Welcome to the 26th WONCA Europe Virtual Conference Programme Scheduling

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1. Background and purpose

Unintended pregnancy (UP) is a global health care issue that affects women from all societal levels. Worldwide, 48% of pregnancies is unintended. 20% of Dutch women face an unintended pregnancy (UP) in their lives. In the Netherlands, the general practitioner (GP) is often the first point of contact for half of women facing an UP and has a role in identifying women at risk. This systematic review aims to define characteristics of women at risk for UP.

2. Methods

Using the keywords ‘Unintended pregnancy’ and ‘Characteristics’, the search was performed in Pubmed, EMBASE, MEDLINE, CINAHL, APA PsycInfo and Web of Science. The search was limited to countries with legal and safe access to abortion.

3. Results

4,121 articles were screened and 12 studies were included. Women with unhealthy lifestyles, as substance abuse, obesity, and avoidance of regular health check-ups, experience more UPs. Psychosocial factors, as lower socioeconomic status or educational level and unemployment, but also history of sexual coercion or violence, are likewise related to high UP-risk. Lastly there are baseline characteristics that increase the risk for an UP, including young age, being multigravidas and being unmarried.

4. Conclusions

GPs have a role in identifying high-risk women and supporting them in prevention of an UP. Guidelines on the topic could improve care and we therefore advise quantitative research on national level on characteristics of women with UPs. As this topic is far from unique, our findings have international relevance in prevention of UP by all primary care physicians.

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Background and purpose

Continuity of care has many benefits, including a better patient-doctor relationship, prevention of hospital admission, reduced health care costs, better medication compliance, and lower mortality rates.

The aim of this study is to investigate the association between personal continuity and general practice characteristics, and to identify additional factors associated with personal continuity.

Methods

Observational study of 4.7 million contacts of 190.886 patients from 48 different general practices in 2013-2018 in the Netherlands. Personal continuity was calculated using four established measures (Usual Provider Continuity; Bice-Boxerman Continuity of Care Index; Herfindahl Index; Modified Modified Continuity Index). Linear mixed models were used to determine the association between continuity level and practice characteristics, adjusted for patient characteristics. In order to identify additional factors associated with personal continuity, we conducted interviews with general practitioners working in practices with the largest difference between observed and predicted continuity.

Results

We identified nine practice characteristics that were significantly associated with continuity of care (p<0.05). Of these characteristics, six were significant in all models: number of registered patients; number of doctors and their working days; number of locums and their percentage of contacts; number of other employees. These effects were adjusted for patient characteristics, including type of contacts, age, sex, medical history, time of registration, and ancestry (p<0.05). Interviews may provide insights in additional factors (analyses will be completed).

Conclusions

Six characteristics were associated with higher continuity of care, which can be calculated using general practice data. Optimization of these characteristics may contribute to improving personal continuity.

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Background and purpose Continuity is a core value of primary care. In particular personal continuity is associated with significant benefits for patients and general practitioners (GP). However, it has become more challenging for GPs to provide personal continuity due to changes in society and healthcare. The aim of this study was to investigate how GPs and patients views on personal continuity have changed in the past two decades and how it can be improved.

Methods Digital surveys were distributed to 499 GPs and postal surveys were distributed to 1599 patients in the Netherlands. Data collection took place in 2019 and results were analysed with descriptive statistics and thematic analysis.

Results 257 GPs and 584 patients completed the surveys. Sixty percent of GPs found it generally important to see their own patients. Seventy-six percent of patients found it generally important to see their own GP. Suggestions for improving personal continuity were collected from 222 GPs and 378 patients. Suggestions were categorised into nine domains: (1) knowing the patient and mutual understanding, (2) GP accessibility and availability, (3) GP–patient communication, (4) GP responsibility, (5) triage, (6) more time for the patient, (7) transmural care, (8) team continuity and (9) GP vocational training.

Conclusions Both patients and GPs valued personal continuity and these views have not changed much in the past two decades. Both patients and GPs provided extensive input for improving personal continuity. This wide range of suggestions will be used in further research to develop a complex intervention for optimising personal continuity for older patients.

