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Abstract Body

Background and purpose

Good medication adherence is associated with decreased healthcare expenditure; however, adherence is usually assessed for single medications. We explored associations of adherence to 23 chronic medications with emergency room (ER) visits and hospitalizations.

Methods

Individuals aged 50-74 years, with a diagnosis of diabetes mellitus or hypertension, treated with at least one antihypertensive or antidiabetic medication during 2017 were included. We determined personal adherence rates by calculating the mean adherence rates of the medications prescribed each individual. Adherence rates were stratified by quintiles. We retrieved information about all the ER visits, and hospitalizations in internal medicine and surgery wards during 2016-2018.

Results

Of 268,792 persons included, 50.6% were men. The mean age was 63.7 years. Hypertension was recorded for 217,953 (81.1%); diabetes for 160,082 (59.5%); and both diabetes and hypertension for 109,225 (40.6%). The mean number of antihypertensive and antidiabetic medications used was 2.2±1.1. In total, 51,301 (19.1%) of the cohort visited the ER at least once during 2017; 21,740 (8.1%) were hospitalized in internal medicine wards; and 10,167 (3.8%) in surgery wards during 2017. Comparing the highest adherence quintile to the lowest, odds ratios were 0.64 (0.61, 0.67) for ER visits, 0.56 (0.52, 0.60) for hospitalization in internal wards; and 0.63 (0.57, 0.70) for hospitalization in surgery wards. Odds ratios were similar for the three consecutive years 2016-2018.

Conclusion

Better medication adherence was associated with fewer ER visits and hospitalizations among persons with diabetes and hypertension. Investing in improving medication adherence may reduce health resources and improve patients' health.

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Background and purpose:

Excessive sedentary behaviour is associated with a number of adverse health outcomes and increased all-cause mortality. This study gained quantitative data on levels of sedentary behaviour among GPs.

Methods

A multi-item sedentary behaviour questionnaire survey was disseminated to GPs in Northern Ireland. Subsequently, a purposive, maximally varied sample of 20 participants were recruited to wear thigh-worn accelerometers and complete a sleep/work log. This allowed comparison of subjective, self-reported data with objective, accelerometer data.

Results

Out of 1999 GPs in Northern Ireland, the questionnaire received 352 valid responses (response rate of 18%). Overall mean workday sedentary time for GPs was 10 hours 20 minutes. Overall mean non-workday sedentary time was 4 hrs 47 minutes. Only 6% of GPs had access to an active workstation, such as a standing desk, however 61% of those who didn’t have an active workstation would consider using one. 81% of GPs reported they are spending more time sitting in work now than prior to the COVID-19 pandemic. 87% of GPs would prefer less time sitting in work.

Conclusions

Sedentary behaviour among GPs has increased since the onset of the COVID-19 pandemic, with the vast majority of GPs exceeding the recommended daily levels of sedentary behaviour. GPs who are more physically active are more likely to recommend physical activity to their patients. Further research is therefore required to identify ways of reducing sedentary behaviour and increase physical activity among GPs.

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Background Several European countries are facing a shortage of general practitioners (GPs). This shortage is in part linked to GP attrition. This study aimed to examine the career trajectories and multiple underlying decisions of general practice graduates. Methods 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. Results We identified 6 main types of career trajectories: ‘stable’ (graduates who had never considered leaving general practice), ‘reaffirmed (graduates who had considered leaving but opted to make substantial changes to their practice whilst remaining), ‘reactional reorientations’ (graduates who had left to escape the challenges of general practice), ‘inspired reorientations’ (graduates who had left to pursue a different job rather than to escape), ‘reorientations out of loyalty’ (graduates who had never wanted to practise as GPs and who had remained true to their original professional aspirations) and ‘mobiles’ (graduates who valued change and did not want to set-up practice). Conclusion 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.

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Background and purpose

Couple relationship satisfaction is related to physical and mental health and longevity. In a Norwegian study from 2020, one of four patients reported that they had talked about their couple relationship with their general practitioner (GP). The purpose of this study was to explore how GPs’ experience couple relationship problems and how they identify patients with couple relationship problems.

