual GP practice varied from no documentation of SNA they had given to 86.7%. GPs more frequently documented SNA they had given for problems that were first presentations (p=0.045), when only one problem was discussed in the consultation (p=0.044), and when the GP had given specific, rather than generic SNA (p=0.007). In consultations where more than one problem was discussed, the frequency of SNA delivered and documented decreased the later a problem was assessed by the GP (p=0.011 and p=0.022, respectively).

Conclusion: GPs often do not document SNA they have given which may have serious medico-legal implications. The frequency of SNA is influenced by problem, GP and consultation factors.

1. https://doi.org/10.3399/bjgp19X706589