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Background and purpose

Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) are frequently described in older people. However, the medical relevance of PIMs/PPOs are seldom reported. Our purpose was to evaluate the medical relevance of STOPP/START criteria in older patients in a Swedish primary care health center.

Methods

In 123 consecutive patients (≥65 years), PIMs and PPOs according to the STOPP/START v.2 (80 PIMs and 34 PPOs) were identified by a specialist in family medicine. Each PIM/PPO, as well as the overall drug treatment, was then assessed from a medical perspective. Individual characteristics of the patient such as morbidity and life expectancy were considered.

Results

A total of 82 (67%) patients had ≥1 PIMs/PPOs according to STOPP/START, with 125 PIMs and 54 PPOs identified in 59 (48%) and 49 (40%) patients, respectively. The medical assessment revealed that 33 PIMs (26%) were reasonable drug treatment, whereas 86 PIMs (69%) and 54 PPOs (100%) could be considered in the long term to improve the drug treatment, and 6 PIMs (5%) could be acted upon directly. Among patients with ≥1 PIMs/PPOs, the overall drug treatment was assessed as reasonable in 42 cases (51%), whereas 30 (37%) could benefit from some action in the long term and 10 (12%) could be acted upon directly.

Conclusions

When a primary care physician perspective is applied at the individual level, there was no medical reason to change the drug treatment in every other patient with at least one PIMs/PPOs.

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Background and Purpose: Cervical cancer screening (CCS) consists in detecting the human papillomavirus that can lead to the development of cervical cancer, aiming to decrease the incidence of malignant neoplasia. The recommendation of The National Low Risk Pregnancy Surveillance Program is to update the CCS at the preconception consultation (PC) or at one of the first trimester consultations (FTC). Our aim is to sensitize physicians, women who are planning a pregnancy and pregnant women to the importance of performing the CCS when screening is not updated and to emphasize the importance of CCS registration, both by 50%.

Methodology: This is a retrospective assessment, whose target population are patients coded W78-Pregnancy, W79-Unwanted Pregnancy, W84 - Risk Pregnancy, as an active problem, and first consultation at PHC during preconception or before 13 weeks and 6 days of gestation, from the health centers of the authors of the study. September 2021: collecting data from the six months prior. October 2021 to March 2022: implementing corrective steps (such as knowledge verification questionnaires, awareness leaflets, family planning health education sessions and others). April 2022: evaluation of collected data.

Results: The evaluation of the CCS update in the PC or one of the FTC is rated as insufficient if less than 40%, sufficient if between 40% and 60%, and good if greater than 60%.

Conclusions: With the application of the corrective measures conceptualized in this quality protocol, we hope to achieve the goals setted.

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Background and purpose: The rapid spread of the COVID-19 Pandemic and its lethality rate, made it imperative to implement emergency response plans. The reorganization of health care services, clinical training, psychological and social support of health workers are additional challenges. Worldwide, institutions such as the World Health Organization (WHO) have been issuing recommendations, which must be tailored to each country’s reality and resources. Objectives: We aim to answer three questions: How are Primary Health Care (PHC) services answering to Covid-19 Pandemic re-organization; How are the PHC health workers dealing with this situation, and what support is being provided; What impact had this support on health workers’ anxiety levels.

Methods: An online questionnaire based on WHO recommendations, will be sent to health professionals of PCH from 8 European countries (Portugal, Spain, France, United Kingdom, Turkey, Bosnia, and Ukrain). Data collection on socio-demographic and professional context, health professional support, PHC re-organization and anxiety levels. Anonymization, confidentiality and data protection policies were warranted. Approuval of Ethics Committees have been asked. A convenience sample of about 200 respondents per country is aimed. Descriptive and inferential statistics, namely bimodal regression will be used to analyze data, using STATA.

Results: Data will be analyzed aiming to describe local specificities and, whenever possible, to compare data between countries.

Discussion and conclusions: Results will provide insight into the reality experienced in organizational service terms, regarding the involvement of health care workers, support perceived, task management involvement, and emotional stress.We expect the reflection and analysis of the results will help decision makers to improve procedures in future situations.