Methods

This is an exploratory qualitative study. In 2020, we conducted three semi-structured focus group interviews with eighteen GPs. We developed a semi-structured interview guide and used systematic text condensation for the inductive analyses.

Results

All participating GPs reported an abundance of experiences handling couple relationship problems in their practice. These issues both served as explanation to relevant clinical problems and were important in a holistic approach to the patients and their families. The GPs had different amounts of training in psychotherapy. Some emphasized that in medical education, doctors learn communication skills useful for individual consultations, but do not develop skills for dyadic counselling. The most experienced GPs felt qualified to support patients with couple relationship problems, though none of the participants could see themselves as couples therapists. Some wanted specific tools for the GP to use when this issue is brought up.

Conclusions

Experienced GPs are comfortable having supportive conversations with individual patients regarding couple relationship problems. GPs could need more skills coping with patients’ relational problems and dyadic counselling. A first-aid-kit for GPs facing patients with couple relationship problems might be useful.

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Background: First licensed in 2017 and currently approved in >30 countries, RZV (GSK) has demonstrated high and persistent efficacy against herpes zoster (HZ) with a clinically-acceptable safety profile. We reviewed available national guidelines/recommendations on RZV vaccination to identify the similarities and differences and highlight any potential gaps.

Methods: For each country where RZV is licensed, we searched their national health authority’s and/or vaccination committee’s website between May-October 2020. RZV recommendations were summarized under 7 topics: HZ vaccine preference, age-group recommendation, use in special populations, medical history prior to RZV vaccination, dose schedule, co-administration with other vaccines and vaccine safety profile.

Results: National guidelines/recommendations were identified in 9 countries: Austria, Canada, the Czech Republic, Germany, Ireland, Spain, the Netherlands, the United Kingdom and the United States. In 7/9 countries RZV is the preferred (or the only recommended) HZ vaccine. RZV vaccination is recommended at ≥50 or ≥60 years of age for the general population in 8/9 countries, and at a lower age for high-risk groups, in 3/9 countries. Several guidelines provide recommendation for RZV vaccination in individuals following a prior HZ episode or receipt of live attenuated zoster vaccine; however, variations exist on timing of RZV administration following these. RZV’s dose schedule, co-administration with other vaccines, reactogenicity and safety profile are also highlighted by some guidelines/recommendations.

Conclusions: In several countries, the high and persistent efficacy of RZV and its anticipated public health impact led to broadening the national HZ vaccination recommendations to additional sections of the general population or to individuals previously not included in those recommendations.

Funding: GlaxoSmithKline Biologicals SA

Abstract Body

Background and purpose

Long term sickness absence is a common risk for workers with depression and poses significant individual and societal challenges. Most people with depression are cared for by general practitioners (GPs). Still, collaboration with secondary mental care, social workers, and the workplace is often required. The purpose of this study is to explore involved professionals' experiences with collaboration in depression care and how such collaboration may promote sustainable work participation.

Methods

We conducted seven geographically spread focus group interviews with GPs, clinical psychologists and psychiatrists, social welfare workers from the Norwegian Labor and Welfare Administration (NAV), and personnel managers from local workplaces in Norway. The interviews were audio-recorded, transcribed, and analyzed thematically, with a resource-oriented salutogenic approach, inferring a focus on factors for improving health and well-being.

Preliminary results

First theme illustrated participants' experiences with interprofessional collaboration as sub-optimal. Fragmented systems for follow-up of sick-listed workers with depression were viewed as barriers, exemplified by poor interprofessional information flow, etc. However, access to informal communication through electronic dialogue messages was experienced as facilitative. Second theme emphasized how improved collaboration could promote sustainable work participation. Personnel managers' role and early collaborative interventions were viewed as vital. Moreover, increased use of existing collaborative tools, such as GPs suggesting proper work adjustments for depressed workers via sick-leave certifications, could promote sustainable work participation.

Conclusion

Our findings suggest a need for integrated health- and welfare systems for following up sick-listed workers with depression to improve interprofessional collaboration and to promote sustainable work participation.